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B-2017-1907
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1907 1065 COLONY HILLS LN CUPERTINO,CA 95014-5801(359 30 008) PURONICS SERVICE INC LIVERMORE,CA 94551 OWNER'S NAME: GUPTA VINAYAK AND MONIKA DATE ISSUED: 11/06/2017 OWNER'S PHONE:408-828-8278 • PHONE NO:(925)456-7000 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-36 Lic.#928595 Contractor PURONICS SERVICE INC Date 02/28/2019 XC BLDG _ELECT XC 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: INSTALL(N)WATER SOFTENER(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. 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:$3495.00 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 359 30 008 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-••' source regulations per the Cupertino Municipal Code,Secti.. !. :. 180 DAYS FROM LAST CALLED INSPECTION. Signature / Date 11-6-20107 Issued by:Kim Dunbar 1111 Date: 11/06/2017 a ► :IiiiBoit t ..:Y !.e I hereby affirm that I a exempt 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:11-6-20107 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER i. 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 I 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,Sections 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date:11-6-20107 I certify that I have read this application and state that the above information is 1` :< .ita` `t .a�et:�iea'': correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that th--'constru '. lend'.= .gency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is i e. =-c.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 11-6-20107 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION r_fl 10300 TORRE AVENUE • CUPERTINO,CA 95014-3255 4.41.9,4., (408)777-3228 • building@cupertino.org PEMIT#B-1,0 t -/ CUPERTINO ❑ NEW CONSTRUCTION D ADDITION ❑ALTERATION ❑T.I. ['MEP ❑RE-ROOF ❑SWIMMING POOL/SPA PROJECT ADDRESS I © / 5 Io y 1 f ] I APN 359 - 3^ -00 K OWNER NAME ' IP I q Lo, 6 0P-774 4'7, ' L O q • C2-13 -q2 / c. E-MAIL STREET ADDRESS I /��J j //S //v(e)/�1 ,r, r I! I/f s"T CITY�CrP 7 t")C9 r /` /1 501 q CONTRACTOR NAME 0 OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE ?oz.-0J l c 5 otz_o,J t c 5 (72-g q S G 36 STREET ADDRESS I CITY,STATE, ZIP X71 G A `74�5 II C) 7'7 S 1.-A-s (PD 5j( �5 t7 Lf✓L 2C E-MAIL PHONE BUS.LIC# 92 5- 45 ; •'7(,--0--0 0 ARCHITECT 0 OWNER 0 OWNER AGENT (XCONTRACTOR AGENT❑ENGINEER 0 DEVELOPER 0 TENANT -3-c.--TT \ ��-{ E-MAIL �,/ ` /� ��7 CONTACT NAME �A( N �` 1 �H�C�I�I' t ' FA—,N L-.--f /�r • C 1 sir 6DPRESS EDGE al e - t-,J fi /�"Y k)i ice- GA 9'`�S,f 5 SAO-PHONE Y- Z7. -f ZG b DECRIPION I 1 •-Z -(f fA)/11---rt-12 co/f T& A)L9- 5V S•71_• i''"' [AINGLE-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($) OA )- REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED BATHROOM SF SF SF SF 0 DETACHED EXISING 0 YES EICHLER 0 YES SECOND STORY ADDITION 0 YES FIRE SPRINKLERS 0 NO ❑ NO 0 NO DWELLING SECOND DWELLING ElyES 0 ATTACHED':DETACHED OTHER UNITS# UNIT ADDITON: ❑NO S F POOLS( 0 FIBERGLASS 0 VINYL-LINED 0 GUNITE 0 PREFABRICATED POOL-SF SPA-SF I SPA ATTACHED❑YES 0 NO TOTAL-SF REC 'jryc , TOTAL VAJ.U_ATION: Commercial or Multi-Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval /' 1' 7��y' 31/.1e - RE-ROOF(EXISTING ROOF TYPE: 0 BUILT-UP ROOF['ASPHALT SHINGLES WOOD SHAKES❑WOOD SHINGLES D TILE OTHER(SPECIFY) REMOVE/REPLACE❑NOI IF NO PLYWOOD El'1/2- ❑3/8' PLYWOOD TYPE: PITCH: ROOF CLASS III YES #OF LAYERS THICKNESS O 5/8" OTHER ❑OSB 0 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 #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 ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. I . •- •dge and authoriz- - . . a.on contained on this application form to be made available for public record. j / Signature of Applicant/Agent: Date: j I / SUPPLEMENTAL INFORMA NED *New SFD/Second Dwelling Uru s/Multifamily Dwellings:A • ' '.n permit is required prior to issuance of a building permit for all new construction. *Commercial Buildings: Provide a completed Hazardous ."! rials 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 BldgApp 2017.doc revised 08/01/17 URONICS PURONICS SERVICE, INC. P 5775 Las Positas Road Livermore,CA 94551 Tei: 925-456-7000 Fax:925-456-7045 www.puronics.com February 21, 2017 Re: Puronics Service, Inc. Contractors License#928595 To Whom It May Concern: This letter hereby authorizes all currently authorized persons listed below on behalf of Permit Services, Inc. to sign for any and all building permits and licenses required by our company. These people are authorized to act as an agent on behalf of our company. Brad Rickard John Rickard Julie Rickard Jeff Dressler Vikki Burns Lynn Kerr Jason Di Pasquale Jeff Reed Danelle Giusti Jeff Raine Mikayla Adams Jim Davis Celina Brown Kevin Conklin Kelly Conklin Eileen Baughman Temika Gomes Ashlee Giello Tim Seaman Lily Kuns Melvin Mohn Jeremy Saeger Niko Da La Campa Danny Brown Alicia Adams Ellyn Clardy Ashlyn Winogrodov Oreste Rocchi Deborah Lanier Shasta Arnold Vanessa Luna Jordin Giello Craig Beckley Jennifer Beckley Dawn Gurman Dan Clardy Trinalynn Katen Danielle Anderson Sincerely, Scott A. Batiste President/CEO 1 '1 SMOKE i CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION CUPERTINO10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•buildinq(a�cupertino.orq _. . - : IIT CANNOT BE FINAEED UTTIL THIS CERTIFICATE IiAS BEEN TCO PL TED SIGNED,AND RETI116 ED all ERE WILDING DIVISION PURPOSEI. 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 $1000.00,CRC Section R314,R315, and CBC Sections 907.2.11.5 and 420 6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the X X bedroom(s)—(Smoke alarms shall not be located within 3 feet of bathroom door) On every level of a dwelling unit including basements and habitable attics X X Within each sleeping room X Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply In dwelling units with no commercial power supply, alarm(s)may be solely battery operated. In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic,basement or crawl space.Refer to CRC Section R314 and CBC Sections 907.2.114 and 420.6.2. An electrical permit is required for alarms which must be connected to the building wiring As owner of the above-referenced property,I hereby certify that the alarm(s) referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes. The alaims specified below have been tested and are operational, as of the date signed below Address. f©6 5 C-0/ C GIA: (S _a-$'Q at)etSo Permit No. e= CD!-7--`907 7 Specify, Number of Alarms #Smoke Alarms J #Carbon Monoxide Detectors 1 I have read and agree to comply with the terms and conditions of this statement Owner(or Owner AName: '� L� ( Signature . . . 1 20 Clc Date: .... Contractor Name: ��• Signature Lic.# Date: Smoke and COfarm.doc revised 01/10/2017