B-2017-1926 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1926
10440 CASTINE AVE CUPERTINO,CA 95014-1309(326 41 029) THE GREAT
AMERICAN
' PLUMBING COMPANY
INCORPORATED
SAN JOSE,CA 95159
OWNER'S NAME: CHUA FAM PARTNERSHIP NO.1 DATE ISSUED: 11/08/2017
OWNER'S PHONE:408-691-6144 PHONE NO:(408)995-6400
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: •
License Class C-36 Lic.#501065
Contractor THE GREAT AMERICAN PLUMBING COMPANY INCORPORATED X BLDG _ELECT X PLUMB
Date 11/30/2018 _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. REPLACE WATER MAIN SERVICE
I hereby affirm under penalty of perjury one of the following two declarations:
1. I have and will maintain a certificate hof 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.
fry 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:$2500.00
permit is issued.
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 326 41 029 •
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 which WITHIN 180 DAYS OF PERMIT ISSUANCE OR
may accrue against said City in consequence of the granting of this permit.
Additionally,t.e applicant understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION. •
source regul/ions per he Cupertino Municipal Code,Section 9.18.
,f" l� / Issued by:Kim Dunbar
SignatuI_.� n�_ _ Date 11-8-2017 Date: 11/08/2017
OWNERUILDER DECLARATION RE-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: 11-8-2017
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 wbrk 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
3. I certify that in the per of thework for which this permit is issued,I material. Additionally,should I use equipment or devices which emit hazardous
shall not employ^anyperson 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 upertino Municipal Code,Chapter 9.12 and
Worker's Compensation law of California. If,after making this certificate of the Health&Safety Cod ,Sectio 'S J15,25533,a . 34.—
exemption,I liecome subject to the Worker's Compensation provisions of the ,, 40Labor Code,I must forthwith comply with such provisions or this permit shall �;
Owner or authorized agen ,. _,, n •-,...-
be deemed revoked'. , Date:11-8-2017
APPLICANT CERTIFICATION C INCrTIO LENDI G AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a onstruction 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 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
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
l � Z�
(408) 777-3228 • building@cupe.rtino.org PEMIT,:B-
214- -
CUPERTINO REVS DEFA
❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. aMEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS APN a
. . 1ca�(-( 0 CA5i1A/f1 AVC
OWNER NAME PHONE E-MAIL
)OAL1/ C7 eL (oG I (oi yc
STREET ADDRESS CITY, STATE,ZIP
CONTRACTOR NAME ❑OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
geA A-rvi e 21 cA,.fLAI s C 0& Cl 310
ISTRf ET ADDRESS CITY,STATE, ZIP
/L44144 A ��/� bsr° Cqs Il
E-MAIL I PHONE BUS.LIC a
I C-TOOSEWWAstivn iYeAMI 06'6-144AiLeov4 4406--, 751 -I 5115— LC 55
❑ARCHITECT ❑OWNER.D DWNER AGENT 0 CONTRACTOR AGENT ENGINEER 0 DEVELOPER 0 TENANT
CONTACT NAME E-MAIL
STREET ADDRESS CITY,STATE,ZIP PHONE
DECRIPTON
{A •
kiAe IA/A-T 2 SLv/rte
•
•
❑SINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL D COMMERCIAL
•
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES d TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION(5)
REMODEL REMODEL KITCHEN REMODELOTHR GARAGE 0 ATTACHED
BATHROOM SF SF SF SF 0 DETACHED
EXISIPRINKLERS 0 NO EICHLER ❑❑ ES SECOND STORY ADDITION DYES
FIRE 0 NO
DWELLING SECOND DWELLING ❑YES 0 ATTACHED DETACHED OTHER
UNITS# UNITADDITON: ❑NO SF
•
POOLS ❑FIBERGLASS ❑VINYL-LINED 0 GUNITE ❑PREFABRICATED
POOL-SF SPA-SF I SPA ATTACHED ❑YES 0 NO I TOTAL-SF
RECEIVF [AtAbUR`FII(JON:
Conmerrial or Multi-Famiht Buildings with Public Swim;ine Pools requires Devartment of Environmental Heath ammo, f7l�
RE-ROOF EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES D WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY)
REMOVE/REPLACE❑NO IF NO PLYWOOD ❑'/"" 0 3/8" • PLYWOOD TYPE: PITCH: ROOF CLASS
DYES s OF LAYERS THICKNESS❑5/S" OTHER DOSS ❑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 sof 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 nspection purposes. I acknowledge and authorize all information'contained on this application form
to be made available for public record.
Signature of Applicant/Agent: Date: //" / /
SUPPLEMENTAL INFORMATION R'QUI ED
*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
Bldg 9pp_2017.doc revised 08/01/17
SMOKE / CARBON MONOXIDE ALARMSreDi
111
OWNER CERTIFICATE OF COMPLIANCE
9r �
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
UPERTINO 10300 TORREAVENUE•CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333•building a(�cupertino.orq
PERMIT CANNOT BE EINALED THIS CE .10VA E EAS BEENI
COMPLETEID,$TGI :Atvn RETUT ED°TO IHE BU LDINC UNTSION:
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 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 alarms specified below have been tested and are operational, as of the
date signed below
Address tOtt,
C 'l is ' , Permit No. `21117Al X
Specify Number of Alarms #Smoke Alarms #Carbon Monoxide Detectors
I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name: f� ?
Signature .... .._;''
s' 1. Date: ... ....
Contractor Name: �
—•y•=
Signature . _ _. •� Lic.# Date 4.L.� 7
Smoke and CO form.doc revised 01/10/2017