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B-2017-1246CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B72017-1246 7967 PUMPKIN DR CUPERTINO, CA 95014-4931 (362 02 039) ATKINSON CLIMATROLLERS INC SAN JOSE, CA 95112 OWNER'S NAME: STEWART WAYNE D AND ORVA L TRUSTEE DATE ISSUED: 07/28/2017 OWNER'S PHONE: PHONE NO: (408) 294-6290 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: - License Class ELECTRICAL Lic. #258540 Contractor ATKINSON CLIMATROLLERS INC Date 12/31/2018 X BLDG —ELECT _PLUMB X MECH X RESIDENTIAL COMMERCIAL 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. JOB DESCRIPTION: REPLACE FURNACE(SAME LOCATION); REPLACE A/C (SAME l,hereby affirm under penalty of perjury one of the following two declarations: LOCATION) 1. I have and will maintain a certificate of consent to self -insure for Worker's pensation, as provided for by Section 3700 of the Labor Code, for the rformance of the ;work•for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by GU Section 3700 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: Valuation: $9081.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this, application and state that the above Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances 36202 and state laws relating to building construction, and hereby authorize 362 039 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 Addition .ljy,the applicant understarl'ds and will comply with all non -point sour egulations per the Cupertino Municipal Code, Section 9.18.180 DAYCALLEDLAST CALLED INSPECTION. egnarture�// ?%%� Date Issued by: Jasmirie Archbold 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: ' All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: m. 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: I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER m. 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 j performance of theiwork 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 maintain compliance with the Cupertino Municipal Code; Chapter 9.12 and the permit is issued. • a. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(x) should I store or handle hazardous devices hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or which emit 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 maintai compliance with the Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Wor`ker's Compensation provisions of the e'Health &Safety Code, Sections 25505, 25533, and 25534. rm Labor Code, I must forthwith comply with such provisions or this peit shall be deemed revoked. 40 Ow or authorized agent: APPLICANT CERTIFICATION D I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY Ireby 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 I and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records. Code, Section 9.18. Licensed Signature Date professional GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.org MISC. ❑ PLUMBING MECHANICAL EDELECTRICAL ❑ MISCELLANEOUS PROJECT ADDRESS q�7 P V h,/1 Q.l hVc— APN # �� _ 0 ^ _ O _� S p OWNER NAME A�v-5��4]]] I� (Itis1 �� I PT Z,55— JS7I E-MAIL I vs4iVi ISSW C11 STREET ADDRESS / 7 CITY ATW q SD I � FAX v t 'r)0 GA CONTACT NAME r ll 1� PH E a -2 &MAIL ^ lie C.r�lL STREET ADDRESS CITY, C,Ln'F Q IP GA ] FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NV4E L LICENSENU n LICENSEE� BUS. LIC # o O n o ((J COMPANY NAME I i� f 1, i In E-MAIILL J Ce ^ r FAX V� U • 1 V� STREET ADDRESS 7 c CITY, TATE, P PH ase. -2 --6 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 PROJECT IN WILDLAND ❑ YES ❑ YES 7FD7NI IS THE BLDG AN ❑ YES BUILDING: ❑ COMMERCIAL URBAN INTERFACE AREA ❑ NO ❑ NO EICHLER HOME? ❑ NO DESCRIPTION OF WORK C C _ J ' TOTAL VALUATION: By my signature below, I certify to each of the following: I am the property owner orauthorized,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 the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to• b�lding construction. I authorizerr resentatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: ACJII `i�-�GiL/ Date: / ✓ SUPPLEMENTAL INFORMATION REQUIRED�� caH i. 2t . MEPMiscApp_2011.d6c revised 06/21/11 11C4 Icy CUPERTINO (�p 6? V VIII -el)_yn 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 • building(a.cupertino.ora , _PERMIT CAN1�flT B� �INALE� UNTIL TRIS. CERTIFICATE HAS SEEN CQARLETE 7 �� T„� .[ET.•iJkNE"D 1 0 T i3UffD Dil" ^-;•:r-M,.�.,;...,�.;u,._.....�...,�..M.,. ...., y,�...�.�..�--""'-r..-.�•�,-.�:��-;;rrm>•-r.'-^'-^•— ... ............ .�-�-�-.,-.-r "i'^'�'r, �-s'-^r �.rrs . 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 the bedroom(s) X X On every level of a dwelling unit including basements X X Within 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- Pr&!Pu� S_ -fl Permit No.A-/n� Specify Number of Alarms: -4) # Smoke Alarms: �..- # Carbon Monoxide Detectors I have read and agree to comoty with the terms and conditions of this statement Owner (or Owner Agent's) Name: f Signature .... .. ...... �:�...,. Date: '(00A Contractor Name: Signature Lic.# Date: Smoke and CO for77:.doc revised 12/15/16