14090014I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 7825 LUNAR CT
OWNER'S NAME: NARVAEZ PETER D AND ARLENE C
OWNER'S PHONE: 4083753190
❑ LICENSED CONTRACTOR'S DECLARATION
License Class # !1 f3f 02-0
Contractor M01( �Al '1 1(A14Ol�'V'� Date —( 1LJ[14
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 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')
Compensation, as provided for by Section 3700 of the Labor Code, for the
erfiormance of the work for which this permit is issued.
ve and will maintain Worker's Compensation Insurance, as provided for by
ection 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
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9 18.
Date J4 % &f
❑ OWNER- BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
I, 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
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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.
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
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
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9 18. __111,
Date / r
CONTRACTOR: MARTI'S PLUMBING PERMIT NO: 14090014
171 BRANHAM LN STE 10-418 DATE ISSUED: 09/03/2014
SAN JOSE, CA 95136 PHONE NO: (408) 375 -3190
JOB DESCRIPTION: RESIDENTIAL R COMMERCIAL E]
PROPERTY LINE CLEAN OUT
Sq. Ft Floor Area: I Valuation: $3200
APN Number: 36220022.00 1 Occupancy Type:
PE R XPIRES ORK IS NOT STARTED
WIT 180 DAYS O PERMIT ISSUANCE OR
180 DA FROM L ALLED INSPE N.
Issued by: Date:
RE- ROOFS:
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.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized agent Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C )
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
GENERAL € ERMIT APPLICATION a
COP\/IMUNITY DEVELOPMENT DEPART MEN T • BUILDING DIVISION 1
10300 T ORRE AVENUE • CUPERTINO, CA 95094 -3253
(408) 777 -3228 • FAX (408) 777 -3333 - buildinoCa cuDertino.oro
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By ny signature below, I certify to ear..h of the following. I am the propel ovmer or authorized agent to act on the property behalf. I have read this
application and the information I have provided is correct I have read the Description of Z ,,cork and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to b 'ldi onscuction I authorize repr esentati ves of Cupertino W enter the above.- identifledd property for i saection purposes.
Signature of.-.pplican "Agent: Date: qpG �/!
PLEI`�IENTAL LNIFOR�L A TION REQU =D
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CITY OF CUPERTINO
�1Vr Ti 4Z I'7MA'T(1R _ RITII.iIINf DIVIRION
LaADDRESS:
7825 lunar ct
___ _
QTY/FEE
DATE: 09/03/2014
REVIEWED BY: Mendez
Plan Check Fee:
APN:
BP #:
*VALUATION: 1$3,200
*PERMIT TYPE: Building Permit
$0.00
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD Or DU 12X
p
Plumb. Permit Fee:
PENTAMATION 1 RPSS
PERMIT TYPE:
USE:
I,,,� "h Tt: =.
F�,t r Plumb Insp. 0.0 hrs
$48.00
t�7Cr t r�C r3 -.
b h- sp. Fee.-
WORK
rtv line clean out
0,0
hrs
$0.00
SCOPE
PME Unit Fee:
NOTE: This estimate does not include fees aue to other uepartments (i.e. f 11Urlrllrlb•y 117"VI : rr ur na, �w•�.�•y � - °°
__ .. :___ ____ar_v_ _._a,.... --I.. __ 4__#_
! wr. tsHo Pont Fnrnddn'I info_
"IstrlCl, et" I. LneJe aea U,G UUJ 6U — wi. /�cw•w••w.
FEE ITEMS (Fee Resolution 11 -053 Eff. 7111131
•.r v...........-
FEE
___ _
QTY/FEE
____ _
I MISC ITEMS
Plan Check Fee:
$0.00
#
$25.00
Plumb. Plan Check 0.0 1 hrs
$0.00
Alec. r m Ch "C`�
;��- >��;,_ >E >;•;� „� Fee..
Plumb. Permit Fee:
IPPERMIT
PME Plan Check:
I,,,� "h Tt: =.
F�,t r Plumb Insp. 0.0 hrs
$48.00
t�7Cr t r�C r3 -.
b h- sp. Fee.-
$0.00
Suppl. Insp. Fee:Q Reg. Q OT
NOTE: This estimate does not include fees aue to other uepartments (i.e. f 11Urlrllrlb•y 117"VI : rr ur na, �w•�.�•y � - °°
__ .. :___ ____ar_v_ _._a,.... --I.. __ 4__#_
! wr. tsHo Pont Fnrnddn'I info_
"IstrlCl, et" I. LneJe aea U,G UUJ 6U — wi. /�cw•w••w.
FEE ITEMS (Fee Resolution 11 -053 Eff. 7111131
•.r v...........-
FEE
___ _
QTY/FEE
____ _
I MISC ITEMS
Plan Check Fee:
$0.00
#
$25.00
Plumbing
jpRSEWER7 Sewer, Sanitary
Suppl. PC Fee: Reg. ® OT
0.0 1
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$48.00
Administrative Fee: 1ADMIN
$45.00
L
0
0
Work Without Permit? 0 Yes e) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non - Residential
Building or Structure
G
,
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: 1BSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
I, .
$142.50
$25.00
TOTAL FEE:
$167.50
Kevisea: uwzuizu,4
CUPERTINO
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • building(d)cupertino.org
� � Permit No. 1610 � 00
Address ��''i� 5 4llA/.gp (�lG�DE�r1 W rj# # of Alarms Smoke: 10 Carbon Monoxide:
PURPOSE
This affidavit is a self- certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314, 2013 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 the
bedroom(s)
X
X
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: h-t 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 have been tested and are operational, as of the date signed
below.
;i-h fha fcrmc nnri conditions of this statement
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Contractor me:
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