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B-2016-2354 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2354 10377 BRET AVE CUPERTINO,CA 95014-3520(375 10 024) RESCUE RESPONSE GROUP INC FREMONT,CA 94538 OWNER'S NAME: YU JIUN-DER AND LIU WEI-LI DATE ISSUED:07/20/2016 OWNER'S PHONE:408-796-4409 PHONE NO:(510)257-1313 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class SANITATION SYSTEM Lic.#93-L464 Contractor RESCUE RESPONSE GROUP INC Date 02/28/2017 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;INSTALL FOUNDATION&PROPERTY I hereby affirm under penalty of perjury one of the following two declarations: LINE CLEANOUTS 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. z 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 14 permit is issued. Sq.Ft Floor Area: Valuation:$4500.00 APPLICANT CERTIFICATION certify that I have read this application and state that the above information is correct.1 agree to comply with all city and county ordinances APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 375 10 024 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 the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR s Additionally,the applicant understands and willl comply with all non-point source regulatio per the Cupertino Municipal ode,Sectio '9.1 s.. 180 DAYS FROM LAST CALLED INSPECTION.. Aw Signature; 4mm Issued by: Date:07/201201 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1. 1,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) z. 1,as owner of the property;am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:07/20/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1. 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. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sect* ns 25505,255 , d 5534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent" APPLICANT CERTIFICATION Date:07/20/2016 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AG CY 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 erformance 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 07/20/2016 - Professional GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERT NO (408)777-3228•FAX(408)777-3333•building(cDcupertino.org misc 2'3 ❑PLUMBING [:]MECHANICAL [:]ELECTRICAL [:]MISCELLANEOUS ' PROJECT ADDRESS �r""�/,Y� � APN# OWNER NAME EMAIL STREET ADDRESS n c L pq� � CITATE�ZIrP [� y 1/�J FAX CONTACT NAME PHOTV0 15� /v�✓E-MAAIIL STREE!jJ' 'js j �) � CITY,S TjjE,ZIP�_ 1 f y FAX ❑OwNERR El OwNER-BUII,DER ❑ OWNERAGENT ONTRACTOR ❑CONTRACTO'R AGENT ❑ ARCHITECT ✓�❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NA I!fl LICE J Z� LIC�ENSE�YP BUS.LIC# 3 /� D I- J COMPANYN� ,/� I /A i EMAIL G_ FAX `� STREET ADDEF CITY ARCHITECT/ENGINEER NAME l�•L�j I! Cf LICENSE NUMBER / / BUS.LIC# l COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑ SFD Or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ YeS ❑ No FLOOD ZONE ❑ Yes ❑ NO DESCRIPTION OF ORK ✓r/J ' u oy' i' TOTAL VALUATION: „ By ray 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�ui g constru 'on. I orize representatives ofCupertino to enter the above-' n�fied prrtY for inspect ionoses. Signature ofApplicant/Agent: U Date: SUPPLEMENTAL INFORMATION REQUIREDIFiCs$oNi „ VER THE-COIIW9, 9w ny u4 0 EXPRESS , . STANDARD a-. :❑ LARGE` a Q AlAJOR MEPMiscApp_201 1.doc revised 03116111 t .. SMOKE . ►1: ► ,N �� ARMS LFILIE b� — 1 7LIZ i° GOMMU'NITY DEVELOPMENT?DEPARTMENT►BUILDING DIVISION 10300 TORRE AUERUE CUPERTINO<,SCA 95014-3255 (408)777-3228-FAX, 777-3383► b'uildirrQ Cupertino org it. 7-7 a•a P-M- ost This affidavit is a self-certification for the installation of all required Smoke and Carboy Monoxide Alarms for campliMce with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access.for it zspections are required. EX%sUng sutgle family and multi-family dwellings shall be provided with Smoke Alarms and Carbo-it MW0110%ide alarms When the valuatioil of additions, alterations,or repairs.to existing dwelling units exceeds $100Bi©O,CIBC Section.8314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarrns and/or Carlon Monoxide Alarms be installed in the following locations: _ AAtA SI G ALARM CO'ALAI Outside of each separate sleeping area iri the rif rnecliafe vicinity©f the ac ?E bedroom{0:`f Orf(kve; 1Oe I,of a dwelt in unit fnclud rt basements __ _ _ � �VV'�+t�nz cad�t�slee zfn roa`ril � � i Ca3rbon Monoxide alar i n s are not required in dwellings Which dog