B-2017-0294CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0294
10826 LINDA VISTA DR CUPERTINO, CA 95014-4740 (356 14 051)
ALLSTAR PLUMBING
CORPORATION
SAN JOSE, CA 95112
OWNER'S NAME: SWANSON FRANKLIN A JR AND BEVERLY J TRUSTEE
DATE ISSUED: 02/22/2017
OWNER'S PHONE: 408-253-9136
PHONE NO: (408) 282-7020
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C-36 tic. #732_611
Contractor ALL ,TAR PLUMBING CORPORATION Date 02/2812017
X BLDG _ELECT X PLUMB
MECH X RESIDENTIAL COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business & Professions Code and that my
license Is in full force and effect.
JOB DESCRIPTION:
REPLACE SEWER MAIN AND BUILDING SEWER; PROPERTY LINE
I hereby affirm under penalty of perjury one of the following two declarations:
CLEANOUT
1. 1 have and will maintain a certificate of consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
.riefformance of the work for which this permit is issued.
,.
2 1 have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor CodeJor the performance of the work for which this
Sq. Ft Floor Area:
Valuation: $12620.00
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
information is correct. I agree to comply with all city and county ordinances
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
356 14 051
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We) agree to save indemnify and keep harmless the
City of Cupertino against li bilitles, judgments, costs, and expenses which
PERMIT EXPIRES IF WORK IS NOT STARTED
may acc a against said Ci in consequence of the granting of this permit.
e ins'
"cant
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additiona I , the appu erstands and will comply with all non -point
source re p r t ertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Llations
it
Signatur Date 2122[201Z
Issued by: Abby —Aygride
Z
OWNERAWELDER DECLARATION
Date: 9212212017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE --ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
1. L as owner of the property, or my employees with wages as their sole
installed without first obtaining an inspection, I agree to remove all new materials for
compensation, will do the work and the structure is not intended or offered for
inspection.
sale (Sec.7044, Business & Professions Code)
2. 1, as owner of the property, am exclusively contracting with licensed
Signature ofApplicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 2122/2017
1 hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
L I have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
HAZARDOUS MATERIALS DISCLOSURE
2. 1 have and will maintain Worker's Compensation Insurance, as provided for by
I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code, for the performance of the work for which this
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
3. 1 certify that in the performance of the work for which this permit is issued, I
n store or hazardous
Health & Safety Code, Section 25532(a) sho!�
material. Additionally, should I use equipment evIces which emit hazardous
shall not employ any person in any manner so as to become subject to the
air contaminants as defined by the Bay Air quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
lir,�ea
Will maintain c t Cu�- 0 Mi -ipal Code, hapter 9.12 and
compliancewith t
exemption, I become subject to the Worker's Compensation provisions of the
the Health Safety C I e, Sectio s2 0 2 33, 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
0 authorized ages
or
APPLICANT CERTIFICATION (.Date:
,Wner
2/22/2017
I certify that I have read this application and state that the above information is
CONSTRUCTIO NGA
I hereby affirm that there is a construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
to enter upon the above mentioned property for inspection purposes. (We) agree
Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
Lender's Address
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
ARCHITECT'S DECLARATION
and will comply with all non -point source regulations per the Cupertino Municipal
I understand my plans shall be used as public records,
Code, Section 9.18.
Licensed
Signature Date 2122/2017
Professional
CUPERTINO
'D -WP-- 1cl
GENERAL PERMIT APPLICATION EP
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 Awak A=%L
(408) 777-3228 - FAX (408) 777-3333 - building(okupertino.org M 15 U
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PROJECT ADDRESS
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OWNER NAM!" HO E-MAIL
STREET < FAX
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CONTACT NAMEE-1,1AIL
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STREET ADDRESS
CITY, STATE, ZIP FAX
❑ OwNER 13 OWNER-BTUUDER ❑ OWNERAGENT, ED CONTRACTOR 51CO\TRAC-TORAGEN`T 13 ARCHFMCT El ENGLNtER 0 DEVELOPER 13 TEN.A,,qT
CONTRACTOR NA - LICENSEnTE
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ARCIETECT/ENGIINTEER NAME LICENSE NUMBER—
BUS. LIC #
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FAX
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STREET ADDRESS CITY, STATE, ZIP
PHONE
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7qsE, CIF 573FI) or DUPLEX u MULTI-FUMILY PROJECT EN 1AaJ)1-ALNTD El -YES PROJECT LN E3 YES
IS THE BLDG ANT
CO"B-iERwa, URBAN 11,1TERFACE.4RZA ❑ NO FLOOD ZONE ❑ NO
EICHLERHOME? ❑ I'To
DESCRIPTION, OF WORK
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TOTAL VALUATION:
am the
By my signature below, I celtity to e ch of the fol wing. the property owner or authorized agent to act on the prope,�.owneAs behaV. I have read this
application and the information I bav vided is - ct. the Description ofsWork and verify it is accurate. I agree to comply with all applicable local
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ordinances and state lawsi -elatin to d' cons c 'on. representatives of Cupertino to enter the above -identified property for inspection purposes,
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Signature ofApplicant/Agent: Date: L`
SUPPLEMENTAL LNIFORMATION REQUIRED
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:to
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.MEPM'isa4pp_�01 ].doe revised 06121111
CUPERTIN]SANITARY DI0MCT
20gG3Stevens Creek Blvd #qOO Cupertino, CA 95014
Tel (4O8)253 -7O71 - Fax (4O8)253-5173
a�
I S
CUPERTINO
SANITARY DISTRICT PERMIT LEVfTR
Cupertino Sanitary District has adopted Resolution No. 1263.
