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B-2017-0462
CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2017-0462 10081 S TANTAU AVE CUPERTINO, CA 95014-3541 (375 07 008) DALCON SAN JOSE, CA 95110 OWNER'S NAME: ZHANG XIAOYUE AND SUN YI OWNER'S PHONE: 408-230-4652 JLJCENSED CONIRACTOR'S CONTRACTOR'SDECLARATION License Class Ct10 Lie. #582916 Contractor DALCON Date 12/31/2017 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. I hereby affirm under penalty of perjury one of the following two declarations: 1. 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. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this 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 and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to say, indemnify and keep harmless the City of Cup�rtino against liabilities, judg . ents, costs, and expenses which may accrue,Vainst said City, in conseq ence of the granting of this permit. Additionally,t a applicant u ers,t��rfdanlcip�l rld will comply with all non -point source reguialions per the G q ftino Cod�ction 9.18. Date 03-22-2017 I hereby afrfmt I am exempt from the Contractor's License Law for one of the following two re ns: I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). ISSUED: 03/22/2017 NO: (408) 278-1809 BUILDING PERMIT INFO: BLDG X ELECT _ PLUMB MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: REPLACE ELECTRICAL PANEL LIKE FOR LIKE SAME LOCATION (100 AMP) Sq. Ft Floor Area: I Valuation: $5000.00 "N Number: Occupancy Type: 375 07 008 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Kim Dunbar Date: 03/22/2017 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature ofApplicant: Date: 03-22-2017 I hereby affirm under penalty of perjury one of the following three declarations:I ALL ROOF COVERINGS TO BE CLASS "A" 1. 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. 2. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 3. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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 and state laws relating to building construction, and hereby authorize 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 liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 03-22-2017 HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use a uipment or devices which emit hazardous air contaminants as defined by: he BaArea Air Quality anagemen istrict I will. maintain compliance with the Cup rtino Municipal de, Chap r 9.12 and the Health & Safety Code, $e tions 2550$,-;,553 , anr), 255 4. 4�Owner or authorized agent: / " ✓ Date: 03-22-2017 1___/ / f I hereby affirm that there is 0 con fgiacti lending agency for of work's for which this per it is ue (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTINO GENERAL PERMIT APPLICATION mmm E 1F FOF& COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AV�NUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingp_cupertino.org misc ❑ PLUMBING ❑ MECHANICAL LECTRICAL ❑ MISCELLANEOUS PROJECT ADDRESS APN# � � V `CJ c�a � Tim o t✓� LS OWNER NAMEs } � _ Vv 11 uc-i PHONF "L' � �i ®Llko�ZI E-MAIL bk1©rmA. Lovy) STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME PHONE E-MAIL �a STREET ADDRESS 7G7 tb Cie - 6 CITY STATE, ZIP eI - ' CA GZ t 6C7 �FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENTCONTRACTOR ElCONTRACTORAGENT 11ARCHITECT ❑ ENGINEER 1:1DEVELOPER ❑ TENANT CONT CTOR NAME LIC ENS MB7E�R LICINffV6 BUYS6 CO ANY NAME - CICt�V1 ids E-MAIL �veaex�c_t� cical -el FAX STREET ADDRESS CIT 1, STATE, Z CA PHONE ARCHITECTBNGINEER NAME LIC SE NUMBER BUS. LIC # COMPANY NAME F -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE. USE OF D or DUPLEX ❑ MULTI -FAMILY PROJECT IN W ILDLAND ❑ YES PROJECT IN El IS THE BLDG AN Eli-Es BUILDING: ❑ COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE KNO EICHLER HOME? ❑ NO DESCRIPTION OF WORK eo^�� y AZ Q_ TOTAL VALUATION: (� fl (� 111 { ll IVED At Ur } ' By my signature below, I certify to each oio, he following: I th propertylowner or authorized agent to act on the property owner's behalf. I have read this application and the information I have prop ided scone . I v ead t q_ escripf of Work and verify it is accurate. I agree xo comply w'th all applicable local ordinances and state laws relating to buil ' co struct' ut rize r u . e v of Cupertino to enter the above-identife property f inspection proposes. Signature of Applicant/Agent: Date: f i S PP TAL I`NFORMAT Q IRED t OFFICE USE ONLY 0 OVER=THE COUNTER { r� - P:.. P ❑ EXPRESS ' - - 0': STANDARD 4 ; El LSRGE A1AJOR. n1E.PMis6,4pp_7011.doc revised 