B-2017-0279 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0279
11648 BIRCH SPRING CT CUPERTINO,CA 95014-5138(366 54 072) SIMPLY GREEN
PLUMBING INC
SAN JOSE,CA 95124
OWNER'S NAME: LIN MEI-YUN TRUSTEE&ET AL DATE ISSUED:02/17/2017
OWNER'S PHONE:408-390-6488 PHONE NO:(408)358-6446
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-36 Lic.#943556
Contractor SIMPLY GREEN PLUMBING INC Date 02/28/2018 X BLDG _ELECT X 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:
SEWER LATERAL REPLACEMENT WITH PROPERTY LINE CLEAN
I hereby affirm under penalty of perjury one of the following two declarations: OUT AND CLEAN OUT AT HOUSE;REPLACE WATER MAIN.
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.
i. I have and will maintain Worker's Compensation Insurance,as provided for by
t ,0� Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$8700.00
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 366 54 072 R3
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save indemnify and keep harmless the
City of Cupertino against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue againstsaidCity in stands andce othe hg oo this WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations p #e Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature kat f X111 e`tir Date 2.17.17 Issued by:SEAN HATCH
t......„...."2
Date:02/17/2017
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofmg 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(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:2.17.17
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,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 I.
be deemed revoked. Owner or authorized agent: R,�(-VA 11'titer ,1 7
APPLICANT CERTIFICATION Date:2.17.17 l
I certify that I have read this application and state that the above information is CONSTRUCTION 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 D CLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Signature Date 2,17.17 Licensed
Si
g Professional
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 22
(408) 777-3228• FAX (408)777-3333•buildino cuD9 tino.ora 5-®qf -'ate
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• NIpLuivaiNG DMECH LAICAL El ELECTRICAL El MISCELLA..NEOUS
PROTECT ADDRESS ,' L0 4 S
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CONTACT NAME PHONE MAD
STREETADDRESS CITY,STATE,ZIP FAX
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❑ ONtvea 0 OA?�.RBUEo 0 o,,NER AGt'r 0 CONTRACTOR 0 CONT SCTORAI? 0 ARC.,..eCT 0 ENC-D 0 DEVELOP c, 0 TENANT
C .�CTORI�A - LTC A'L't:C= 4 LICENSE t - -
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ARCHITECT/ENGINEER NAME . • LiC TSE NLASER BUS.LIC r .
CON3ANQYVA113 •
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STREBT ADDU SS •
1 CITY,STATE,ZS I PHONE
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USE OF 0 S.FD or D'JPLr'Y, 0 MULTI-FAT LY PROTECT LR WB.DLAN'D 0 YES PROTECT RI 0 YRS IS TETI BLDG AN ❑YES
BULLIVO: ❑C01,2, -RCL'.L I�uEA?I0TERFACEAREA ❑ NO 51.000?OMS 0 NO =BIM Home? 0 NO
DESCP71TION OF WORK • ,
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kkn 0,10.arl e0- ' curb cAdj)(3_-(- \noose- r
TOTAL VALUATION: $ zr'^f41- E .F G .
By my signature below,I certify to each of the following: I am the property owner or authorized aent to act on the property owner's behalf. I have read this
application and the info:ration 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 haws relating to build ,o - 3'1ction. I a L' Orin esenta Ives of Cupertino to enter the above-ides timed properly for inspection purposes.
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@,\meq SPRIT.,9,,,,, ,, f,
CUPERTINO SANITARY DISTRICT S sON
20863 Stevens Creek Blvd#100, Cupertino, CA 95014 za,,; ;
Tel (408)253-7071 • Fax(408)253-5173 •s-,- 41sx.3'44
46` CUPERTINO
SANITARY DISTRICT PERMIT LETTER
Cupertino Sanitary District has adopted Resolution No. 1263.
Building Permit Request
(Over-the-Counter)
`Single Family Project ❑ Multi-Family Project Commercial Project
Project Address: /I(O'er i R.7.,4_, �ou1 n4.
Permit Number: V J
•
Scope of Work: ?/i A --/- /0114-'\ 616 '- i ll-zd _ei ,,g
Owner/Applicant Name: Si mai i ?/c.G IU Phone: r"358-(�`al
Address:
Date: Prepared By:
City Authorized Representative
I, as property owner or authorized agent, acknowledge that all Cupertino Sanitary District requirements
will be met and all required fees will be paid prior to the approval of final inspection for proposed project.
