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B-2017-1296CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1296 11146 PALOS VERDES DR CUPERTINO, CA 9501411723 (356 20 040) DELSUR CONSTRUCTION ENTERPRISES SOUTH SAN FRANCISCO, CA 94083 OWNER'S NAME: LIN SHING-FEN ISSUED: 08/07/2017 OWNER'S PHONE: 408-667-4471 1 1 PHONE NO: (415) 305-7638 LICENSED CONTRACTOR'S DECLARATION License Class B Lic. #932951 Contractor DELSUR CONSTRUCTION ENTERPRISES Date 05/31/2019 I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Prof6ssions 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 4 rformance 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 understands and will comply with all non -point source regulations per the Cupert=Date 8. Sign 17 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) 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: 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. 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. 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 Date 8/7/2017 BUILDING PERMIT INFO: X BLDG —ELECT X PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: REPIPE SFD (COPPER) -FULL Sq. Ft Floor Area: I Valuation: $3000.00 "N Number: Occupancy Type: 356 20 040 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: 08/07/2017 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 ofApplicant: Date: 8/7/2017 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, 25533, ar 5 . Owwrw ized agent: D 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 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(l-)cupertino.org [—I NEW CONSTRUCTION ❑ ADDITION ALTERATION / TI * ❑ REVISION /DEFERRED ORIGINAL PERMIT # F l — JZ � %5 ��. PROJECT ADDRESS L/V C APN# � c OWNER NAME PHONE //(J o -7 twd //E-MAIL 4'/� r STREET ADDRESS �F 1_t/�5 �r CITY, STATE, ZIP /? n FAX f / pC L CONTACT NAME - PHONE S /Gj 6:2 6 E-MAIL STREET ADDRESSl / /� J - �r v�Gl CITY, STATE, ZIP FAX OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT of CONTRACTOR ❑ CONTRACTOR AGENT ❑: ARCHITECT EIENGINEER ❑ .DEVELOPER ❑ TENANT CONTRACTOR NAME / LICENSE NUMBER /A �^ / LICENSE TYPE BUS. LIC # n L 1/ COMPANY NAME EMAIL —( -y- _ / FAX Q 47 STREET ADDRESS o° Z�,� CITY, STATE, ZIP ' Sam awn��sca �lo�� PHONE L -305-763g ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE I�'•� TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA - BATHROOM_ KITCHEN REMODEL AREA REMODEL AREA OTHER REMODEL AREA j PORCH AREA DECKAREA - TOTAL DECKIPORCH AREA GARAGE AREA: DETACH �f j E] ATTACH #DWELLING UNITS: ISASECONDUNIT ❑YES SECONDSTORY [:]YESNG BEI. ADDED? []NO ADDITION? [:]NO PRE -APPLICATION El YES IF YES, PROVIDE COPY OF PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑YES EICHLER HOME? E] NO °, TO AIAI�UATION: C By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property own is 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 building construc 'on. I autho ' resentatives of Cu er the above -identified pr perty for inspection purposes. Signature of Applicant/Agent: Date: S ' SUPPLEMENTAL INFORMATION REQ _ New SFD or Multifamily dwellings: Apply for demolition permit for x q 0 r ❑ suHDIxG PLAN RE«wM existing building(s). Demolition permit is required prior to issuance of building OVER THE COUNTER I permit for new building. ¢ ExPREs`s '' ❑4 PLANNING PLANREVIEw°r ` 455. Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ sTnrmAR Dr 'r ` ? k ❑ woRKs ruBLlc \ Y form if any Hazardous Materials are being used as part of this project. +x ❑ LARGE � � � , �' " ' "��,� .r i ❑ FIRE DEPT t ` '` a � s _ Copy of Planning Approval Letter or Meeting with Planning prior to 5iv�AaoR' ❑ submittal of Building Permit application. SANITARY SEWER DISTRICT ❑ . �?,,.- :"ENVIRONNIENTAI;.iiEALTH , ,' ,,.,�``: B1dgApp_2011.doc revised 06121111 SMOKE / CARBON MONOXIDE ALARMS { OWNER CERTIFICATE OF COMPLIANCE Y.� COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION CUPERTINO10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333•building(a cupertino.orq :MOM GANNO°T BE FIIYALED IiNTIL T ITS CERTIFICATE HAS BEEN Col _TETE]) ,s ,Al\rD RTFIRNED {): IE MV,ISION 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 bedroom(s) On every level of a dwelling unit including basements X X Within each sleeping room X 1' 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. I Power Supply.In dwelling units with no commercial power supply, alarm(s)may be solely battery operated. 1' 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. IAs 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- 1 I 1,4 V1/4,, \.PQ \ C%152-Z, Permit No. Specify Number of Alarms: #Smoke Alarms: 'm #Carbon Monoxide Detectors. 1 have read and agree to comp y with the terms and conditions of this statemen Owner(or Owner Agent's)Name: Signature . .. . .. ..... . /71i, Date: Contractor Name: Signature Lic.# Date: Smoke and CO fonn.doc revised 12/15/16 WATER-CONSERVING PLUMBING FIXTURES r OWNER CERTIFICATE OF COMPLIANCE Ylg COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING,DIVISION CUPERTINO 10300 TORRE AVENUE• CUPERTINO,CA 95014-3255 (408)777-3 28 FAX(408)777-3333• building(a cupertino.orq Owner Name �� '� Permit No. � -7� ' C t� r--f Address l l l 6 \)°,1-A* 1. - Is your real property a registered historical site? .2/ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. No Go to Question 2. It 2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the property or its plumbing,installation of water-conserving plumbing fixtures is not technically feasible? C)114Yes Civil Code Sections 1101.1 through 1101.8 do not apply. ❑ The licensed plumber's certification has been provided to the Building Division. Skip the rest of the form and sign bottom of form. C No Go to Question 3. 3. Is water service permanently disconnected for your building? 0 Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. No Go to Question 4. 4. Is your real property built and available for use or occupancy on or before January 1, 1994? ❑ No My real property is built and available for use or occupancy after January 1, 1994. Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. Yes My real property is built and available for use or occupancy on or before January 1, 1994. Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign bottom of fonn.. 5. Please check ONE of the following: My property is a single-family residential real property. See Civil Code Section 1101.4. On and after January 1, 2014,building alterations or improvements shall require all non-compliant plumbing fixtures to be replaced with water-conserving plumbing fixtures throughout the building. On or before January 1,2017, all non- compliant plumbing fixtures shall be replaced with water-conserving plumbing fixtures (regardless of whether property undergoes alterations or improvements). ❑ My property is a multifamily residential real property. See Civil Code Section 1101.5. On and after January 1, 2014,specified building alterations or improvements shall require non-compliant plumbing fixtures to be replaced with water-conserving plumbing fixtures. On or before January 1, 2019,all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvements). ❑ My property is a commercial real property. See Civil Code Section 1101.5. On and after January 1, 2014,specified building alterations or improvements shall require non-compliant plumbing fixtures to be replaced with water-conserving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving j plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvements). I,as the owner or owner's agent of this property,certify under penalty of perjury that non-compliant plumbing fixtures will be replaced prior to date specified above with water-conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 through 1101.8,the current California Plumbing Code and California Green Building Standards Code, and manufacturer's installation requirements,and that the water-co A,erving plumbing fixtures comply with the requirements as indicpted in the table on the following page. ( / • Owner or Owner Agent's Signature: 7 1Wal Date: ♦ Upon completing and signing this C ri ease return it to the Building Division in order to final your buil.ing pe it. SB407 2015.doc revised 01/05/17