B-2017-1464 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1464
10383 COLBY AVE CUPERTINO,CA 95014-2421(316 29 021) ON-TIME AIR
CONDITIONING&
HEATING INC
PLEASANTON,CA
94588
OWNER'S NAME: JENKINS DALE S AND FRANCESCA G TRUSTEE DATE ISSUED:09/01/2017
OWNER'S PHONE:408-973-1506 PHONE NO:(925)872-7326
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-20 Lic.#817040 X BLDG _ELECT X PLUMB
Contractor ON-TIME AIR CONDITIONING&HEATING INC Date 09/30/2019
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 40 GAL WATER HEATER-SAME LOCATION
I hereby affirm under p . ty of perjury one of the following two declarations:
1. I have an. ill maintain a certificate of consent to self-insure for Worker's
Corn.. sation,as provided for by Section 3700 of the Labor Code,for the
44 p-, ormance of the work for which this permit is issued.
'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. Sq.Ft Floor Area: Valuation:$2858.00
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 316 29 021
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 o e granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and I comply with all non-point
source regulations per the Cupertino M icipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
5gnature Date 9/1/2017 Issued by:AbbyAyende
Date:09/01/2017
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,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:9/1/2017
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
i. 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
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. 1 will
permit is issued. 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(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 ardous
air contaminants as defined by the Bay Area Air Quality Manage I. t District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Cod•. apter 9.12 and
exemption,.I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Se 25505,255,:,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked, er or authorized agent: 'Ilei
:APPLICANT CERTIFICATION Date:9/1/2017
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. I understand my plans shall be used as public records.
• Licensed
Signature Date 9/1/2017
/ CONSTRUCTION PERMIT APPLICATION
y�'� COMMUNl'1'Y DEVELOPMENT DEPARTMENT • BUILDING DIVISIONB.
( , 10300 TORRE AVENUE • CUPERTINO,CA 95014-3255
Ze ..r. (408) 777-3228 • building@cupertino.org PEMIT#B-20 14- - itgl q
CUPERTINO REV# DEF#
❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS /0
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OWNER NAI, PHONE 7 7 J E-MAIL
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STREET AD ESS CITY,STATE,ZIP
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ANTRACTOR NAME 0 OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
IS E�DRESS / / CITY, ZIP I
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El ARCHITECT ❑OWNER ❑OWNER AGENTNTRACTOR AGENT❑ENGINEER 0 DEVELOPER El TENANT
CONTA tty /� � /�� E- L �
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K,INGLE-FAMILY/DUPLEX 0 MULTI-FAMILY ❑INDUSTRIAL 0 COMMERCIAL
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES# TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
REMODEL REMODEL KITCHEN REMODEL OTHR ' GARAGE ❑ATTACHED
BATHROOM SF SF SF SF El DETACHED
EMSISPRINKLERS El NO NO EICHLER YES0 SECOND STORY ADDITION ❑
YES
FIRE ❑NO
DWELLING SECOND DWELLING ❑YES El ATTACHED❑DETACHED OTHER
UNITS# UNIT ADDITON:, ❑NO S F
POOLS' ❑FIBERGLASS ❑VINYL-LINED ❑GUNrrE ❑PREFABRICATED
POOL-SF SPA-SF I SPA ATTACHED ❑YES 0 NO TOTAL-SF
RE EIVED BY: T ALVALUATION:
Commercial or Multi-Family Buildings with Public Swimming Pools requires Department of Environmental Heath anroval �j o.,I uN# F/ 1/4tz �
RE-ROOFI EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES❑WOODODSHIN LES E4TILLE 1•`OTHER(SPECIFY) (11))1 UUU
REMOVE/REPLACE❑NOI IF NO PLYWOOD ❑1„ ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
❑yEs #OF LAYERS THICKNESS El5/8" OTHER ❑OSB 1=1CDX OTHER •12 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES El WOOD SHAKES❑WOOD SHINGLES El 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 i ave read the Description of Work and verify it is accurate. I agree
to comply with all applicable local ordinances and state laws relax o building construction. I authorize representatives of Cupertino to
enter the above-identified property for inspectiposes. I a .'owledge and authorize all information cont ' ed o this application form
to be made available for public record. /^'�
Signature of Applicant/Agent: r A Date: ` / /
SUPPLEMENTAL INFORMATION REQUIRED
*New SFD/Second Dwelling Units/Multifamily 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
BldgApp_2017.doc revised 08/01/17
CUPERTIN O
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildinana.cupertino.org
P RIIIIT C: N flT:V- 1I1 AIS UNTI :T S CERTIF C -ATE _HAS B El
CO L�T�➢,-����N� ANI'.RF I'LTI2 n TD fiH�: $I7iIJIiIl�GiiIVISION:
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
Monoxid&,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
the bedroom(s)
X
X
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- UE- A \/L:: , u p zn),j ®} e Q 9'SO) � Permit No. - 2-0
Specify Number of Alarms: # Smoke Alanns. _:-Z�. 1 #_Carbon Monoxide Detectors
1 have read and agree to ca ply with t1ielerms and conditions of this statement
Owner (or Owner Agent's) Name:�7
Signature ®/ 6�1 >J.
�c 5 : v,'x-) V_ i .1S
. �.. c� Date:
Contractor Name:
Signature Lic.# Date.
Smoke and COfo»n.doc revised 12/15/16