not,contain fuel.bu m,ing apptliances a cl fh do noikSna've oris a�ttaelzed arae Carbon monoxide alarms;co=. g g mbuled w�tl smoke alarms sln�all co•xn�i{ly�v>t�. CBC Sections VOW,and,shall be ap°p'roved by the office a£the State.Eire lvMrshal. Power Swpply:Eno s=wellnng urns wxthl nocommercial porwer s=app>ly,aI'arrrc(s)`inay, be s.o7Tiely ba{ffexy operated. lr ex,�Sti n dwelling uiZlts,Alarms,are perm,l ted to be'solely battery operated where repaks or: aillterat>ox1s de, 1 of wa{ not=r<esu;]�t mi the remava` s�` lI�atld ceilu;1g finsrrnes ox there zs iso;access by means of aattrc,b=a=s�rnen�t o�crawl! space.Refer to=Cl C Sectio 11Z31�4 and CDC Sections gOI.2..T1.4 anal 42s,.6=.2..Aiz electrlcalpe _ "t s.re=juire, tar allariis:Cvl2icln must lxe coi uected to tine budding wrxunb. As owner otf the alia�e referenced property,I li�ereby certifi�fllaf tl1.e alarzn�s��referenced above lrnas/lime b�eeil in}staliled.in acc'ordaince,wiffi then afnufactuxer s instz ctiom aindl: n compTi4nce with.the California BtuRdin , and Ca xforinia Resod en,t ali C®des.`hie alarms haave Feely,tested altd axe o,,eratioinal,as ofthe date si,.gized b:elo=w., ,- 1,G�a3ue ne'ad, an. a gee:to;coin,�`.t with tEie:termsr and conr:ditcon;s than,stb;t'ement 14 _. ., ►al � Ltc -� Date WATER-CONSERVING PLUMBING FIXTURES FILE OWNER CERTIFICATE OF COMPLIANCE _ COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 7a CUPERTIN'O 10300 TORRE AVENUE CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•buildingO-cupertino.org __ ^- �__Owner�I*Tan�e�7 �Yermzt IVo. -... 1. Is your real property a registered historical site? �._ ❑ Xes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. Dot/N Go to Question 2. 2. Does your real property have a licensed plumber certifying that,due to the age or configuration of the property or its plumbing,installation of water-conserving plumbing fixtures is not technically feasible? 0 Yes Civil Code Sections 1101.1 through 1101.8 do not apply. El The licensed plumber's certification has been provided to the Building Division. Skip the rest of the form and sign bottom of form. j No Go to Question 3. 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. _� N0 Go to Question 4. 4. Is your real property built and available for use or occupancy on or before January 1, 1994? ❑ No My real property is built and available for use or occupancy afterJanuary 1, 1994. Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. F-AYes My real property is built and available for use or occupancy on or before January 1, 1994. Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign bottom of form.. 5. , Plebe check ONE of the following: /My property is a single-family residential real property. See Civil Code Section 1101.4. On and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing fixtures to be replaced with water-conserving plumbing fixtures throughout the building.On or before January 1,2017,all non- compliant plumbing fixtures shall be replaced with water-conserving plumbing fixtures (regardless of whether property undergoes alterations or improvements). ❑' My property is a multifamily residential real property. See Civil Code Section 1101.5. On and after January 1,2014,specified building alterations or improvements shall require non-compliant plumbing fixtures to be replaced with water-conserving plumbing fixtures. On or before January 1,2019,all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvements). ❑ My property is a commercial real property. See Civil Code Section 1101.5. On and after January 1,2014,specified building alterations or improvements shall require non-compliant plumbing fixtures to be replaced with water-conserving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvements). I,as the owner or owner's agent of this property,certify under penalty of perjury that non-compliant plumbing fixtures will be replaced prior to date specified above with water-conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 through 110'1.8,the current California Plumbingrode and California Green Building Standards Code,and manufacture 's installation requirements,and that the water-cons ruing plumbing fixtures c ply with r irements as indicated` the table on the following age. Owner or Owner Agent's Signatgtre: 1 Date: Upon completing and signing this Certificate,please return it to the Building Division m order to final yoilroKuilding permit. SB4072015.doc revised 08126115