Date: Signature:
Owner/Authorized Agent
CUPERTINO SANITARY DISTRICT OFFICE USE ONLY
n Pre-inspection Requi e Final Inspection Required
Date Scheduled: 14,--
Date: Conditional Approval By:
Authorized Representative
Cupertino Sanitary District
District will notify owner of the required fee within 5 days after Pre-Inspection has been completed and cc
City of Cupertino.
a Inspection Fee Paid Date Paid: - -- I-7 `(7
Inspect•n Fees:
1 $250/unit-Single Family Residential already connected, but new cleanout is required
ll $150/unit-Single Family Residential already connected with existing cleanout in working order
LI $350 Minimum-Commercial and Retail Actual Amount:
0 $200/each-Disconnect and/or abandon lateral service
Connection Permit Fees:
0 $350/unit-Single Family Residential connecting to existing lateral
0 $650/unit-Single Family Residential connecting with new lateral
0 $100/unit-Multi, Hotel, Living Units, etc. Actual Amount:
0 $500/connection -Commercial and Retail Actual Amount:
Connection Use Fees(See Attached Calculation Sheet):
0 Area and Frontage Fees Amount:
0 Residential Excess Fees over 3.5 unit/acre Amount:
I—I Commercial and Retail Connection Fees Amount:
71 Commercial and Retail Change in Use Fees Amount:
Date: P f_ k-7 Final Approval By: . Mig-e--Th k-----,,
i Authorized Repreesenti i
Cupertino Sanitary District
'rl-
SMOKE I CARSON MONOXIDE ALARMS
OWNER-CERTIPICATE. OFCOMPLIANct
-COMMUNITY DEW-LOPMENT QFPX�TmMqT* gUILOING DIVISION
0304TORRE�AVEN
_UE OP8911NOXA9,
14 81 -0.228 I -FAX. (400
41A
PURPOSE
imtagat'o"Pf a"' reqi"!rCdSTn0ke and -Ca rbOn Monoxide Alarm for
ZOW
Plianoe& ' W
fflb 201.6 CIRCS'ection, R314,.R3'15, 7016,CBC Sections 420.6 and 907,211.2:wh'*Iior access
frtrin. pat,ons are, req.lir d:
GENERAL INFORMATIONi
Existing Single-familY andmuld-6 mily dwellin shy be i
IVvigil
. P . PTOV ded WA Sm6l<e Ala;,Tms and Ca.r�ojt
110noxi'do-a"laons, Aq�onthova tibli, of'Additiorm, alterations, or repaid t6-existiq4'dwelling Unit% exceeds
aila
C1C5_eM'dA1 X14, R4%And CDC SectiOnS 907,2.11. and 420.6 require that Snjoke Alarms and/or
Carbon Monoxide Ajr ins-Wjed in the foHow-
ing locations�
Outgide af each se
p.MtO Sleeping are,ivt the imm
edjate vicil-lity pf tile
b A
on
j jti
,7v
Carbon PMoikoxide alarms are not
r!letltdred in dwelfinggs which do not cdntain, fu -burn zkpplian&as and that.
don have an attached-gbra ge.Carbunmo'
noxide alanns-.c rabiPe,d with smol;e ahimls shall -comply. with
CBC',k1cfi0n,4 l.6 and shall be approved by the Office of'!the State Fim. IMarglijil,
W power supply, alarin I)Atter operated,
In.vN15fitig dw'011ing unit,
not .. r % ala rMIS ere, Permitted to. be solely battery operated where hairs or alterations, do
ll: inti eremoval of ,1Ila nc- cellingj
, f vy,l,
or there is nQ acv ess'by means of snns attic Refer to rRC R314 Secti 154sernentor0rawl
pace,
On on
907,2,1'1'.4'and 4220.6.2, An electrical permit. is raquiwd. fo±
, 'Avu 16 mu'
{al 'h st be connected ,6,� the buff4ingiii r.
- I $I W. '
As owner of IN above -referenced pppefty., I ljer, bycrtify that j� 'h areferenced -above kujhave been
_c' e 1 1( am s )
installed in arcordance, with fl*. mapufaCtUrees instrwfiong- and,in cornph!mce with theC.4 arnia Bui ding
and Cali6mia Residea fidt-Codo, The alarrn* specifif4d I bel W- have beim tested, and are
operationat, as of' tbe
date signeii bejow
Specif 0.1
y N(nob O(AWrms:
haVe rbad and e to E=1Z saqh t0rwa ascffhjs :stetgnXW_'
Z
712-111
C
%�Oke, and
WATER -CONSERVING PLUMBING FIXTURES
i OWNER CERTIFICATE.OF COMPLIANCE
COMMUNITY DE WELOPMIENT DEPARTMENT - BUILDING DIVISION
CUP#t .# 1030TO
0 RRE AVENUE - OU PERTWO, CA 95014-3255
E
0"'.(408)777�,3228-ir'AX-(4n),777.-3333-_',��klq:i aT
A
Owner _,Nalue
-Perin it No
C
Address e7 I
JA_�,
Is 'You]- re ' al property registered ?
