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14060092CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 891 E ESTATES DR CONTRACTOR: ROCHA'S COMPANY PERMIT NO: 14060092 OWNER'S NAME: CHAUDHARY VIVEK AND MALIK SHILPA 2191 MONTICELLO AVE DATE ISSUED: 08/11/2014 OWNER'S PHONE: 4086219723 SAN JOSE, CA 95125 PHONE NO: (408)593-7405 ❑ LICENSED CONTRACTOR'S DECLARATION f— r— � BUILDING PERMIT License Class Q20 Lic. #--�SLi�! % 2. INFO• BLDG ELECT PLUMB �— F � MECH RESIDENTIAL COMMERCIAL Contracto Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION CONSTRUCT A FIRST FLOOR ADDITION (1054 SQ FT); (commencing with Section 7000) of Division 3 of the Business & Professions WITH COVERED FRONT PORCH (81 SQ FT), AND TWO REAR Code and that my license is in full force and effect. COVERED PATIOS (351 SQ FT); SECOND FLOOR ADDITION I hereby affirm under penalty of perjury one of the following two declarations: 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 Sq. Ft Floor Area: Valuation: $300000 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION APN Number: 36924023 00 Occupancy Type: I certify that I have read this application and state that the above information is o correct. I agree to comply with all city and county ordinances 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnity and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Ad itionally, the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non -point sourc egulations per the perti unicipal Code, Section 918. S e ature Dale -.21.1— 1 �[ Issued by:^o/� j �i Date: G ' p ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is the following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for 1, as owner of the property, or my employees with wages as their sole compensation, inspection. will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant: Date: 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1 hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation, as provided for by Section 3700 of the Labor Code, for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance, as provided for by compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Section 3700 of the Labor Code, for the performance of the work for which this Safety Code, Section 25532(a) should I store or handle hazardous material. permit is issued. Additionally, should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued, I shall contaminants as defined b the Ba Area Air y y Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health & S Code, Sections 25533, and 25534. Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I mu forthwith comply with such or this shall be deemed r uthoriz eig Date:7, provisions permit revoked. 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 of work's correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued (Sec. 3097, Civ C.) to building construction, and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, Lender's Address costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section ARCHITECT'S DECLARATION 9 18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 891 E ESTATES DR CONTRACTOR: CHAUDHARY VIVEK PERMIT NO: 14060092 AND MALIK SHILPA OWNER'S NAME: CHAUDHARY VIVEK AND MALIK SHILPA 891 E ESTATES DR DATE ISSUED: 08/11/2014 OWNER'S PHONE: 4086219723 CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL [J COMMERCIAL CONSTRUCT A FIRST FLOOR ADDITION (1054 SQ FT); License Class Lic. # WITH COVERED FRONT PORCH (81 SQ FT); AND TWO REAR Contractor Date COVERED PATIOS (351 SQ FT); SECOND FLOOR 1 hereby affirm that I am licensed under the provisions of Chapter 9 ADDITION (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. 1 hereby affirm under penalty of perjury one of the following two declarations: 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 Sq. Ft Floor Area: Valuation: $300000 performance of the work for which this permit is issued. 1 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. APN Number: 36924023.00 Occupancy Type: APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. 1 agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS O+ RMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS ALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, / costs, and expenses which may accrue against said City in consequence of the g//!' / granting of this permit. Additionally, the applicant understands and will comply Da e: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS - Signature Date All roofs shall be inspected prior to any roofing material being installed. if a roof is installed without first obtaining an inspection, 1 agree to remove all new materials for inspection. OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous 1 have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: permit is issued. I certify that in the performance of the work for which this permit is issued, 1 shall of employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, 1 