B-2017-2038 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-2038
20110 MERRITT DR CUPERTINO,CA 95014-2011(316 33 104) DOLLENS ELECTRIC
INC
SAN JOSE,CA 95173
•
OWNER'S NAME: CREGAN VALERIE L DATE ISSUED:11/28/2017
OWNER'S PHONE:408-921-4686 PHONE NO:(408)929-6100
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-10 Lic.#867376
Contractor DOLLENS ELECTRIC INC Date 11/30/2019 X BLDG X ELECT _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 PANEL(200 AMPS)-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
erformance of the work for which this permit is issued.
/R t P." 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:$2600.00
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 316 33 104
representatives of this city to enter upon the above mentioned property for
inspection purposes.:(We)agree to save indemnify and keep harmless,the
City,iof Cupertinojagainst 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-point
sou;rce regulations pertheCupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
signature .• r'V\, `r Date 11/28/2017 Issued by:Abby Ayende
Date: 11/28/2017
•
OWNER-BUILDER DECLARATION
I hereby'affir,nt tliat I ant exempt from 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(Sec17034,Business&Professions Code)
2. I,as owner,of the property,am exclusively contracting with licensed Signature of Applicant:
i,contractors,to construct the project(Sec.7044,Business&Professions Code). Date: 11/28/2017
•
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
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,C apter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25533 d 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owne or authorized agent:
APPLICANT CERTIFICATION e.11/28/2017
I certify that I have read this application and state that the above information is CONSTRUC N LENDING AGENCY
correct.I agree,to comply 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(Sec.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.
•
Signature • _ Date 11/28/2017 Licensed •
Professional
CONSTRUCTION PERMIT APPLICATION
v
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ,
10300 TORRE AVENUE • CUPERTINO,CA 95014-3255
�Si t tr\
(408)777-3228 • building@cupertino.org PEMIT#B- aO 11 - 7,
CUPERTINO REV# DEF#
0 NEW CONSTRUCTION ❑ADDITION El ALTERATION El T.I. 0 MEP ❑RE-ROOF ((❑SWIMMING POOL/SPA
PROJECT ADDRESS �h 15 ` ‘Avs- Vat o r I L ( Q I APN# D1(��I/9_ �1
OWNER NAME PHONE� � EMAIL
L l l`'1
. �lIJf,,-q�1
STREET ADDRESS ' t CITY,STATE,ZIP
' 20 It() I(�e(bri c ' •
it CONTRACTOR NAME 0 OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
log sm -e 1\e),"s .0 o 5 hoc-vices 6 Lo3- 6/0
STREET ADDRESS CITY,STATE,ZIP
E-MAIL PHONE I BUS.LIC#
0 ARCHITECT ❑OWNER ❑OWNER AGENT 0 CONTRACTOR AGENT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTACT NAME E-MAIL
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTON'
' N.S6..l( Ca‘t, KaA-.5 7,06 14-010 re,,,L0 to r74 tcv Q>G
❑SINGLE-FAMILY/DUPLEX ❑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($)
REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE 0 ATTACHED
BATHROOM SF SF SF SF 0 DETACHED
MUSING ❑YES EICHLER 0 YES SECOND STORY ADDITION ❑YES
FIRE SPRINKLERS 0 NO 0 NO 0 NO
DWELLING I SECOND DWELLING ❑YES 0 ATTACHED 0 DETACHED OTHER
UNITS it UNIT ADDITON: 0 NO S F
POOLS' 0 FIBERGLASS ❑VINYL-LINED 0 GUNTTE 0 PREFABRICATED
POOL-SF SPA-SF I SPA ATTACHED❑YES 0 NO TOTAL-SF
RE D BY: VALUATION:
Commercial or Multi-Family Buildings Buildings with Public Swimming Pools requires Department of Environmental Heath approval Le fat)
RE-ROOF EXISTING ROOF TYPE: 0 BUILT-UP ROOF 0 ASPHALT SHINGLES 0 WOOD SHAKES 0 WOOD SHIN ES❑ E OTHER(SPECIFY)
REMOVE/REPLACED NO IF NO PLYWOOD ❑'h" 03/8" PLYWOOD TYPE: PITCH: ROOF CLASS
0yEs #OFLAYERS THICKNESS❑5/8" OTHER ❑OSB 0 CDX OTHER '12I 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 > 'u ses. I acknowledge and authorize all information contained on this application form
to be made available for public record. .
Signature of Applicant/Agent I\4 l , Date: ]t I ti'' i
SUPPLEMENTAL INFORMATIO REQL`IRED .
*New SFD/Second Dwelling Units/M ' '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.do'c revised 08/01/17
SMOKE / CARBON MONOXIDE ALARMS FEIE
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO
(408)777-3228•FAX(408)777-3333•buildina(a�cupertino.orq
PERIYIIT CANNOT BE INALv1 ,u L THIS CERTIFICATE HAS BEEN
COMPLETED.,SIGNED.AND RETUI ED TO I lIE BUILDING 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-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 alarm(s) referenced above has/have been
installed m 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 D n IA V�t '2,g6
Address- O//2 e ' �Permit No. °00
�7
Specify Number of Alarms #S o e larms. #Carbon Monoxide Detectors. I / I
1 have read and agre--:o co p y it he terms and conditions of this statement
Owner(or Owner
Aen)t's)Name: r
0 5Vv 1�1� Signatures-'' .� . .... Dater
Contractor Name:
A-f 44 JI. Lj vL. Signat .e . . , '� Lic.# g67.3. h. Date:J.2.,^:07.7
Smoke and COform.doc revised 01/10/2017