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B-2017-1348CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1348 10423 NOEL AVE CUPERTINO, CA 95014-1250 (326 47 062) PAYLESS WATER HEATERS & PLUMBING INC ' VALENCIA, CA 91355 OWNER'S NAME: SHEN YUESHI AND TIAN RE DATE ISSUED: 08/14/2017 OWNER'S PHONE: 408-663-8285 PHONE NO: (661) 775-2979 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-36 Lic. #83ii216 Contractor PAYLESS WATER HEATERS & PLUMBING INC Date 08/31/2018 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 Divisio ,of the Business & Professions Code and that my e and a ect. license igSection3700 JOB DESCRIPTION: (N) 50 GAL WATER HEATER- SAME LOCATION I herebyr enalty of perjury one of the following two declarations: 1.will maintain a certificate of consent to self-insure for Worker's tion; as provided for by Section 3700 of the Labor Code, for the ce of the work for which this permit is issued. will maintain Worker's Compensation Insurance, as provided for by 00 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: Valuation: $1550.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 326 47 062 representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 'indemnify and kee armless the City of Cupertino against liabilities, judgments, costs, anpenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the nting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the applicant understands and will ply with all non-point source regu tions per the Cupertino Munici Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Sin Mr e Date 8/14/2017 Issued by: Jasmine Archbold Date: 08/14/2017 OWNER-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 1. 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) z. I, as owner of the property, amexclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 8/14/2017 I hereby affirm under penalty of perjury. one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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. HAZARDOUS MATERIALS DISCLOSURE z. 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 permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the s. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a), should I store or handle hazoodilis material. Additionally, should I use equipment or devices which emi azardous shall not employ any person in any manner so as to become subject to, the laws air contaminants as defined by the Bay Area Air Quality Maria int DistrictI Worker's Compensation ofCalifomia. If, after making this. certificate of will maintain compliance with the Cupertino Municipal Co , Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the/Trau'thorlzed ealth & Safety Code, Se ' 25505, 25 , and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. agent:RTIFICATION I certify that I have read this application',,and state that the above information is CONSTRUCTION LENDING AGENCY 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, 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 and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 2 1 9 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT e BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 IM] (408) 777--3228 o building@cupertino.org PEMIT #B - _ - 1 15 �P CUPERTINO ❑ NEW CONSTRUCTION ❑ ADDITION, ❑ ALTERATION ❑ T.I. MEP ❑ RE -ROOF ❑SWIMMING POOL/SPA PROJECT ADDRESS o Z -5 40� a4 � APN OWNER NAME PHONE _21 vi> E-MAIL STREET ADDRESS CITY, STATE, ZIP 1 CONTRACTOR NA ❑ OWNER-BUILDERCO ANY NAME /'e?C's LICENSE NUMBER S__� 6. LICENSE TYPE C _3 (el STREET ADDRESS Z CFIY, S ATE II' E q L d�cl e PHRe 7 / - 5> -i � BUS.LC(D' vlJ� ❑ ARCHITECT ❑ OWNER ❑ OWNER AGENT NTRACTOR AGENT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT , CONTACT NAME E-MAIL STREET ADDRESS CITY, STATE, ZIP PHONE DECRIPTON - �f n INGLE-FAMILY/DUPLEX ❑ MULTI -FAMILY ❑ INDUSTRIAL ❑ COMMERCIAL USE TYPE OCC SQ.FT. VALUATION. ($) EXISTING USE I EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES # TOTAL NET SF REMODEL BATHROOM SF REMODEL KITCHEN SF REMODEL OTHR GARAGE SF SF ❑ ATTACHED ❑DETACHED EXISING ❑ YES FIRE SPRINKLERS ❑ NO EICHLER ❑'. YES ❑ NO SECOND STORY ADDITION OYES NO DWELLING I SECOND DWELLING ❑ YES, ' ❑ ATTACHED [I DETACHED OTHER LO S F Nns # UNIT ADDITON: ElN POOLS ❑ FIBERGLASS ❑ VINYL -LINED, ❑ GUNITE ❑ PREFABRICATED POOL - SF SPA - SF ; SPA ATTACHED ❑ YES ❑ NO TOTAL - SF Commercial or Multi-Familp Buildings with Public Swimming Pools requires Department ofEnviromnental Heath approval ECEI ED BY: r TOT_,,L VALUATION: RE -ROOF EXISTING ROOF TYPE: ❑,BUILT-UP ROOF ❑ ASPHALT SHINGLES❑ WOOD SHAKES❑ WOOD SHINGLES ❑TILE OTHER (SPE IFY) REMOVE/REPLACE ❑ NO 1:1 YES IF NO # OF LAYERS I ❑'� PLYWOOD ❑ 3/8" THICKNESS ❑ 5/8" OTHER I PLYWOOD TYPE: [_]OSB ❑ CDX OTHER PITCH: 12 ROOF CLASS I A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER *Provide a,signed copy of the Cupertino's Tear -Off Policy SF! #of SQUARES By my signature below I certify to each of the following: I am the property owner or authorized agent to act n th property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description ork and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. authorize representative of Cupertino to enter the above -identified property for inspection purposes. I ac dg and authorize Information conta' on t ' application form to be made available for public record. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION' REQUIRED *New SFD/Second Dwelling Units/Multifamily Dwellings: A Demolition permit is required prior to issuance of a buildingpermit for all new construction. *Commercial Buildings: Provide a, completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. *Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. *HOA -Provide a letter of approval from the Home Owner's Association I B1dgApp_A17.doc revised 08/01/17 SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228• FAX(408)777-3333• buildinq(&,cuoertino.orq .PERMIT:.CANR6T:$E`F, AIIEDUII?TIa.3' II`..:,,..... ..__.�....._.. _.,..................... v,S CERTIFICATE HAS BEE_1� COMPLETED,$_SI4NED�AN]) 2ETURNED TO TIE B ' . , - Old ...,.„„ye'X-"�2;-"'.%'rv;si •,.»;. .�.... -a;Ya.^ •SE:My•.^.fl:. ., ._. 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. GENERALI ORMA'_CT _ 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 907.2.114 and 420.6.2.An electrical permit is required for alamts 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 to Afo4ze__ .. ( Permit No. -?mol 7 - Specify Number of Alarms: #Smoke Alarms. Mil #Carbon Monoxide Detectors 111111 /have read and agree to comply wit the terms and conditions of this statement Owner(or Owner Agent's)Name: L Signature Q`--� Date; �� Contractor Name: f f Signature Lic.# Date: • Smoke and CO form.doc revised 12/15/16