B-2017-1971 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1971
10411 TONITA WAY CUPERTINO,CA 95014-2931(359 14 008) AFFORDABLE WATER
HEATERS AND
PLUMBING INC
28358
CONSTELLATION RD
VALENCIA,CA 91355
OWNER'S NAME: GLUMAC EMMY B TRUSTEE DATE ISSUED: 11/15/2017 -
OWNER'S PHONE:408-252-9266 PHONE NO:(855)345-9087
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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 GALLON WATER HEATER-GARAGE
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.
W. 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
Sq.Ft Floor Area: Valuation:$2000.00
permit is issued.
APPLICANT CERTIFICATION
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 359 14 008
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 a.pli - understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION.
source regulatio pe t • Cupertino Municipal Code,Section 9.18.
`.` Issued by:Jasmine Archbold
ature, Date 11/15/2017 Date: 11/15/2017
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. OWNER-BUIL,1E" DECLARATION RE-ROOFS:
I hereby affirm that I 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 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&Professions Code) Signature of Applicant:
2. ,I,as owner of the property,am exclusively contracting with licensed Date: 11/15/2017 •
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
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
z. 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
• s. 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
air contaminants as defined by the Bay Area Air Quality Management District I
shall not employ any person in any manner so as to become subject to the will maintain compliance with the Cupertino a nicipal Code,Chapter 9.12 and
Worker's,Compensation laws of California. If,after making this certificate of the Health&Safety Code,Sec'r 7705,25533,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 so .• A
or authorized agent:
be deemed revoked. 1 ie e:11/15/2017
AP LICANT CERTIFICATION C 1 NSTRUCTI 1_]i�1J.NDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a cons ln 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 iss . (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 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 source regulations per the Cupertino Municipal I understand my plans shall be used as public records.
Code,Section 9.18.
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CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
. ,
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AA 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 •
(408) 777-3228 • build.ing@cu>7ertino.org PEMIT;B- a___ - l Q'(
CUPERTINO REVF DEFT
•
❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.1. MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS 104) ASSN a
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O + +ER NAME �/'u J' cic P Nkiz5� gz66 E-MAIL
STREET ADD„-ei n CITY, .ATE,
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9501 .
` ONTRACTOR NAME ❑OWNER-BUILDER C MPANY .ME LICENSE NLABER LICENSE TYPE
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0 A CHITEC 1 ]OWNER.0 OWNER AGEN 0 CONTRACTOR AGENT 0ENGINEER ID 0TENANT
CONTACT NAME. E-MAIL
STREET ADDRESS CITY,STATE,ZIP • PHONE ' .
DECRIPTON ' / '—'
Cil . 1"tiq' e-k- g-ea. e,f . Somik- / 0 C-447a."7
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( NGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL ❑COMMERCIAL 1
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES I TOTAL NET SF USE TYPE OCC' SQ.FT: VALUATION(5) I.
REMODEL , REMODEL'KITCHEN REMODEL OTHR GARAGE 0 ATTACHED '
' BATHROOM SF ; SF SF SF , 0 DETACHED .
EXISING . DYES 1 EICHLER 0 YES SECOND STORY ADDITION ❑YES '
FIRE SPRINKLERS 0 NO 0 NO 0 NO
DWELLING SECOND DWELLING' ❑YES 0 ATTACHED❑DETACHED OTHER •
UNITS S UNIT ADDITON: : .❑NO 5F
' POOLS 0 FPRERGI:ASS 0 VINYL-LINED ❑UNITE ❑PREFABRICATED
POOL-SF SPA-5F' I SPA ATTACHED❑YES ❑ NO I TOTAL-SF
IVSD BY:
jIP. TOTAL VALUATION:
Commercial or Mulli-Familu Butldinr's with Public-Swdmmin�Pools remdres Devon!meal of Environmental Heath uvvrm+al W U I �0
RE-R0 OF EXISTING ROOF TYPE: E BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPEC t-Y)
REMOVE/REPLACE❑NO IF NO PLYWOOD ❑1" ❑3/8" ` PLYWOOD TYPE: PITCH: ROOF CLASS
❑AYES 'r OF LAYERS (THICKNESS❑S/B" OTHER ❑OSB ❑CDX OTHER :12I A
PROPOSED ROOF TYPE:'❑gLilLT-UP ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 OTHER
`Provide a signed copy of the Cupertino's Tear-Off Policy SFF +of SQUARES
By my signature below I'certify td 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 ordi an d state laws relating to building construction. I authorize representatives of Cupertino to
enter the above-identilfied property for i s ti urposes. I acknowledge and authorize all information c ntaine on this application form
to be made available for public record. % 5 /
Signature of Applicant/Agent: !� Date: • -
SUPPLEMENTAL INFORMATION REUR.ED
*New SFD/Second Dwelling Units/Muld Dwellings:A Demolition permit is required prior•to issuance of a building permit for all new construction.
*Commercial Buildings:.;Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
*Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application.
"HOA-Provide a letter'of approval from the Home Owner's Association
Blcz'gApp_201 Z.doc revised O&'OI117
/ SMOKE / CARBON MONOXIDE ALARMS•
` OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO-
(408)777-3228•FAX(408)777-3333.buildinana cupertino.orq
PERMIT CANNOT:BE,;FINALED UNTIL TM:CERTIFICATE HAS BEEN.
- CQMPLETEP,SIGNET) AINI RET IED TO TIlCE BUI MNG.DIVISIO :
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 shat be provided w th Smo.ke_Alar-ms,and Carbon --
Monoxide
Monoxide alarms. When the valuation of additions, alterations,or repairs to existing dwelling units exceeds
$1000 00, CRC Section IR314,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 907.2.114 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 m 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. (OH ki ToN 0044
Permit No..9—Z o 7 7
Specify Number of Alarms #Smoke Alarms. I 1 #Carbon Monoxide Detectors_I , !
I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name:
Signature... ...
Contractor Name:
fr�q1j16 IA) -/-1, Signature
Lic.# Le.Z.1.3 (Per-
Date: /1.4./..
c o f e Smoke and COform.doc revised 01/10/2017