B-2017-0594CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0594
883 BRENT DR CUPERTINO, CA 950144552 (369 24 043)
KL & C ELECTRIC INC
DALY CITY, CA 94014
OWNER'S NAME: DUGAN WILLIAM G AND MELVA L TRUSTEE
DATE ISSUED: 04/14/2017
OWNER'S PHONE: 408-663-3799
PHONE NO: (415) 722-8313
I ICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class B: C-10 Lic. #803388
Contractor KL & C ELECTRIC INC Date 08/31/2017
X BLDG X ELECT _ PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
MECH X RESIDENTIAL _ COMMERCIAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
UPGRADE PANEL (200 AMPS); SAME LOCATION
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.
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
Sq. Ft Floor Area:
Valuation: $1000.00
permit is issued. 2 _ H_ _
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
369 24 043
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
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
SignatureDate 4/14/2412
Issued by: Abby Ayende
Date: 04/14/2017
OWNER-BUIL DER DECLARATION
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. I, 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. I, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Scc.7044, Business & Professions Code).
Date: 4/14/2017
I hereby affirm, under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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.
HAZARDOUS MATERIALS DISCLOSURE
2. I 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. I will
compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.maintain
S. I certify that in the performance of the work for which this permit is issued, I
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices 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 Area Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sections 25505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
A�af O
Owner or authorized agent: r
APPLICANT CERTIFICATION
Date: 4/14/2017
I certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
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
relating to building construction, and hereby authorize representatives of this city
of work's for which this permit is issued (Sec. 3097, Civ C.)
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,
judgments, costs, and expenses which may accrue against said City in
Lender's Address
consequence of the granting of this permit. Additionally, the applicant understands
DECLARATION
and will comply with all non-point source regulations per the Cupertino Municipal
ARCHITECT'S
1 understand my plans shall be used as public records.
Code, Section 9.18.
Licensed
Signature Date 411412017
Professional
CUPERTINO
`16,6011
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT. DEPARTMENT • BUILDING DIVISION
10300 TORRE.AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildino(a--)cupertino.org
PLUMBING . ❑ MECHANICAL FZELECTRICAL ❑ A4ISCELLANEOUS
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ElOWNER 1:1 OWNER -BUILDER ❑ OWNERAGENT CONtTRACTOR ❑ CONTRACTORAGENT ❑. ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME l C LICENSE NUMB
LICENSE TYPE
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USE OF SFD orDUPLEX ❑ MULTI-FAMTI:Y
BUILDING: ❑ COMMERCLAL
PROJECT IN WILDL.AIND ❑ •YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLllG AN ❑ ITS
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
�20 0 }�
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TOTAL VALUATION:
RECEIVEDBI Z -
By my signature below, I certify to each of the following: 1 am the property owner or authorized agent to act on the property o ner's bdlhalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to bullding construction. i authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE USE o>
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SMOKE I CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMM -UNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISIO`N%;
10300 TORRE AVENUE CUPERTINO CA 95014-3255
(408) 777-3228 FAX (408) 777-3333 building(c-)cupertino.org
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PURPOSE -
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2016 CRC Sect -ion 8314, R315, 2016 CBC Sections 420 6 and 907.2.11.2 where no mtenor access
for inspections are required.
GENERAL INFORMATION
Existing
NFORMATION-
Existing single-family and multi -family dwellings shall be provided with Smoke Alarms and Carbon
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Monoxide alarms. When the valuation of additions, alterations, or repairs to I existing dwelling units exceeds
y$!OQO 00, CRC-Section
Section R314, R315, and CBC Sections 907.2.11.5 and 4-90.6 -require that Smoke Alarms and/or
Carbon Monoxide Alarms be installed in the following locations -
AREA SMOKE ALk-4M CO -ALARM
Outside of-each-8-eparate sTeepili ig- area in the immediate vicinity of the X
X
bedroom(s) - (Smoke alarms shall, not be located within 3 feet of bathroom door)
--Qii every level, of
7 -
&unit in6ludinb, basements and habitable attics
X X
Within each,sleePT,�a rb,�lw
X
dCarbon Monoxide alarms are not required in dwellings which do not contain fuel-burrung- appliances and that
o not h'ave_,antdtathed garage.
shall w
Carl monoxide alarms combined with smoke lcomply jffi
s
CBC Qectxm -
`t .and shall "D6 approved by the Office of the State Fire Marshal.
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Power Supply In dwelling units
withno commercial power supply, alarm(s) may fie solely battery operated.
In qxistil'ig-dwelling units, alarns are permitted` to be solely battery operated vhere -repaii:s or al'terati do
not resulfbi the r ons
oval W411 acid firdshes-or there,is no access by Tr�eqrs 4'ahtdc-, basement or crawl
C�ftirio
space. Refer to CRC -Section 3, d CBG;Se��'
aria R 14� ong- 907:2:11 4 and 420.6.2. An electnca 'ermit is,re(pired for
`alarms which mii�sit connec'to
the buildinpwirng
AsotiTler of�Itk4ab: o'.,v'b-refor&--pd-,rcertify`
certify that the alarms) referencdce has/have been
installed in acc= with tR6-mih�?k"'
At tmctioti5 'and in compliance with "aBuildina,
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and California
tial Q specified,below el�qw h
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avebeen tested and
date signed below 7, as of the
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Specify in fJ
Carbon Monoxide Detectors
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have Q
-d�o�&aj-i6to cornpVwfrh the terms and conditions of thi�,staie!77,dn
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Owner (or Owner Name:
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Contractor Name:
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