B-2017-1553 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1553
22771 STEVENS CREEK BLVD CUPERTINO,CA 95014-5628(342 12 036) T&N PLUMBING&
ELECTRICAL INC
MODESTO,CA 95353
OWNER'S NAME: WHONG JASON A AND TRUDY LEE TRUSTEE DATE ISSUED:09/12/2017
OWNER'S PHONE:408-858-8579 PHONE NO:(209)408-8078
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-10:C-36 Lic.#999455 X BLDG _ELECT X PLUMB
Contractor T&N PLUMBING&ELECTRICAL INC Date 12/31/2018
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 75 GAL WATER HEATER-GARAGE
I hereby affirm under penalty of perjury one of the following two declarations:
t. .. 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
.erformance of the work for which this permit is issued.
4q. '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:$900.00
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 342 12 036
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 applican nd-rstands and will comply with all non-point
source regulations.p; a✓pertino Munic'e s 'ode,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
1.
gnatur- a/ • Date 9/12/2017 Issued by:Abby Ayende
Date:09/12/2017
I herebyaffirm 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
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)
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:9/12/2017
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. 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. 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
3. 1 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
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
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of Califomia. If,after making this certificate of will maintain compliance with the Cupertino Munici•al Code,Chapter 9.12 and
exemption,l become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections_•,:"0,:!25533,and 2.553 .
Labor Code,I must forthwith comply with such provisions or this permit shall /
be deemed revoked. dialter or authorized agent:,
APPLICANT CERTIFICATION Date:9/12/2017 aw--
I certify that'I have read this application and state that the above information is CONSTRUCTION LENDINC
• correct.I agree tocomply 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 9/12/2017
Professional
b-zon-- 1 3.
\(11111441/441/ GENERAL PERMIT APPLICATION M E P
/' COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
�5S•r9rf 10300 TORRE AVENUE••CUPERTINO, CA 95014-3255 M I S C
(408)777-3228•FAX(408)777-3333•buildind(a)cupertino.oro
CUPERTINO
RI PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS APN#
22771 STEVENS CREEK BLVD, CUPERTINO,CA 95014 34212036
OWNER NAME PHONE E-MAIL
JASON AND TRUDY WHONG (408) 858-8579
STREET ADDRESS
22771 STEVENS CREEK BLVD CITY,sTATE,zIP CUPERTINO, CA 95014 FAx
CONTACT NAME PHONE E-MAIL
FRANCES KUMAR (209)408-8078 COORDINATOR@TNELECTRICALPLUMBING.COM
STREET ADDRESS 946 MCHENRY AVE, #4 CITY,STATE,ZIP MODESTO, CA 95350 FAX
(209)408-0807
❑OWNER 0 OWNER-BUILDER 0 OWNER AGENT Ja,CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC#
SAME AS CONTACT 999455 C10/C36
COMPANY NAME E-MAIL T&N PLUMBING & ELECTRICAL INC.COORDINATOR@TNELECTRICALPLUMBING.COM FAX (209)408-0807
STREET ADDRESS . CITY,STATE,ZIP PHONE
SAME AS CONTACT SAME AS CONTACT (209)408-8078
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME ' , E-MAIL FAX
STREET ADDRESS , CITY,STATE,ZIP PHONE
USE OF XSFD or DUPLEX 0 MULTI-FAMILY PROJECT IN WILDLAND 0 YES PROJECT IN ❑YES IS THE BLDG AN 0 YES
BUILDING: 0 COMMERCIAL URBAN INTERFACE AREA X NO FLOOD ZONE XNO. EICHLER HOME? XNO
DESCRIPTION OF WORK
REPLACE 75 GALLON NATURAL GAS WATER HEATER IN THE GARAGE
TOTAL VALUATION: $900.00 RECEIVED BY: r A4 Q,�`� I(,^A jt....._. , -
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property oowner's�bbee�hha"if..'I�haveread this
application and the information I have provided is correct. I have read the Description of Work and verify it is 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 for inspection purposes.
Signature•of Applicant/Agent:, PT /1./Mti 4, Date: 05/15/2017
SUPPLEMENTAL INFORMATION REQUIRED ' ,, ,, -
,-OFFICE USE ONLY'
i;1,':," 0 OVER TILE-COUNTER
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MEPMiscApp_2011.doc revised 06/21/11
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
CUPERTINO10300 TORRE AVENUE• CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333• buildincl cupertino.orq
€t� ,aa�-d! " �f a �r�'.�' .a
PERMIT CANNOT BE FII�IALED UNTIL THIS CERTIFICATE HAS BEEN'
!L OMPLETED IGNED AND,l2ETUR1 T D T�Qi HE BU ,LDING 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 907.2.11.4 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.
Address: ,?.a.:1"7 al vot Cc/pea-m-0 Ch, `I“)14 Permit No. T l SS 3
Specify Number of Alarms: #Smoke Alarms: I s I #Carbon Monoxide Detectors: I 2- I
I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name:
Signature %N.\ C"--' to o� �.�...1 .Date:
Contractor Name:
Signature Lic.# Date:
Smoke and CO form.doc revised 12/15/16