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Home My WebLink AboutB-2017-0279CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0279 11648 BIRCH SPRING CT CUPERTINO, CA 95014-5138 (366 54 072) SIMPLY GREEN PLUMBING INC SAN JOSE, CA 95124 OWNER'S NAME: LIN MEI-YUN TRUSTEE & ET AL DATE ISSUED: 02/17/2017 OWNER'S PHONE: 408-390-6488 PHONE NO: (408) 358-6446 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class CC-36 Lie. #943556 Contractor SIMPLY GREEN PLUMBING INC Date 02/28/2018 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: SEWER LATERAL REPLACEMENT WITH PROPERTY LINE CLEAN I hereby affirm under penalty of perjury one of the following two declarations: OUT AND CLEAN OUT AT HOUSE; REPLACE WATER MAIN. 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. 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: $8700.00 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 and state laws relating to building construction, and hereby authorize 366 54 072 R3 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 this permit. Additionally, the applicant understands and will comply with all ll non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations p #e Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signaturev�k 116.1 Date 2,17.17 Issued by: SEAN HATCH OWNER-BUILDER DECLARATION Date: 02/17/2017 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 (Scc.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 2.17.17 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 wiR 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, Sections 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall / be deemed revoked. Owner or authorized agent,,:ra-VL4 < OITA" APPLICANT CERTIFICATION Date: 2.17.17 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 2.17.17 Professional 'MNERAI L PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPAR T fJiENT - BUILDING DIVISION '10300 TORRE AVENUE - CUPERTINO, CA 95014-3285 � M I Q r22 {408) 777-3228 - FAX (4D8) 777-3333 - build!no6cuDe iino.ora r3" ®4�V `&J PLU1 ?�G Ellacaklglca.L ❑Zs,BCTRICA T. II'mCELL.4 rsous Pr O CTA?DR=SS' Vo ,p C� J yl (� �(� c�T m f STRF=I A --')D? MS ,�. • A; no (I COIqTACY Iit1's PROMS I E NL•R. ST?.cwt ADDP.:.:S CITY, ST., , Zip I PtX ONtv-Y..❑ OA? r,•3u?� L� Om AGty? ❑ C0:+-.?-4COR ❑COT' SCTORAC ? ❑ k?m -crsNC-=rFY?l ❑ DEME-OPEP, ❑ -=?WT C��f ' L t i 5CS81;'L'i,�i LICE)iSE i I - 'i �E 9 C �Y � n9S Si s �/Y d` � iJ t � �y LA cqk IA y (ZD Ctt�',ST t �C?it EGT C1h_eRNt1 I LICT-TSE Wulsm I BETS. LIC CON3tyQY1�.41 I &NAL I FAX STR-z-T ADD?.=55 I CITY, STATE, ZIP I PiiO? VS OPQ _� or D"UPLzX 0 Kum-FAI-lmy � PROir.CT LR WMD�D El ti Bs PRO7-r•CT Ilv El Y=- MI BU G: COIJ1r,-:CL.L IMBA?1RT=RiACEAFZA NO --LO D?,0'.'--- [3)"0 I IS =.z BLDG AN 0 1:$ ❑ 1"0 DBSCPJPTION O? Ta 0RK Lau tmt n4- A e 0 Ct TOTAIT YALUATION: By ny si�latare below, I certiy to etch of the f olio;;ir�;: I zr,� uts property of; -ter or auu'�oriwi z�ert to act en �-:e props:- �y o:aner`s behalf. I ha;e rsad ;.his application and the info :ration I have provided is core -,t. i have read u:e Description of TJork arid es it is zce_-ate. I am -e-- to comply with ail applicable local ordinances and stat -a laws relative to buildsa � action. I a ' a � - -esea zcives Of CUPS Lino ie eater die (�ao�ow iderti=ieOd1)grope y or irslection pu poses. Si�zt+re of:.ppl�cant��aPnt: -. m SUPPT—_�- TAT, L?,rOR_/ETTIONRE-U= . _-� ' GFS : •s CTS TE.- ME me � M M- - h,j-a.AAJc1.p.p2011.doc revised 06/21/11 CUPERTINO SANITARY DISTRICT 20863 Stevens Creek Blvd #100, Cupertino, CA 95014 Tel (408) 253-7071 • Fax (408) 253-5173 0 FST�gdrswsoi�� CUPERTINO SANITARY DISTRICT PERMIT LETTER Cupertino Sanitary District has adopted Resolution No. 9263. Building Permit Request (Over -the -Counter) `Single Family Project ❑ Multi -Family Project ❑ Commercial Project AA Project Address: Permit Number: Scope of Work: IT?