B-2017-1825 CITY OF CUPERTINO BUILDING PERMIT '
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1825
22931 STONEBRIDGE ST CUPERTINO,CA 95014-5640(342 13 023) AFFORDABLE WATER
HEATERS AND
PLUMBING INC
28358
CONSTELLATION RD
• VALENCIA,CA 91355 .
OWNER'S NAME: VELLEQUETTE DAVID W TRUSTEE&ET AL DATE ISSUED: 10/25/2017
OWNER'S PHONE:408-518-1856 PHONE NO:(855)345-9087
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: ,
•
License Class C-36 Lic.#627368
Contractor AFFORDABLE WATER HEATERS AND PLUMBING INC Date X BLDG _ELECT X PLUMB
09/30/2018 _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. (N)80 GAL ELECTRIC WATER HEATER-GARAGE
•
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.
,.p 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:$5051.00
permit is issued.
APPLICANT CERTIFICATION • APN Number: Occupancy Type:
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 , 342 13 023
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 whichWITHIN 180 DAYS OF PERMIT ISSUANCE OR
may accrue against said City in consequence of the granting of this permit.
Additionally,t I ap.licant understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION.
source regul- . s r%-r the Cupertino Municipal Code,Section 9.18.
Issued by:Jasmine Archbold
000
gna�ur- Date 10/25/2017 Date: 10/25/2017
OWNER-1 1 ER o ECLARATION RE-ROOFS:
I hereby a hat 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 t •r asons: installed without first obtaining an inspection,I agree to remove all new materials for
1. I,:.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: 10/25/2017
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
s. 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 Cu."rti r Municipal Code,Chapter 9.12 and r
Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code,/chi 25505,25533,and 25534.
exemption,I become subject to the Worker's Compensation provisions of the
r
Labor Code,I must forthwith.comply with such provisions or this permit shall _wee*aruthorized agent:' �.
be deemed revoked. '. "
.10/25/2017
APPLICANT CERTIFICATION I ONSTRU' ON LENDING AGEN V
I certify that I have read this application and state that the above information is I hereby affirm that there is a.�.truction 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 permit i ssued(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 expensesiwhich 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 -B -
\, COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
v5f{''
(408) 777-3228 • building@.)cupertino.org PEMIT#B- 1----0(.1— - I j Zs-
CUPERTINO
REVS DEFE
❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.1. MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS Zg31 - APN s �(
OWN NAME P ONE E-MAIL
6cvLU�1161Li Dt _5`t-ig, - -
STREET 22 ci DS1 hGlPS�` i TE,ZAP 0 `� V , 9544
tm
.+ 'CONTRACTOR NAME ❑OWNER-BUILDER OM Y NAM J LICENSE NUMBER LICENSE TYPE
S � -e-6,--e-V'S r bUt Litik4- I-,• --i 23-31,0d- (-36
ISIRE ADHRESS q CITY,ST E, ZIP
`Z ins.-ct 1c Di 0 - a pc,q c4 41/3,5C
E-MAILNE BUS.LIC x
�v4- �t. �� ass) 345 )4,g 4ovt 5I
❑ARCHITE T ❑OWNER.❑OWNER AGENT 0 CONTRACTOR AGENT❑ENGINEER 0 DEVELOPER 0 TENANT ,
CONTACT NAMEE-MAIL
ba 1 ' t 0-14_@ 'A 1..'k Cs? '1
STREET 2-A55 ADDRESS
W 92 CITY,t-� u 11 �1 , a 1. f riltel 9c3 644)
DECRIPT pl/�/�3 g6.,..fre..._J1 .
,, C,0 ,.ten (jev--y--f j
❑SINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL ❑COMMERCIAL I
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES A TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION(S)
REMODEL REMODEL KITCHEN REMODELOTHR GARAGE 0 ATTACHED •
BATHROOM SF SF SF SF 0 DETACHED
EXISINGYES
FIRE SPRINKLERS❑❑YESNO EICHLER 0 YES SECOND STORY ADDITION O
I0 NO NO
DWELLING SECOND DWELLING ❑yEs 0 ATTACHED❑DETACHED OTHER
UNITS4 UNITADDITON: 0N SF .
POQLSI 0 FIBERGLASS 0 VINYL-LINED ❑GUNITE ❑PREFABRICATED , '
POOL-SF SPA-SF I SPA ATTACHED ❑YES 0 NO I TOTAL-SF
RECEIVED BY: TOT L VALUATION:
Commercial or Multi-Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval 56 S J r
RE-ROOFI EXISTING ROOF TYPE: E BUILT-UP ROOF❑ASPHALT SHINGLES WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY) JJJi6J� /
REMOVE/REPLACE❑NO IF NO PLYWOOD ❑1" ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
1yEs F OF LAYERS THICKNESS❑5/8" OTHER 1=1 OSB ❑CDX OTHER .12 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 OTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy sF eof 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 ordinani es, state laws relating to building construction. I authorize representatives of Cupertino to
'enter the above-identified property for ins'ction rposes. I acknowledge and authorize all information con ained on thi pplication form
to be made available for public record. .�
.) .
Signature of Applicant/Agent: ' Date: L •
SUPPLEMENTAL INFORMATION REQUIR D
*New SPD/Second Dwelling Units/Multifai\i1 Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings: Provide a complet azardous 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
•
Bldg,4pp_2017.doc revised 08/01/17
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE c`
%re' COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORREAVENUE••CUPERTINO,CA 95014-3255
CU R NO
(408)777-3228•FAX(408)777-3333•buildinca.cupertino.orq
PE1211'BT CANNO INA EI3 u TIL:THTS cERTWNIT I AS°'DE; 1
COMPLETED,SI RED,AND 01,111161D TO THE BUTLDING 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
-- Existingsingle-family and-multi-family dwellings shallbe provided with-Smoke Alarms-andCarbon = -
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 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 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 alann(s) referenced above has/have been
installed in accordance with the manufacturer's instructions and m 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 2 2 9 5 1 e_4 r) c j\-- Permit No.3 -2 O ) 7 -
Specify Number_0 f_Alarms. #Smoke Alanns . 6 I #Carbon Monoxide Detectors. I I J
I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name:
JE ke1r ,
' � e� Signature ..% :A:. .Date:
Contractor Name:
ff b „hie //1/c/-f y Signature i V Lic.# .(( 2 73(pe- Date: 43/./7.
Smoke and COform.doc revised 01/10/2017