14040028CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10166�IofC'S`1*TC P�
`
Pi-
CONTRACTOR: ONE DAY COMPLETE
PERMIT NO: 14040028
.
R E N
REPIPE
OWNER'S NAME: HATAMI MOHAMMAD H AND SUSAN D
617 N 12TH ST
DATE ISSUED: 04/04/2014
OWNER'S PHONE: 4084460802
SAN JOSE, CA 95112
PHONE NO: (408) 603 -0554
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
LICENSED CONTRACTOR'S DECLARATION
COPPER REPIPE
License Class Lic. #
Contractor Date ��^
I her irm icensed under, the provisions of Chapter 9
( encing with Section 7000) of Division 3 of the Business &Professions
Co and that my license is in full force and effect.
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.
Sq. Ft Floor Area:
Valuation: $7950
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 31621046.00
Occupancy Type:
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXP S IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 YS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAYS F AST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
against said City in consequence of the
/
costs, and expenses which may accrue
Issued by Date.
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
918.
RE-ROOFS:
Signatu Date `/ .- /
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
OWNER- BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(a) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self - insure for Worker's
material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized a Dater
permit is issued.
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
APPLICANT CERTIFICATION
Lender's Address
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances 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
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
918.
Signature Date
_ GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION U�
10300 TORRE AVENUE CUPERTINO, CA 95014 -3255 (�
(408) 777 -3228 • FAX (408) 777 -3333 • building a.cupertino.org
GUPEtkTIN0 �✓�
TT T T2 A"O TT.T/'! r'l l..rcru e MY' e T n FT .F1'TRIC'.Q I . F- MISCELLANEOUS
MEP
MISC
MEPMiscApp_2011.doc revised 06121111
PROJECT ADD SS
APN #
OWNER N �
PHONE
E-MAIL
STREET ADDRES
ta
CITY, STATE, ZIP .
FAX
'2
CONTACT NAME
PHONE
5: E -MAIL
STREET ADDRESS r
STATE, ZI
❑ OWNER ❑ OWNER- BUTAER ❑ OWNER AGENT
ONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACT NAME
r LICENSE NUMBER 19
7
BUS. LIC #
;TREE PANY N
E -MAIL
FAX
TADD S
CIr STATE
PHONE
ARCHITECT/ENGINEER NAME
LICENSE NUMBER.
BUS. LIC #
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX ❑ MULTI - FAMILY
PROJECT IN WILDLAND ❑ YES
PROJECT IN ❑ YES
IS THE BLDG AN YES
BUILDING: ❑ COMMERCIAL
URBAN INTERFACE AREA ❑ NO
FLOOD ZONE ❑ NO
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
�4
A= 0
M
TOTAL VALUATION
By my signature liglow, I certify to each of the following: I am the property owner or authorized agent to act the prope o)Amer's behalf. I have read this
application and the information I have provided is c
have read the Description of Work and verify it is acc I afire to comply with all applicable local
ordinances and state laws relating to build' onstru
entatives of Cupertino to enter the above -icd n roperty fob inspection purposes.
Signature of Applicant/Agent:
Date: _
MENTAL INFORMATION RE UIRED
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MEPMiscApp_2011.doc revised 06121111
CITY OF CUPERTINO
Fff-w-Wo IPVV VqTll%4ATnR — RITILDING DIVISION
kaADDRESS: 10116 me claren pl
7DATE:
04/04/2014
REVIEWED BY: Mendez
UNITS
APN:
BP
*VALUATION:
1$7,950
*PERMIT TYPE: Plumbing Permit
1
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION 1 RPRP
PERMIT TYPE:
WORK
er repipe,
SCOPE
�co
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
Re-Pipe Interior
1 PRREPIPE
1
#
$14
Mv-ln
slq)p,/. lul !) 1-
PME Unit Fee:
$14.00
PME Permit Fee:
$47.00
(7ons1rucil on tCM
F
Administrative Fee: 1ADMN
$44.00
Work Without Permit? 0 Yes 0 No
$0.00
TOTALS:
I
Travel Documentation Fee: I TRA VDOC
$14.00
Strong Motion Fee: 1BSEISA1ffCR
NOTE: This estimate does not include fees due to other Departments (ie. Planning, Public Works, Fire, Sanitary sewer Vistrict,'5cnoot
L 4-i)"t,7,-t tiff D,,ntfnraddnlin.fo-
FEE ITEMS (Fee Resolution I1 -053 Eff 711113)
FEE
QTY/FEE
MISC ITEMS
Plari, Cbecl�,
PME Plan Check:
$0.00
Mv-ln
slq)p,/. lul !) 1-
PME Unit Fee:
$14.00
PME Permit Fee:
$47.00
(7ons1rucil on tCM
F
Administrative Fee: 1ADMN
$44.00
Work Without Permit? 0 Yes 0 No
$0.00
A
Travel Documentation Fee: I TRA VDOC
$47.00
Strong Motion Fee: 1BSEISA1ffCR
$0.80
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
41 —z'
$153.80
$0.00 TOTAL FEE:
$1
Revised: 04/01/2014
CUPERTINO
Building Department
CITY OF CUPERTINO
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
TELEPHONE: (408) 777 -3228 • FAX: (408) 777 -3333
c
AFFIDAVIT — SELF CERTIFICATION OF INSTALLATION OF
SMOKE /CARBON MONOXIDE ALARM(S)
FOR COMPLIANCE WITH SECTIONS R314,907.2.11.2 AND 420.4 OF THE CALIFORNIA BUILDING AND
CALIFORNIA RESIDENTIAL CODES WHERE NO INTERIOR ACCESS FORINSPECTION IS REQUIRED.
PROPERTY ADDRESS: b MC PL
OWNER NAME
PERMIT NO ft 0q0 0q0 01`p
NUMBER OF ALARMS INSTALLED: SMOKE: ; CARBON MONOXIDE: 2
Existing single - family and multi - family dwellings shall be provided with Carbon Monoxide alarms.
When the valuation of additions, alterations, or repairs to existing dwelling units exceeds $1000.00, Sections R314,
907.2.11.5 and 420.4.2 of the California Building and California Residential Codes require that Smoke Alarms
and /or Carbon Monoxide Alarms be installed in the following locations:
1. Outside of each separate dwelling unit sleeping area in the immediate vicinity of the
bedroom(s).
• Smoke alarm and Carbon Monoxide Alarm
2. On every level of a dwelling unit including basements
• Smoke Alarm and Carbon Monoxide Alarm
3. Within each sleeping room.
• Smoke Alarm
Carbon Monoxide alarms are not required in dwellings which do not contain fuel- burning appliances and that do not
have an attached garage.
Multi- purpose alarms: Carbon monoxide alarms combined with smoke alarms shall comply with Section 420.4.3.1 of
the California Building Code 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. See
Sections R314,
907.2.11.4 and 420.4.1.1 of the California Building and California Residential Codes. 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 have been tested and are operational, as of the date signed below.
Signature: 6k4"
Contractor Name: contractor namel Date:
Signatu