B-2017-1242CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1242
19890 PEAR TREE IN CUPERTINO, CA 95014-2360 (316 31 009)
PAYLESS WATER
HEATERS &
PLUMBING INC
VALENCIA, CA 91355
OWNER'S NAME: SWANSON PAULA AND TAI-SWANSON ELIZABETH
DATE ISSUED: 07/28/2017
OWNER'S PHONE: 408-391-4920
PHONE NO: (661) 775-2979
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C36 Lie. #838216
Contractor PAYLESS WATER HEATERS & PLUMBING INC Date 08/31/2018
X BLDG —ELECT X PLUMB
—
X RESIDENTIAL COMMERCIAL
m that I am licensed under the provisions of Chapter 9 (commencing
I hereby affirm
— — —
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
(N) 40 GAL WATER HEATER -SAME LOCATION
I hereby affirm under penalty of perjury one of the following two declarations:
'I 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.
a . 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: $1805.00
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
316 31 009
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 conseque' of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understands: ,d will comply with all non -point
source regulations per the Cupertin unicipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 07/28/2017
Issued by: Kim Dunbar
Date: 07/28/2017
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -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)
2. I, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 07/28/2017
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
z. 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
permit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
a. 1 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
shall not employ any person -in any manner so as to become subject to the
material. Additionally, should I use equipment or devices which emit hpardous
Worker's Compensation laws of California. If, after making this certificate of
air contaminants as defined by the Bay Area Au Quality Manage District I
exemption, I become•; subject to the Worker's Compensation provisions of the
µ maintain compliance with the Cupertino Municipal Cod apter 9.12 and
the Health & Safety Code, Se 'on 25505, 255 , and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked. °
Owner or authorized aaem
APPLICANT CERTIFICATION
Date: 07/28/2017
1 certify that I have read this application and state that the above information is
COJT TION LENDING AGENCY
correct. I agree to comply with all'city and county ordinances and state laws
I hereby affirm that there is a construction lending agency for the performance
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 menbon4l! roperty for inspection purposes. (We) agree
Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expenses1which may accrue against said City in
Lender's Address
consequence of the granting of this;permit. Additionally, the applicant understands
and will comply with all non;point'source regulations per the Cupertino Municipal
ARCHITECT'S DECLARATION
Code, Section 9.18, 1.
1 understand my plans shall be used as public records.
Licensed
Signature Date 07/28/2017
Professional
Y i}
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTI,NO (408) 777-3228 • FAX (408) 777-3333 • building(akunertino.ord I S C
PLUMBING ❑ MECHANICAL ❑ ELECTRICAL ❑ MISCELLANEOUS
PROJECT ADDRESS p
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El OWNER IJOWNR OWNFR-BUILDER El OWNER AGENT 13 CONTRACTOR CONTRACTOR AGENT. ❑ ARCHITECT E] ENGINEER ❑ DEVELOPER 13 TENANT
CONTRACTOR NAME
LICENSE NUMB
LICENSE TYPr
BUS. LIC #
COMPANY NAME E-I\/AI/
FAX
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ARCHITECT/ENGINEER'NAME
LICENSE NUMBER
BUS, LIC #
COMPANY NAME
E-MAIL
'FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OFSFD or DUPLEX ❑ MULTI -FAMILY
BUILDING: ❑COMMERCIAL
PROJECT TN Rr[LDLAND ❑ YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN El YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
TOTAL VALUATION:
001
RECE
By my signature below, I certify to each of the following: I am the property o er or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I have read escription of Work and verify it is accurate. I agree to comply 'th all applicable local
ordinances and state laws relating to building co s o . I autho ' representatives of Cupertino to enter the above-identifie roper / or inspection purposes.
Signature ofApplicant/Agent: i Date: /
SUPPL9MEENT TFORMATION REQUIRED
oFFicE USE ONLY.,
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`❑ OVER THE COUICTER
❑ EXPRESS
❑ STANDARD
❑ LARGE
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s;❑ MAJOR
MEPMsc.4pp_2011.doc revised 06121111
•
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
• SY 9S
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION :3
CUPERTINO 10300 TORRE AVENUE• CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333• buildino cupertino.orq
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{ * `PERMIT CANNOT BE ,INALED�ILiTHIS CERT ICATElHAS BEEN ` ; •
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F, CO�LPTED,SI NED R*T.., DgO THE B U ,ILD,.I G D ISIOw G
PURPOSE
• This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms
for compliance with 2016 CRC Section R314,2016 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 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 X X
the bedrooms)
On every level of a dwelling unit including basements X X
Witivn 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: /qg(� �Q2y /'�C(� � j�2J Permit l�To. l''G )?"3 a
Specify Number of Alarms: #Smoke Alarms: J 3 ( #Carbon Monoxide Detectors: ! 2.. (
1 have read and agree to coy ay with the terms and concs..of this statement •
Owner(or Owner Agent's)Name: •
1/a4iiel- 744: Signature... ..., .. / 1.... ! Date:4 k
Contractor Name:
Signa•re Lic.# Date:
Smoke and CO fonn.doc revised 12/15/16