B-2017-2121 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-2121
10260 STONYDALE DR CUPERTINO,CA 95014-1030(326 37 027) AFFORDABLE WATER
HEATERS AND
PLUMBING INC
28358
• CONSTELLATION RD
VALENCIA,CA 91355 •
OWNER'S NAME: MAJOR JO S AND DIANN M TRUSTEE DATE ISSUED: 12/11/2017
OWNER'S PHONE: 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: .
licenseis in full force and effect. 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.,,
2. 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:$2901.00
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 37 027
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 s'e the Cupertino Municipal Code,Section 9.18.
Issued by:Kim Dunbar
Signature !!� Date 12-11-2017 Date: 12/11/2017
OW ER-BU ' DER DECLARATION
RE-ROOFS:
NV I hereby affirm t 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 roofis
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: 12-11-2017
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 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. I 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 C p• r Municipal Code,Chapter 9.12 and
Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code, .ecTor 25505,25533,and 25534.
exemption,I become subject to the Worker's Compensation provisions of the -
' Labor Code,I must forthwith comply with such provisions or this permit shall Owner or authorized agent'
' be deemed revoked. Date:12-11-2017
• APPLICANT CERTIFICATION •NSTR II LE 'i INC A EN Y
I certify that I have read this application and state that the above information is I hereby affirm that there is a .nstruc'on lending'agency for the performance
correct.I agree to comply with all city and county ordinances and state laws of work's for whichthis permit is'.sue. (Sec. 097,Civ C.)
relating to building construction,and hereby authorize representatives of this city Lender's Name
to enter upon the'above intentioned 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 9.18j '
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION . B a, _
�C 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 •
(408) 777-3228 • build inglcupertino.org PEMIT xB- Z4 I— - 21 L
CUPERTINO REV4 DEER
❑ NEW CONSTRUCTION ❑ADDITIONALTERATION El T.1. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS /V2( S1y7 �^ D APN k / - 0
OWNER NAME PHO rE-MAIL�."
1-)(01r) 111 Id 614 6490 nt—Citlei
•
•
STREET ADDRESS I CITY,STATE v °4
A /f5 aI A
gCONTRACTOR NAME 0 OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
C:60 e62.-...,..4 ika‘V ( 441 LAcr. (9i--- 3 e? G-34
[STREET AD� S CITY, ATE, ZIP 51CI
E Ei Go�.S-�/��t 1/a,Qi e��• � °111 gV dam, e �'i wlAf. C/OYYI , Q"I 3J-6iio BULIC tt
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❑ARCHITECT ❑OWNER.0 OWNER AGENT 0 CONTRACTOR AGENT ENGINEER 0 DEVELOPER 0 TENANT
CONTACT NAME E-MAIL
STREET ADDRESS CITY,STATE,ZIP PHONE
DECRIPTON i vei
Ica n j 50 cl clikn - j e ' Ack.. •
•.S rY1-tlific T0n
•
•
JGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL ❑COMMERCIAL
EXISTING USE. EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES A TOTAL NET SF USE TYPE OCC ' SQ.FT. VALUATION(5)
• REMODEL REMODEL KITCHEN REMODELOTHR GARAGE 0 ATTACHED
BATHROOM SF 5F - SF SF ❑DETACHED
EXISTNG ❑YES EICHLER ❑ YES SECOND STORY ADDITION DYES
FIRE SPRINKLERS 0 NO ❑ NO - 0 NO
DWELLING SECOND DWELLING ❑YES 0 ATTACHED❑DETACHED OTHER
.
UNITS a UNITADDITON: 0 NO SF
•
POOLS '❑FIBERGLASS 0 VINYL-LINED 0 GUNITE ❑PREFABRICATED
POOL-SF SPA-SF I SPA ATTACHED ❑YES 0 NO I TOTAL-SF _..
RECB TOTAL VALUATION
Commercial or Multi-Famihl Buildings with Public Stain:min Pools;mires Deoai•lment of Environmental Heath amn'oval 2-9 o I
" RE-ROOF EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY)
REMOVE/REPLACE❑NO IF NO PLYWOOD Ej D 3/8" ' PLYWOOD TYPE: PITCH: ROOF CLASS •
„i; DYES ?OF LAYERS THICKNESS❑518" OTHER ❑OSB E CDX OTHER •12 A
'! PROPOSED ROOF TYPE:❑BUILT-LT'ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES DWOOD SHINGLES ❑OTHER
'I "Provide a signed copy of the Cupertino's Tear-Off Policy SF of SQUARES
11,, 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
1„ 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
1; enter the above-identified property for 'Asp- tion purposes. I acknowledge and authorize all information co Laine on us application form
' to be made available for public record
I' Signature of Applicant/Agent: / Dater 2- 1) / -
SUPPLEMENTAL INFORMATION REI
RED ,
' *New SFD/Second Dwelling Units/Muldfa.i ly 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 '
CUPERTINO
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT ^ BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building@cupertino.org
PERMIT CANNOT BE F'INALED UNTIL THIS CERTIFICATE HAS BEEN
COMPLETED, SIGNED, AND RETURNED TO THE 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
bedroom(s) — (Smoke alarms shall not be located within 3 feet of bathroom door)
X
X
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 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: /0 26-0 Std,-Xg,(Je �✓CL�dJ � ✓�' Lur � SSG/ �/ Permit No. ,e 2017 �ZiZ
Specify Number of Alarms: # Smoke Alarms: l o l # Carbon Monoxide Detectors:
I have read and aaree to comvty with the terms and conditions of this statement
Owner (or Owner Agennt's) Name:
UU
0_1�1.......................................
_w r/l
Signature........ .w^:..... .....................Date:.l..11./ ,
Contractor Name:
'
Signature ... ... ........ ......... ............... Lic.# ...... ...... ... ... Date:
Smoke and COform.doc revised 0111012017