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B-2017-1513 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1513 7581 ORANGE BLOSSOM DR CUPERTINO,CA 95014-5224(366 11 057) AFFORDABLE WATER HEATERS AND PLUMBING INC 28358 CONSTELLATION RD VALENCIA,CA 91355 OWNER'S NAME: TILLEY ALBERT P AND PATRICIA J TRUSTEE DATE ISSUED:09/08/2017 OWNER'S PHONE:408-253-6543 PHONE NO:(855)345-9087 S►_I: I t'_ I :_t:_I I BUILDING PERMIT INFO: License Class C36 Lic.#627368 Contractor AFFORDABLE WATER HEATERS AND PLUMBING INC Date X BLDG _ELECT X PLUMB 09/30/2018 _MECH XC 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 JOB DESCRIPTION: license is in full force and effect. REPLACE WATER HEATER(50 GAL)SAME LOCATION 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. s4., 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:$2492.00 permit is issued. APPLICANT CERTIFICATION APN Number: Occupancy Type: I certify that I have read this application and state that the above 366 11 057 information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the PERMIT EXPIRES IF WORK IS NOT STARTED City of Cupertino against liabilities,judgments,costs,and expenses which WITHIN 180 DAYS OF PERMIT ISSUANCE OR may accrue aga', st said City in consequence of the granting of this permit. Additionally,th= =pplt understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION. source regula.o s be Cupertino Municipal Code,Section 9.18. �. Issued by:Kim Dunbar Signet Date 09-8-2017 Date:09/08/2017 0 E'-11_11 1 I _ Ox ,RE-ROOFS: I hereby a firm t I at I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed.If a roof is following •o re,sons: installed without first obtaining an inspection,I agree to remove all new materials for i,as -wner of the property,or my employees with wages as their sole inspection. compensation,will do the,work,and the structure is not intended or offered for sale(Sec.7044,Business&Professions Code) Signature of Applicant: 2. I,as owner of the property,am exclusively contracting with licensed Date:09-8-2017 contractors to construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued.• I have read the hazardous materials requirements under Chapter 6.95 of the 2. I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will Section 3700 of the Labor Code,for the performance of the work for which this 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 3. I certify that in the performance of the work for which this permit is issued,I 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`.•rea Air Quality Management District I will maintain compliance with the Cu •rtin I 4 unicipal Code,Chapter 9.12 and Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code,/S ctio .05,25533,and 25534. exemption,I become subject to the Worker's Compensation provisions of the ,. Labor Code,I must forthwith comply with such provisions or this permit shall Owner or authorized age l// be deemed revoked. Date:09-8-2017 APPLICANT CERTIFICATION CO.SIL:U( C,1►/tI:�N 3, GE.0 I certify that I have read this application and state that the above information is I hereby affirm that there is a onst ucti o'n lending agency for the performance correct.I agree to comply with all city and county ordinances and state laws of work's for which this permi•is is-Lied(Sec.3097,Civ C.) relating to building construction,and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments,costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands ARCHITECT'S DECLARATION and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records. Code,Section 9.18. CONSTRUCTION PERMIT APPLICATION \/'k/ COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION V10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 s iasrW r4- - r 57 3 .. , (408) 777-3228 • building@cupertino.org PEMIT#B- CUPERTINO REV# DEF# ❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. rirMEP ❑RE-ROOF ❑SWIMMING POOL/SPA PROJECT ADDRESS i sq 0 De, B/tOff0 APN# p�L1/lyA 1GI p a�/lg/] sOWNER E � �' PHO E-MAIL STREgT AM 0. Y csr) 1 J! 0 s o inn . CITY„S'TA ZIP n 6 _ ,. 1 v 4�� CONTRACTOR NAME 0 OW -BUILDER' 'COMPANY NAME (//'Al✓' LICENSE NUMBER LICENSE TYPE IE UVoL '{�eiV'trq t1( c;14 W �- [-le4--le-,J (02"3-3(p 8. --S(01STTESS ' IIt ` ' V ;A 1 11ScS CA Dn -MATE JV, 1 � ltA` tfl) q ❑ARC ❑, NE ❑ RAGEN ❑ ONTRAo CONTRACTOR ENGINEER❑DEVELOPER 0 TENANT BUS. C 0 to,s CONT�,CT NAME E-MAIL 1 @.