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CONSTRUCTION PERMIT APPLI r COMMUNITY DEVELOPMENT DEPARTMENT • BUILDIN 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • build in cu mertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI VISION DEFERRED ORIGINAL PERMIT # I,e()CUa7Z PROJECT ADDRESS 7 s I APN # OWNER NAME w PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP 0-7 FAX CONTACT NAME PHONE E-MAIL ( \) —� vC , r STREET ADDRESS CITY, ST ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # 1 COMPANY NAME E-MAIL ` FAX -F -J AJIA%� / STREET ADDRESS CI , STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK D EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK(PORCH AREA GARAGE AREA: DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑YES BEING ADDED? []NO ADDITION? ❑NO PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY: TOTAL VALUATION: PLANNING ADPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO By my signature below, I certify to each of the following: I am the property owner agent to act on the property owner's behalf 1 have read this Fonzed application and the information I have provided i o Tect. 1 h read the Des1riptiork and verify it is accurate. 1 agree to comply with all applicable local ordinances and state laws relating to buildin structin. au orize repr entaupertino to enter the above-iden 'feed purposes. =tion Signature ofApplicant/Agen Date: / SUPP ENTAL INF*MATION REMIRED PLAN CHECK TYPE ROUTING SLIP' ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure C1 STANDARD El PUBLIC PUBLIC WORK form if any Hazardous Materials are being used as part of this project. ❑ :LARGE ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to F-1 MAJOR El submittal of Building Permit application. SANITARY SEWER DISTRICT ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06121111 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(o)cupertino.O g ❑ NEW CONSTRUCTION ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS�I APN # — / OWNER NAME ��E I 1//1 v 1 1 _ � 2 PHONE10� -U21(� 4ZIP o a/b E-MAIL STREET ADDRESS /y' (/r / CITY, STATE, FAX - ` � 1 CONTACT NAME � � � � `, � � PHONE � o ttt E-MAIL STREET ADDRESS Q^�� /( �411 4P er CITY, STATE, ZIP Jos -e CJI) FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT gr ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAMEAdo G (� LICENSE NUMBER BUS. LIC # ^ ^x�` 4 e�I _ t / COMPANY NAME 9 6 I� `7 Il...' ` '� E-MA[L % �' a� Qg"'l+ 1y� FAX STREET ADDRESS lG�� CITY, STATE, ZIP G I Int, q'9112-- P*Nk/2-"IZ,W INj W DESCRIPTION OF WO RK I _ vl _ `� A)) EXISTING USE PROPOSED USE -- le -USE -- CONSTR TYPE # STORIES TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA { NEW FLOOR DEMO AREA I ` b 3+� AREA I o 00 TOTAL NET AREA BATHROOM REMODEL AREA KITCHEN OTHER REMODEL AREM -' REMODEL AREA JJ ►(JM ,j" , V PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH 161Cot--b'2 S TTACH G�j R j� l o'k, / �` / SI # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY S 1 BEING ADDED? ANO ADDITION? NO PRE -APPLICATION IF YES, PROVIDE COPY OF PLANNING ADPL # ❑ NO PLANNING APPROVAL LEITER IS THE BLDG AN [3 YES EICHLER HOME? ❑ NO i2ECIVED BY��y� �kw4,`�L°".4 Xtl� sxxh*d� ,.Y'�� x. TOTAL VALU�j /T)ION: o SOV „t?y z,'`' �tr `'IOU (/ r 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 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 cont cti of Cupertino to enter the above-ide ified popcrtv for inspection purposes. �ri�zerepresentatives Signature of Applicant/Agent: Date: fI SUPPLEMENTAL INFO"ON ON REQUIRED © �� New SFD or Multifamilydwellings: APP1 for demolition Permit for existing building(s). Demolition permit is required prior to issuance of building OYER i copNTrR c�riAty F'ti permit for new building. �xP�ss '� o)Gi�Y1YREYEWf Commercial Bldgs: Provide a completed Hazardous Materials Disclosure A7vnAttn r� form if any Hazardous Materials are being used as part ofthis project.' Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. ,, `, fi �}� 5 y " BldgApp_201 1. doe revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION limADDRESS: 891 East Estates Dr DATE: 01/12/2015 REVIEWED BY: Sean APN: BP#: `VALUATION: 1$1,200 nPERMIT TYPE: Building Permit Suppl. PC Fee: D Reg. Q OTT PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: $0.00 PENTAMATION 1GENRES PERMIT TYPE: WORK Revision #1: Reduce shearwall to add door from bedroom to under stair for storage. SCOPE $0.00 Suppl. Insp. Fee:D Reg. Q OT NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Deptfor addn'1 info. FEE ITEMS (Fee Resolution 11-05.3 Ea'7%1/131 FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 0 hours Plan Check, Hourly $143.00 ISTPLNCK Suppl. PC Fee: D Reg. Q OTT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:D Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential G Building or Structure 0 A Strom Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bld�,, Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $143.00 TOTAL FEE: 1 $144.50 Revised: 