B-2017-1954 •
CITY OF CUPERTINO BUILDING PERMIT
, BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1954
10315 ANN ARBOR AVE CUPERTINO,CA 95014-1651(326 55 023) GAGNE BROTHERS
ENTERPRISES INC
NOVATO,CA 94949
OWNER'S NAME: ONISHI STEVEN TAND CHAO CONSTANCE TRUSTEE DATE ISSUED: 11/14/2017
OWNER'S PHONE:408-621-4353 PHONE NO:(415)763-4002
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C36 Lic.#857357
Contractor GAGNE BROTHERS ENTERPRISES INC Date 04/30/2019 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 50•GAL WATER HEATER-SAME LOCATION
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:$3.190.00.
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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 326 55 023 •
representatives of this city toenter 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 accru, ,ainst said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Addition.-ly,the,.pplicant understands and will comply with all non-point
source egulatio s per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
•
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Signa Date 11-14-2017 Issued by:Kim Dunbar
Date: 11/14/2017
- ILR D $
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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 roofingmaterial 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 thoprogeity,am'ezclusively contracting with licensed , Signature of Applicant:
contractors to,construct,the project(Sec.7044,Business&Professions Code). Date:11-14-2017
•
I hereby affirm tinderpenalty;of perjuryione 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 prouided,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'matntain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700,d-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
material. Additionally,should I use equipment or devices which emit hazardous
shall not employany;person in any manner so as to become subject to the p
air contaminants as defined by the Ba Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with t • upe tinOMunicipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions Of the the Health&Safety ode,Sec ons 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall I, •
be deemed revoked. Owner or authorized age ,4107
it
APPLICANT CERTIFICATION Date:11-14-2017 • ��•
I certify that I,have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree tocomply 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(See.,3097,Civ C.)
to enter upon;the above mentioned'property for inspection purposes. (We)agree Lender's Name i
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 11-14-2017 • Professional
•
CONSTRUCTION PERMIT APPLICATION
�` COMMUNITY DEVELOPMENT DEPARTMENT •. BUILDING DIVISION
l,. ,.A:, 10300 TORRE AVENUE • CUPERTINO CA 95014-3255
'YA' ��
'�a `" (408) 777-3228 • buil d.ng�1cupertino.Org PEMIT4B- D I - ��J
' CUPERTINO • REV z DEFE
❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. ,�I�9EP ❑RE-ROOF ❑SWfl 4ING POOL/SPA
PROJECT tAI�DA SS" LJ�\ \V CA.Y\ 6\ APPN A 3 2�- 55_0 Z3
OWi ER 1114lN,E�/ `S \ P 1`' �!/1�3 1E-MAIL
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STREET ADDRESS / gi6
a CITY, STATE,ZIP
CONTRACTOR NAME ❑OWNER-BUILDER COMPANY NAI}1E `,^ LICENSE NUMBER LICENSE TYPE
C ,G1ne,P� s bc3 r t��AWAR.k‘ `6 'i"3 - , 3/0' STRE SS ` CITY, 4E, ZIP I
E-MAIL il JPHONE_ BUS.LIC✓t
❑,ARCHITECT ❑OWNER.❑OWNER AGENT 0 CONTRACTOR AGENT ENGINEER 0 DEVELOPER ❑TENANT
CONTACT NAVE ........./.*
STREET`ADDRESS CITY,STATE,ZIP PHONE
DECRIPTON�.,_ r ace 56. rAA, , wee„,,._ Venn C� _
111V (`O I�/'AU�..,/�-" /Vt �/ 'IVet,
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NGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES 4 TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION(5)
REMODEL REMODEL KITCHEN REMODELOTHR ' GARAGE ❑ATTACHED
BATHROOM SF SF SF SF 0 DETACHED •
EXISING ❑YES EICHLER ❑ YES SECOND STORY ADDITION ❑YES
'FIRE SPRINKLERS 0 NO '❑ NO 0 NO
DWELLING SECOND DWELLING O v s 0 ATTACHED 0 DETACHED OTHER
UNITS X UNIT ADM-TON:. ENO S F
POOLS' ❑FTBERGLSS, ❑VIN;Y-L-LINED 0 GUNITE ❑PREFABRICATED
POOL-SF SPA-:SFS ,I '1. SPA ATTACH ED❑YES 0 NO I TOTAL-SF -
RECEI\
TOTAL, VALUATION:
I Commercial or Multi-Family Builder s with u61ir Srui»mii�ic Pools remtires Department of-Environmental Heady am•onai p, � �. 1 yl
RE-ROOFI EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES WOOD SHAKES❑WOOD SHINGLES.❑TILE OTHER(SPECIFY)
REMOVE/REPLACE D NO IF NO!I ' PLYWOOD ❑' " ❑3/8" • PLYWOOD TYPE: PITCH: ROOF CLASS
D YES p OF LAVERS THICKNESS❑5/B" OTHER ❑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 :of SQUARES
By my signature below I ce tify!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 . •--noes and state laws relating to building construction. I authorize representatives of Cupertino to
enter the above-identified propert for ins ection purposes. I acknowledge and authorize all information contained on this application form
to be made available for public r: a•.
Signature of Applicant/Agen,t:� l Li
Date:'1 C I L 1 ) -
SUPPLEMENTAL INFORMATI MEWED
*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
Blc/g4pp_2017.doc revised 08'01/17
-04 SMOKE I CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
CE
.61-.194COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
[ PR'i'& 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildina()cuoertino.orq
" _� PE T.CAS''h�C T 13-E i LED-UNTIL'T' IS aC I A trA.�t ��'�7_
Y�c:62 4e cs .--....gixy'T • +•r5ry..-- -.F..-a. -.' -1 +/ sr
- -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 907.2.112 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 907.2.11.4 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 alarms)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: (3 j'
nv AgOvse
vt~ .'z€. .fG[ rs -r ,CGS ` f`/ Permit No3 Cl— il S4\'
Specify Number of Alarms: 4 Smoke Alarms: MEM #Carbon Monoxide Detectors: F
I have read and agree to comply with the terms'and cond-tions of this statement I
Owner(or OwnerAgent's)Name: /s
j r9r
signature.... ... Date: l
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Contractor Name:
..
, 6
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Lic.0 ,f.....:-r... Date: l �l 1t/MI
��f I Signature.... .. .. . � 66
Smoke and COform.doc revised 07/10/2077