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B-2017-1823 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1823 10340 PLUM TREE LN CUPERTINO,CA 95014-2019(316 33 017) AFFORDABLE WATER HEATERS AND PLUMBING INC 28358 CONSTELLATION RD VALENCIA,CA 91355 OWNER'S NAME: LUO WEI DATE ISSUED: 10/25/2017 OWNER'S PHONE:408-253- PHONE NO:(8555 345-9087 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-36 Lic.#627368 • Contractor AFFORDABLE WATER HEATERS AND PLUMBING INC Date X BLDG _ELECT X PLUMB • 09/30/2018 . _MECH X RESIDENTIAL_COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business&Professions Code and that my JOB DESCRIPTION: license is in full force and effect. (N)40 GAL WATER HEATER-GARAGE • , I hereby affirm under penalty of perjury one of the following two declarations: 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 t, / ,,,,, formance of the work for which this permit is issued. 41 IV. .` have and will maintain Worker's.Compensation Insurance,as provided for by ii- Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$2100.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: , information is correct.I agree to comply with all city and county ordinances 316 33 017 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,judgments,costs,and expenses which WITHIN 180 DAYS OF PERMIT ISSUANCE OR may accrue against said City in consequence of the granting of this permit. Additionally,the-p.;jV,nt understands and will comply with all non-point . 180 DAYS FROM LAST CALLED INSPECTION. source regulatio'. p.T the Cupertino Municipal Code,Section 9.18. -,,.4" by:Jasmine Archbold a g 'ure �m Date 10/25/2017 Date: 10/25/2017 OWNER-Bo IDE LARATION )2E-ROOFS: I hereby affirm VI am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed.If a roof is following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1. I,`as owner of theproperty,or my employees with wages as their sole inspection. compensation,will do the work,and the structure is not intended or offered for sale(Sec.7044,Business&Professions Code) Signature of Applicant: 2. I,'as owner of the property,am exclusively contracting with licensed Date: 10/25/2017 contractors to construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER i. 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 Bay Area Air Quality Management District I will maintain compliance with the Cu'.•rti o unicipal Code,Chapter 9.12 and Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code,' do 5505,25533,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 ,-..,t Al, be deemed revoked. • O ,., - authorized agent: 11R 0/25/2017 APPLICANT CERTIFICATION CONSTRUCTMf.NDING AGENCY I certify that,I have read this'application and state that the above information is I hereby affirm that there is a co •ctid lending agency for the performance correct.I agree to comply with all city and county ordinances and state laws of work's for which this permit is . ed(Sec.3097,Civ C.) • relating to building construction,and hereby authorize representatives of this city Lender's Name to enter upon the above'mentioned property for inspection purposes. (We)agree to save indemnify and keepiharmless the City of Cupertino against liabilities, Lender's Address judgments,costs,and expenses which may accrue against said City in consequence of the greriting of this permit. Additionally,the applicant understands ARCHITECT'S DECLARATION and will comply with all non=point source regulations per the Cupertino Municipal I understand my plans shall be used as public records. Code,Section 9.18. , • CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 #.•;61.13#.,..,.. . 3s; (408) 777-3228 • buil din g©cupertino.org PEMIT#B- `2(1)l 3 - (82- CUPERTINO 82CUPERTINO REV# DEF T✓ ❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. MMEP ❑RE-ROOF ❑SWIIvIMING POOL/SPA • PROJECT ADDRESS I APN a V ER NAME P(�ONF� _� 12$;�(ID Orel E-MAIL , Vit; ° ut{" J f�I STREIT u....!._ A9 p 1 u r 1.1rL . \ r/\ Cn STAT Z Ail ` c$ Cro� P CONTRACTOR NAME ❑OWNER-BUILDER COT NY NA E LICENSE NUMBER LICENSE TYPE \ Or -$ cctiy- .11)rdek it 64 /€4 4.