Mstoricalisite
El Yes Civil Code Scebuns 12171.1 tbro,'agli 1101.8 do not apply. Skip the rest of the form and sign bottom of form,
X_No Go to Question 2.
Does your real property have a licensed I plyrnber ccrtifyirig that, due to the age or configuration of the property or its
plumbing, installation of fixtures is riot Technically feasible?
Civil Cade Sections 2101..1, through I W1 .8 do not ap
I - , ply.
0 Thu licensed plutilber's, cert.;,fication has been provided to the Building Division.
No Go to Question 3.
k -water service permanently disconnected {fbr your building?
0 Yes Cvvi I Code Sections 1101-I fluough t 10 1.8 do not apply, Skip tile rest of the m and sign bottom of form.
N' 0 Go to Question 4.
Is your real property built and available for"use oi- occupancy on orbefore January 1, 1994?
0
No Myreal propertyiNbuiltand ava!i[able,flor use or occupancy after January 1, 1994,
Civil Code Sections 1101,1 throlligh 1101.8 dorootapply. Skip the rest of the foMa and sign bottom of fibrin.
Yes- My reTt property is btrilt and'avitildble for u or occupancy can orbef«rq January 1, 1. 994.
ckdl Code Sections 1101,1 thrM4gh 1101.8 apply- Check one of and sign,
bottom of ffirrn, i .
}, Please chick qNE of tile followin.-
My property is ashlgk-/cVn41, residen-ti d
I real property. See Civil Code Section 1101.4,
Ou and after January 1, 2014, building 41teratioxu& or it.riprovem
ents shall require all 'non-coinpliant plumbing fixtures
to ba replaced 'with 'water -conserving pliA d Inbing fixtures throughout the building. On or before Jatluary 1., 201.7, all non-
,compliain- plumbing fixtures shall be Ire -placed with wator-conserving plumbing fixtures (regardless of whether
property undergoes,alterations or unprovementi),
01, My property is a nudiji'aodly residential teal property. See Civil Code Section 1101.5.
On Prid after January 1, 2014, specified 1juilding alterations ornriprovernents, shall require lion- compliaut
--r rtilwbini fixftlr-e s-to-b—c' rep -laced with 6i 1-1 "Pi x tu r6 s-, __
0n or before Jarnuary 1, 2019, 19, a I I noncoblpli ant pluMb in 9 -fixtures shall be rf" placed with iv. a ter -
i ing C, the building (regardless (if whether property undergoes alterati ja8 o
C-011servin"),plutub - fxturesthroug, lioui 1
improv, ements ),
1,143? property isla cotnty-m-rcial red]. properfySee Civil Code Section 1101.5.
and
,)n after)anuary-1, 2014,specificelbUilding alterations or improvements ,,,,hall require non- compliant
pluiribing fixfua` es to be replaced -%vith w#ter-conserving pluinbi1v fixtures.
On or beftife J'anuaily 1, 2019., aJl iioiicornpliant pturnbing fixtures shall be 'replaced Avfth water- conserving,
plLunbing fixtbre.-IAhrou.4-Lout the building (reg ardless of- whetberprOperty utidergoes alterations or iinprovernents).
1, -,1-, tile oAvilar or o acyclit of th is propt, iy, certify tinder etialty of perhuy that non-compliant
ZV P Plumbing fixtures v, -J11 be
replaced prior to chat e,�,pccified abovewithing
ter-conservi pluirbing fixtures in accordance vvith Civil -Code Sections 1,101.1
through 110 LS, the cufrout catirbrilia manti
Ping Code andQatif6rnia Green Building Standards Code, and ni"ufacturei�s
tm,tallation requiremems, and,Vhat the water-ic-onservinip2iirrbing fixtures comply Nvith the requirements as indicated in flic
table on the following ntai-e,
Owner or Owner Agent's Signature: Date:
Upoii 6ornpletingand Signing this Certific,14e, plcas(Xtumi, to the Buildina Division in order to final. your building pe-nnit-
SE407 12015.doc reviyed