01/06/2015 CITY OF CUPERTINO FMP-1 FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 891 a estates DATE: 06/13/2014 REVIEWED BY: Mendez I'PERMITTYPE: APN: BP#: W19 , "VALUATION: 1$300,000 Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: 2nd Unit? 0 Yes No TOTC? 0 Yes E) No PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK 2nd floor addition 1534 sq ft to include 81 sq ft porch, patio 351 sq ft remodel through 1000 sq ft panel SCOPE upgrade 200 amp OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) i1-B,III-B,IV,V-B 1,966 $2,777.30 1R3PLNCK $2,334.50 IR3INSP PME Plan Check: $0.00 LILLs.f. $558.00 Remodel, Other 1REMRESOTH Permit Fee: $2,334.50 Suppl. Insp. Fee:E) Reg. 0 OT 0.0 I hrs $0.00 F-1-367 s.f. Remodel, Kitchen (<=300 sf) $626.00 IREMRESKIT PME Unit Fee: $0.00 PME Permit Fee: $47.00 = s.f. Remodel, Bath (<=300 sf) $626.00 IREMRESBAT TOTALS: 1,966 $2,777.30 $2,334.50 MECH, HOURLY 0 Yes G No PLUMB, HOURLY Q Yes Q No ELEC, HOURLY 0 Yes (E) No MISC ITEMS Elec. Plan Check 0.0 1 hrs $0.00 $2,777.30 200 amps $47.00 Elec. Permit Fee: IEPERMIT ]--7L Other Elec. Insp. 0.0 hrs 1 $47.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addh 7 info. FEE ITEMS (Fee Resol lion 11-053 Ef Z%1%'13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,777.30 200 amps $47.00 Electrical IBELEC200 Services Suppl. PC Fee: (j) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 LILLs.f. $558.00 Remodel, Other 1REMRESOTH Permit Fee: $2,334.50 Suppl. Insp. Fee:E) Reg. 0 OT 0.0 I hrs $0.00 F-1-367 s.f. Remodel, Kitchen (<=300 sf) $626.00 IREMRESKIT PME Unit Fee: $0.00 PME Permit Fee: $47.00 = s.f. Remodel, Bath (<=300 sf) $626.00 IREMRESBAT 0 G Work Without Permit? 0 Yes (D No $0.00 Advanced Planning Fee: IPLLONGR $275.24 Select a Non -Residential Building or Structure E) Q Travel Documentation Fee: ITRA VDOC $47.00 Stronp, Motion Fee: IBSEISMICR $30.00 Select an Administrative Item Bldy- Stds Commission Fee: IBCBSC $12.00 SUBTOTALS: $5,523.041$1,857.00 TOTAL FEE: 7$7,380,041 Revised: 04/01/2014 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 891 E ESTATES DR CONTRACTOR: ROCHA'S COMPANY PERMIT NO: 14060092 OWNER'S NAME: CHAUDHARY VIVEK AND MALIK SHILPA 2191 MONTICELLO AVE DATE ISSUED: 08/11/2014 OWNER'S PHONE: 4086219723 SAN JOSE, CA 95125 PHONE NO: (408)593-7405 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] CONSTRUCT A FIRST FLOOR ADDITION (1054 SQ FT); % License Class Lic. # WITH COVERED FRONT PORCH (81 SQ FT); AND TWO Contractor Date REAR COVERED PATIOS (351 SQ FT); SECOND FLOOR ADDITION I here ,y arm tha I am 1 nsed under the provisi ns of. apter 9 (commencing with Section 7000) of Division 3 of the Business & Professions REVISION #1: REDUCE SHEARWALL TO ADD DOOR Code and that my license is in full force and effect. FROM BEDROOM TO UNDER STAIR FOR STORAGE. I hereby affirm under penalty of perjury one of the following two declarations: ISSUED 1/12/15. 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 Sq. Ft Floor Area: Valuation: $300000 performance of the work for which this permit is issued. l 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 APN Number: 36924023.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the 7 Issued by: fG� Date: granting of this permit. Ad Tonally, the applic t and rids and will comply with all non-point source ulations p e e o unicipal Code, Section 9.18. Signatu z ol Date ��C3­ RE-ROOFS: All roofs shall be inspected prior to any rooting material being installed. if a roof is installed without first obtaining an inspection, l agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.I2 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cup mo Municipal apter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections _ 05, 2553 d Section 3700 of the Labor Code, for the performance of the work for which this Owner or authori agent: Datel permit is issued. 1 certify that in the performance of the work for which this permit is issued, l shall not employ any person in any manner so as to become subject to the Worker's /// Compensation laws of California. If, after making this certificate of exemption, 1 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, l must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that l have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances 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 City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: �' g Z �' �' f PERMIT # ` S l I OWNER'S NAME: C,��.k--.;.i'�J t� �y L,l PHONE GENERAL CONTRACTOR; BUSINESS I.,ICENSE # ADDRESS: moi, p ��' --, CITY/ZIPCODE: "Our municipal code requires all businesses working in the city to have a City of Cupertino business license. O BUILDING FINAL. OR FINAL OCCUPANCY INSPECTION(S) WILL, BE SCHEDULED UNT11- T14E GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millworker-'L-- Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing` S, - Heating I Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing^ - Roofing Septic Tank Sheet Metal'. Sheet Rock._.G Tile A---1- 7--ox- Owner/ , tra for Si ture ®ate CONTRACTOR/ SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertiuo, CA 95014-3255 Telephone: 408-777-3228 Fax: 4()11-777-.3333 JOB ADDRESS: Ainsworth Dr., Cupertino, CA 95014 � 131�°RN41 t � 12120074 __ .. C)tVNl~W S NAM.0 Ryan Lin i — - .............. .1 �liCx408 694-3472 m. . . GENE- CONTRACTOR: Rockstt Inc BUSINESS NSE 432839 .... ..... ......._................................