06/21/11 B -aOI 7 � 0 � Ad SMOKE l CARBON MONOXIDE ALARMS N L E OWNER CERTIFICATE OF COMPLIANCE ((-77/1�- COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION CUPERTtN+L7 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 - building0cuR2riino.org PERMIT CANNOT BE FINALED UNTIL THIS CERTIFICATE HAS BEEN COMPLETED, 5IGNED, AND ,U1111MED TO THE BUILDING DIVISION PURPOSE This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2016 CRC Section 8314, 8315, 2016 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections are required. GENERAL INFORMATION Existingsingle-family and multi -family dwellingsshallbe 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 R3I4, 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" X X bedroom(s) — (Smoke alarms shall not be located within 3 feet of bathroom door) On even, Ievel of a dwelling unit including basements and habitable attics X X t Within each sleeping roam I X Carbon Monoxide alarms are net 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 divelling units with no commercial power supply, alarm{s} may be solely battery operated. In existing dwelling units, alarms are permitted to be stalely 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, basernent or crawl space. Refer to CRC Section 8314 and CBC Sections 907.2.11.4 and 420.06.2. 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 'instruction and in compliance with the California Building and California Residential Codes. The alarims sveeiFied below have been tested arid area perational, as of the date signed below. Address: ! (500 -6kvyina kL Cl&lylb Permit No. Specify Number of Alarms-, # Stroke Alarms: = Z # Cartoon Monoxide Detectors: Smoke and RC1 form.doc reWsed 01/1012017 B-2017-OK��z FILE WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION CUPteRTtMt3 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408),777-3228; FAX (408) 777;3,333 hMR 1nxa@-QM9rtlno.oro Is your real properly a registered historical site? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. o Go to Question 2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the property or its plumbing, installation of water -conserving plumbing fixtures is not technically feasible? 0 Yes Civil Code Sections 1101.1 through 1101.8 do not apply. D The licensed plumber's certification has been provided to the Building Division. Skip the rest of the form and sign bottom of form. No Go to Question 3. 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form, o Go to Question 4. 4. Is your real property built and available for use or occupancy on or before January 1, 19942 ❑ No My real property is built and available for use or occupancy January 1. 1994. Civil Code Sections I 1 of .1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. Yes My real property is built and available for use or occupancy on or byre January 1, 1994. Civil Code Sections 1101.1 through 1101.8 apply. Check out of the three following statements and sign bottom of form.. PI 5T1- check ONE of the following: My property is a single-family residential real property. See Civu Code Section 1101.4 Ou and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing fixtw% to be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1, 2417, all non- Compliant onCompliant plurbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless of whether property undergoes alterations or improvements). ❑ My property is a mutt fam* residential real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water - conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or in�}sru`�xtaents�. ❑ My property is a commercial real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. On or before January 1, 2019, all non-00nlliltant phrmbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building (regardless of whetlim property undergoes alterations a rr-itrprov=mts), I, as the owner or owner's agent of this property, certify under penalty of perjury that non -Compliant plumbing fixtures will be replaced prior to date specified above with water -conserving phvnnbing fixtures in accordance with Civil Cotte Sections 1101.1 through 1101.8, the current California Plumbing Code and California Green Building Standards Code, and,manufaeturer's installation requirements; and that the: water -conserving plumbing fixtures comply with the requirements as indicated in the table on the following e. Owner or Owner Agent's Signature: Date: Upon completing and -signing this Certificate, please return it to the Building Division in order to ficial your building permit. SB4072013 d©e wised 81193117