- to 243 fp e s.I'r c CITY, TATE, ZIP I S ; s .coni- ei/a v) -I0 /q Cenci' • 913�5`S E-MAIL ` ✓W Y 1 J PHoN 345.E q 04 I/ BU I Ca 4.I s 2 ' ❑�RCHI T ❑OWNER.❑OWNER AGENT 0 CONTRACTOR AGENT 0 ENGINEER 0 DEVELOPER 0 TENANT CONTACT NAME I � \ E-MAIL ' 1 r� t� \OV e 4�h STREET ESS NJ P O CITY,STATE,ZIP N Lo iji /57 ic'''11/1> 16X I Ci-r3 C/17 DECRI I TON pitrabt_ , If j4//eii L. i ee- .- ller • r IGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL ❑COMMERCIAL I EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES a TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION(5) I REMODEL REMODEL KITCHEN REMODELOTHR GARAGE 0 ATTACHED BATHROOM SF SF SF SF 0 DETACHED EXISTNG ❑YES EICHLER 0 YES SECOND STORY ADDITION ❑YES FIRE SPRINKLERS 0 NO 0.NO 0 NO . DWELLING SECOND DWELLING ❑YES 0 ATTACHED DETACHED OTHER UNITS# UNIT ADDITON: ❑NO S F ' POOLSI 0 FIBERGLASS 0 VINYL-LINED 0 GUNITE ❑PREFABRICATED POOL-SF SPA-SF I SPA ATTACHED El YES 0 NO I TOTAL-SF ,- I ' — I`1EIVE TQTA1� ®UQTION: Commercial or Mulfi-Famiht Buildings with Public Swiiiuvivg Pools renuires Depnrfntenf o(Envirotanettlnl Heath approvalJ '�J 1 f 1 RE-R0OFI EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY) 1 h/ REMOVE/REPLACE 0 NO IF NO PLYWOOD E 1"" ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS ' 1 ❑YES a OF LAYERS ' THICKNESS❑5/8" OTHER ❑OSB ❑CDX OTHER :12 A PROPOSED ROOF TYPE:❑BUTLT-UP ROOF DASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 OTHER *Provjide,a signed copy of the Cupertino's Tear-Off Policy SF go(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 ve provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordin ces and tate laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for in ec 'n rposes. I acknowledge and authorize all information c Rained o this application form to be,made available for public record. �� Signalture of Applicant/Agent: Date: - SUPPLEMENTAL INFORMATION REQUh ED ' *New SFD/Second Dwelling Units/Mul'!fam ly Dwellings:A Demolition,permit is required prior to issuance of a building permit for all new construction. *Commercial Buildings: Provide a com et Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. *Copylof Planning Approval Letter or Mng with Planning prior to submittal of Building Permit application. *HOA:Provide a letter of approval from the Home Owner's Association • • Bldg,4pp_2017.doc revised 08/01/17 46\7 \ & �. SMOKE / CARBON MONOXIDE ALARMS • OWNER CERTIFICATE OF COMPLIANCE rY COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION ; CUPERTINO 10300 TORRE AVENUE•CUPE_' INO; CA 959,1!-3255 7 (408)777-3228•F• ffl cr m' a a "..a �+�I ?�\. a,:r ,tea s: `" C €s. y �, e, �", , ."f'. . n.., ,;� � �,a:.*c;*r r t � �� n * x +�s� L� e,�:� j`� '�� .: c,�� r� t ,,z x ,� � a f% i s Q r i, F o w a• '��B T MJ i.. W °R D44-ti 1111,-91-b13' �% q wool) :" ,._is�'� -�""'� f a. v �r" a.,.. �' '" a r �uu;� :S %La' z' ?eAt `' 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, R315,2016 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,R315, 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 X X bedroom(s)-(Smoke alarms shall not be located within 3 feet of bathroom door) On every level of a dwelling unit including basements and habitable attics 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 specified below have been tested and are operational, as of the date signed below./ Address: l O 3 b P 1(1 I'y)*v P L_y� . Permit No.,6 Z 0/ 7 —/ r23 Ml1ee h artM''-3: art, �Ll s+' "aFlitola 4331:10 e et®}? G i� ''.i I I have read and agree to comply with the terms and conditions of this statement Owner(or Owner Agent's)Name: Signature Date: Contractor Name: /Yp— -� )��ah/p �Gt7L-e/-- Signature C Lic.# .(. 273 `�'d Date:(D. .3/ /0 f_ct r-LP Smoke and CO form.doc revised 01/10/2017