_._ ...._. A,Dlyl ESS:1999 S. Bascom Ave. Suite 700, CITY..."ZIPC;�71-}F _Campbell, 95008 — *Our municipal code requiresall businesses world€ in the city to have a Cy of Cupertino business license, NO BUILDING FINAL OR FINAI., OCCUPANCY INSPECTION(S) `11A., BE SCHEDULED UNTIL THE GENERAL CONTRACTOR ANIS ALL SUBCONTRACTORS HAVE - OBTAINED A (.ITT OF CUI'EI 'I'INO BUSINESS IACt S.I . I ani not using any subcontractors: ._...._....._.. ......... .............................. -................................ -- Signature Date Please check applicable, subcontractors and. complete the following information: ... -................ .............. .................... ... ................... - — -- --- SUBCONTRACTORBUSINESS NAME ' BUSINESS LICENSE ..._.................... --...................... ......................... ............................ _ --- Cabirnets S: Millwork RenovateMax Inc. 3 j Receipt Included .......... . . .. ..... ....... ......._.... C:ernerit Finishing Electrical Shine Electric Inc. 33899 ..... _...... _..... ..... _................---.._..........-............................._...............................__..._................. _.._-- .................... _..... _....__----- F;x.cavtation Straightline Builders Inc. Receipt No. 0100052231 Y Contractor Signature 1/ /7-5 &2,g 1 7 Date U Fencin- .u._ ........ _._.............................................. _............. I ............... ......_ — Flooring,' Carpeting ............... ._................. ..__._............................... _......... __._ Glass/ Glazing RenovateMax Inc. _..........................___........._.._._........_._......................................._._..._ — _ - ... _.... _........... _.......................... ..........._.._..._.._._..-- __. _ Receipt Included ---- _ _. --- �._ ................._........ Fleatrng _.._._.................... ............. .........._.._— Christian Brothers Mechanical of SC Valley Inc. _......__.._.. _—__.. i 25419 Insulation Landscaping Lathing .. Masonry _ _......... _ . ......._..... ................ Painting ,` Wallpaper Paving Plastering ........ ....... .... -... ...... _.._.... - Plumbing Roofing Pacific Plumbing & Sewer Service Inc. Winter Roofing Inc. �_............ - 22640 21207 _....._..... -............... Septic 'yank _......_____...............____...._._ __ ..._ –._.._.._.............. _._ _. Sheet Metal Sheet Rock "File Y Contractor Signature 1/ /7-5 &2,g 1 7 Date U Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 C O P E RT I N O Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: _ E .: :: ; _` ^ e l' " :....< ; PERMIT # OWNER'S NAME: PHONE # GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANC INSPECTIONS) WI BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCO RAC RS HA AINED A CITY OF CUPERTINO BUSINESS LICENSE. I amt using any subcontractors: Signatu Date Please check applicable subcoractoxs and complete the following information: r. f wner / Contractor Signature SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile r. f wner / Contractor Signature CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Tone Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: S q 1 L. C-4takii �%R . tz!Az PERMIT # OWNER'S NAME: V Vev k CtiA-Lc S NtA4k PHONE # 4 O 9 21 - 'q7 23 {,26 616 GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: I CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date ✓ I SUBCONTRACTOR BUSINESS NAME I BUSINESS LICENSE # / Contractor Signature 19it I If Date n --r 0112— Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile / Contractor Signature 19it I If Date n --r 0112— CUPERTINO Address 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 - buildina a).cmertino.ora PURPOSE 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 CSC 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 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 8314 and CBC Sections 907.2.11.4 and 420.6.2. An 91ectrical permit is required for alarms which must be connected to the building wiring. FILE As owner of the above -referenced property, I hereby certify that the alarm(s)refef 1« 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 have been tested and are operational, as of the date signed below. read'and aaree to with the terms and conditions of this statement Owner (or Owner Agent'/Is) Nam Signature ....... ........... ................................................................ Date: .. ..� . . ContyactName- { Signature... ..............