14060008CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10109 RIDGEWAY DR
CONTRACTOR: CONSOLIDATED
PERMIT NO: 14060008
PLUMBING INC
OWNER'S NAME: IGOR & LILYA GODZDANKER
3732 CHARTER PARK DR STE D
DATE ISSUED: 06/03/2014
OWNER'S PHONE: 4082572460
SAN JOSE, CA 95136
PHONE NO: (408)978 -3093
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑
INSTALL (N) PROPERTY LINE CLEANOUT
mss— / /
License Class � � � � Lic. # :� � -57 ( (7 Z
Contractor 0 0 PL [% L►'l Date 6- '� -?'
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.
TAR
I hereby affirm under penalty of perjury one of the following two declarations:
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
Sq. Ft Floor Area:
Valuation: $17500
performance of the work for which this permit is issued.
"liave and will maintain Worker's Compensation Insurance, as provided for by
ection 3700 of the Labor Code, for the performance of the work for which this
APN Number: 34241023 00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
AST-CALLE SPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
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granting of this permit. Additionally, the applicant understands and will c ply
sued by: Date:
with all non -point source regulations per the Cupertino Municipal Co on
918.
3 '
RE- ROOFS:
Signature Date
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
❑ OWNER- BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(a) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self - insure for Worker's
material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bag Area Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the C e o Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, coons 5 2 3, d 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date: 6 ^ 9—
permit is issued.
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must
I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C )
Lender's Name
APPLICANT CERTIFICATION
Lender's Address
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 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
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9 18.
Signature Date
GENERAL PERMIT APPLICATION
° 0 MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE' AVENUE • CUPERTINO, CA 95014 -3255 O
CUpEit f NO (408) 777- 228 - FAX (408) 777 -3333 • buildino(ftuDertino.org;
MISC
53XLUh1B1TI13 ❑IYM A TTICAL -- ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS
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OWNSRNA.�
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STREETADDRESS
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CITY, ZiP
FAX
CONTACT NAME
PHONE E-K&IL
STREETADDRESS
CITY, STAT Zip
FAX
❑ 011'NER ❑ Ol1')gR- SUII:DER
❑.:OIANER AGENT CONTRACTOR ❑: CON"MACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTPJ,CTOR NAME
LICENSE NIJN.$ER LTCENT
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BUS. LIC #
COMPANY N.A2 r
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STREETADDRESS_ 7
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ARCffiTECT/ENGWEER LAAME
LICe'h'SE NMIE
I BUS. LIC #
COMPANYNAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ Sib or DUPLEX
BUII.DING: [3 00NUMCIAL
❑ mt;LTt -FAmmY PROJECT W VMDLAND ❑ YES
- URBAN INTERFACE AREA ❑ 40
PROJECT IN ❑. YES-
FLOOD ZONE_ ❑ NO
IS THE BLDG AN ❑ ITS
EICMER HOLD:? ❑ NO
DESCRIPTION OF WORK r,
-
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TOTAL VALUATIO*I:
By my signature below, I certi . to eacS efthe folioaving: I am the property owner or aL46DISed agent to act on o I have ad this
application and the information I have provided is correct. I have read the Description of Work and verify it is c ree to co y with a pplicable local
ordinances and state:la-ws relating to building cops - LI. I authorize repres !atire Cupertino to enter the above -i entif ed perty for ' ection purposes.
Signature of Applicant/Agent: Date: AJV '0
AL RMATIO : D-
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:LIEPhliscApp .2011.doc revised 06121111
CITY OF CUPERTINO
IVIWV F crrnvr A Tnu _ RTTTT ,DING MVISION
ka,
ADDRESS: 10109 RIDGEWAY DR
DATE: 06/03/2014
REVIEWED BY: MELISSA
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APN: 342 41 023
BP #:
*VALUATION:
$17,500
*PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Du lex
p
r'IOr! c: " / ?E�� k
PENTAMATION 1 RPSS
USE:
PERMIT TYPE:
WORK
INSTALL N PROPERTY LINE CLEANOUT
$0.00
Pie frail l `hr-c!?
SCOPE
$24.00
APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES
Sewer, Sanitary 1PRSEWER 1 # $24
TOTALS: $24.00
NOTE: This estimate does not include fees due to other Departments (i.e. rianning, ruoue vrortcs, rtre, aunttury .ewer "tatimt, . Lnvvt
/'—mpf tho [)ant fnr addn'r info_
FEE ITEMS (Tee Resolution 11 -053 E . 711113)
'
QTY/FEE
MISC ITEMS
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.S'Llppl, P( � Fc-
PME Plan Check:
r'IOr! c: " / ?E�� k
Plumb. Plan Check
0.0
hrs
$0.00
Pie frail l `hr-c!?
PME Unit Fee:
$24.00
VecVr'
c>,?rtid Fete:
-T-T- C Ctnstruclion Tax:
Plumb. Permit Fee:
IPPERMIT
Administrative Fee: IADMIN
ofilo ,
$0.00
Other Plumb Insp.
0.0
hrs
$47.00
Ofiwr Li"'( his/ >.
$1.75
Select an Administrative Item
131d.g Stds Commission Fee: IBCBSC
?4"""7 IfzzE?. l f',,.
$164.75
/Y'91 ubhisp. Fce:
$164.75
1 -u'C_ .r I '.
NOTE: This estimate does not include fees due to other Departments (i.e. rianning, ruoue vrortcs, rtre, aunttury .ewer "tatimt, . Lnvvt
/'—mpf tho [)ant fnr addn'r info_
FEE ITEMS (Tee Resolution 11 -053 E . 711113)
FEE
QTY/FEE
MISC ITEMS
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.S'Llppl, P( � Fc-
PME Plan Check:
$0.00
PME Unit Fee:
$24.00
PME Permit Fee:
$47.00
-T-T- C Ctnstruclion Tax:
Administrative Fee: IADMIN
$44.00
Work Without Permit? ® Yes No
$0.00
Travel Documentation Fee: ITRAVDOC
$47.00
Strom; Motion Fee: IBSEISMICR
$1.75
Select an Administrative Item
131d.g Stds Commission Fee: IBCBSC
$1.00
$164.75
$0.00 TOTAL FEE:
$164.75
Revised: 04/01/2014
COMMUNITY MANAGEMENT SERVICES
To Whom It May Concern
March 18, 2014
Re: De Anza. Oaks Homeowners Association
Dear Sirs:
Consolidated Plumbing, 1,nc- has the association's permission to seek permits for the repairs of any domestic
water lines orsewer lines located within the De Anza Oaks community-.
;rIj,
inUnity Mana� rent Services, Inc.
Bill %,nubbard,) Ass ociation Manager
De Oaks Homeowners Association
B H /st
cc: Board of Directors
1935 Dry Creek Road, Suite 208 ■ Campbell, CA ■ 95008 -3631 ■ voice (408) 559 -1977 ■ fax (408) 559 -1970
Address
4
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SMOKE / CARBON MONOXIDE ALARMS
O "14E=R C "ERTI'fICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDIN(C D[VISION
10300 TORRE AVENUE - CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 - buildin a�cupertino.org
PURPOSE
This affidavit is a-self- certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314, 2013 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 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)
X
X
On every level of a- dwelling unit including basements
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 have been tested and are operational, as of the date signed
below.
t h. »va marl and adrPP to comply witii,�he�t"erms and conditOns of this statement
fFiwner (or''O
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Conopr Name:
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ature .... ... ' .. ......... .. _ tic.# ..7 .... ... Date: '�1...
Smoke and CO form.doc revised 03118114