B-2017-1511 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1511
7528 DONEGAL DR CUPERTINO,CA 95014-5218(366 16 058) AFFORDABLE WATER
HEATERS AND
PLUMBING INC
VALENCIA,CA 91355
OWNER'S NAME: SIVARAMAKRISHNAN VISWESWAREN AND RAMAN ROOP DATE ISSUED:09/08/2017
OWNER'S PHONE:408-873-9423 PHONE NO:(855)345-9087
`- - I IL t: 11'..1_ :_t_:_ IL BUILDING PERMIT INFO:
License Class C36 Lic.#627368
Contractor AFFORDABLE WATER HEATERS AND PLUMBING INC Date x BLDG _ELECT X PLUMB
09/30/2018 _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 JOB DESCRIPTION:
license is in full force and effect. REPLACE WATER HEATER(50 GAL)SAME LOCATION
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
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 Sq.Ft Floor Area: Valuation:$1949.00
permit is issued.
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 366 16 058
and state laws,ielating,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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR
may accrue a•.i, ,said�'City in consequence of the granting of this permit.
Additionallyga•p leant understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION.
source regula§•ns ••r,th`e Cupertino Municipal Code,Section 9.18.
Issued by:Kim Dunbar
Signatu,P" •®�!
Date 09-08-2017 Date:09/08/2017
I .IL_ -t d141f S: PI - •-`•- -aL RE-ROOFS:
. All roofs shall be inspectedprior to anyroofingmaterial beinginstalled.If a roof is
I hereby affi+��;f i at I am;'exempt from the Contractor's License Law for one of the P
following two're=sons: ,' installed without first obtaining an inspection,I agree to remove all new materials for
i. I,as caner of the property,or my employees with wages as their 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:09-08-2017
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. I 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
pemut,ts issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous
s. I certify that in the performance of the work for which this permit is issued,I material. Additionally,should I use equipment ordevices which emit hazardous
shall;uot 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
will maintain compliance with the Cupertino'Municipal Code,Chapter 9.12 and
Worker's'Compensation laws of California. If,after making this certificate of the Health&Safety Code,Sections.25505,25533,and 25534.
exemption,I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall Owner or authorized agent:
be deemed rvoed. Date:09-08-2017
,APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is 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 • ITECT'S DECLARATION
and will comply with all non-point source regulations per the Cupertino Municipal I understand my pj s all ^e used as public records.
Code,Section 9.18. .
Licensed/
Professi
Signature Date 09-08-2017 , j
\-.1
•
CONSTRUCTION PERMIT APPLICATION
\ `— COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
rV 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
'gf.tID,r
w. s,- (408) 777-3228 • building��cuPertino.org PEMIT#B-
- it_SI
CUPERTINO REVS DEF#
❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. �1a MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS 15n (�- �or A s. I Dr, APN# 3� /, �
OWNS ME L CJX C� P ONS (�E-MAIL
6 0 0.3 9473
STREETADRES, C/ T/ryvV1S2 dOveer1 Dr a501-1
rCONTRACTOR NAME ❑OWNER-BUTtvf12 COMPANY NAME
LICENSE NUMBER LICENSE TYPE
P, (6rq 'v,�QL.1.J4��.-
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, ❑ARCHITEj❑OWNER ❑OWNER AGENT ❑CONTRACTOR AGENT 0 ENGINEER DEVELOPER❑TENANT
CON�9CT NAME E-MAIL @- 1
Irp
S S 1 R'.V"",�'� 4" T -1 CV I�A� ISP 1 .CA, q, J-�J � QNUI,) ,,3,CJ/o
DECRIPTON '
ep/g�� 6,)q- 1-t-64. �.- 5b 34,)1 6.,
g am 0 ,sfdi d(xtrP
tliSINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL I
EXISTING USE EXISTING SF NEW FLOOR SF,PORCH SF DECK SF DEMO SF STORIES I TOTAL NET Si USE TYPE OCC SQ.FT. VALUATION($)
REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED
BATHROOM SF SF SF SF 0 DETACHED
EXISING ❑YES EICHLER ❑ YES SECOND STORY ADDITION ❑YES
FIRE SPRINKLERS❑ NO ❑ NO 0 NO
DWELLING SECOND DWELLING ❑yEs (ATTACHED 0 DETACHED OTHER
UNITS a : UNIT ADDITON: ❑NO S F
'
POOLS' ❑FIBERGLASS :12 VINYL-LINED 0 GUNITE '0 PREFABRICATED
POOL-SF SPA'-SF I SPA ATTACHED 1:1 YES ❑ NO I TOTAL-SF
�I
RECEIV Y, / TOTALT�TION:
Commercial or Multi-Fmvilu Buildings with Pithily Swimming Pools remrires Department of Environmental Heath approval f r ''`A
RE-ROOF'EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES WOOD SHAKES❑WOOD SHINGLES E TILE OTHER(SPECIFY)
REMOVE/REPLACE❑NO IF NO PLYWOOD ❑'A„ ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
1=1YES 1i9'OF LAYERS THICKNESS El 5/8" OTHER ❑OSB ❑CDX OTHER •12 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF DASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES ❑OTHER
*Provide a signed copy'o'f the Cupertino's Tear-Off Policy SF Oaf SQUARES
By my signature below I certify'to,each of the following:, I am the property owner or authorized agent to act on the property owner's behalf. I
have read this application and..,the.information I .ave provided is correct. I have read the Description of Work and verify it is accurate. I agree
to comply with all applicable local or`d•. nces . d state laws relating to building construction. I authorize repr sentatives of Cupertino to
enter the above-identified property for- .pe=p . poses. I acknowledge and authorize all inform.atigt�c I ii ed�Tg this application form
to be made available for public record.
