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
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IgIPLUMBING I—(MECHANICAL I—F.TF.CTRTCAT, F IMTSCF.T.T.ANP.nTTC
PROJECT ADDRESS
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APN # a ,. 62- C�
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OWNERNAME � G � J iR.,t7 IJ�1
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PHONE f G �Q qa3 �%( 00
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR 2CONTPACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
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CONTRACTOR NAMED
LICENSE NUMBER y/ j�
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LICENSE T Tn
BUS. LIC # 2:IW14 0
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COMPANY NAME ^�%' p IYJJ l��l�° ✓ n'l '� el
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STREET ADDRESS2� SA%o Cr
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ARCHITECT/ENGINEERNAME
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LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
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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:.
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STAN AAO
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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'�
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�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
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Si.
. ............................... .. ............
Contractor Name:
Signature ............. .................................. Lic.#�. ................ Dated.:. 9.-,...
Smoke and CO form.doc revised 01/10/2017