/Z- Owner/Applicant Name: Address: Date: Prepared By: Phone: r -85e -&V* 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 approval of final inspection for proposed project. Date: Signature: Owner/ Authorized Agent CUPERTINO SANITARY DISTRICT OFFICE USE ONLY ❑ Pre -inspection RequireLa— Date: Date Scheduled: Conditional Approval Final Inspection Required Authorized Representative Cupertino Sanitary District District will notify owner of the required fee within 5 days after Pre -Inspection has been completed and cc City of Cupertino. " Inspection Fee Paid Date Paid: 1 `i lnspecti n Fees: $250/unit - Single Family Residential already connected, but new cleanout is required $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 D $650/unit — Single Family Residential connecting with new lateral [� $100/unit — Multi, Hotel, Living Units, etc. Actual Amount: D $500/connection - Commercial and Retail Actual Amount: Connection Use Fees (See Attached Calculation Sheet): D Area and Frontage Fees Amount: D Residential Excess Fees over 3.5 unit/acre Amount: D Commercial and Retail Connection Fees Amount: Commercial and Retail Change in Use Fees Amount: Date: 0-P _ Final Approval By: Authorized Represent ive Cupertino Sanitaryy iistrict 'rl- SMOKE I CARSON MONOXIDE ALARMS OWNER-CERTIPICATE. OFCOMPLIANct -COMMUNITY DEW-LOPMENT QFPX�TmMqT* gUILOING DIVISION 0304TORRE�AVEN _UE OP8911NOXA9, 14 81 -0.228 I -FAX. (400 41A PURPOSE imtagat'o"Pf a"' reqi"!rCdSTn0ke and -Ca rbOn Monoxide Alarm for ZOW Plianoe& ' W fflb 201.6 CIRCS'ection, R314,.R3'15, 7016,CBC Sections 420.6 and 907,211.2:wh'*Iior access frtrin. pat,ons are, req.lir d: GENERAL INFORMATIONi Existing Single-familY andmuld-6 mily dwellin shy be i IVvigil . P . PTOV ded WA Sm6l<e Ala;,Tms and Ca.r�ojt 110noxi'do-a"laons, Aq�onthova tibli, of'Additiorm, alterations, or repaid t6-existiq4'dwelling Unit% exceeds aila C1C5_eM'dA1 X14, R4%And CDC SectiOnS 907,2.11. and 420.6 require that Snjoke Alarms and/or Carbon Monoxide Ajr ins-Wjed in the foHow- ing locations� Outgide af each se p.MtO Sleeping are,ivt the imm edjate vicil-lity pf tile b A on j jti ,7v Carbon PMoikoxide alarms are not r!letltdred in dwelfinggs which do not cdntain, fu -burn zkpplian&as and that. don have an attached-gbra ge.Carbunmo' noxide alanns-.c rabiPe,d with smol;e ahimls shall -comply. with CBC',k1cfi0n,4 l.6 and shall be approved by the Office of'!the State Fim. IMarglijil, W power supply, alarin I)Atter operated, In.vN15fitig dw'011ing unit, not .. r % ala rMIS ere, Permitted to. be solely battery operated where hairs or alterations, do ll: inti eremoval of ,1Ila nc- cellingj , f vy,l, or there is nQ acv ess'by means of snns attic Refer to rRC R314 Secti 154sernentor0rawl pace, On on 907,2,1'1'.4'and 4220.6.2, An electrical permit. is raquiwd. fo± , 'Avu 16 mu' {al 'h st be connected ,6,� the buff4ingiii r. - I $I W. ' As owner of IN above -referenced pppefty., I ljer, bycrtify that j� 'h areferenced -above kujhave been _c' e 1 1( am s ) installed in arcordance, with fl*. mapufaCtUrees instrwfiong- and,in cornph!mce with theC.4 arnia Bui ding and Cali6mia Residea fidt-Codo, The alarrn* specifif4d I bel W- have beim tested, and are operationat, as of' tbe date signeii bejow Specif 0.1 y N(nob O(AWrms: haVe rbad and e to E=1Z saqh t0rwa ascffhjs :stetgnXW_' Z 712-111 C %�Oke, and WATER -CONSERVING PLUMBING FIXTURES i OWNER CERTIFICATE.OF COMPLIANCE COMMUNITY DE WELOPMIENT DEPARTMENT - BUILDING DIVISION CUP#t .