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B-2017-0477CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0477 7401 ROLLINGDELL DR CUPERTINO, CA 95014-5812 (359 32 001) Z R - RAM INC TARZANA, CA 91356 OWNER'S NAME: HSU CHEN JUNG TRUSTEE OWNER'S PHONE: 510-579-2857 LICENSED CONIRACTOR'S DECLARATION License Class J1 Lic. #876128 Contractor Z R - RAM INC Date 07/31/2018 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 4performance of the work for which this permit is issued. s�have and will maintain Worker's Compensation Insurance, as provided for by ', ction 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 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 upertino Mu ' ipal Code, Section 9.18. Signature Date 03124/2017 Lill 4-11 DxefWMEW I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project(Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 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. s. 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 03/24/2017 ISSUED: 03/24/2017 PHONE NO: (818) 424-5820 BUILDING PERMIT INFO: BLDG —ELECT —PLUMB MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: VOLUNTARY FOUNDATION RETROFIT/REPAIR; I I PIERS (ENGINEER OF RECORD TO APPROVE IN FIELD) Sq. Ft Floor Area: I Valuation: $29500.00 APN Number: Occupancy Type: 359 32 001 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: MELI A Date: 03/24/ All roofs shall be inspected prior to any roofing material being installed. If'a r�yyof is installed without first obtaining an inspection, I agree to remove all new materials Tor inspection. Signature of Applicant: Date: 03/24/2017 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, nd 25534. Owner or authorized agent Date: 03/24/2017 �QNLENDING AGENCY hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed CL!PERTmo ❑ NEW CONSTRUCTION PERMITCONSTRUCTION COMMUNITY DEVELOPMENT DEPARTMENT ® BUILDING DIVISION 10300 TOR RE AVENUE $ CUPERTINO, CA 950'24-32-55 {403) 777-33228 ® FAX 115} 73333 R bW ai i_s rq ;�P ®� �7 ❑ ADDITION r_1/� ALTERATION / TI REVISION / DEFERRED ORIGINAL PERMIT # p PROJECT ADDRESS 7 I y t777N # OWNER NAME v t7-> PHONE ITU 5 /7 - 2435 ( {�� ! i�i ( imp Id ..1 STREET ADDRESS (� -(y �0 . CONTACT NAME ^p f ti i� A4 4 4Z{ U� IG o"% 7i® - 0 6 o L E-MAIL PHONE!CITY, STREET ADDRESS STATE, ZIP — /��,, FAX ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR XCONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT FCON:TRA7CTOR NAME, d� LICENSE NUMiBER LICENSE E 8A-/ cAice® JaJ 0 /(7Z t �� BUS. LIC # -303c) yo COMPANY NAME 2, .* E-MAIL �7� FAX lJ STREET ADDRESS ®- CITY, STATE, ZIP x;mfy 2i'`ii t . e/05- PHONE _ ARCHITEC NGE LEER NAME LICENSE -� NUMBER BUS. LIC # COMPANY NAME EMAII,�P' j p � � f f FAX l`�.� iti STREET ADDRESS 6� CITY, STATE, ZIP �r PHON DESCRIPTION OF WORK �P �2 r < <.. EXISTING USE '-f-5 PROPOSED USE CONSTR. TYPE # STORIES USE k__�C000 t TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA BATHROOM REMODEL AREA KITCHEN REMODEL AREA OTHER REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: El DETACH - PATTACH # DWELLING UNITS: IS A SECOND UNIT 171YES SECOND STORY ❑YES IBEING ADDED? AVO ADDITION? iro PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OFF PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER IS THE BLDG AN ® YES RECE ETCIiLER ROME? - TOTAL VALUATION: Z -ST C -0p By my signature below, I certify to each of the following: I am the property owner or authorized ag et on the operty owner's behalf. I have read this application and the information I have provided is correct. I have read the Description Work itis of an rift' urate. I agree to comply with all applicable local ordinances and state laws relating to building cO ction. I a onze r resentatives of Cup er the above -identified proper for inspection purposes. Signature of Applicant/Agent:i� Date: 5UPPLEMEN AL INFORMATION REQUIRED PLAN CHECK TYPE . ROUTING iNG SLIP _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building ❑ OVER THE COUNTER ❑ BUILDINGPLANREVIEW permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW —Commercial Bldgs: Provide a completed Hazardous Materials Disclosure E3 STANDARD El PUBLICWORKS form if any Hazardous Materials are being used as part of this project. © LARGE E1 MM DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. MAJOR ❑ SMVTARY SEWER DISTRICT ENVIRONMENTAL HEALTH BldgApp Z01 Ldoc revised 06/21/11 CUPERTINO SMOKE % CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF. COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • build in p_cupertino.orcl PERMIT CANNOT BE FINALED UNTIL THIS CERTIFICATE HAS BEEN COMPLETED, SIGNEDAND RETURNED TO THE BUILDING DIVISION PURPOSE �M This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2016 CRC Section R314, R315, 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, R315, 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 �- CO ALARM , _ Outside of each separate sleeping area in the immediate vicinity of the bedrooms) - (Smoke alanns shall not be located within 3 feet of bathroom door) _ALARM X X On every level of a dwelling unit including basements and habitable attics X_ X _ �Nithin each slee mfiroom -- —g -- ---- - X ------ —� ------ Carbon Monoxide alarms are not required in dwellings which do not contain fuel. -burning applianr_es and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall_ comply with CBC Section 42.0.6 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: b f- Co P4 lr� 0 Permit No. ,24 Q'f? 7 Specify Number of Alarms: # Smoke Alarins: �•S� # Carbon Monoxide Detectors: I have read and agreetaporr?ply w%t44he terms and conditions of this statement Owner (or Owner Agent's) Name: 4V % � 4 L I SNL Si nature................................................................................................... Date:: ...�. Contractor Name: Signature...................................................................... Lic.#........................................ Date:................... Smoke and COforrn.doc revised 0111012017 WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION — I 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPIERT11V (408) 777-3228 •FAX (408) 777-3333 • building(a),cupertino.org Owner Name D at TWL P—rgi Permit No. / Address C(, .FJA-5 b4^ 1. Is your real property 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. :, No Go to Question 2. 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? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. ❑ 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 110 1. 1 through 1101.8 do not apply. Skip the rest of the forn and sign bottom of forn. O•No Go to Question 4. 4. Is your real property built and available for use or occupancy on or before January 1, 1994? ❑ No My real property is built and available for use or occupancy after January 1, 1994. Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the forn and sign bottom of forn. Yes My real property is built and available for use or occupancy on or before January 1, 1994. Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign bottom of forn.. Please check ONE of the following: *4:_ My property is a single-family residential real property. See Civil Code Section 1101.4. On and after January 1., 2014, building alterations or improvements shall require all non-compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1, 2017, all non- compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless of whether property undergoes alterations or improvements). ❑ My property is a multifaccily 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 improvements). ❑ My property is a c07777cercial 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 improvements). I, as the owner or owner's agent of this property, certify under penalty of perjury that non-compliant plunbing fixtures will be replaced prior to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 110 1. 1 through 1101.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's installation requirements, and that the water/ -conserving plumbing fixtures comply with the requirements as indicated in the table on the followinz page. /I\ 1 I n IOwner or Owner Agent's Signature: N%I Date: b / i4' /1 -4- I Upon completing and signing this Certific te, please return it to the Building Division in order to final your building permit. SB4072015.doc revised 01/05/17