Building Permit Request
`~,~-'~'~~=~"/
Single Family Project F-1 Multi -Family Project F-1 Commercial Project
r�
Permit Number: o2ot4
Scope of Work: -F ./
(]YVD Name:
Address: 3U, WcAc,
Date: Prepared By:
1, as property owner orauthorized agent, ux
will bemet and aflrequired fees will bepaid
Signature:
Phormu!
c(Sk7
Representative
Sanitary District requirements
mpectionfor proposed project
Authorized Agent
CUPERT|N[]SANITARY DISTRICT OFFICE USE ONLY
' F-� Pre -inspection Required F-1 Final Inspection Required
Date Scheduled:
D8t8:9-ZConditional Approval By: '
Cupertino Sanitary'sistrrict
District will notify
' owner of the required fee within 5 days after Pre -inspection has been completed and cc
City nfCupertino.
0 Inspection Fee Paid Date Paid:
Inspection Fees:
$250/unit - Single Family Residential already connected, but new cleanout is required
$1501unit - Single Family Residential already connected with existing cleanout in working order
[-] $35UMinimum - Commercial and Retail Actual Amount:
[_] $2Q0/each-Disconnect and/or abandon lateral service
Connection Permit Fees:
$350/unit Family Residential connecting to existing latera
[�] $G5O/unit-Single Family Residential connecting with new lateral
[�] $1OO/unit-Multi, Hotel, Living Units, etc. Actuu\Amount
[�] $5UO/oonnaoUon-Commercial and Retail Actual Amount:
Connection Use Fees (See Attached CaoulatinnSheet):
[_]
Area and Frontage Fees Amount
[�]
Residential Excess Fees over %.Sunittoore Amount:
[_]
Commercial and Retail Connection Fees Amount
Commercial and Retail Change inUse Fees Amount
DBte' Final Approval By:
Authorized Representative
� Cupertino Sanitary District
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE -
,w
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
CUPER TINO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildingQ),cupertino.ora
PERMIT CANNOT BE FINALED UNTIL THIS CERTIFICATE HAS BEEN .
COMPLETED, &QU AND RETURNED TO T.113 II DING DIVISION Y
PURPOSE . - ..
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide A1ams for
compliance with 2016 CRC Section R314, 8315, 2016 CBC Sections 420.6 and 907.2.11.2 where no interior access
for inspections are required.
GENERAL INFORMATION
Existing single-family and multi -family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds
$1000.00, CRC Section R314, 8315, and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or
Carbon Monoxide Alarms be installed in the following locations:
AREA
SMOKE ALARM
CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the
bedroom(s) — (Smoke alarms shall not be located within 3 feet of bathroom door)
X
X
On every level of a dwelling unit including basements and habitable attics
X
X
Within each sleeping room
X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl
space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for
alarms which must be connected to the building wiring.
As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms specified below have been tested and are operational, as of the
date signed below. _
Address: �� &01=1f►lY?� �1� /fJC� C (/ 1?�'(Tll11C� G ��r} �. 1� Permit No.201L7' . k-1
Specify Number of Alarms: # Smoke Alanns• �s 1 # Carbon Monoxide Detectors:
I have read and agree to couUAHg6M th erms and conditions of this statement
Owner (or Owner Agent's) Name: � („ j !� 7
' ..................................I........................ Date:..................
�(i!' �41/rjdiiS'� sin ure......................................................
Contractor Name:
Sinature...................................................................... LicA.................. ....................... Date:...................
Smoke and COfornn.doc revised 01110/2017