B-2017-1347CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1347
10668 SANTA LUCIA RD CUPERTINO, CA 95014-3975 (342 16 144)
PAYLESS WATER
HEATERS&
PLUMBING INC
i1
VALENCIA, CA 91355
OWNER'S NAME: YANG CHIPING AND BEE CHOO TRUSTEE
DATE ISSUED: 08/14/2017
OWNER'S PHONE: 408-873-8698
PHONE NO: (661) 775-2979
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C-36 Lic. #896216
Contractor PAYLESS WATER HEATERS & PLUMBING INC Date 08/31/2018
X BLDG —ELECT X PLUMB
—
MECH X RESIDENTIAL COMMERCIAL
I hereby affirm that Iam 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 ct.
JOB DESCRIPTION:
(N) 75 GAL WATER HEATER - GARAGE
I hereby affirm under enalty of perjury one of the following two declarations:
1. I have will maintain a certificate of consent to self -insure for Worker's
Com sation, as provided for by Section 3700 of the Labor Code, for the
nuance of the work for which this permit is issued.
ave 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: $4100.00
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
342 16 144
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, judgment ,costs, and expenses which
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequ ce of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understand nd will comply with all non -point
source regulations perthe Cuperti Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
S' „ a ure_7�W_ 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 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. 1, :as owner of the property, am exclusively 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. Lhave 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 & Safety Code, Sections 25505, 25533, and 25534. I will
permit is issued�:j
maintain compliance with the Cupertino Municipal Code, Chapter .9.12 and the
3. I certify that in the performance of the work for which this permit is issued, I
Health & Safety Code, Section 25532(x) should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the
material. Additionally, should I use equipment or devices which emit ha dous
bra
Worker's Compensation Paws of California If after making this certificate of
air contaminants as defined by the Bay Area Air Quality Managem I
Cupertino Code 9.12
exemption, I become subject to the Worker's Compensation provisions of the
will maintain compliance with the Municipal apter and
the Health & Safety Code,RSer"25505, 255 , and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
thorized agent:APPLICANT
CERTIFICATION
0,0.20 17
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 8/14/2017
Professional
CONSTRUCTION PERMIT APPLICATION
121 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - building@cupertino.org PEMIT #B - &O
CUPERTINO
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION ❑ T.I. WNMP ❑ RE -ROOF ❑ SWIMMING POOL/SPA
PROJECT ADDRESS/0 ` N #
OWNER NAME / + • A ' I PHONE
4A'h/LI K/'�L
_
9F
E-MAIL
STREET ADDRESS
CTIY, STATE, ZIP
CONTRACTOR NAME ❑ OWNER -BUILDER
CNY N
LICENSE NUMBER
LICENSE TYPE
STREET ADDRESS(t, CITY, n
I n� PHONE B LI C l 3 S J.
❑ ARCHITECT ❑ OWNER ❑ OWNER AGENT CONTRACTOR AGENT [I ENGINEER ❑ DEVELOPER ❑ TENANT
CONTACT NAME
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP PHONE
iDECRIPTON
AN-FAMILY/DUPLEX ❑MULTI -FAMILY ❑ INDUSTRIAL ❑ COMMERCIAL
USE
TYPE
OCC
SQ.FT.
VALUATION ($)
EXISTING USE
I EXISTING SF
NEW FLOOR SF
PORCH
SF DECK SF
I D7P:IDETACHED
TOTAL NET SF
REMODEL
BATHROOM SF
REMODEL KITCHEN
SF
REMODEL OTHR❑
SF
ATTACHED
EXISING ❑ YES
FIRE SPRINKLERS ❑ NO
EICHLER ❑ YES
ElNO
SECOND STORY ADDITION S
N
DWELLING �SECONDDWELLING [:]YES ❑ ATTACHED ❑ DETACHED OTHER
UNITS # UNIT ADDITON: ❑ NO S F
POOL'S ❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNITE ❑ PREFABRICATED
POOL - SF SPA - SF SPA ATTACHED ❑ YES' ❑ NO TOTAL - SF
I
or Multi -Fancily Buildinfs with Puhiic Swimming Pools requires Department o(Environmenlal Heath aypraval �
IVED BY:
I
TO AiLbT �Cotnmercial
i
RE ROOF
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES❑ WOOD SHAKES ❑
WOOD SHING ES ❑TILE OTHER ( ECIF1�
REMOVE /REPLACE ❑ NO
❑ YES
I IF NO
# OF LAYERS
PLYWOOD ❑ 1�„ ❑13/8"
THICKNESS ❑ 5/8" OTHER
PLYWOOD TYPE:
❑ OSB ❑ CDX OTHER
PITCH:
2
ROOF CLASS
A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑ WOODISHAKES ❑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 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 building construction. I au e repres tatives of Cupertino to
enter the above -identified property for inspection purposes. I acknowledge d uthorize all inf--nation cont ' d on ._ application form
to be made available for public record.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED j
*New SFD/Second Dwelling Units/Multifamily Dwellings: A Demolition permit is required prior to issuance of building permit for alfnew 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
B1dg,4pp_2017.doc revised 08101117
I
, SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
U E Tit4Q 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333• buildinci cupertino.orq
PERMIT ,ANNO BE MALED UNTIL THIS CERTIFICATE IIAS:BEEN
COMPLETED,SIGNED _AND FTUr n=Tp THE BUILDING: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 INFORMATIONExisting 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, alarzn(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 ., .
`Address• rt5e - Sem 'GC �aG 64,,Avan, U�Permit No. 2- f 743 ce
Specify Number of Alarms.: #Smoke Alarms. ME #Carbon Monoxide Detectors
I have read and agree to comply with the—terms and conditions of this statement
Owner(or Owner Agent's)Name: �.r
Signature C 6 r '?
Date:qfrAp
Contractor Name:
Signature Lic.# Date:
Smoke and CO fonn.doc revised 12/15/16