B-2017-1970 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1970
20197 HOGUE CT CUPERTINO,CA 95014-2342(316 24 039) AFFORDABLE WATER
HEATERS AND
PLUMBING INC
• 28358
CONSTELLATION RD
VALENCIA,CA 91355
OWNER'S NAME: HOWARD BETTY J TRUSTEE&ET AL DATE ISSUED: 11/15/2017
OWNER'S PHONE:408-564-4920 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)50 GALLON WATER HEATER-(INSIDE CLOSET)
I hereby affirm under penalty of perjury one of the following two declarations:
a. 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. •
\ d 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:$3180.00 •
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 316 24 039
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,the applicant understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION. •
source regulatio pe*Cupertino Municipal Code,Section 9.18.
a
Issued by:Jasmine Archbold
ature Date 11/15/2017 Date: 11/15/2017 •
OWNER-BUILD 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
a. I,as owner of the property,or my employees with wages as their sole inspection.
compensation,will do the work,and the structure isnot intended or offered for
sale(See.7044,Business&Professions Code) Signature of Applicant:
2. I,as owner of the property,am exclusively contracting with licensed Date: 11/15/2017 •
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
a. 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
3. 1'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 Cup rti • icipal Code,Chapter 9.12 and
Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code, '+ ••.2. 05,25533,and 25534.
exemption,I become subject.to the Worker's Compensation provisions of the I
Labor Code,I must forthwith comply with such provisions or this permit shall.
be deemed revoked. O uthorized agent:
AC.11/15/2017
APPLICANT CERTIFICATION CONSTR CT gfl ENDING AGENCY
I certify that'I,have read this application and state that the above information is I hereby affirm that there is a cons Iron 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.
CONSTRUCTION PERMIT APPLICATION
•
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
_,,q:`+. 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 •
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• .,,,, g` . (408) 777-3228 • build.ing@Icupertino.org PEMIT,:B- 2011 - kcti.0
CUPERTINO REV>± DEF#
-• ❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.1. 4EP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS zo j q 1z u c1.,_ IAP ✓< rb L 2-t{-075 a
OWNER NAMr PHO [EMAILE OV`�/ ( )g4`1V0
• STREET ADDRESS /r___ffv_ J1 ]/_qSTA ,aphivo
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CONTRACTOR NAME 0 OWNER-BUILDER MPANY NAME 11_ 9 ir
LICENS NUMBER LICENSE TYPE
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0 A CHITEC OWNER.0 OWNER AGEN 0 CONTRACTOR AGENT 12 ENGINEER 0 DEVELOPER 0 TENANT
CONTACT NAME E-MAIL
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STREET ADDRESS CITY,STATE,ZIP PHONE
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❑SINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES I TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION(5) I
REMODEL REMODEL KITCHEN REMODEL OTHR ' GARAGE o ATTACHED
BATHROOM SF 'SF SF 5F 0 DETACHED •
FIREiSPRINKLERS❑1:1 YNOS EICHLER' 0 NO SECOND STORY ADDITION 0 NO '
DWELLING SECOND DWELLING 0 yEs ❑ATTACHED DETACHED OTHER
UNITS F UNIT ADDITON/ 0 NO 5 F
POOLS' ❑FIBERGLASS 0 VINYL-LINED 0 GUNITE 0 PREFABRICATED
POOL-SF SPA-SF ';.I SPA ATTACHED❑YES 0 NO I TOTAL-SF ,
D BY: T L�77A�LUATION:
' Commercial or Multi-Familu Buildings with.Public Swinouinq Pools rem(fres Devm4ment orEuvironmenlal Heath approval A.121/4...01
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RE-ROOFI EXISTING ROOF TYPE: E BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY)
REMOVE,REPLACE 0 NO IF NO PLYWOOD 01/2"" ❑31s" ' PLYWOOD TYPE: PITCH: t ROOF CLASS
AYES F,OF LAYERS THICKNESS❑5/8" OTHER ❑OSB E CDX OTHER '12 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF DASPHALT SHINGLES 0 WOOD SHAKES DWOOD SHINGLES 0 OTHER ,
*Provide a signed copy of the,Cupertino's Tear-Off Policy SF :of SQUARES
By my signature below I dertify 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 ordi,an d state laws relating to building construction. I authorize representatives of Cupertino to.
enter the above-identified,property for i-s ti urposes. I acknowledge and authorize all information c ntaine on this application form
to be made available for public record. % 5 /
Signature of Applicant/Agent: Date: -
SUPPLEMENTAL INFORMATION REP'. ED
*New SFD/Second Dwelling Units/Multi y 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
BldgApp_2017.doc revised 08/01/17
'- SMOKE / CARBON MONOXIDE ALARMS
OWNER-CERTIFICATE OF COMPLIANCE I ' ���
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
CUPERTINO10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•cbuildina ancupertinb.orq-
PERMIT C:A vNQT.ft_ NALE1 OTTIL THIS= ITTIIN IC. TE HAS BEN.
CO 'LETEa,SIGN Dn AND RET N1l D TOM 3E BU1LDI7 O's 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-
Existing single-family and multi-familydwellings shall be provided wifh Sfnok'e ins andC-arbonr - --- —
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 mustb connected to-the-buifidnrg-wiring- - — 4
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
Addtess• o2 ®/g 7 -21 6 e a 1 5,7 I`77OA-Permit No. i,—2 D 17 —/ 770
2
- --Specify Number of Alarms__ 3 .#Smoke Alarms I A J #Carbon Monoxide Detectors,Li I
/have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agents)Name %a
me( w- r Si.nature..... .... ..`:1- 1. .. [Date: .
Contractor are:
�
c /�/ /2 /J)Gl`fP� Signature Lic.# �G! 273 (PGI.1 Date: .I1..2!/ 7
Smoke and COform.doc revised 01/10/2017