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15030088 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20641 MCCLELLAN RD CONTRACTOR:PLUMBING TECH INC PERMIT NO: 15030088 OWNER'S NAME: BELL KENNETH AND THIEU HUAN LE 278 E GISH RD DATE ISSUED:03/13/2015 OWNER'S PHONE: 4087578333 SAN JOSE,CA 95112 PHONE NO:(408)437-6207 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL 2 INSTALL(N)PROPERTY LINE CLEANOUT(SANITARY License Class tJ'� Lic.#_�_7/�� APPROVED 3/13/15) Contractor ` 'Date,413� 1�57 I hereby affi m 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'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:$2200 { 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 APN Number:35916005.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYSOF IT 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 DAY ED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the 3 11 granting of this permit. Additionally,the applicant understands and will comply Iss with all non-point source regulations per the Cupertino Municipal Code,Section 918. RE-ROOFS: Signature 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 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 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 a d I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized ag Dat permit is issued. 3 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 CONSTRUCTION LENDING AGENCY 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 O� MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 0 CUPERT[NC3 (408)777-3228•FAX(408)777-3333- buildingftupertino.org M-1sc PLUMBING ❑/MECHHANICAL [:]ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS �/%/.., / // /�//„ / 'Y'�' APN# 'S !6 O o, OWNER NAME ^�^ PHO Q J/Zf, J E-MAIL STREET ADDRESS CITY,STATE,ZII[�/J��Q FAX CONTACT NAME or/// E-MAI; STREET ADDRESS `vvC/� �/ � n� CITY,STATE,�n� G / FAX ' ❑ OWNER ❑ OWNER-BUILDER� ❑ O ,{WNERf AGENT (CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ""-0-ENGINEER-- ❑ DEVELOPER ❑ TENANT - CONTRACTOR NAME /UM /� A-964 me LICENSE ER � � LI�ENS��E-� BUS.LIC#J�� 47 COMPANY NAME L// E-MAIL (- FAX STREET ADDRESS //O 1-14& -nAIW O JZ CITY,ST ZIP ��o C 139Q -.29 ARCHITECT/ENGINEERNAME �J LICENSE NUMBER Ti 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 C le.4 N 0 Uz7' l V TOTAL VALUATION: 22-0 V �REC � 1 1 By my signature below,I certify to each of the following: I am the property owner or authorized agent to act o erty 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 ordinances and state laws relating to build' construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED IaF1c � �; YER ,IIE��U�1TERt MEPMiscApp_201 Ldoc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 20641 MCCLELLAN RD DATE: 03/13/2015 REVIEWED BY: MELISSA APN: 359 16 005 BP#: *VALUATION: 1$2,200 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1 RPS WORK INSTALL N PROPERTY LINE CLEANOUT SANITARY APPROVED 3/13/15 SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Building 1PRSEWER 1 # $25 TOTALS: t s a $25 00 4 �w a' v Mech. Plan Check Plumb,Plan Check 0.0 hrs $0.00 h7ec.Plan Check Mech. Perwit Fee: Plumb.Permit Fee: 1PPERMIT I lec. Perini?Fee: Ocher_Meeh.Irup. Other Plumb Insp. 0.0 hrs $48.00 offer Ek"c�.Insp. wech. Insp. Fe. Plumb. ]resp.Fee: Eler,Inst), Fee: NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,eta). Thesefees are based on the prelhiniina information available and are on an estimate. Contact the De t or addn7 info, FEE ITEMS(Fee Resolution 11-053 E f 711113) FEE QTY/FEE MISC ITEMS Man Check Tee: sappl. PC:'Pee PME Plan Check: $0.00 1'erinit 1'ee: Stc ypl. Z ee PME Unit Fee: $25.00 PME Permit Fee: $48.00 C onsti,tiction lax: Administrative Fee: ]ADMIN $45.00 Work Without Permit? ®Yes (E) No $0.00 Advanced Plunning Fees: Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 NON $167.50 $0.00 TO AL FEE .: $167.50 mak. tr h`9 �i '.� 349`n`t ' r ^46" �: ra' Revised: 02/14/2015 WATER-CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE- CUPERTINO,CA 95014-3255 t h r 408),27;-:_ 281 j-AX(408)777-3333•building6lcupertino.orci /�Q 3 66 Owner Name 1�{' /-� t-,e I Permit No. S-joe Address Z c C 1 P( �� fZ C� CP- 9,3� ( `f' 1. Is your real property a registered historical site? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. )R�No Go to Question 2. 2. Does your real property have a licensed plumber certifying that,due to the age or configuration of the property or its plumbing,installation of water-conserving plumbing fixtures is not technically feasible? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. ❑ The licensed plumber's certification has been provided to the Building Division. Skip the rest of the fonn and sign bottom of form. No Go to Question 3. 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. ,X'No Go to Question 4. 4. Is your real property built and available for use or occupancy on or before January 1, 1994? ❑ No My real property is built and available for use or occupancy after January 1, 1994. Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. ,<Yes My real property is built and available for use or occupancy on or before January 1, 1994. Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign bottom of form.. 5. Pq,ycjpropjrty heck ONE of the following: is a singlefamily residential real property. See Civil Code Section 1101.4. and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing fixtures to be replaced with water-conserving plumbing fixtures throughout the building.On or before January 1,2017,all non- compliant plumbing fixtures shall be replaced with water-conserving plumbing fixtures (regardless of whether property undergoes alterations or improvements). ❑ My property is a multifamily residential real property. See Civil Code Section 1101.5. On and after January 1,2014, specified building alterations or improvements shall require non-compliant plumbing fixtures to be replaced with water-conserving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvements). ❑ My property is a commercial real property. See Civil Code Section 1101.5. On and after January 1,2014,specified building alterations or improvements shall require non-compliant plumbing fixtures to be replaced with water-conserving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvements). I,as the owner or owner's agent of this property, certify under penalty of perjury that non-compliant plumbing fixtures will be replaced prior to date specified above with water-conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 through 1101.8, the current California Plumbing Code and California Green Building Standards Code,and manufacturer's installation requirements, and that thewater-conserviaKlumbing fixtures comply with the requirements as indicated in the table on the following pa e. Owner or Owner Agent's Signature: Date: Upon completing and signing this Certificate,please return it to he Building Division in order to final your building permit. SB4072015.doc reiRsed 08126115 RT SMOKE / CABON MONOXIDE ALARMS OWNER C IIFIICATE OF COMPLIANCE FILE COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION -22 --4J- 10300 CUPERTINO 10300TORREAVENUE • CUPERTINO, CA 95014-3255 c, (408)777-3228• FAX(408)777-3333 • building an0 cupertino.org 1 57p�j p �i Permit No. tJ (V_C_ Address Z'% 1 FA C C IPI Ie„,A '4 of Alarms Smoke: Carbon Monoxide: 7— PERMIT PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE HAS BEEN SIGNED AND RETURNED TO THE BUILDING DIVISION 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 X X 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 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 have read and ijqree to Gomply with the terms and conditions of this statement (or Owner Agent's)Name: 1r7_4h A SI na ........................................................................Da : ................... Contractor Name: Signature...................................................................LIc.#......................................Date: ................... Smoke and COform.doc revised 03/18/14