B-2017-1512 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1512
18740 NEWSOM AVE CUPERTINO,CA 95014-3855(375 30 009) AFFORDABLE WATER
HEATERS AND
PLUMBING INC
28358
CONSTELLATION RD
VALENCIA,CA 91355
OWNER'S NAME: LECLAIR LYNDA AND MICHAEL L DATE ISSUED:09/08/2017
OWNER'S PHONE:408-320-7811 PHONE NO:(855)345-9087
C. `__1 •._ r: • '- I- -- s -1. 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 3X 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(40 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.
,� 401.'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 Sq.Ft Floor Area: Valuation:$1400.00
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this'application and state that the above APN Number: OccupancyTyp e:
information is correct.I agree to comply with,all city and county ordinances 375 30 009
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 PERMIT EXPIRES IF WORK IS NOT STARTED
City of Cupertino against liabilities,judgment's,costs,and expenses which WITHIN 180 DAYS OF PERMIT ISSUANCE OR
may accrue agai i ity in consequence of the granting of this permit.
Additionally,the;f-. , nderstands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION.
source regulati• 1 - 10-• pertino Municipal Code,Section 9.18.
i Issued by:Kim Dunbar
Signat w , Date 09-028-2017 Date:09/08/2017
I .I _s-B Di • IE ) • • • _O RE-ROOFS:
11
I hereby affir :t I am exempt from the Contractor's License Law for one of the All,roofs shall be inspected prior to any roofmg material being installed.If a roof is
following two '•• '•ns: installed without first obtaining an inspection,I agree to remove all new materials for
1. I,as o,•ler 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 8F Professions Code) Signature of Applicant:
2. I,as owner of the property,aril exclusively contracting with licensed Date:09-028-2017
contractors to construct the project(Sec.7044,Business&Professions Code).
I ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three 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 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
permit is issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous
3. I certify that in the performance of the work for which this permit is issued,I material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the air contaminants as defined by the B y •a Air Quality Management District I
will maintain compliance with the C p VI Municipal Code,Chapter 9.12 and
Worker's Compensation laws of California. If,'after making this certificate of the Health&Safety Code • .*505,25533,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 age:
be deemed revoked. Date:09-028-2017 ���
APPLICANT CERTIFICATION CO.S ' CJJI_l, Ni I G:GE- C_
I certify that I have read this application and state that the above information is I hereby affirm that there is a c. s'ructio'ending 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 i•is.ued( ec.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 ARCHITECT'S DECLARATION
and will comply with all non-point souide regulations per the Cupertino Municipal I understand my plans shall be used as public records.
Code,Section 9.18.
CONSTRUCTION PERMIT APPLICATION
`�z COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
, ,,
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
4:0.rD, (408) 777-3228 • building@cupertino.org PEMIT#B-20 6 - di 5 / "-
_ CUPERTINO REV# DEF#
❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. v� MEP ❑RE-ROOF ❑SWIMMING POOL/SPA •
PROJECT ADDRESS ^_ J a e�I L. C,CAA /CC"
i APN tt 3 - 3/ t e o
OWNER NAME I l� 1-/� o L• &Om ^ V HON /Lo�\ +1 �(`�j E-MAIL
S i L.IFi, N p L 1 IJ1) �r-tl' J !//{V/ d I
STREETAADn V/�t, 0,44,,,,v.,
me c� per- � , ��U,
( CONT 1ILLRACTOR NAMELL ❑OWNER-BUILDER COMPANY NAME 1 LICCENSE NUMBER LICENSEE TYPE
a ire i6-:ce r qi A , 0f ai e.L dAe.. ( 4q (.02"i'3(P C SC9
I SLEryA,t3 Ess lNn;!J ll Dr\ � O ATE, Z ' ,e4` _ `\cs~s
.
I
l
EMAIFri142,00) BUS.�k
� otqe6togslo oo tp
❑AC �/ ❑ NE ❑ R AGENT 0 CONTRACTORAGENT ENGINEER0 DEVELOPER 0 TENANT
CONT NAME Z Ce wtfq E-MAIL 1, @— ,l P. r^
S EET/AVID R&95 �'V CI ,SIAM,ZIP "IW �1` N gq� ��
o,
10
DECRIPTON,
� 1?� c leg .er- 40 Oaflim
cS p �a� 0104 C/1,054" .
