B-2017-1726 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1726
10094 RANDY LN CUPERTINO,CA 95014-2343(316 23 067) A R S AMERICAN
• RESIDENTIAL
SERVICES OF
CALIFORNIA INC
MEMPHIS,TN 38120
OWNER'S NAME: TAN HEOW M AND ANNE E TRUSTEE 1 DATE ISSUED: 10/06/20.17
OWNER'S PHONE:508-932-5830 , PHONE NO:(901)271-9700
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
•
License Class C36 Lic.#765155
Contractor A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC X BLDG _ELECT X PLUMB
Date 07/31/2018 _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 JOB DESCRIPTION:
license is in full force and effect. REPLACE 50 GAL WATER HEATER-SAME LOCATION
I hereby affirm under penalty of perjury one of the following two declarations:
r. 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
per ormance of the work for which this permit is issued.
ave 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:$2800.00
permit is issued.
r7
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above APN Number: Occupancy Type:
information is correct.I agree to comply with all city and county ordinances 316 23 067
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,judgment's,Costs,and expenses which WITHIN 180 DAYS OF PERMIT ISSUANCE OR
may accrue against said City in consequence of the granting of this permit.
Additionally,the applicant understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION.
source regulations per the Cupertino Municipal Code,Section 9.18. '
Issued by:Kim Dunbar
Signature •
Date 10-6-2017 Date: 10/06/2017
OWNEr'-BUILDER DECLARATIONRE-ROOFS:
I hereby affirm that 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 two reasons: installed without first obtaining an inspection;I agree to remove all new materials for
1. I,as owner 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:10-6-2017
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
i
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 CupertinoiMunicipal 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 Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code,Seciions,25505,25533,and 25534.
exemption,I become subject to the Worker's Compensation provisions of the I ' •,
Labor Code,I must forthwith comply with such provisions or this permit shall Owner or authorized agent:
be deemed revoked. Date: 10-6-2017 ,I ,i
APPLICANT CERTIFICATION CONSTR "ION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is A. onstructionlending agency for the performance
correct.I agree,to comply with all city and,county ordinances and state laws of work's for which this permit is issued'.(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.
Licensed
CONSTRUCTION PERMIT APPLICATION
" COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
(11
IV
10300 TORRE AVENUE • CUPERTINO,CA 95014-3255 i�-
���.,9s, (408)777-3228 • building@cupertino.org PEMIT#B- 20' 1 - I ` -2—(10
GU:PERTINo REV# DEF#
❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. D MEP ❑RE-ROOF []SWIMMING POOL/SPA
PROJECT ADDRESS APN 83 -m/ I
10094 RANDY LN `� Co 1
OWNER NAME PHONE E-MAIL '
HEOW KEN 508-932-5830
STREET ADDRESSCITY,STATE,ZIP' - '
IIII99444ANTallY LN EM IIs, &ttA.95014 ,
0 CONTRACTOR NAME 0 OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
RED' IDlll V , ARS 76 C36 SAA
ISTREET ADDRESS CITY,STATE,ZIP I
2305 PAI1�R SA�i1.�0 10AA9?�Il�1
E MAIL PHONE I BUS.LIC#
VGAIVARES.a0141 408-982-0405 403526
0 ARCHITECT 0 OWNER ❑OWNER AGENT ❑x CONTRACTOR AGENT ENGINEER 0 DEVELOPER 0 TENANT -
CONTACT NAME E-MAIL
VAN CAO „ , VCAO@ARS.COM
STREET ADDRESS CITY,STATE,ZIP PHONE
2305 PARAGON DR ' , SAN JOSE,CA 95131 ' . 408-982-0405.
DECRIPTON
' INSTALL 50 GAL WATER HEATER ,
(]SINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL
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 0 ATTACHED
BATHROOM SF SF SF SF 0 DETACHED
EXISING ❑YES EICHLER ❑YES SECOND STORY ADDITION El YES •
FIRE SPRINKLERS 0 NO ❑ NO ❑NO
DWELLING SECOND DWELLING ,❑YES ❑ATTACHED 0 DETACHED OTHER
UNITS# UNIT ADDITON: ❑NO S F
POOLS' '0 FIBERGLASS ❑VINYL-LINED ❑GUNITE ❑PREFABRICATED
POOL-SF SPA-SF I SPA ATTACHED❑YES 0 NO I TOTAL-SF
RE B TOTAL VALUATION:
Commercial or Multi Family Buildings with PuHic Swimming Pools requires Department of Environmental Heath approval $2,800
RE-ROOF'EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY)
REMOVE/REPLACE❑NO IF NO t PLYWOOD ❑1" ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
❑YES It OF LAYERS THICKNESS❑5/8" OTHER ❑OSB ❑CDX OTHER :12 I A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF DASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES ❑OTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy SF #of SQUARES_ 1
Bmy y
read this signature
below
on and the eachof the following: I am the property owner or authorized agent to act on the property owner's behalf. I
B
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. I acknowledge and authorize all information contained on this application form
to be made available for public rec. d.
Signature of Applicant/Agent: _ Date:10/06/17 ,
SUPPLEMENTAL INFORMAT a` REQUIRED
*New SFD/Second Dwelling U t /Multifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all newconstruction.
*Commercial Buildings: Provide arcompleted 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 1
I l
{ BldSAPp_2017.doc revised 08/01/17
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\ernik\ik../. SMOKE / CARBON MONOXIDE ALARMS i T
OWNER CERTIFICATE OF COMPLIANCE 1111a59
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COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CU , TMO
(408)777-3228•FAX(408)777-3333•building a(�cucertino.orq
PERMI1 CANNOT BE F NALED UN] 1.THIS CERTIFICATE HAS BEEN
COMPLETED;SIGNED, AND RETURNED TO In BITIT.DING 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,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 Section R314,R315, and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or
Carbon Monoxide Alanns 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 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 / r
Address f OQ t �1 (cc A pf` .V v C t �' _ • Permit No. 2V11— (1 2_6
Specify Number of Alarms #Smoke Alarms Mr= #Carbon Monoxide Detectors. I 2-
I have read and agree to comply with the terms and conditions of this statement
- Owner(or Owner Agent's)Name: f
��1.�✓Vi Signature ...... Date:to—167-.1
Contractor Name: /I/
AQ_5 A V A r— C"CF A Si nature ® p
t ` �_ Smoke and COform.doc revised 01/10/2017