B-2017-1291CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
11877 WOODHILL CT CUPERTINO, CA 95014-5149 (366 04 067)
CONTRACTOR: PERMIT NO: B-2017-1291
ANTHONY LEWIS
INCORPORATED
SAN JOSE, CA 95126
Date 8123/2017
I hereby affil at am exempt from the Contractor's License Law for one of the
following two reasons:
1. 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 u.'der 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.
z. 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. I
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 9:1;8.
Signature Date 8/23/2017
by: ABBY Mwz
RF. -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.
Signature of Applicant:
Date: 8/23/2017
ALL ROOF COVERINGS TO BE CLASS "A" ORBETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of tF
California Health & Safety Code, Sections 25505, 25533, and 25534. I wP-
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 ani.
Health & Safety Code, Section 25532(a) should I store or handle hazard
material. Additionally, should I use equipment or devices which emit haz
air contaminants as defined by the Bay Area Air Quality Management D`
will maintain compliance with the Cupertino Municipal Code, Chapter'
the Health & Safety Code, Sections 25505, 25533, and 25534.
1000
caner or authorized agen
Date: 8/23/2017
CON UCTION LE NC
I hereby affirm that theis a constr n lending agency for thc.
of work's for which this er ssued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed"
OWNER'S NAME: MONAHAN KEVIN M
DATE ISSUED: 08/07/2017
OWNER'S PHONE: 408-996-9897
PHONE NO: (408) 217-8621
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
,License
Class C-10: B Lic. #851107
Contractor ANTHONY LEWIS INCORPORATED Date .08/31/2019
BLDG X ELECT _PLUMB
MECH Y 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:
(1) EV CHARGING STATION (GARAGE); INSTALL SUB -PANEL
I hereby affirm under penalty of perjury one of the following two declarations:
GARAGE (100 AMP)
r. 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 3.700 of the Labor Code, for the performance of the work for which this
permit is: issued.
1
Sq. Ft Floor Area:
Valuation: $1800.00
APPLICANT NT 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
366 04 067
representatives oflthis 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
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against"said City in consequence of the granting of this permit.
WITBIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understands and will comply with all non -point
source regulatio the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Date 8123/2017
I hereby affil at am exempt from the Contractor's License Law for one of the
following two reasons:
1. 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 u.'der 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.
z. 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. I
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 9:1;8.
Signature Date 8/23/2017
by: ABBY Mwz
RF. -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.
Signature of Applicant:
Date: 8/23/2017
ALL ROOF COVERINGS TO BE CLASS "A" ORBETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of tF
California Health & Safety Code, Sections 25505, 25533, and 25534. I wP-
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 ani.
Health & Safety Code, Section 25532(a) should I store or handle hazard
material. Additionally, should I use equipment or devices which emit haz
air contaminants as defined by the Bay Area Air Quality Management D`
will maintain compliance with the Cupertino Municipal Code, Chapter'
the Health & Safety Code, Sections 25505, 25533, and 25534.
1000
caner or authorized agen
Date: 8/23/2017
CON UCTION LE NC
I hereby affirm that theis a constr n lending agency for thc.
of work's for which this er ssued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed"
PI'App_2011.d6c revised 031161
no
ALTERNATIVE ENERGY PERMIT APPLICATION
's
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
ALM
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(40B) 777-3228 • FAX (408) 777-3333 • build ing(Douperiino.Drg
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PROJECT ADDRESS
OWITERNAME
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CITY, STATE, ZIP t^'r n
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FAX
❑ OWNER ❑ OWNER -BUILDER 'ER AGENT ❑ CONTRACTOR ❑ CONIRACTORAGENT ❑ ARCHITECT ❑ ENOMEER ❑ DEVELOPER ❑,TENANT
CONTRACTORNAME
LICENSE NUMBER ` iJ LICENSET ^ +(
BUS.LIC'`I (2
COMPANY NAME
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FAX
STREETADDRESSiC �r rn f.,.
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PHONE
USE OF SFD or Duplex uld-Family
PROJECT IN WILDLAND
PROJECT IN
STRUCIt1RE: ❑ C13inmercial
URBAN INTERFACE AREA ❑ Yes ❑ No
FLOOD ZONE ❑ YCS ❑ NO
❑ SOLAR PAN=
I �4LECTRIC VEHICLL- CHARGING STATION
I ❑ SOLAR WATER HEATING
❑ OTHER: _
POR SOLAR PANELS: NUh4BER OF PANELSIUNrfS; KILOWATTS (COMMERCIAL ONLY):
TOTAL VALUATION: d .�
DESCRIPTION OF WORK Sq
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By my signature below, I certify to each of the following: I ant the property owner or authorized agent to a t on t e property owner's behalf. I have read this
application and the infonttation I have provided. is correct. I have read the Description of Mork and verify it is accurate. I agree to comply with all applicable local
ord nances and state l $relat*ngtob*.I&g structi I autho ' esentatives of Cupertino to enter the above -id tified property for inspection purposes.
Si�anatum ofApplicant/Agent: —t-�� Date: 21-7 /
SUP LEMENTAL 1N 1tA4ATION 12EQUIRED
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r P.'FFJC9.W;9:ONI'sY
ER -TATE COUIjYE
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PI'App_2011.d6c revised 031161
no
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(ahcupertino.orq
.31RMIT CANNOT.BE FTNALED UNTIL TIIIS CERTIFICATE HAS BEEN
`COMPLETED,STGNED\AND likTIV:Nka TO HIE 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 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 907.2.114 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
installedinaccordance 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: \ 17 oc3ck;[ Cj Permit No. 2017- e
Specify Number of Alarms: #Smoke Alarms. 6- I #Carbon Monoxide Detectors. 7-1
I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name:
�( Signat re Date: ���t'A4, . .. . . _�`�`�..•
intr'a�T°14 ' 1°is �l4
°• .. .
Signature Lic.# Date:
Smoke and CO fonn.doc revised 12/15/16