B-2017-1412CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1412
7716 OROGRANDE PL CUPERTINO, CA 9501474112 (362 18 030)
BIGHAM SERVICES
INC
SANTA ROSA, CA
95404
OWNER'S NAME: LAU KAI-HUNG AND HELEN Y
DATE ISSUED: 08/23/2017
OWNER'S PHONE: 408-257-1175
PHONE NO: (707) 545-1800
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class= Lic. #Z40999
Contractor BIGHAM SERVICES 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); REPLACE AC UNIT
I hereby affirm under penalty of perjury one of the following two declarations:
(SAME LOCATION"
m. I have and will maintain a certificate of consent to self -insure for Worker's
ompensation, as provided for by Section 3700 of the Labor Code, for the
erformanc . 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: $11985.00
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
362 18 030
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 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 Cupertino'Municipal;Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature to 08/23/2017
Issued by: Kim Dunbar
Date: 08/23/2017
OWNE -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
i. 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 & Profe'ssions Code)
2. I, as owner of the property tam exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business &Professions Code).
Date: 08/23/2017
I hereby affirm,underpenalty of perjuryone of the following three declarations:
"A"
m. have and will maintain a Certificate' of Consent to self -insure for Worker's
ALL ROOF COVERINGS TO BE CLASS OR BETTER
'1
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.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
I 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 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 hazardous
Worker's Compensation laws of 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 toahe Worker's Compensation provisions of the
the Health &Safety Code, Sections 25505, 25533, and 25534.
LaborCode; I must forthwithcomply with such provisions or this permit shall
be deemed revoked. !
Owner or authorized ages .
APPLICANT UERTIFICATION
Date: 08/23/2017
111.
certify that I have read'this application and state that the above information is
CONSTLENDING 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'b"uildirg.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 prpeity 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 mayaccrue 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 08/23/2017
Licensed
professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 /
PEMIT #S -JAL
(408) 777-3228 • building@cupertino.or;
CUPERTINO I REV # DEF #
F] NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION ❑ T.I. MMEP ❑ RE -ROOF ❑ SWIMMING POOL/SPA
PROJECT ADDRESS
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ONTRACTOR NAME ❑ OWNER -BUILD COMPANY
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LICENSE NUMBER LICENSE
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❑ARCHITECT . ❑ OWNER ❑ OWNER AGENT CONTRACTOR AGENT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTACT NAMY'? _ p y .
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STREETf DRESS'
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SINGLE-FAMILY/DUPLEX ❑ MULTI -FAMILY ❑ INDUSTRIAL ❑ COMMERCIAL
USE
TYPE
OCC
SQ.FT.
VALUATION ($)
E STING USE
EXISTING SF
NEW FLOOR SF
PORCH
SF DECK SF
I DEMO SF
STORIES #
TOTAL NET SF
REMODEL
REMODEL KITCHEN
REMODEL OTHR GARAGE
❑ ATTACHED
BATHROOM SF
SF
SF SF
❑ DETACHED
EMSFIRESNG 11 SPRINKLERS [JNtO
EICHLER 0 No
SECOND STORY ADDITION OYES
NO
,
DWELLING SECOND DWELLING []YES ❑ ATTACHED❑ DETACHED OTHER
UNC # UNIT ADDITON: ❑ NO S F
POOLS ❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNITE ❑ PREFABRICATED
POOL - SF SPA - SF SPA ATTACHED [:]YES ® NO TOTAL - SF
Commercial or Multi -Family Buildings with Public' Swimming Pools requires Department of Envirornnental Heath approval
RECE B OTAL VALUATjQN:
S �'
RE-R09FJ
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES❑ WOOD SHAKES ❑
WOOD SHINGLES ❑ TILE OTHER (SPECIFY)
REMOVE /REPLACE Q NO
IF NO
PLYWOOD E:1 'h" , ❑ 3/8" PLYWOOD
TYPE:
PITCH:
ROOFACLASS
YES
I # OF LAYERS. -
THICKNESS ❑ 5/8" OTHER
❑ OSB E]CDX OTHER
:12
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 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 accurate. I agree
to comply with -all applicable local, ordinances and state laws relating to building construction. I authorize representatives of Cupertino to
enter the above -identified property formispectian purposes. I acknowledge and authorize all information contained on this application form
to be made available for public'rec0 cl,
/
Signature of Applicant/Agent: i' Date:
SUPPLEMENTAL INFORMATION kEQUIRED
*New SFD/Second Dwelling Units ultifamily Dwellings: A Demolition permit is required prior to issuance of a building permit 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
B1dgApp_2017.doc revised 08101/17
riu 11
• : SMOKE / CARBON MONOXIDE ALARMS /Matti
OWNER CERTIFICATE OF .COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
CUPERTINO
10300 TORRE AVENUE• CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333• buildinqcupertino.orq
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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 -
the bedroom(s)
On every level of a dwelling unit including basements 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 CaliforniaResidential Codes. The alarms specified below have been tested and are operational, as of the
date signed below. • •
f
Address: 1.-1 t On ,00 i• 1' Pk- Permit No.Y)7 4\1-ilk!),
Specify Number of Alarms: #Smoke Alarms: MI #Carbon Monoxide Detectors: ` 7--
•
/have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name:Kai
i
") "HIA.n .LSC G'
Signature......... . 7 Date://AV/
Contractor Name:
Signature Lic.# Date:' '
Smoke and CO form.doc revised 12/15/16