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B-2017-1265CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1265 6376 MYRTLEWOOD DR CUPERTINO, CA 95014-4625 (369 19 010) HARRIS WATER HEATERS CASTRO VALLEY, CA 94546 OWNER'S NAME: LAPIN ELEANOR J TRUSTEE OWNER'S PHONE: 408-209-4980 LICENSED CONTRACTOR'S DECLARATION License Class C-36 Lic. #1026214 Contractor HARRIS WATER HEATERS Date 04/30/2019 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 hereb under penalty of perjury one of the following two declarations: , I have and will maintain a certificate of consent to self -insure for Worker's 00�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. 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, of the granting of this permit. Additionally, the applicant understands arld will comply with all non -point source regulatio_p*15-67131e Cupertino Muiticipal Code, Section 9.18. 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 propert3; 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. 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 , Date18/ /2017 ISSUED: 08/01/2017 PHONE NO: (661) 3134035 BUILDING PERMIT INFO: X BLDG —ELECT X PLUMB MECH X RESIDENTIAL COMMERCIAL JOB DESCRIPTION: REPLACE 40 GAL WATER HEATER- GARAGE Sq. Ft Floor Area: I Valuation: $1700.00 APN Number: Occupancy Type: 369 19 010 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: JASMINE ARCHBOLD Date: 08/01/2017 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: 8/1/201 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 Voile, Chapter 9.12 and the HSilth & Safety Code, Sec " 25505 '255 3, and 25534. Own orized agent: D STIJI GAGENCY I hereby affirm that there is a c uction 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 CUPERTINO GENERAL PERMIT APPLICATIONM ERE= P COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE ° CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(Mcupertino.org 'zjM1SC ?7.>2b l I-- I r&LUMBING F I MECHANICAL F ELECTRICAL F -1 MISCELLANEOUS PROJECT ADDRESS APN # 19 ®� D f v \ 0 OWNER NAME L_C_ L~ 1, `C ( EMAIL STREET ADDRESS CITY, STATE, ZIP FAX p e- bd l CONTACT NAME PHONE E-MAIL rc{©, r e STREET ADDRESS C1;Y, STATE, ZIPc �t� jr FAX e Hti V Gb Ct -l'.'l5 ❑ OWNER ❑ OWNER.BUILDER ❑ 01�TIER AGENT �. CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER 13 TENANT CONTRACTOR NAME n LTC SE ,^ , LICENSE Tl PE BU l ��r , d -i L4 v —L (J COMPANY NAME E-MAIL FAX ` G STREET ADDRESS CITY, STATE, IP PHONE —QK6 ✓ o� ` Q - $3k 14 ARCHITECT/ENGINEER NAME LTC SE NUMBER BUS. LTC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ MULTI-FAMTLY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑ YES IS THE BLDG AN ❑ YES BUILDING: ❑ COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO EICHLER HOME? ❑ NO DESCRIPTION OF WORK TOTAL VALUATION: �� 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'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 buildin construction I authorize representatives, of Cupertino to enter the above -identified property for inspection purposes. ! Signature of Applicant/Agentr Date: / .I SUPPL ENTAL INFORMATION REQUIRED OFFICE USE OALY W ' ❑ OVER THE COUNTER U: ❑ EXPRESS W .i STAN AARD �. U 4 '. ❑ LARGE ❑ MAI OR k` MEPMisi .App_2011.doc revised 06121111 SMOKE / CARBON MONOXIDE ALARMS h, 71 OWNER CERTIFICATE OF COMPLIANCE ' F==' / c.r, COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•buildinq(a.cupertino.orq CE 'TIFI . 0S 1:00 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 alarms 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 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 Cl"Address: (o C„, /MLA CrJ LTIVe Permit No. V,-/ `7_ Specify Number of Alarms. #Smoke Alarms. M #Carbon Monoxide Detectors. I have read and agree to jomply with t • terms and conditions of this statement caner(or Owner Agent's)Name: 14v1AV� K( -� S Signature / abate: Contractor Name: Signature . .. .. ... . ... . . . . Lic.# . . . . .. .Date: .. . . . Smoke and CO form.doe revised 01/10/2017