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B-2017-0357CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0357 6413 BOLLINGER RD CUPERTINO, CA 95014-4632 (369 20 028) PACIFIC PLUMBING & SEWER SERVICE INC MILPITAS, CA 95035 OWNER'S NAME: JARAMILLO RUBEN AND ROSALIE TRUSTEE & ET AL DATE ISSUED: 03/03/2017 OWNER'S PHONE: 408-423-8000 PHONE NO: (408) 894-9120 LICENSED ONTR TOR' DECLARATION BUILDING PERNUT INFO: License Class C-36 Lic. #745976 Contractor PACIFIC PLUMBING & SEWER SERVICE INCDate 05/31/2018 X BLDG —ELECT X PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing MECH X RESIDENTIAL COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: REPLACE SEWER MAIN; PROPERTY LINE CLEAN OUT I hereby affirm under penalty of perjury one of the following two declarations: t. 1 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 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 permit is issued. Sq. Ft Floor Area: Valuation: $2000.00 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 369 20 028 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 against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature,Zf6c�e� Date 3/3/2017 Issued by: AbbyAyende OWNER -B iii D R DECLARATION Date: 03/03/2017 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 roofing 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 (See.7044, Business & Professions Code). Date: 3/3/2017 I hereby affirm under penalty of perjury one of the following three declarations:ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER s. 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. 1 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 2 505, 25533, and 5534. Labor Code, I must forthwith comply with such provisions or this permit shall �G�'���� be deemed revoked. Owner or authorized agent: i y G APPLICANT CERTIFICATION Date: 3/3/2017 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 DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 3/3/2017 Professional GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ( ` I 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 MIS ��, ��� (408) 777-3228• FAX (408) 777-3333 • building&cupertino.org - IC IgIPLUMBING I—(MECHANICAL I—F.TF.CTRTCAT, F IMTSCF.T.T.ANP.nTTC PROJECT ADDRESS ChM APN # a ,. 62- C� (.J OWNERNAME � G � J iR.,t7 IJ�1 L L0 PHONE f G �Q qa3 �%( 00 111 b v-- E-MAIL STREET ADDRESS S� kC^ �K�f CITY, STATE, ZIP FAX CONTACT NAME O i � % {� � I PHONE $ q4 0 E-MAIL ,C� I STREET ADDRESS CITY, STA/TE, ZIP F ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR 2CONTPACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT '� ly} e l CONTRACTOR NAMED LICENSE NUMBER y/ j� ' Er LICENSE T Tn BUS. LIC # 2:IW14 0 "®C�p't COMPANY NAME ^�%' p IYJJ l��l�° ✓ n'l '� el EMAIL t� FAX ij1q Tj STREET ADDRESS2� SA%o Cr CITY, STATE, ZIP l�)IV PHON`$ ARCHITECT/ENGINEERNAME [ � LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF 2SFD.,DUPLEX ❑ MULTI -FAMILY BUILDING: E] COMMERCIAL PROJECT IN WILDLAND Q YES URBAN INTERFACE AREA p NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES EICHLERHOME? ❑ NO DESCRIPTION OF WORK J WJ C' C N-0qT TOTAL VALUATION: , `RE By my signature below, I certify to each of the following: I am the property owner or authorized agent to action the property owner's behalf. I 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 cons ctio I auth ' e pr entatives of Cupertino to enter the above-idre�nti ed pro erty for inspection purposes. Signature of Applicant/Agent: Date: SUPPL MENTAL INFORMATION REQUIRED OFFICE USE orti Y:. ''"; ;.❑ .OVEB-THE-COUN'TER':.,...; p�W.+,; �^ D EXPRESS ' STAN AAO 0 LARGE fes. i ;.� MAJOR MEPMiscApp_2011.doe revised 06/21111 CUPERTINO SANITARY DISTRICT 20863 Stevens Creek Blvd #100, Cupertino, CA 95014 Tel (408) 253-7071 • Fax (408) 253-5173 ,A8 OKITA,?,b'� v �sP'Tgt rsaeo ~9 c} 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 Permit Number: Scope of Work: A- Piv 3b01 -2_0-02_F' Owner/Applicant Name: 'Fke,1 r -t c- 'Pkt_,V�16 k� - r Address: Date: 3 I 1(-7 Prepared By: CA Phone: ` cV - Thy - 9f2-0 City Authorized Representative 1, 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 appy val f final inspect' for proposed project. Date: 3 I 17 Signature: Owner / Authorized Agent CUPERTINO SANITARY DISTRICT OFFICE USE ONLY ❑ Pre -inspection Req ui edK Final Inspection Required Date Scheduled: 4- ����,J/ Date: Z11 Conditional Approval By: c%�`r-i t Authorized Repr en ative Cupertino Sanita trict District will notify owner of the required fee within 5 days after Pre -Inspection has been completed and cc City of Cupertino. NInspection Fee Paid Date Paid: —� Insp tion Fees: $250/unit - Single Family Residential already connected, but new cleanout is required (Cjx_e&�_oo� $150/unit - Single Family Residential already connected with existing cleanout in working order [� $350 Minimum - Commercial and Retail Actual Amount: O $200/each - Disconnect and/or abandon lateral service Connection Permit Fees: D $350/unit - Single Family Residential connecting to existing lateral $650/unit - Single Family Residential connecting with new lateral D $100/unit- Multi, Hotel, Living Units, etc. Actual Amount: $500/connection - Commercial and Retail Actual Amount: Connection Use Fees (See Attached Calculation Sheet): (� Area and Frontage Fees Amount: C� Residential Excess Fees over 3.5 unit/acre Amount: Commercial and Retail Connection Fees Amount: D Commercial and Retail Change in Use Fees Amount: Date: — I Final Approval By: �l-t'(, ° Autho i ed Representative Cuperbfio Sanitary District CUPER' (NO PURPOSE 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 • buildinct(cD-cupertino.org PERMIT CANNOT.BE FINALED UNTIL TH)CS CERTIFICATE HAS BEEN COMPLETED, SL Gn�, AND U_ U & + D TO THE BUILDING DIVISION 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 X X bedroom(s) — (Smoke alarms shall not be located within 3 feet of bathroom door) On every level of a dwelling unit including basements and habitable attics X X Within each sleepi Mroom i� 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 t6 CRC Section 8314 and CBC Sections 907.2.114 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. C> `b -7 ",�`- Address: �yV�)fb ��i 03 Permit No. Specify Number of Alarms: # Smoke Alarms: 1 `7 1 # Carbon Monoxide Detectors: l have read and agree to comply with the terms and conditions of this statement Owner (or Owner Agent's) Name: L Cm -.(.Dae Si. . ............................... .. ............ Contractor Name: Signature ............. .................................. Lic.#�. ................ Dated.:. 9.-,... Smoke and CO form.doc revised 01/10/2017