B-2017-1292CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1292
10384 N PORTAL AVE CUPERTINO, CA 95014-2351 (316 29 009) DUKE ELECTRIC INC
SAN JOSE, CA 95008
OWNER'S NAME: XIN HOU
OWNER'S PHONE: 614-397-2279
LICENSED CONTRACTOR'S DECLARATION
License Class= Lic. #969786
Contractor DUKE ELECTRIC INC Date 06/30/2019
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 hereby affirm under penalty of perjury one of the following two declarations:
t. 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.
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 consequence of the granting of this permit.
Additionally, the applicant underst rids and will comply with all non -point
source regulations pe
,pH Cupefno Municipal Code, Section 9.18.
Date 08/07/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
t. I, as owner of the property, 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)
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. 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.
i. 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.
s. 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 expense's 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 08/07/2017
DATE ISSUED: 08/07/2017
PHONE NO: (408) 309-9395
BUILDING PERMIT INFO:
BLDG X ELECT _ PLUMB
MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
UPGRADE PANEL (200 AMP)
Sq. Ft Floor Area: I Valuation: $3500.00
"N Number: Occupancy Type:
316 29 009
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180' DAYS FROM LAST CALLED INSPECTION.
Issued by: Kim Dunbar
Date: 08/07/2017
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.
ture of Applicant:
08/07/2017
BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materiats 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(x) 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, Sectio 505, 25533, and 25534.
Owner or authorized agent:
Date: 08/07/2017
CONSTRUCTION LE IXAGENCY
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
GENERAL PERMIT APPLICATIONM I'VEMM P
COMMUNITY DEVELOPMENT DEPARTMENT ^ BUILDING DIVISION
10300 TORRE AVENUE ° CUPERTINO, CA 95014-3255
CUPERTINNO (408) 777-3228 • FAX (408) 777-3333 • building cupertino.org MISC
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PLUMBING ❑ MECHANICAL ELECTRICAL ElMISc llylUS
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❑ OWNER . ❑ OWNER=BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑. DEVELOPER ❑ TENANT
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USE OF SFD or DUPLEX ❑ MUTT -FAMILY •
BUILDING: ❑ COMMERCIAL
PROJECT IN WILDLAND ❑YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
i5 THE BLDG AN ❑YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
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TOTAL VALUATION: O
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By my signature belo certify to each of the following: I am the property owner or authorized agent to act on the property owner's b6hal£ 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 building c on. I aut orize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date: ' L'���
SUPPL ENTAL RMATION REQUIRED
OFFICE USE ONLY ,
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MEPMisc.4pp_201 1. doc revised 06/21/11
SMOKE / CARBON MONOXIDE ALARMS
tir/ OWNER CERTIFICATE OF COMPLIANCE
4'�t'¢. COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
No 10300 TORRE AVENUE• CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333• buildings cupertino.orq
PERMIT CANNOT BE FINALED Ul\T I IL TI OS CERTIFICM$r S:BEEN
+CO V PLETED,SI NEI1;A.ND RrtuRNEb,'TO TFIR B org DIVISION
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
$1000.00,CRC Section R314 and CBC Sections 907.2.11.5 and 420 6 require that Smoke Alarms and/or Carbon
Monoxide Alarms be installed in the following locations.
AREA SMOKE ALARM CO ALARM
Outside of each separate sleeping area in the immediate vicinity of X
the bedroom(s) X
On every level of a dwelling unit including basements X
Within each sleeping room X
X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420 6 and shall be approved by the Office of the State Fire Marshal.
Power Supply In dwelling units with no commercial power supply, alarm(s)may be solely battery operated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic,basement or crawl
space.Refer to CRC Section R314 and CBC Sections 907.2.11 4 and 420 6.2. An electrical permit is required for
alarms which must be connected to the building wiring
As owner of the above-referenced property,I hereby certify that the alarm(s)referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms specified below have been tested and are operational, as of the
date signed below ll�� //��
Address. /Q3$'L IV P°J {4( Ave, CtADev-fl°I1O, CA 9 O/4- Permit No 17—Id d
Specify Number of Alarms: #Smoke Alarms: #Carbon Monoxide Detectors. II I
I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name: ,,A!�
�Signature "l '
Date:5/3//Ial-
Contractor Name: / '
1$
Signature /,j.; Lic.#
Date: 8- 3j 1
Smoke and CO form.doc revised 12/15/16