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B-2017-0842CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0842 1149 HOLLYHEAD LN CUPERTINO, CA 95014-5041 (362 26 021) GRAHAM HOME IMPROVEMENTS SAN JOSE, CA 95130 OWNER'S NAME: NESSLER ROBERT C AND FLORENCE M OWNER'S PHONE: 408-446-3973 LICENSED CONTRACTOR'S DECLARATION License Class B: C-10 Lic. #864319 Contractor GRAHAM HOME IMPROVEMENTS Date 09/30/2017 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. z. 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. V r 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 re lations per the Cupertino mapal Code, Section 9.18. Signa Date 5/26/2017 DATE ISSUED: 05/26/2017 PHONE NO: (408) 234-9459 BUILDING PERMIT INFO: BLDG X ELECT _ PLUMB MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: PANEL UPGRADE (200 AMPS) - SAME LOCATION Sq. Ft Floor Area: I Valuation: $2000.00 APN Number: Occupancy Type: 362 26 021 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Abby Avende Date: 05/26/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the RF. -ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 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) z. 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. 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 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. 1 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 5/26/2017 Signature of Applicant: Date: 5/26/2017 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, 255533, and 25534. Owner or authorized agent: I� Date: 5/26/2017 CONSTRUCTION LENDING AGENCY I 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 Professional -2oi�- 6�y2 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 mise CUPERTINO g ❑ PLUMBING ❑ MECHANICAL ❑ ELECTRICAL ❑ MISCELLANEOUS (408) 777-3228 •FAX (408) 777-3333 •building .cupertino.or PROJECT ADDRESS I q -7 I I 1 i I��n ' ,J (�N . - APN # 2 I .,_ r% ( 02 1 c�'Z/jj OWNER NAME ✓ � ' S I PHONE S(},) I (� ; 1 `-� `(J J 1 E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME 0 ` Z+ ` .. _ �. - I„- C J l'(J (1� lJl u PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR' NAME l �� �� LICENSE NUMBER LICENS TYPE O BUS. LIC �I COMPANY NAME V ✓�1 �.J✓`-� 1 I c �V�„ rCVi N'v E-MAIL v1 r"V e I lVe. Ccs w--� FAX STREET ADDRESS 4 3 J i' + ' �� 1 / j I CITY, NE, ZIP TIC C � ' 3 O PHONE Y _ _995 995 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF SFD or DUPLEX ❑ MULTI -FAMILY BUILDING: ❑ COMMERCIAL PROJECT IN WILDLAND ❑ YES URBAN INTERFACE AREA ❑ NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO DESCRIPTION OF WORK �% �2v,v I C L t c /_ - e, v U0 TOTAL VALUATION: Z C�06 "D RECEIVED BY: By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner' behalf. I ave read t—his 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 of Cupertino to enter the above -identified property for inspection purposes. ordinances and state laws relating to ing construe ion. I ann7;�; Signature of Applicant/Agent: Date: 5 /2_ f -7 SUP EMENTAL INFORMATION REQUIRED OFFICE USE ONLY w ❑ OVER-THE-COUNTER ❑ EXPRESS V x ❑ STANDARD V ❑ LARGE a ❑ MAJOR MEPMiscApp_2011.doc revised 06121111 SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE c,,# COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228•FAX(408)777-3333•building©cupertino.org PERMIT,CANNOT BE FINALED-IJNTIL THIS CERTIFICATE HAS:BEEN COMPLETED,SIGNED.AND RETURNED TO THE.BIJILDINGD SIO.;N PURPOSE 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 ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the X X bedroom(s)-(Smoke alaiuis shall not be located within 3 feet of bathroom door) On every level of a dwelling unit including basements and habitable attics X X Within each sleeping room X Carbon Monoxide alainis 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 907.2.114 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 tt� }} � Address `7i d'-1 k4 L-r. peAi 0 //4 4 SES IL( Permit No.(2-20 '®49t''L Specify Number of Alarms #Smoke Alarms I C3 I #Carbon Monoxide Detectors Fri /have read and agree to comply with the terms and conditions of this statement Owner cg,c Owner Agent's)Name. eJ J Signature Date. .. . .4 Contractor Name: Signature Lic.# Date: Smoke and CO form doc revised 01/10/2017