B-2017-1819 •
• • CITY OF CUPERTINO BUILDING PERMIT •
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1819
19702 VICKSBURG DR CUPERTINO,CA 95014-3322(369 10 012) ROOTER HERO
PLUMBING INC
MISSION HILLS,CA
91346
OWNER'S NAME: WANG WENCHUNG AND HSU YILING DATE ISSUED: 10/24/2017
OWNER'S PHONE:408-806-2327 • PHONE NO:(888),929-4376
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-36 Lic.#973014
Contractor ROOTER HERO PLUMBING INC Date 05/31/2018 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 PROPERTY SEWER
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.
..60.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
permit is issued. Sq.Ft Floor Area: Valuation:$8000.00
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 369 10 012
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 applicant'understands and will comply with all non-point
source regulation r the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
ature7.1--%-- t LJr-- Date 10/24/2017' Issued by:Jasmine Archbold
•
Date: 10/24/2017
OWNER-BUILDER 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.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: 10/24/2017
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)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 Management District 1
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject'to the Worker's Compensation provisions of the the Health&Safety Code,S ' ns 25505, 533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Own:' "-uthorized agent:
APPLICANT CERTIFICATION Da, "'i 2. 20 7
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply 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,
Signature Date 10/24/2017 Licensed
Professional
•
•
f CONSTRUCTION PERMIT APPLICATION
t COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO,CA 95014-3255
(408) 777-3228 • building@cupertino.orgPEMIT#B-2c t '- - I bt 9
CUPERTINO REV# DEF#
•
b'NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. MEP ❑RE-ROOF ❑'SWIMMING POOL/SPA
PROJECT ADDRESS ` / I N#
ADDRESS/
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OW,`NE�R�AME PHONE E-MAIL I
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STREET ADDRESS /� 1/�c k s i y r �P. CITY,CUA f 4 k D CA
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❑CONTRACTOR NAME 0 OWNER-BUILDERS COMPANY NAME LICENSE NUMBER/ 9. 7)
y LICENSE TYPE
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0 ARCHITECT ❑OWNER ❑OWNER AGENT 0 CONTRACTOR AGENT 0 ENGINEER❑DEVELOPER 0 TENANT • ..
CONTACT NAME E-MAIL
STREET ADDRESS CITY,STATE,ZIP PHONE
DECRIPTO
€IAJ,er- /n t_ f-e.Flokctyvt FAO\rd eir-ty /� •
SINGLE-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 ❑DETACHED
EXISING .YES EICHLER !❑YES SECOND STORY ADDITION ❑YES
FIRE SPRINKLERS❑NQ I❑i NO (RNO
DWELLING SECOND DWELLING ❑'YES ❑ATTACHED 0 DETACHED OTHER
UNITS# f- UNIT ADDITON: ❑NO SF
POOLS( ❑FIBERGLASS:0 VINYL-LINED 0 GUNITE ❑PREFABRICATED
POOL-SF SPA-SF ; SPA ATTACHED❑YES 0 NO TOTAL-SF
IIVE/ D BY: � 4Al. •��L�VALUAT
'Commercial or Multi-Fancily Buildings with Public Swimming Pools requires Department of Environmental Heath airoroval I�� Xl 0 0 v
RE.ROOFI EXISTING ROOF TYPE: -❑BUILT-UP ROOF❑ASPHALT SHINGLES 0 WOOD SHAKES❑ OOD SHINGLES E TILE OTHER(SPEC I ) CCJI
:REMOVE/REPLACE❑,NOI IF NO PLYWOOD ❑1" ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
DYES #OF LAYERS THICKNESS❑5/8" OTHER 0 OSB ❑CDX OTHER .12 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF DASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 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 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 ord. . .es and state laws relating to building construction. I authorize representatives of Cupertino to
enter the above-identified property fo section pure s. I acknowledge and authorize all information contained on this application form
to be made available for public;reco : f •
/�
Signature of Applicant/Agent: G�-)— C_ . Date:/U - 2 e -71-
'SUPPLEMENTAL INFORMATION R QUIRED .
