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15120061tip CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22435 SALEM AVE CONTRACTOR: TANG WARREN M AND PERMIT NO: 15120061 JEANETTE L OWNER'S NAME: TANG WARREN M AND JEANETTE L 1642 EAGLE DR DATE ISSUED: 12/07/2015 OWNER'S PHONE: 4087325187 SUNNYVALE, CA 94087-4635 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL UNIT 2 - REPLACE (E) WATER BEATER, SAME SIZE & License Class Lie. # LOCATION Contractor Date 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. 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: $900 performance of the work for which this permit is issued. 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 APN Number: 32615045.00 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 D ERMIT 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 180 D OM T CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the z granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. 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) ¢(, s 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(x) 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 Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and 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 the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: ���_ Dat is issued. ,—Permit rtify 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 h CUP ERTINO. GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (4-08) 777-3333 - buildinc cuoeriino.org ❑ PLUMBING ❑ MECHANICAL ❑ ELECTRICAL, 65—` �� ❑ h�SCELLAu\�'OUS PROJECT ADDRESS 4PN T O1vTiRNA1YO-7 /,{ i!/ r4AIG /J�'RI G v V PHONE I �3z 6'l W Ya 8 ZOO `(�cC/ STREET ADDP,ESS CITY, STATE, ZIP G r � � q I FAX CONTACT N.iT✓E �'� �� I PHO;\ E-MAIL G STREETA.DDRESS CITY, STATE, ZIP PAX ❑ OFr11­Et AG—=NT ❑ CO?SIK1kCTOR ❑ CO? TRACTOR AGD�T ❑ .,RCI -=CT ❑ ENGr;.'R EIDETLOPM ❑ i-BN.'1\Z' CONTRACTOR NA1,iE /� I LICEIQSE NU.'MER I LICENSE TYPE I BUS. LIC 4 COMOANY Nk1E 6v- T� �. E-NLAIL I FAX STREET A DDRESS CITY, STATE, ZIP PHONE ARCHITECT,-NGIAnERNA14E LICENSENUM3ER BUS. LIC r COIJPA_WNAME E-IJUSIL I FAX — STREET .ADDRESS CITY, STATE, ZIP I PHONE I USE OF ❑ SFD or DL -P= ❑ MULTI-F.42,0LY PROJECT L^ WIT DLA .'D ❑ YFS PROi-CT LN ❑ Y FS IS THE BLDG .4N ❑ 17-S BUIIDD.G: ❑ CON,='- ,CLAL URB14-t' R\TT F?.CE AR4A ❑ Y'O FLOOD ZOI\- ❑ NO EICFZ--R HOME? ❑ NO DESCRIPTION OF WORK /�� w � � ,- / p /i�-�„ / V6 -T eW e ' �l TAL VALUATION: O61 d U tI r rs,. i By my signatre below, I certify to each of the following: I am the arope_ty owner or authorized agent to �ct on the prop-- L er' al£ I have read this application and the information I have provided is correct. I have read the Description of '>,70rk and verify it is accurate _- e to comply with all applicable local ordinances and state lag's relating to building constm-ction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature ofA.pplicant/Agent: Date: Z SU—t PLEMENTAL Li\TFORv ATION P E U D Q OVEi?Ti COT��TrR i❑� STA"D��:D ,TAT, . .4.� A�EPArisctlpp_2011. do remised 0 612 1/11 CITY OF CUPERTINO W -M FEE ESTIMATOR -BUILDING DIVISION ESS: 22435 SALEM AVE FEE DATE: 12/07/2015 REVIEWED BY: MELISSA P32615045 BP#: VALUATION: $900 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY SFD or Duplex USE: $0.00 CI,ec"'i PENTAMATION PRWHEATR PERMIT TYPE: WORK UNIT 2 - REPLACE E WATER HEATER SAME SIZE & LOCATION SCOPE Plumb. Permit Fee: DOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, Schooi District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 E(f. 7,/l/I.T FEE QTY/FEE MISC ITEMS Afcecb. ,'lcr (,"heck Supp'L PC fe'e; Plumb. Plan Check 0.0 hrs $0.00 CI,ec"'i Permit r-: tlf>r;a, .F' s'„aia r ece: Plumb. Permit Fee: ./PPERMIT PME Unit Fee: 1 lcec. 1'<r°:;: -rt IW. PME Permit Fee: $48.00 F7 Other Plumb Insp. 0.0 hrs $48.00 C3r're> Eli c•. i,�,<,u. Work Without Permit? 0 Yes (F) No $0.00 Afech, 1%SI?. FS:', 111ilzrib, ff p3 f' -e: $48.00 &a I1^s.SJ7. DOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, Schooi District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 E(f. 7,/l/I.T FEE QTY/FEE MISC ITEMS Supp'L PC fe'e; PME Plan Check: $0.00 Permit PME Unit Fee: $29.00 PME Permit Fee: $48.00 F7 Administrative Fee: IADMIN $45.00 Work Without Permit? 