��...................Lic.#...................................... Dated./C.1h Smoke and COform.doc revised 03/18/14 STATE OF CALIFORNIA ALTERATIONS - HVAC CEC-CFIR-ALT-03-E !Revised 06/141 X Ao CALIFORNIA ENERGY CERTIFICATE OF COMPLIANCE _ r CF1R-ALT-03-E Alterations - HVAC CZ 1, 3 to 7 and 16 (formerly CF -IR -ALT -HVAC) J l:6 (Page 1 of 1) Site Address: Enforcement Agency: Date Prepared: Permit#: i 3i. 1v n Equipment Type Equipment Efficiency New: Ducting, Plenums, Lineset Conditioned Thermostat Required R -value Floor Area (sq ft) ❑ Packaged System ❑ Evaporator Coil AFUE COP V R-6 (CZ 1,3-7) Ducts Served by system Setback ❑ Split System ❑ Condensing Unit SEER ❑ R-8' (CZ 16) Ducts �fda s ft q (If not already HSPF ❑ R-6 (all CZ's) Plenums present, must ❑ Furnace ❑ Lineset EER ❑ R-5 or R7.5 Lineset3 I be installed) HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this form is allowed to be filled out by hand. For final inspection all forms are to be registered (no hand filled forms allowed) and a copy left on site. Pt1. HVAC Changeout/Repair Required Compliance Documents to be left on site for Final: Can include new ducting All Equipment, CFIR-ALT-02-E Condenser Unit, Evaporator Coil, CF2R: MECH-01, MECH-20-HERS Air Handler/Furnace CF3R: MECH-20-HERS Installer Requirement: Duct leakage (: .15% or, < 10% to outside, or seal all accessible leaks) Exempted from duct leakage testing if: ❑ 1. Duct system registered with HERS provider as previously sealed, or ❑ 2. There is less than 40 linear feet of duct in unconditioned space, or ❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building ❑ 2. New HVAC System Required Compliance Documents to be left on site for Final: All new equipment and All New Ducts' CF1R-ALT-02-E CF2R-MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS CF3R-MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS' Installer Requirement: Duct leakage < 6%, Fan Efficacy (.58W/CFM), Air Flow_ 350 CFM/ton (or Standards Table 150.0-C / D alternative) ❑ 3. All New Ducts with Replacement Required Compliance Documents to be left on site for Final: Includes replacing or installing All New CFIR-ALT-02-E Ducts' and one or more of the following: CF2R-MECH-01, MECH-20-HERS, MECH-(23 or 24) -HERS Condenser Unit, Evaporator Coil, Furnace CF3R-MECH-20-HERS, MECH-(23 or 24) -HERS Installer Requirement: Duct leakage < 6%, Air Flow>_ 350 CFM/ton (or Standards Table 150.0-C / D alternative) ❑ Exempted from duct leakage testing I existing duct systems are constructed, insulated or sealed with asbestos. ❑ 4. New Ducting over 40 feet Required Compliance Documents to be left on site for Final: Adding or replacing ducts in unconditioned CFIR-ALT-02-E space but less than All New Ducts' CF2R: MECH-20-HERS CF3R: MECH-20-HERS Installer Required to: Duct leakage (S.15% or, < 10% to outside, or seal all accessible leaks) ❑ Exempted from duct leakage testing I existing duct systems are constructed, insulated or sealed with asbestos. ' All new ducting R-8 required when more than 40 ft installed and R-6 when less than 40 1 IIU This - lu n I�s% tween floors etc. ' A New Duct system is when the duct system is constructed of at least 75 percent new d ma t a d up 25 �e may consist of reused parts from the dwelling unit's existing duct system (e.g., registers, grilles, boots, air han r, du at al. R-5 1" thick insulation) for linesets 1" and less. R-7.5 1.5' thick ins i se 1 f `� to I D ter � �g " ' � with insulation as the following 1.5-2T-2%", 2.5-3T-2%",(3.5 to 4T-2%' ; Contractor (Documentation Author's /Responsible Designer sJDr ra ' n e t) ALL TIM ES I certify the following under penalty of perjury, under the laws of the State of Californ MCTN ON 1. The information provided on this Certificate of Compliance is true and correct. AOSS I 2. 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the information on this document. 3. That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations (CCR). 4. That the energy features and performance specifications, materials, components, and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the CCR. 5. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. Responsible Designer Name: Responsible Designer Signature: Date Signed: License: Company: ep Address: City/State/Zip: Phone: �-2io40e/Aa 3� "7ec` S o r 62 7 For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300 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 • building aacupertino.org • o Permit No./ Address �2JU / M �L_Lj4, /'— # of Alarms Smoke: i Carbon Monoxide: "Z PURPOSE 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 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 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. A As owner of the above -referenced property, I hereby certify that the alarm(s) re installed in accordance with the manufacturer's instructions and in compliance and California Residential Codes. The alarms have been tested and are below. I have read and agree to comply with the terms and conditionsW this above has/have been Califn" F1i e Owner (or Owner Agent's) Name: Bev, `a."ti V1 L=,A_ Si nature.......