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B-2017-1964 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1964 • 10596 LONNA LN CUPERTINO,CA 95014-4318(359 19 014) STREET PLUMBING AND ROOTER SAN JOSE,CA 95128 OWNER'S NAME:-TALLA DEEPENDRAAND PATALAY KANCHAN DATE ISSUED: 11/21/2017 OWNER'S PHONE:408-380-4405 PHONE NO:(408)496-1155 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class CC=36 Lic.#582217 Contractor : _ '_U u: ►G:►• :S• _: Date 12/31/2017 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 40 GAL WATER HEATER-SAME LOCATION I hereby affirm under penalty of perjury one of the following two declarations: i. I have and will maintain a certificate of consent to self-insure for Worker's Co pensation,as provided for by Section 3700 of the Labor Code,for the'" erfonnance of the work for which this permit is issued. 1I'�l i���.ca 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:$1500.00 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 19 014 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 accfue against said City in consequence of the granting of this permit. WIT�IIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and will comply with all°non-point source°regulatioI = pr the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Si a ure wig '/ Date 11/21/2017 Issued by:AbbyAyende Date: 11/21/2017 � I A1._ UILDER DECLARATION - 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 roofmg material being installed.If a roof is i',; 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:11/21/2017 . I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER is 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 i. 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 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 Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Mun. ',al Code,Chapter 9.12 and ' exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Co. ions 2. 05,255 .,and 25534. ,,, Labor Code,I must forthwith comply with such provisions or this permit shallIV 1 be deemed revoked. ilo wner or authorized agent: & p'_ APPLICANT CERTIFICATION Date:11/21/2017 I certify;that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct:l agree•to comply with all city and county ordinances and state laws I hereby affirm that there is construction lending agency for the performance relating'•to building construction,and hereby authorize representatives of this city of work's for which this perm t is issued(Sec.3097,Civ C.) to ente?upon the,above mentioned property for inspection purposes. (We)agree Lender's Name . to save,indemnifyand 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 11/21/2017 Professional CONSTRUCTION PERMIT APPLICATION \f/: COMMUNITY DEVELOPMENT DEPARTMENT®BUILDING DIVISION `,=" 10300 TORRE AVENUE ® CTJPERTINO,CA 95014-3255 ,, (408)777-3228 ® buiiding@cupertino.org PEWIT#B- . , - ' V CU PR11 NO /77p„ i c\6 G1 REV# DEF# 0 NEW CON Su UCClON ❑ADDr1TON 0 ALTERATION❑T.I. 0 MEP ❑RE-ROOF ❑SWTh 4ING POOL/SPA PROJECT ADDRESS 105-9/ LO iv N A iv I IFN# ,: „.5q , - 6..._014 OWNERNAME r �rc�-o->`r �' €�r r PHONE I bsM!", P o y �� - ��-ol . STREET ADDRESS CITY,STATE ZZIPG�`� , 1651C, LGVNA LA-M-T-7 c c -eri2774,, Cir cgsoIel ,%CONTRACTOR NAME ®OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE ti c 7` (ant 52=7- namaima JPoo77L 6--g2217 C • STREET ADDRESS CITY.STATE,ZIP �� titMi-miii .D AN C4 qs/ Z , E-MAILPHONE BUS.LIC s-$f t-c i ,i ,_, &jit: v fig- i; `(/• 400 ?O 0 ARCHITECT 0 6Its(WNER D O ,J' AG CONTRACIORAGENTD ENGINEER 0 DEVELOPER Q TENANT . CONTACT NAME %�/�.Lic. �,to. E-MAIL T iC irtt—f�WI�(✓ilk ,+ J STREET ADDRESS P✓`/1 (�( r CITY,STATE,ZIP ! PHO r 22 73 W �i2T/t S E t be " lift l/S— — €DECRIPTON, 40 G 4 L l.,U dv Et rc l L-f c -- 1 °, 1 E T L -m- " c`� I , g ESQ, Li CA-7/OfJ t J E `H SINGLE—FAMILY/DUPLEX DMULTI-FAMILY El INDUSTRIAL ,El COMMERCIAL ' S . G USE EXISTING SF NEW FLOOR SF PORCINE DECK SF DEMO SF STORIES# TOTAL NEFSF 1 USE TYPE OCC SQ.FT. VALUATION($) • r REMODEL REMODEL KITCHEN REMODELOTHR GARAGE D ATTACHED , r BATHROOM SF SF SF SF D DETACHED SING ©YES ElCFm 0 YES SECOND STORY ADDEON _OYES EIRE SPRINKLERS 0 NO [3 NO _OYES ' DWELLINGSECOND DWELLING OYES DETACHEDDATTACHED 0OTHER .UNUS# �UN1TADDTTON: ONO SF e 'POOLSI 0 FIBERGLASS D VINYL-LINED 0 GoNrre Q PREFABRICATED POOL-SF SPA-SF I SPA ATTACHED®YES El NO TOTAL-SF , f' BY: TOTAL VALUATION Cr mnercial or Multi-FirrOu Buildings with Public Smimmine Pmts re atir s Department of Envirorm enhd Heathapmooal ANAtionvk /5-67) + [RE-ROOFRO 01 EXISTING ROOF TYPE: ❑BUILT UPROOF❑ASPHALT SHINGLES 0 WOOD SHARES❑WOOD SHINGLES 0 OTHER(SPECIFY) REMOVE/REPLACE 0 NO IF NO PLYWOOD 0 1e 0 318'" PLYWOOD TYPE: PITSR003 ASS I 0yrs I #OF LAYERS THICKNESS©s)8" OTHER t]ose EI OTHER :12 J CLA PROPOSED ROOF TYPE:©BUILT-UP ROOF DASPHALT SHINGLES 0 WOOD SHAKES D WOOD SHINGLES D OTHER °'EProvide 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 inspectioy clnhowledge an• --thorize all information contained on this application form to be made available for public record. l Signature of Applicant/Agent: // Date: l Z(_Y/L1 SUPPLEMENTAL INFORMATION RE a1.t;r e. *New Sl'U/Second Dwelling Units/Mui.i. 'y w z !!olitionpennitisreqIiredprior 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. II''FHOA-Provide a letter of approval from the Home Owner's Association BldgApp 2017.doc revised 08/01/17 r- SMOKE / CARBON MONOXIDE ALARMS ' ►°z-itf--i7 OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION C U P E RTi N O 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•buildinqacuoertino.orq -.�.,,..__..z. ....n,» ,>. -<;-_x_---_.:max, .._ �.,.�rr ==^�_ — _ -- - = .-_-_.�--s— sem -- _.. �....-.,,..._._.._.,- . ----'-.'--�- �' ..... . T-�..__�.�..s_rc..._-.hie'."-._�_> ^:�.xi _ _ _.uc-:.�Y-�.c_z.� =—.uS` -..>;-u: .°-�--. �.. <-, _ _••._.____:_..._.._-.,.__..M�... __ --`��._ __ __ __ _ M_Sts. „a� �£':��:1�._mss-=`�_� � ".� ''n�.* ;*x4�` . ��+" -Fk �' s�k�'�.,.-_ "� �?t �"��.1 � mss'-.��".������ ��. ��-,�-�- -.''�-x,H €...d.�.s.... :,_,. , .' .= g , "sn - s,..,0-44 �,.=...,. .-.;,_ 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-familry 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 8314,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 atjd 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 alann(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 t LONA t.11 1 C 777OA 9 OA 5S6 r Address. ! b �� "T' Permit leo Z0/1- 6q(4- XSpecify Number of Alarms* )( #Smoke Alarms: , 2— I )( #Carbon Monoxide Detectors: L. I have read and agree to comply w'h the terms and conditions of this statement Owner(or Owner Agent's)Name: Signature Contractor Name: - 7 fLifititSla IZbOTIC- signatur Lic.# ` 22 f 7 ..,.. .... � .... ... Date: Smoke and COfornn.doc revised 01110/2017