-nA-dj S �I R'l/" 4 t \`p • CV IiA�T(),C \ � 1 S �C�/ird) 5'93&,d f 0 ' DECRIPTON e49! °1 ( • W `i 6 L -eq I (J V c I f V 7r7Jc'g2e Chi ' a�J sio SINGLE-FAMII:Y/DUPLEX '❑MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL I EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES# TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION(5) i REMODEL ' ' REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED BATHROOM SF SF SF SF 0 DETACHED ' EXiSTNG ❑YES EICHLER 0 YES SECOND STORY ADDITION ❑YES 'FIRE SPRINKLERS(]NO 0 NO 0 NO DWELLING SECOND DWELLING ❑YES ❑ATTACHED❑DETACHED OTHER UNITS# UNIT ADDITON: ❑NO S F 1 POOLSI 0.FTBERGLASS. 0 VINYL-LINED 0 GUNITE 0 PREFABRICATED POOL-SF ' ' SPA-SF I. SPA ATTACHED❑YES 0 NO I TOTAL-SF RECE. Y: T AL VALUATION: Commercial or Multi-Family Buildings with.Public wimming Pools requires Department of Envirmuventat Heath approval 2 q '. RE-ROOFI EXISTINGIROOF TYPE; ❑BUILT-UP ROOF❑ASPHALT SHINGLES E WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY) REMOVE/REPLACE❑NO IF NO. , PLYWOOD 0 1/2" ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS 0 yES #OF LAYERS THICKNESS❑5/8" OTHER ❑05B ❑CDX OTHER •12 A PROPOSED ROOF TYPEi❑BUILT-UP ROOF DASPHALT SHINGLES ❑WOOD SHAKES❑WOOD SHINGLES 0 OTHER *Provide a signed copy of.the Cupertino's Tear-Off Policy SF ' Sof 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 .ave provided is correct. I have read the Description of Work and Verify it is accurate. I agree . to comply with all applicable local ordi ncestate laws relating to building construction. I authorize repro sentatives of Cupertino to enter the above-identified property for ' .pectio . . poses. I acknowledge and authorize all informatigr�c T it ed o this application form to be made available for public record. [%I, ,Jr� Signature of Applicant/Agent: .4 Date: SUPPLEMENTAL INFORMATIO 1 RE a UI r ED V *New SFD/Second Dwelling Units/Mul famil, Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction. *Commercial Buildings: Provide a'co 1.lete. Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. *Copy of Planning Approval Letter;or l eeti'g with Planning prior to submittal of Building Permit application. *HOA-Provide a letter of approval from the Home Owners Association • B1dgApp_20/7.doc revised 08/01/17 A F F O R • D A B L E AND PLUMBING INC . March 2017 LETTER OF AUTHORIZATION "I,undersigned; give permission to accept any of the signatures that appear below, on a permit being issued, in lieu of my signature at the counter. I hereby certify under penalty of perjury,that I will comply with all declarations and agreements on the permit, which bears my signature or my representative signature, and as required by the city." The following authorized representatives have my permission to sign and take receipt of construction permits in the name of my company: Jorge Becerra Lemke Roux �er�-fie (7 Contractor Name Contractor Signature Date Contractor Information: ii Affordable Water Heaters & Plumbing, Inc. Phone: 855-345-9048 28358 Constellation Road#698 Valencia, CA.91355 Contractors State License Number: 627368- Class C 36 Workers Comp Insurance: Insurance Company of the West WSA503249701 Exp. 1.1.18 See .Attached Caner ..... Acknowledgment See Attached California Acknowledgment 28358 Constellation Road, Suite 698 • Valencia, CA 91355 (855) 345-9048 • FAX: (661) 259-9556 • www.waterheatersandplumbing.com CA State Lic#627368 nALr SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE RaCi5 q19415 • COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE• CUPERTINO,CA 95014-3255 (408)777-3228?' ` •tt o 7 7f- 8,0 ouoer1 ore k'�'� ���� IN FIT 3, ,.dam -s" °ck*`' '�".2 EENtatitetAq 0' S 3 r+ dMUMT '4 `u 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: ^] $ F / d Y g n e J /0{f$ o rn 9 Y - Permit No. 620/ 7 / LC/3 Specify Number of Alarms: tSto mL�S 0N-51,0u ©uoxile".0®��t�L��'�� I have read and agree to comply wit terms and conditions of this statement es Y7r Contractor Name: 1 //ffo -,o/ ble IL-el”- Signature a0 Lic.# .. 2-1 LP g‘ Date://22//7 t af-ek- Smoke and CO form.doc revised 12/15/16