B-2017-1695 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1695
7480 BARNHART PL CUPERTINO,CA 95014-5208(366 15 058) GLADIATOR REPIPE
INC
SAN JOSE,CA 95136
OWNER'S NAME: LO HSIN SHENG AND CHEN JANG SAM TRUSTEE DATE ISSUED:09/29/2017
OWNER'S PHONE:408-444-2696 PHONE NO:(408)444-2696
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C_36 Lic.#1008291
Contractor GLADIATOR REPIPE INC Date 10/31/2017 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:
REMOVE AND REPLACE WATER MAIN LINE WITH COPPER.
I hereby affirm under penalty of perjury one of the following two declarations:
i. I have and will maintaina 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.
2. I have and will maintain Worker's Compensation Insurance,as provided for by
`t rt Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$1250.00
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 366 15 058 R3
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save indemnify-fSd keep harmless the
City of Cupertino against liabilities,judgments,c. ,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence . the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the a.)plicant understands an. ill comply with all non-point
source regulation. per the rtino Mu cipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature 44 Date 9.29.17 Issued by:SEAN HATCH
Date:09/29/2017
a .A__t-' l .iJ.. `� �►-
I hereby affirm that I-,, 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
1. I,as owner o 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 prolierty,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:9.29.17
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
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. I certify that in'the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a) ould 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 equi ent or devices which emit hazardous
air contaminants as defined by the Bay rea Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the C y rtino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Co.e, f ctions 25505,25533,and 25534.
Labor Code,I.must forthwith comply with such provisions or this permit shall $
be deemed revoked. Owner or authorized agent.,,. I��
APPLICANT CERTIFICATION Date:9.29.17
I certify that I have read this application and state that the above information is CONSTRUC r0 t IN ENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a con.tr ction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is i-s ed(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 9.29.17 Professional
J CONSTRUCTION PERMIT APPLICATION
\` t COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION '
,...& 10300 TORRE AVENUE.• CUPERTINO,CA 95014-3255
4 s (408)777-3228 • building@cupertino.org PEMIT#B- i' 7 - 1M6
CUPERTINO REV# DEF#
❑ NEW CONSTRUCTION ['ADDITION ❑ LTERATION ❑T.I. IgMEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS 7,j 0 h /_ ( P� I APN# ��
OWNER NAME fV.,,.,
I/7 [/ /0,y V 1 PH47o9 19*L' c . E-MAIL
STREET ADDRESS r�D b� /I /7::::/
FL / CITY'
S TE,ZIP e j ^CD/7
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„ CONTRACTOR NAME( ❑OWNER-BUILDER COMPANY NAME h LICENSE NUMBER ` //v LICENSE( TYPE /SL
t /. 4, � � I /j-nzi-i-z-ec
T A RE�S� / / Jo - crrY,9TAiZIP ' ef I
E-MAIL 111 PHONE BUS.LIC#
❑ARCHITECT ❑OWNER ❑OWNER AGENT ❑CONTRACTOR AGENT 0 ENGINEER 0 DEVELOPER❑TENANT
CONTACT NAME E-MAIL
STREET ADDRESS CITY,STATE,ZIP PHONE
DECRIPTON y
74,zuce
Te9
1' ' . IVAle,i- fryt6r,c: 2d... (4.,-d----4, a.,;:,r--42----1 .
INGLE-FAMILY/DUPLEX 0 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($)
REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED
BATHROOM SF SF SF SF 0 DETACHED
EXISING 0 YESFIRESPRINKLERS❑NO EICHLER ❑❑ NOYES SECOND STORY ADDITION0 YES
NO
DWELLING SECOND DWELLING 0 YES ❑ATTACHED❑DETACHED OTHER
UNITS 0 UNIT ADDITON: I ❑NO ( S F
POOLS] 0 FIBERGLASS ❑VINYI-LINED ❑GUNITE 0 PREFABRICATED
POOL-SF SPA-SF Ij i SPA;ATTACHED DYES 0 NO TOTAL-SF
I I. , .i RECEIVED 13,14!
tR. L. tyle..
Commercial or Multi-Familq Buildings with Public Swimming Pools requires Department ofEnviro nnental Heath approval Y" �, ;.41:
/
RE-ROOFI EXISTING ROOF TYPE:.❑BUILT-UP ROOF❑ASPHALT SHINGLES]]WOOD SHAKES❑WOOD SHINGLES E TILE OTHER(SPECIFY)
REMOVE/REPLACE 0 NO IF NO i I . PLYWOOD CI 1/2-
❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
0 vis t OF LAYERS i THICKNESS❑5/8" OTHER DOSE ❑CDX OTHER .12 A
PROPOSED ROOF TYPE:❑BUILT jUP ROOFI�DASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 OTHER
*Provide a signed copy of the Cuperlltino's Tear-Off Policy SF #of SQUARES
By my signature below I icertif i to eiach 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 have read the Description of Work and verify itis accurate. I agree
to comply with all applicable;;local lordinances ..ff state laws relating to building construction. I authorize representatives of Cupertino to
enter the above-identified property for insp--.. purposes. I acknowledge and authorize all m}6rmation cont ' ed'on th pplication form
toSi ben tmade eavailable for public'record. 7
Signature of Applicant/A'gent:, h �^�^,,tttt,,��� A�:� Date:
SUPPLEMENTAL INFORMATION RIRED
*New SFD/Second Dwelling Units/Mul amily 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
:I! 14
B1dgApp_2017.doc revised 08/01/17
r,. SMOKE / CARBON MONOXIDE ALARMS ;
OWNER CERTIFICATE OF COMPLIANCE `��ern1 •
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
CUPERTENO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildinq(a�cupertino.org
ii✓����_,.� ��h r��,�. t.�v3✓�� .������.z�.��mr ;� � '�„ya ��y�s�z� ��'z�Ce�i��'� F ks`a�s�.��k�`�' � N�.�, �€x���� �h �..
PERMIP CANNOT BEALED"�TIL T.HIS�GERTICATE lAS BEEN :t� mv
V, 1VIPLETE IGNIED N RET N\ DYTO HE B IN SI IN
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,R315,2016 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 SectionR314,R315, 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 X X
bedroom(s)—(Smoke alarms shall not be located within 3 feet of bathroom door)
On every level of a dwelling unit including basements and habitable attics 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 4204 andj shall be approved by the Office of the State Fire Marshal.
Power Supply:In dwellingunits 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: 7ftO C-50 1-1/N F P I Permit No.
Specify Number of Alarms: #Smoke Alarms: #Carbon Monoxide Detectors:
l have read and agree to comply artkgrand conditions of this statement
pwii r(or Owner Agent ) me: '
i /
��n""L � � `!h _ _ Signature Date: 70#
Contractor Name: '
Signature Lic.# Date: _
Smoke and CO form.doc revised 01/10/2017