# 1030TO 0 RRE AVENUE - OU PERTWO, CA 95014-3255 E 0"'.(408)777�,3228-ir'AX-(4n),777.-3333-_',��klq:i aT A Owner _,Nalue -Perin it No C Address e7 I JA_�, Is 'You]- re ' al property registered ? Mstoricalisite El Yes Civil Code Scebuns 12171.1 tbro,'agli 1101.8 do not apply. Skip the rest of the form and sign bottom of form, X_No Go to Question 2. Does your real property have a licensed I plyrnber ccrtifyirig that, due to the age or configuration of the property or its plumbing, installation of fixtures is riot Technically feasible? Civil Cade Sections 2101..1, through I W1 .8 do not ap I - , ply. 0 Thu licensed plutilber's, cert.;,fication has been provided to the Building Division. No Go to Question 3. k -water service permanently disconnected {fbr your building? 0 Yes Cvvi I Code Sections 1101-I fluough t 10 1.8 do not apply, Skip tile rest of the m and sign bottom of form. N' 0 Go to Question 4. Is your real property built and available for"use oi- occupancy on orbefore January 1, 1994? 0 No Myreal propertyiNbuiltand ava!i[able,flor use or occupancy after January 1, 1994, Civil Code Sections 1101,1 throlligh 1101.8 dorootapply. Skip the rest of the foMa and sign bottom of fibrin. Yes- My reTt property is btrilt and'avitildble for u or occupancy can orbef«rq January 1, 1. 994. ckdl Code Sections 1101,1 thrM4gh 1101.8 apply- Check one of and sign, bottom of ffirrn, i . }, Please chick qNE of tile followin.- My property is ashlgk-/cVn41, residen-ti d I real property. See Civil Code Section 1101.4, Ou and after January 1, 2014, building 41teratioxu& or it.riprovem ents shall require all 'non-coinpliant plumbing fixtures to ba replaced 'with 'water -conserving pliA d Inbing fixtures throughout the building. On or before Jatluary 1., 201.7, all non- ,compliain- plumbing fixtures shall be Ire -placed with wator-conserving plumbing fixtures (regardless of whether property undergoes,alterations or unprovementi), 01, My property is a nudiji'aodly residential teal property. See Civil Code Section 1101.5. On Prid after January 1, 2014, specified 1juilding alterations ornriprovernents, shall require lion- compliaut --r rtilwbini fixftlr-e s-to-b—c' rep -laced with 6i 1-1 "Pi x tu r6 s-, __ 0n or before Jarnuary 1, 2019, 19, a I I noncoblpli ant pluMb in 9 -fixtures shall be rf" placed with iv. a ter - i ing C, the building (regardless (if whether property undergoes alterati ja8 o C-011servin"),plutub - fxturesthroug, lioui 1 improv, ements ), 1,143? property isla cotnty-m-rcial red]. properfySee Civil Code Section 1101.5. and ,)n after)anuary-1, 2014,specificelbUilding alterations or improvements ,,,,hall require non- compliant pluiribing fixfua` es to be replaced -%vith w#ter-conserving pluinbi1v fixtures. On or beftife J'anuaily 1, 2019., aJl iioiicornpliant pturnbing fixtures shall be 'replaced Avfth water- conserving, plLunbing fixtbre.-IAhrou.4-Lout the building (reg ardless of- whetberprOperty utidergoes alterations or iinprovernents). 1, -,1-, tile oAvilar or o acyclit of th is propt, iy, certify tinder etialty of perhuy that non-compliant ZV P Plumbing fixtures v, -J11 be replaced prior to chat e,�,pccified abovewithing ter-conservi pluirbing fixtures in accordance vvith Civil -Code Sections 1,101.1 through 110 LS, the cufrout catirbrilia manti Ping Code andQatif6rnia Green Building Standards Code, and ni"ufacturei�s tm,tallation requiremems, and,Vhat the water-ic-onservinip2iirrbing fixtures comply Nvith the requirements as indicated in flic table on the following ntai-e, Owner or Owner Agent's Signature: Date: Upoii 6ornpletingand Signing this Certific,14e, plcas(Xtumi, to the Buildina Division in order to final. your building pe-nnit- SE407 12015.doc reviyed