B-2017-1549CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1549
10168 BYRNE AVE CUPERTINO, CA 95014-2808 (357 16 098)
FRANS CARTWRIGHT
SAN JOSE, CA 95133
OWNER'S NAME: NIEH CALVIN PAND LESLIE M
DATE ISSUED: 09/12/2017
OWNER'S PHONE: 408-504-1257
PHONE NO: (408) 250-6672
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class CC=36 Lic. #828814
Contractor FRANS CARTWRIGHT 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:
REPLACE 50 GAL WATER HEATER (SAME LOCATION)
I hereby affirm under penalty of perjury one of the following two declarations:
t. 1 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.
[ have and will maintain Worker's Compensation Insurance, as provided for by
S tion 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Sq. Ft Floor Area:
Valuation: $2000.00
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
357 16 098
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, he applicant understands and will comply with all non -point
source reg tions per the'Cuperti Mun' pal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signatur Date 09-12-2017
Issued by: Kim Dunbar
;.
Date: 09/12/2017
O WNEWBUILDER, 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:1044,,Business & Professions Code)
2. 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: 09-12-2017
1 hereby affirm under penalty ofperjury one of the following three declarations:
1.I have and will Certificate Consent fo for Worker's
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
maintain a of self -insure
Compensation, as provided for by Section 3700 of the Labor Code, for the
performan'celofthe work for'which this permit is issued.
HAZARDOUS MATERIALS DISCLOSURE
z; 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. I
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
3. I certify tliat+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
air contaminants as defined by the Bay Area Air Quality Manage ent District I
Worker's Compensation Paws of California. If, after making this certificate of
will maintain compliance wit the Cupertino Munic' 1 Code, C _ter 9.12 and
exemption, hbecome subjectto the Worker's Compensation provisions of the
the Health & Saf y ode, Sections 5 533, and 534
Labor Code„I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized ag nt �
APPLICANT CERTIFICATION
Date: 09-12-2017
I. certify that I have read this application and state that the above information is
CON T I GE
correct. I agree to comply with all'city and county ordinances and state laws
I hereby affirm that there is a construction lending agenc or a 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, casts, 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 09-12-2017
Licensed
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
LTJ I (408) 777-3228 • building@cupertino.org PEMIT #B - ( -
CUPERTINO REV # DEF #
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION ❑ T.I. `6 MEP ❑ RE -ROOF ❑ SWIMMING POOL/SPA
PROJECT ADDRESS ! m B n
T/
APN ✓< a 5- ^� K
11
�? �O r / / � �
OWNER NAME � ��� l
h61 n
EMAILCA,
STREET ADDRESS
Vol 6 d
CITY, STATE, ZIP
rnQLI L951D
CONTRACTOR NAME ❑ OWNER -BUILDER �(//1�1
pi
LICENSE NUMBER LICENSE
TYPE
l'z� rev Wolf C�ec els I m
STREET ADDRESS I 0 R1
JL
CITY, STATE�IP CW �v q5q 33
L/ 9�a ^'
E-MAIL IPH�ONE BUS. LIC #
i
10 n� � a;) - � - 50 - G
❑ ARCHITECT ❑ OWNER ❑ OWNER AGENT CTORAGENT❑ ENGINEER ❑}DEVELOPER [:]TENANTp��
CONTACT NAME m e ( I' ndc Ca - 1V V u k� EMAIL
l
19S ` 1P.V�'�
STREET ADDREsb O ^V ;
CITY, ST yZ1,P J b, 4 . a, q5J PI�ON�
c"
- ` -7 - 4 4G5
"�/ 4Y
DECRIPTON V ct t l � UV k I t
INGLE-FAMILY/DUPLEX ❑ MULTI -FAMILY ❑ INDUSTRIAL ❑ COMMERCIAL
USE
TYPE
OCC
SQ.FT.
VALUATION ($)
XLSTING 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
EMSING ❑ YES
FIRE SPRINKLERS: ❑ NO
EICHLER ❑ YES SECOND
;❑ NO
STORY ADDITION ❑ YES
❑ NO
DWELLING ❑ YES ❑ ATTACHED ❑ DETACHED OTHER
JSECONDDWELIING
UNITS # UNIT ADDITON: NO SF
I
POOLS ❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNITE ❑ PREFABRICATED
POOL - SF SPA - SF SPA ATTACHED ❑ YES ❑ NO TOTAL - SF
Commercial or Multi -Family Buffdings with Public Swimming Pools requires Department of Environmental Heath approval
~ 1
RE -ROOF
EXLSTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES[-] WOOD SHAKES ❑
WOOD SHINGLES ❑ TILE OTHER (SPECIFY)
REMOVE /REPLACE ❑ NO
IF NO
PLYWOOD ❑ h" E13/8" PLYWOOD
TYPE:
PITCH:
ROOF CLASS
YES
I # OF LAYERS
THICKNESS ❑ 5/8" OTHER
❑ OSB ❑ CDX OTHER
12
A
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 ' rmation I have provided is correct. I ve read the Description of Work and verify it is accurate. I agree
to comply with all applicable l ' al o dinances and state 1 s relating to ilding construction. I authorize representatives of Cupertino to
enter the above -identified pro rty tion purpo s. I acknowle and authorize all information co aired on this application form
to be made available for publici 'ecor
L
Signature of Applicant/Agent:.: Date: fli'2,h-7
SUPPLEMENTAL INFORMATION' REQUIRED
*New SFD/Second Dwelling Units/Multifamily Dwellings: A Demolition per -t 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.doe revised 08/01117
kN ,. : SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE Arc
Y p COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO10300 TORRE AVENUE• CUPERTINO,CA 95014-3255
(408)777-3228• FAX(408)777-3333• buildinq(a cupertino.orq
MIL a 4.... ._ r F� i, a tel?A s � c. _ WM
M PEkMtT�AN:Nbi YF,iI\A ti t N f THIS CEiZTiFICATi+ HAS BEEN
�``€"40' ".'' r 8 E+ `� * itieh ' ? 5�.zk b y�a x x r.tom ting A
rs
E
!LINO),SJOI *1
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
$1000.00,CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon
Monoxide Alarms be installed in the following locations:
AREA SMOKE ALARM CO ALARM _
Outside of each separate sleeping area in the immediate vicinity of X X
the bedroom(s)
On every level of a dwelling unit including basements X X
Within each sleeping room X
Carbon Monoxide alarms are not required,in dwellings which do not contain fuel-burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply:In dwelling units with no commercial power supply, alarm(s) may be solely battery operated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in:the removal of wall and'ceilingfinishes or there is no access by means of attic,basement or crawl
space. Refer:to CRC SectionR314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for
alarms which must be connected to the building wiring.
As owner of the above-referenced property,I hereby certify that the alarm(s) referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms specified below have been tested and are operational, as of the
date signed below. Q 9 501'1
Address: i O k 6 �) Q r ane c �` v1'o C Permit No. �j`�1f l Plias
1
Specify Number of Alarms: #Smoke Alarms: to ! #Carbon Monoxide Detectors:
1 have read and agree to cprcnply with t term and conditions of this statement .
Owner(or Owner Agent's)Name: �/
Signature ,$Z- -- • Dat `
Contractor Name:
Signature Lic.# Date:
•
Smoke and CO fonn.doc revised 12/15/16