B-2017-1500 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1500
21976 MCCLELLAN RD CUPERTINO,CA 95014-4058(356 08 048) STREET PLUMBING
AND ROOTER
SAN JOSE,CA 95128
OWNER'S NAME: TSAU PEI AND KOPPES KEITH DATE ISSUED:09/07/2017
OWNER'S PHONE:520-245-4645 PHONE NO:(408)'496-1155
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class CC=36 Lic.#582217
Contractor STREET PLUMBING AND ROOTER Date 12/31/2017 X BLDG _ELECT X PLUMB
_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:
(N)75 GALLON WATER HEATER-GARAGE
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
performance of the work'for which this permit is issued.
-: .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 .
permit is issued. Sq.Ft Floor Area: Valuation:$1500.00
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 356 08 048
representatives of this city to enter upon the above mentioned property for -
inspection purposes.,0A/e)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 regulati. per the Cupe-•o Municipal Code',Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Al 1
'. `ure _
- _ Date 9/7/2017 Issued by:Abby Ayende '
/` Date:09/07/2017
I Jk_ :-: J e ` e =`!'--sL 1
I hereby a irm 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,roofmg material being installed.If a roof is
i.;, I,as owherof 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,IBusiness&Professions Code)
2.' •I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractorsito construct the project(Sec.7044,Business&Professions Code). Date:9/7/2017
I hereby affirm under penalty of perjury one of the following three declarations:
t: I have and:will maintain a Certificate of Consent to self-insure for Worker's ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 wiltmaint'ain 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
Il maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued.
Health&Safety Code,
Section 25532(a)should I store or handle hazardous
a'' I certify that in the performance of the work for which this permit is issued,I•
shall nooy'anyperson in any manner so as to become subject to the
material. Additionally,should I use equipment or devices which emit hazardous
t empl
l air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
' exemption)I become'subject to the Worker's Compensation provisions of the the Health&Safety Co, `•ctions 25 :.,25533,and 25534.
Labor Code;I must forthwith comply with such provisions or this permit shall /
be deemedIrevoked. Dor authorized agent ��
,
i APPLICANT CERTIFICATION ate:9/7/2017 '6l
I certify that I,have read this application and state that the above information is CONSTRUCTION L' NDING AGENCY
correct.I agree to comply,with all city and county ordinances and state laws I hereby affirm that there is a cdnstruction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit t 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 withlallnon-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,'Section 9.18. I understand my plans shall'be used!as public records.
•
Signature Date 9/7/2017 Licensed
'
Professional
i
' \ ,. GENERAL PERMIT APPLICATIONmE p
i„
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
-• ' M I S C
_,;.,;` 90300TORRE-AVENUE-CUPERTINO;CA 95014-3255 .
CUPERTINO (408)777-3228-SAX(408)777-3333•buildiriqRcuoertino orti
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PROW-ADDRESS 2/11/ A GCWIL -/ PJn • APNQ 2C G-08.-0q1
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CQMPANYNAM& t u'''j C/,b%"AlE �,5 J I GAG,^ e i�`+i,l F'1 7 6 )ill 6.63
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STREETADDRESS CIIY,STATE,ZIP PHONE
- •usa opSFD or Duplex 0 Multi-Family PROIEcraIwHWLAND PROJECT R4
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By my signamtubelow,I cel y!to each of the foil••l‘a• I am the property owner oranthorizzedagent to act on the prop'erty oamer'sbeba2E I have rcad this
application and the sstformatianIMlle jI ,;111.. ,,'. ,kerect the D. :.,ofWoricand very itis accurate.Iagree tocomply with all applicable local
ordinances and state laws relating io �P*..' ,ice? __,,,,,,,;,----.-;7F-7.: tatives of Cupertino to enter the aboov 'd - ed gropertyforinspectionpmpo� ; ,
Signature of ApplicantfAgen>; ��41 i'�i�� Date: 1/7/7
, ': :IA •CARIVIA 114REQUIRED :xr. LST ti�- x.
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MEPMrse.Rpp 1011.doc revised 03/16/11
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
_,471.%:.- COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333• buildino cupertino.orq
t.
,,...PERMIT':CA NO 'BE I..:. ?ALED; IL T S_CERT: . ; :C TKITAS;B E
. O ttilI3 Sl' 3 t mu\fgoT"-O EBU G DwisioN
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 7 /_ �— 'jAddress• V� MLLLAJ P Permit No. !J OI1 (SOD
Specify Number of Alarms! #Smoke AlarmsMN f Carbon Monoxide Detectors. f ,--
I have read and agree to comply with the terms and conditions of this statement
,Owner o Ow Age 't's)Name:
� � Signature s Date:!/1(4777
Contractor am . . ��Q ( � � 12,E,6§0-g---', Lic.# .5222 I Tl 1
�J�e-�"��I�UL�'""fir ;"� .,t� �.; ... . .. Date:
Smoke and CO fonn.doc revised 12/15/16