I +
SINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES I TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE 0 ATTACHED
BATHROOM SF " SF SF SF 0 DETACHED
^EXISISPRINKLERS 0 NO
EICHLER 0❑ NO SECOND STORY ADDITION ❑
YES
FIRE0 NO
DWELLING SECOND DWELLING ❑yES 0 ATTACHED DETACHED OTHER
UNITS N I UNIT ADDITON: ❑NO S F
POOLSII Q FIBERGLASS 0 VINYL-LINED ❑GUNITE '❑PREFABRICATED
POOL-SFJ SPA-SF I SPA ATTACHED AYES 0 NO 1 TOTAL-SF
REQ •J TOA V, (h..)TION:
Commercial or Multi-Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval `r , // i ' Ivj�J
RE-ROOF!EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES E WOOD SHINGLES❑TILE OTHER(SPECIFY)
REMOVE/REPLACE❑NO IF NO PLYWOOD 01" ❑3/8" ' PLYWOOD TYPE: PITCH: ROOF CLASS
❑YES R OF LAYERS THICKNESS❑5/8" OTHER El OSB E CDX OTHER :12 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES 0 OTHER
•
*Provide a signed copy of the Cupertino's Tear-Off Policy SF Fof 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 ordin nces . d state laws relating to building construction. I authorize repr sentatives of Cupertino to
enter the above-identified property for' opectio p r poses. I acknowledge and authorize all informatic ntail ed this application form
to be made available for public record (%J
Signature of Applicant/Agent: Date; '
SUPPLEMENTAL INFORMATIOIgi E 1 UIRED
*New SFD/Second Dwelling Units/Mu].famil1'Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings: Provide a co 1.1ete. 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_2017.doc revised 08/01/17
•
A F F O R D A B L E
wATER ;wsii ica
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 Roux gar
Contrctor'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 At€ached Catlin
Acknowledgment
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
N-cw SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUP ERTINo 10300 TORRE AVENUE.CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buiIding(aa.cupertino.orq
_..
AO'
` PE LMIT.Cr I`ltatiO NAI ED ' II_THIS C RT iiICA E'HAS'BE3El�i
�. IFi SSGNEI • , __�,
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 withsmoke 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)maybe 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,[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: \ H .O 1\3 e uucc' try I ' Y t. PermitNo.J -% 1 "7 H S i 2
Specify Number of Alarms: #Smoke Alarms: #Carbon Monoxide Detectors: 1
I have read and agree to comply wit terms and conditions of this statement
Owner(or Owner Agent's)Name:
Signature Date: €.
Contractor Name: /) ! //
fro Y c'b / W ci i-e r- Signature !
10/24/2017 10:37PM 4082554129 MICHAEL LECLAIR PAGE 01/01
\\ /7 SMOKE / CARSON MONOXIDE ALARMS
� OWNER CERTIFICATE OF COMPLIANCE
.1., COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
GUl'ERTT.No (408)777-3228•FAX(408)777-3333•buildina@cuoertino.orq
•yro me. ..y,.00��.c>- ,.�.��eue•;.;ro:K.i'Jlarn::.. `''m',;?��cE4'"•'F ens.
...��,+ - :"raa,.v:sP:iu;" "'k ";x: =titin`,� - �.,�.q 1'^ �k ,r4:C"Y� 5�m�:^T.c`i.Mo
j: wi�•n:i:..'^�� ..r'w. ;y`,v`v.., - -,�w.�C�r: �J u �"C''l:,�?�tY'- ti.�f� yr� f:5� cNxo"S'.•i�:e....�,»�li:�.y t�:.,a..�.. o,r;riw;".,,�'.��":l,i r�
. .�2� ky T 8. .�' Y;_ ark ,�'v4^' . "-%.;., 'a d±'N`'J 1 •, .... " �- _ sL n. 6�i'., t,r,;� �.x2�R
xt� t�' �.ate,°f"� v '��f�.����" �.' hr�e ��"� i�3� o' �},r...v7n'�iiX�..... .� .i'�^, ci�l $"'•�
N ps, t�j7 Yrs){ k
�OC7•E,it tiFn rF Y^',...s -rT Fh `4� t.+s'
..._�:—__.-_-""''x�l =•-:v='-.wn 1-.-.—:Xr.,...—.`._r G� —=r�.:f'��;�=�— ..'�. - ._�,ir' 15�� �-M L
:
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
51000.00,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 axe 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 specified below have been tested and are operational, as of the
date signed below.
Address: \ g.1 H e Lu cs Permit,No. , X2 01 "1 —ISI
Specify Number of Alarms: #Smoke Alarms: Wim #Carbon Monoxide Detectors:
I have read and agree to comp! wip terms an conditions of this statement
Owner(or OwnerAgenf's)Name: ""v y� • �0 �6 ' f .
Signature Date:
Contraptor Name:
q d 1 W t*-e r Signature '�v Lio.# ..(3..�.. .J 44)r I Dater/22/i;
a
H�afe rrJ' s
Smoke and CO fonn.doc revised 12/15/16