0 Yes (F) No $0.00 Travel Documentation Fee: ITR,4VDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS $171.50 $0.00.:.. .TOTAL';FEE :. $171.50 Revised: 10/01/2015 CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS; . Ccc V!0 PERMIT # �p OWNER'S NAME: 2&PHONE ## 4-0 97 p 73 Z — S ( 7 GENERAL CONTRACTOR: BUSINESS LICENSE ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am notusing any subcontractors- ® Signature Date Please check applicable subcontractors and complete the following information_ 10 rt D SUBCONTRACTOR BUSINESS NAMEBUSINE 7^1 ICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry - Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile D SMOKE I CARBON MONOXIDE ALARMS OWW'UER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT ► BUILDING DIVISION 10300 TORRE AVENUE ► CUPERTINO, CA 95014-3255 (408) 777-3228 ► FAX (408) 777-3333 ► building a.cmertino.ora PERMIT CANNOT BE RNALED A 'D COMPLETER UNTIL T111S CERTIFICATE CA WN C. q: AND 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 u1 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 420.6and shall be approved by the Office of the State Fire Marshal. Power Supply: In dwelling units with no commercial power su In existing dwelling units, alarms are permitted to be solely bai not result in the removal of wall and ceiling finishes or there is space. Refer to CRC Section 8314 and CBC Sections 907.2.11.4 alarms which must be connected to the building wiring. As owner of the above -referenced property, I hereby certify the installed in accordance with the manufacturer's instructions ar and Califonmia Residential Codes. The alarms have been tested below. Y, alarm(s) may be solely battery operated. y operated where repairs or alterations do access by means of attic, basement or crawl 420.6.2. An electrical permit is required for the alarm(s) referenced above has/have been in. compliance with the California Building nd are operational, as of the date signed t have, read anal a Fee ba Corn; d Lkh- the terms and.conditcons of this statement l/i%fl21?�N %iIV nature,.......:... Gontraciar Name: ....... Lie ..... ............ ate: ................, Smoke aizd CO fb nn.dac revised o3/Z'8/I:'4 W,w,e t..AwPMewA"7iwl6.A14`eAA7win .�'A�kBAAtl4AiA� l/4A'N1l6F�.v COMMUNITY DEVELOPMENT DEPARTMENT -BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777=3333 • bu iding@_)cupertino.org Owner Namelk lwlyr' Permit No. /S_4_eO6 Address Z Z 4�- 3, .- 544'� AIZ"E' L1!G e� 1. Is your real property a registered historical site? 0 vts Civil "Code Sections 1101.1 through 1101,8 do not apply. Skip the rest of the form and sign bottom of fon-. Of L+ihto Go to Question 2. 2. Does your real property have a licensed pluiriber certifying that, due to the age or configuration of the property or its plumbing, installation of water -conserving plumbing fixtures is not technically feasible? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. The licensed pluinber's certification has been provided to the Building Division.. Skip the rest of the form and sign bottom of form. @/No Go to Question 1 3. Is water service permanently disconnected for your building? Q Yes Civil Code Sections 1101.1 through 1101,8 do not apply. Skip the rest of the form and sign bottom of form. ' R No Go to Question 4. 4. Is your real property built and available for use or occupancy on or before January 1, 1994? El No Ivey real property is built and available for use or occupancy after January 1, 1994. Civil Code Sections 1101.1 through 1101.8 .do not apply. Skip the rest of the form and sign bottom of form. I d Yes My real. property is built and available for use or occupancy on or before January 1, 1994. Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign bottom of form., 5 Please check ONE of the following: ❑ IvYyproperty is asingle family residential real property. See Civil Code Section 1101.44. On and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures throughout the building. On, or before January 1, 2017, all non- compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless of whether property undergoes alterations or iiripToveinents). , property is a muhifarnily res�ideniiaT real property. See Civil Code Section 1101.5`, On and after January 1, 20`14, specified: building alterations or improvements shall require non- compliant plumbing fixtures to be replaced: with water -conserving plumbing fixtures. Oh or before January 1,. 2019,, all non-compliantplumbing fixtures shall bereplaced with water- conserving plumbing fixtures throughout thebuilding (regardless of whether prop city undergoes alterations or improvements). lufy property is a commercial read propeity- See Civil Code Section 1101.5. On and after January 1, 2G,14, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. On or before January 1, 29,19`,, all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements) I, as the,owner or, ownerrs agent of`this property, certify under penalty of perjury that non-compliant plumbing fixtures will be repjaced prior to date specified above with.. water -conserving plumbing fixtures in accordance with Civil Code Sections 1101. I through 1101.9,, the: canent Calrfornia,Pluinbirig Code and California. Green Building Standards; Code„ and manufacturer's. installation requirements,, and that the, water -conserving plumbing fixtures comply with the requirements as. indicated in the fable on the following page s_ h_ a I Owner or Owner Ag;ent's Sig.natu:r'.�.� �it/cn� .c,..1 I't/L c �,v�. �P D°atex_!/� �6 Upon completing and signing, this Ceitfflicate, please return it to the BuilVg g Division in order too final your buil:diing permit. S&407201'5.doc revised 08/26/15