&:::.�.......................................Date: S /2 Zat Contras r Name: Signature................................................................... Lic.#...................................... Date: ................... Smoke and CO form.doc revised 03118/14 r SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE S__2.e71( COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 FIVE (408) 777-3228 • FAX (408) 777-3333 • building ageupertino.org u �l V I �eQ Permit No. oQ 3/ Address *0211 - !� V C�1 • 5 -DI u 1 # of Alarms Smoke: Carbon Monoxide: PURPOSE 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 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 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 the manufacturer's 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. i nava mart and ansa to cmmnly with the terms and conditions of this statement Owner (or Owner Agent's) Name: C! p S i� �V /�- Signature ................................... ..'f'.......................................................... Da/te ................. Contractor Name: Signature................................................................... Lic.#...................................... Date: ................... 1* Smoke and CO form.doc revised 03/18/14 Address �tji.t9ss 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 • buildingacupertino.org Q t 10g�(6- h�vlrfl �. P« Inqo Permit No. j A# of Alarms Smoke: Carbon Monoxide: PURPOSE 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. "LlE GENERAL INFORMATION Existing single-family and multi -family dwellings sh be r ed 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 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 shallbe 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 8314 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 the manufacturer's 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. t have read and agree to comply with the terms and conditions of this statement Owner (or Owner Agent's) Name: r. -DO�df z__ JZ _ % / //Ll ....................................................... Signature .................. ........................ Date: ................... Contractor Name: Signature................................................................... Lic.#...................................... Date:.,................. Smoke and CO form.doc revised 03/18/14 CUPERTINO SMOKE / CARBON MONOXIDE ALARMS won 10 OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.org Permit No. 1,1802 /% Address 1p33 OUQ #0 C%ft # of Alarms Smoke: / 5 Carbon Monoxide: / PURPOSE 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 CSC 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 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 the manufacturer's 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. I have read and aaree to comply with the terms and conditions of this statement Owner (or Owner Agent's) Name: V Signature .... ...... --- ............................................... Date: 61�_.21y:./..... Contractor Name: Sinature................................................................... Lic.#...................................... Date: ................... Smoke and COform.doc revised 03/18/14 CUPERTINO Address 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 • building(a)cupertino.org Permit No. 14 O% 6/3S PURPOSE 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 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 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 the manufacturer's 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. I have read and a ree to comply with the terms and conditions of this statement Owner (or Owner Agent's) Name: ` fir' Sign ture .... ........................ ...................................................... Date:2. ......... 04, Contract6r Name: Signature................................................................... Lie.# ...................................... Date: ................... Smoke and CO form.doc revised 03/18/14 I� CUPERTINO Address 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 • building alcupertino.orp �O X425/ Permit No. PURPOSE 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 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 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 the manufacturer's 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. d IF- m 1 with the terms and conditions of this statement t have read an agree co p Owner (or Owner Agent's) Name: �,:.; •, 9bSi nature ........ ...... .... .... ........................................................................ Date: .. ..... Contractor Nam DG(1/J� p/ ? S`v�..1.(�Date: . Si nature..................�............................................Lic.# .4.?............ ............. .Y...r.. Smoke and COform.doc revised 03/18/14 I