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B-2016-2774CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: 10641 GLENVIEW AVE CUPERTINO, CA 95014-4514 028) CONTRACTOR: PERMIT NO: B-2016-2774 (369 26 A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC MEMPHIS, TN 38120 OWNER'S NAME: TRAM DE H AND YEE CAROLYN DATE ISSUED: 09/21/2016 OWNER'S PHONE: 408-234-4801 PHONE NO: (901) 271-9700 LICENSED CONMACTORIS DECLAgATION BUILDING PERMIT INFO: License Class B Lia #765155 ContractorA R S AMERICAN RESIDENTIAL �5ERVICES OF CALIFORNIA INCX BLDG _ELECT X PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL Date 07/31/2018 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: license is in full force and effect. INSTALL FOUNDATION CLEANOUT (2-WAI) 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:':',, r` Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. y I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 Labor of the Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area Valuation $3540.00 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 369 26 028 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 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 180 DAYS FROM LAST CALLED INSPECTION. source regulations/per the Cupertino Municipal Code, Section 9.18. Si nature g / Date 09/21/2016 Issued by: MELISSA Date: 09/21/2016 �- O R -B m D R DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: I installed without first obtaining an inspection, I agree to remove all new materials for 1. 1, as owner of the property, or my employees with wages astheir 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: 09/21/2016 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. 1 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 Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sections 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall Owner or authorized agent' be deemed revoked. Date: 09/21/2016 CONSTRUCTION APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is LENDING AGENCY I hereby affirm that there is -a construction lending agency for the performance correct. I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned 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 9.18. Licensed CLJFERTING GENERAL PERMIT APPLICATION COMMLNITY DEVELOP(/TENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 ' (408) 777-3228 • FP,X (408) 777-3333 • buifdingQcuDerino.ora Misc r ���- IPLL�BING Ivll\�CH_�ZCA.L nELF(°TRT('AT_ � t,/,-]i\/,at\rFntic PROjEECT A.DDR -SS //��' k ` � 1 4�' T C✓ 0 WN ER KA I;E _ �- PHONE I '��G,..� C•� STPEET:ADDPES" - i CITY, STATE, j i" FAX STREETIDIIt ' " ( � CITY,ST4TE, ZIP P i t FA} ❑ OF?:m ❑ oi,--\zP,-$UazI: ❑ 0VN7Et.,GK1!T CO.?P.4CTOR ❑ CONUK1,CTORAGEnT ❑ kRCHTCT❑ 2c cm\'EEER ❑ DE\%EL❑ TEN AN CO R TO t+ LICE SEN\'L7,?ER t� g� LICr�-'.C�EryTYP= 7 E�3 Co - 126&1 �7%� BUS. LIC' CO���;.� .'Y' F- /C4 G<zauK i/ E-MAIIa j pelf(92 {? �f FAX 'STREET AD;RESS �fir- �.�-� -. I CITY - TE, ZIP I �,, `--AL- - C,7 PHot� Ll S 'RCtIITECTf�tiGLNEERMMIE j LICE\SENLI,'BBFR BUS. LIC= C Ot 4P Y K.:?uE I E-MLML I FAX STREET ADDRESS I CITY, STATE, ZIP j PHONE USE OF L SF -D o,DUTLEX ❑ MULTI -FAMILY PROJECT N WILDLANO ❑ YES PROJECT L\\, - ❑ 1'TS BUILDNG: ❑Coh"i�C]_hL. iJPBANLN"TF7LFACEAREA ❑ wo FLOOD ZOKE ❑ I\O IS THE BI..DG AN ❑ YES EiChLER-HONE? ❑ N+O DESCRIPTION OF NA70PJ +� L✓�� a�'�^_ G`? LA JI TOT. ? PA-UATION: "� L " By my signature below, I certify to each of :he follo\a ipg: I am Coe prope_-q% oti;•ner or author ized agent t con the proper% owner's behalf. I have read his application and the 1,fonpation haF,e proN ided is co I have read the Description of'Work and 1 ify itis accurate. I agree to comply with all applicable local ordinances and state laws -elan• to buldi�a c ctio I au 5oriz - _ _ _ �� of Cupe to enter the " ice -i 'entifiedtop , or inspection purposes. Signature of."wlicant gent: Date: " SUPPLEMENT A L LNFOR>\1.aTION REQUIRED ER TnE CO Rfw Ll. ❑FSTA -DJD F; ❑ :h2470R i ' A-LEF !isc, pp_?011.doc remised 06.31/11 Owner CUPERTINO WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE a CUPERTINO, CA 95014-3255 Address Is your real property a registered historical site? VN es CivilCode Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. o Go to Question 2. 2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the property or its plumbing, installation of water -conserving plumbing fixtures is not technically feasible? El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. ❑ The licensed plumber's certification has been provided to the Building Division. / Skip the rest of the form and sign bottom of form. ©No Go to Question 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. Go to Question 4. V511110 4. Is your real property built and available for use or occupancy on or before January 1, 1994? El No My 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: CYes .: 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: Li IMy property is a single-family residential real property. See Civil Code Section 1101.4. 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 improvements). El My property is a multifamily residential real property. See Civil Code Section 1101.5. 'On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. On or before January 1, 2019,, all non-compliant plumbing fixtures shall be replaced with water - conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). ❑ My properly is a commercial real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures.. On or before January 1, 2019, 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 owner's agent of this property, certify under penalty of perjury that non-compliant plumbing fixtures will be replaced prior to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 through 1101.8, the current California Plumbing 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 table on the followina naee. Owner or Owner Agent's Sig completing and signing this Certificate, please retumlit to the Building Division in order to final your SB4072015.doc revised 08126/15 C'UPERTINt Address -_J PURPOSE SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE ae E COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 l� (408) 777-3228 • FAX (408) 777-3333 • building cDcupertino.orq C /_n o \-Peru it—No. 13.. 2,9 -W eh vi e_,, TI ilk ­# of -A .--m Rmnl Q PERMIT �� T BE TINALED AND'COMPLETED. UNTIL T iT A'L.7 T)'T,'i°T#7 C+7/^11\TT71 r:�7ai T'lmarr'f�Tair� m'�.marr�. r.a�ar.�a, CERT%ETCATE 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 CSC 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 -U-he manufactu ergs 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. Smoke and CO forin.doc revised 03118114