Signature of Applicant/Agent: Date:.
SUPPLEMENTAL INFORMATIO`.RE'1 UI r ED
' *New SFD/Second Dwelling Units/Mul famil, Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction,
*Commercial Buildings: Provide a co i.lete•Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
*Copy of Planning Approval Letter or .eeti,g with Planning prior to submittal of Building Permit application.
*HOA-Provide a letter of approval from the Home Owner's Association
BldgApp_20I7.doc revised 08/01/17
A F F TEA
R DAB L E
AND PLUMBING INC .
March 2017
LETTER OF AUTHORIZATION
"I, undersigned, give permission to accept any of the signatures that appear below, on a
permit being issued, in lieu of my signature at the counter. I hereby certify under penalty
of perjury,that I will comply with all declarations and agreements on the permit, which
bears my signature or my representative signature, and as required by the city."
The following authorized representatives have my permission to sign and take receipt of
construction permits in the name of my company:
Jorge Becerra
Leonce RouxAtec-�
Contractor Name Contractor Signature Date
Contractor Information:
Affordable Water Heaters & Plumbing, Inc. Phone: 855-345-9048
28358'.Constellation Road #698
Valencia, CA 91355
Contractors State License Number: 627368- Class C 36
Workers Comp Insurance:
Insurance Company of the West WSA503249701 Exp. 1.1.18
See Attaphed Calif
AcknowEedgmertt
See Attached California
Acknowledgment
28358 Constellation Road, Suite 698 • Valencia, CA 91355
(855) 345-9048 • FAX: (661) 259-9556 • www.waterheatersandplumbing.com
CA State Lic#627368
; ,::;,,:::0,,,,•, -4," ,
SMOKE I CARBON MONOXIDE ALARMS
rb. .. OWNER CERTIFICATE OF COMPLIANCE
,.. .
COMMUNITY DEVELOPMENT DEPARTMENT.BUILDING DIVISION
cuPERT1,140
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
' --., - ,
.- '. (408)777-3228.FAX(408)777-3333.-buliciincletipertino.orq
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42,,• ,-,„ 444;/,44 4
1 kl",e;• PERMIT7C,AlsjNOtREFilN'TAIEDATISITIL:TEIIS aRITEICATE ILAS,BEEN--,-,'''''''',,A- , =
, .
, .
'-''' s''',.`4,,'''' 'OMPLETED ,SIGNEV,AND RETURNED TO TIIE BUILDIPN,91)1VIS P. --,t'' ', 11
PURPOSE
Thisaffidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms
-',...
. ' for compliance with 2016 CRC Section R314,2016 CBC Sections 4206 ana907.2.14wheienOMterlor access ,...,
-
for inspections are required..
GENEL INFORMATION ' • - , , :''•''”''.,`''''' ''''' --.'"- ,
Existing single-family and multi-family dwellings shall be provided with Smoke Alarms and Carbon
11
' - ,. • • -toexisting dwelling units exceeds
Monoxide alarms. When the valuation of additions,alterations,or repairs , .
$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 in the following locations:
AREA SMOKE ALARM CO ALARM -I
____
Outside of each separate sleeping area in the immediate vicinity of , X X
the bedroom(s)
_
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 mono)dde: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
-' es It in the removal of wall and ceiling finishes or there is no access by means of attic,basement or crawl *'
:4:- ''''''''' 11-1-- -''''.'
'- -
ction R314 and CBC Sections 907.2.114 and 420.62.An electrical permit is required for
pin e-. )
alarms whiehi -. ceeteato e building
wiring.
.*77 ,,". .,'. -
As owner of the above-referenced property,I hereby certify that the alarm(s)referenced aboye has/have been
installed in accordance with the manufacturer's instructions and in compliance withthe California Building
1.- and California Residential Codes.The alarms specified below have been tested and are operational, as of the
date signed below.
, . .. „
Address: -7 s z r )2 0 r-, i-(1 Gt./ Permit No. b'2.0/ 7
Specify Number of Alarms44 Smoke Alarms: 6 4 CarbbiiMonoxide'Detect°Tc:
:
I have read and agree to comply ' the terms and conditions of this statement
,_
Owner or Omer Agent's)Watrm,t-
,, ii T170 r Of 4 i.-1 (-- v v''' 1 t.•1 SignatureDate:
...............401r.119 . 1 ' w 0
7
Smoke and CO form.doc revised 1241 5/1
00
Plt
Ls ,
:4 SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE I Il
4,4
1-19COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO O 10300 TORRE AVENUE• CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildinci cupertino.orct
PERl1'IIT CANNOT Il t1 ALED UNTIL 1 HIS CERllI'ICATE.PIAS BEEN
COMPLEI .D,SIGNED,,AND RETURNED TO TO BUILDINGDIWSION
.............
PURPOSE —
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms
for compliance with 2016 CRC Section R314,2016 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 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 X X
the bedroom(s)
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 907.2.114 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
Address. 7 ,SZ b Yl Numbere et �/ C� Permit No. a2 0 - I J-/ /
s- � c
Specify of Alarms: #Smoke Alarms: NEM #Carbon Monoxide Detectors. M •3 I
/have read and agree to comply wit the terms and conditions of this statement
Owner(or Owner Agent's)Name:
�� g s Signature �i�^'� /` Date: �o�%i«
o2ttr ctorN me:bl V✓c71 Cr
Signature Lic.# .LO. .7 ? C� Date./ 22 /7
Smoke and CO fonn.doc revised 12/15/16