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B-2017-1363CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1363 21834 BENETTI CT CUPERTINO, CA 95014-1221 (326 49 028) PELLE HEATING & AIR INC SAN JOSE, CA 95111 OWNER'S NAME: CHITALE PARUAT AND POONAM DATE ISSUED: 08/18/2017 OWNER'S PHONE: 408-309-3620 PHONE NO: (408) 978-7060 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class CC=20 Lic. #809887 Contractor PELLE HEATING & AIR INC Date 10/31/2017 X BLDG _ELECT _PLUMB X 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 FURNACE SAME LOCATION); ADD (N) AC 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 p_eLformance of the work for which this permit is issued. z. ve 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: $10978.00 t 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 326 49 028. 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue agains6aid 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 a Cupertino Munici al Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. eignat,r e 8/18/2017 Issued by: AbbyAvende OWNER-BUIL� �'DECLARATION Date: 08/18/2017 I hereby affirm that I am exemptTrom the Contractor's License Law for one of the RE ROOFS: following two reason's: i All roofs shall be inspected prior to any roofing material being installed. If a,roof is 1. I ,as ownei 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 ownei of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 8/18 201 I hereby affirm under penalty of perjury one of the following three declarations: I have and maintain: Certificate Consent to self for Worker's ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. will a of -insure 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 i. I hav6 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 Health & Safety Code, Section 25532(a) should I store or handle hazardous a. I eertify'that in the performance of the work for which this permit is issued, I material. Additionally, should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the Wo'rker's Compensation laws of California. If, after making this certificate of air contaminants as defined by the Bay Area Air Quality Management. District I Chapter,9.12 wiR maintain compliance with the Cupertino Municipal Code, and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, S r55059 25533, and 3§534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. _�s �3'ner or authorized agent;,-- APPLICANT CERTIFICATION Date: 8/18/2017 I certify that l' have read this application and state that the above information is CO S RUCTION G 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 indemnity 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. Signature Date 8/18/2017 Licensed Professional X, GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildincecupertino.org ❑ PLUMBTNG MECHANICAL b6ECTRICAL ❑ MISCELLANEOUS• MEP misc PROJECT ADDRESS APN # 4A- 07A ✓��i OWNERNAME. "I �,�y �� PHONE ��% / ^() E-MAIL (1� O�\ _30 STREET ADDRESS ^ FAX �� CITY, STA , ZIP j N y 96 0 I / /l�/ , CONTACT NA E PRONG / S, 7 C .7k d E-MAIL A4 0 Sl L lr �j0 d 4��.F.V STREET ADDRESS CTTY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMESi� LI LICENSE TYPE BUS. LTC # COMPANY NAME Pell(! Hea ti hg a' -P i E MAtL S F Pelle- h fie... �- STREET ADDRESS ��I -D C1,1nrtr Cwj- /,f !J V 1 (L- lJL10ENSENUMI3ER C��j�ri�®Se CA CIL/36 PH EW �.jg-.jo�� ARCHITECT/ENGINEER NAME BUS. LTC# COMPANYNAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OP P,96 or DUPLEX ❑ MULTI-FAMTLY PROJECT M WILDLAND ❑ YES PROJECT IN ❑ YES IS THE BLDG AN ❑ YES BUILDING: ❑ COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ,� • �O NO EICHLER HOME? ❑ NO DESCRIPTION OF WORK ?-eI acg r u r - IcQ, 0013'RA C -tro(0 see V, VALUATION:©� 7 RI t7,b TOTAL By my signature below, l certify to each of the following: 1 am the property owner or authorized agent to act on the property ow er's bel I£ 1 have read this application and the information 1 have provided is correct. 1 have read the Description of Work and verify it is accurate. lagreetocamply with all applicable local - t I nstruction. I rite re esentatives of Cupertino to enter the above-iden ed prop for inspection purposes. ordinances and state laws relatir' T Signature of Applicant/Agent: Date: PPLEMENTAL I FORMATION REQUIRED sH ,_ --a+, NWAI MEPMiscApp_2011.doc revised 06/21/11 Abby Ayende 08/21/17 Abby Ayende 08/21/17 Abby Ayende 08/21/17 Abby Ayende 08/21/17 08/21/17 B-2017-1363 Abby Ayende - SMOKE / CARBON MONOXIDE ALARMSapt& IO// r OWNER CERTIFICATE OF COMPLIANCE x.p COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE• CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333• building a(�cupertino.orq PERM T CANNOT,R FII AUDUNTIL MS CER:MA.TE.HAS..BttN, COMPL,IT D,SIGNED,AND.1 E URNED)TO TUUE-BUILD.ING: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 $1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420 6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations: AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area-in the immediate vicinity of X X the bedroom(s) On every level of a dwelling unit including basements X X Within each sleeping room X Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply.In dwelling units with no commercial power supply, alarm(s)may be solely battery operated. In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic,basement or crawl space.Refer to CRC Section R314 and CBC Sections 907.2.114 and 420 6.2.An electrical permit is required for alarms which must be connected to the building wiring. As owner of the above-referenced property,I hereby certify that the alarm(s) referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes.The alarms specified below have been tested and are operational, as of the date signed below Address 21$ t V)e—±1 C+ Curiiho cp, 9001 Permit No. 3-2(11-1'5 03 Specify Number of Alarms: #Smoke Alarms. I 7 I #Carbon Monoxide Detectors. ! I I have read and agree to comply with the terms and conditions of this statement Owner(or Owner Agent's)Name: Signature . 1.. Date: 17 Contractor Name: 7 t Signature Lic.# 47Date: f f Smoke and COfo»n.doc revised 12/15/16