*New'SFD/Second Dwelling Units/Multifamily 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
BldgApp_2017.doc revised 08/01/17 '
CUPERTINO SANITARY DISTRICT
20863 Stevens Creek Blvd#100, Cupertino,CA 95014 / \
Tel(408)253-7071 • Fax(408)253-5173 •s). cISHEO ti9�� CUPERTINO
SANITARY DISTRICT PERMIT LETTER
Cupertino Sanitary District has adopted Resolution No. 1263.
Building Permit Request
(Over-the-Counter)
Single Family Project n Multi-Family Project n Commercial Project
Project Address: ) 9702 Vicks ,.r' "7 . j<lPN` 60/-l0 -CUd2
Permit Number:
Scope of Work: I4IS-1-41: l1 s-at Per /4t a_ `/e
Owner/Applicant Name: 1-Un-I-erz c Phone: 4/O$- ( 09-0T33
Address:
Date: Prepared By:
City Authorized Representative
I, as property owner or authorized agent, acknowledge that all Cupertino Sanitary District requirements
will be met and all required fees will be paid prior to the approval of final inspection for;proposed project.
Date: Signature:
Owner/Authorized Agent
CUPERTINO SANITARY DISTRICT OFFICE USE ONLY
n Pre-inspection Required Final Inspection Required
Date Scheduled:
Date: Conditional Approval By:
Authorized Representative
Cupertino Sanitary District
District will notify owner of the required fee within 5 days after Pre-Inspection has been completed and cc
City of Cu ertino. /t7 Inspection Fee Paid Date Paid: 107251
Inspection Fees:
$250/unit-Single Family Residential already connected, but new cleanout is required
D $150/unit-Single Family Residential already connected with existing cleanout in working order
0 $350 Minimum—Commercial and Retail Actual Amount:
D $200/each—Disconnect and/or abandon lateral service
Connection Permit Fees:
D $350/unit-Single Family Residential connecting to existing lateral
$650/unit—Single Family Residential connecting with new lateral
0 $100/unit—Multi, Hotel, Living Units, etc. Actual Amount:
O $500/connection-Commercial and Retail Actual Amount:
Connection Use Fees(See Attached Calculation Sheet):
El Area and Frontage Fees Amount:
CI Residential Excess Fees over 3.5 unit/acre Amount:
El Commercial and Retail Connection Fees Amount:
F-1 Commercial and Retail Change in Use Fees Amount:
Date: iFi2e-///17 Final Approval By: : . -
Auth. • ed •epresentative
Cup-• . anitary District
_ � 0.,'_
SMOKE / CARBON MONOXIDE ALARMS ? "' U.,#,
_
OWNER CERTIFICATE OF COMPLIANCE
�ST.,,ss COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTlNO
(408)777-3228•FAX(408)777-3333•building ac cupertino.orq
ii-TD-L T,Th )7— (9'f g
\l1 Glf-5�7�` , ermit No.
Address - #of Alarms Smoke: Carbon Monoxide: Cr
z. -ss. ",.k*^x^w^y ,uF-P-,f y^7 rr—rT ',,.,, ,,,F.s r a k'�e^rkrb.. t�r't c '' >n I a sc"�. �. "�,^*' /f//J/,q
`. PE TC,ANNOT"BE`FIN ' ED;AND C'OMPLETED�'UNTIL THIS`CERTIF CAw.1*�
1 F + Bx r a%ak � � -aJf � ;-dh w'&'.x'� '� `��-� `� �'.,i"ak �%`7 ,re4*�m'",���y�yam,..�,y�, a "w'r*�^xeXy.��,�.r�»—v.
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( it '+B.EEN SIGNED ` e`.-.k.,,....,,,RET�� EDDTO T H BU LD G f�IS O 1�0� 11,,1,
x."S-1"a pa "4 .si^-,,, ,' N - � �e+� „� -pper�,v'�`' ,, ','t"`s 's`�"'' Tfi:sggs�{ I�.
PURPOSE
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314,2013 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 the X X
bedrooms)
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 have been tested and are operational, as of the date signed
below.
I have read and agree to comply with the terms and conditions of this statement
Own (or Owner Agent's)Name:
e►ti 4-6(r/A/ VBG nr,� a t
Signature ,- Date: /Vil
Contractor Name:
Signature Lic.# Date:
Smoke and COform.doc revised 03/18/14