B-2017-1326FA
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT B-2017-1326
21108 WHITE FIR CT CUPERTINO, CA 95014-4234 (359 05 084)
NST WATER
-NO:
HEATERS AND
PLUMBING
FREMONT, CA 94538
OWNER'S NAME: HUANG FA -LIEN CHUNG ET AL
DATE ISSUED: 08/10/2017
OWNER'S PHONE: 408-568-2549
PHONE NO: (510) 676-3771
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C36 Lic. #997251
Contractor JUST WATER HEATERS AND PLUMBING Date 10/31/2018
X BLDG —ELECT X PLUMB
—
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 40 GAL WATER HEATER - SAME LOCATION
I hereby affirm under penalty of perjury one of the following two declarations:
1. I have and willlmaintain 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
Sq. Ft Floor Area:
Valuation: $1400.00
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
359 05 084
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 liabilitiesJudgments, 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
Additionally, the applicant understands and will comply with all non -point
source regulations per the Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
/n,Cupertino
Signatur 1-1 Date 08/10/2017
Issued by: SEAN HATCH
Date: 08/10/2017
O -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
m. I, as !owner of the property, or my employees with wages as their sole
'
installed without fust 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)
z. 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: 08/10/2017
I hereby affirm under penalty, of perjurylime of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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.
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 & Safe Code, Sections 25505, 25533, and 25534. I will
t3'
is issued,
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
0-.perinit
I certify that in the perfoimnance of the work for which this permit is issued, I
Health &Safety Cade, Section 25532(a) should I stare or handle hazardous
+ -
shall not employ any person in anymanner so as to become subject to the
material. Additionally, should I use equipment or devices which emit hazardous
. Worker's Compensation lawsbf California. If, after making this certificate of
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
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sections 25505, 25533, and 25534.
Labor Cade, I must forthwith'cotnply with such provisions or this permit shall
be deemed revoked. ,,
Owner or authorized agen
APPLICANYCERTIFICATION
Date: 08/10/2017
certify that I have read this application And state that the above information is
CONS UCTION LENDINGAGENC
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 mentioned property for inspection purposes. (We) agree
Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgment's, costs, and expenses,which 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 sourceregulations per the Cupertino Municipal
ARCHITECT'S DECLARATION
Code, Section 9.18.
I understand my plans shall be used as public records.
Licensed
Signature Date 08/10/2017
Professional
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
� TIN 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO (408) 777-3228 o FAX (408) 777-3333 • buildin4CcDcupertin%�o..org misc
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Ii17PLUMBING F] MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS 24106 1 • r h G+e
APN # 2 Aa(q
OWNERNAME f --t C11a rd V+1 E4 h
PHONE l Q- S�10 y
/ZIP l�
E -MY I AI
STREET ADDRESS
CITY, STATE,
FAX
CONTACT NAME y/ , I_ _ -� c1„ m �
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STREET ADDRESS
CITY, STATE, ZIP
FAX
OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
6��11AT—Flf 0/V7A u�
LICENSE NUMBER
-2-5-1
LICENSE TYPE
BUS. LIC # O
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STREET ADDRESS
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CITY, STATE, ZIP
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PHONE
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ARCHITECT/ENGINEERNAME /IjI�
LICENSENUMBER N /
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COMPANYNAME
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STREET ADDRESS j1A
CITY, STATE, ZIP AJIA
PHONE JA
USE OF ❑ SFD or DUPLEX MULTI -FAMILY
BUILDING: E] COMMERCIAL
PROJECT IN WILDLAND ❑YESPRO]ECTIN
URBAN INTERFACE AREA NO
❑ YES
FLOOD ZONE IWNO
ISTBE .BLDG AN ❑YES
EIC HLER HOME? NO
DESCRIPTION OF WORK
0
TOTAL VALUATION: I' l7 Q O
RECE
By my signature below, I certify to each of the following: I am the property owner or authorized agent to ct on a property owner's behalf. I have read this
application and the information I have pro ided is correct. I have read the Descripfi of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to i ing co traction. I u orize representative of Cupertino to enter the ab, oove--iden 'fled property for inspection purposes.
Signature of Applicant/Agent: Date:����
SUPPLEMENTAL INFORMATItt REQUIRED
' OFFICE USE ONLY
w ",
ti
• D ' OVER-THE-COUNTER
.D EXPRESS•.
D STANDARD ,
LARGE
❑ MAJOR
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCEMICE
s:,9sa COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO10300 TORRE AVENUE• CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333• buildinc7(a.cupertino.orq
` S�VERMIT CANNOT'SEFINALED UNTIL€THIS$CERTIFICATE7HAS BEET , , 1
LVD,SIGNED, RFT D 3 D $ Il D •
ISIO l
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
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.
P
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Address: �i ���°)C-42l j �� -Fc-Y" �� art"a 0' Permit No: zot 1��
Specify Number of Alarms: #Smoke Alarms: !� #Carbon Monoxide Detectors: I / 1
I have read and agree to comply with th terms and conditions of this statement
Owner(or Owner Agent's)Name:
Signature C� �G�� 1J Date: q4y/
Contractor Name: I it 1 zr
'
Signature.. ... ... .. .... .... Lic.# ( Date:����f 7
Smoke and CO form.doc revised 12/15/16