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B-2017-0976CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0976 10138 IMPERIAL AVE CUPERTINO, CA 95014-5955 (357 22 045) K S ELECTRIC SAN JOSE, CA 95129 OWNER'S NAME: CHI CHIEH AND TAN QIAOLIN DATE ISSUED: 06/21/2017 OWNER'S PHONE: 408-666-5327 PHONE NO: (408) 568-0928 LICENSED D ONT A TOR' DECLARATIQNL BUILDING PERMIT INFO: License Class C_-10 Lic. #768223 Contractor K S ELECTRIC Date 09/30/2017 X BLDG X ELECT —PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing — MECH X RESIDENTIAL — COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: INSTALL 3 LED LIGHTS - BEDROOMS I hereby affirm under penalty of perjury one of the following two declarations: 1. I have and will maintain a certificate of consent to self-insure for Worker's l Compensation, as provided for by Section 3700 of the Labor Code, for the formance of the work for which this permit is issued. 2. 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. Sq. Ft Floor Area: Valuation: $200.00 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 APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 357 22 045 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal) Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. �► Signature s �—� v Date 6121/2017 Issued by: Abby Avende Date: 06/21/2017 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is t. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) z. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 6/21/2017 1 hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER t. 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. HAZARDOUS MATERIALS DISCLOSURE z. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous Worker's Compensation laws of California. If, after making this certificate of 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 exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sections 25505, 25537 553 , and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent:/ i, Ot— APPLICANT CERTIFICATION Date: 6/21/2017 1 certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Signature Date 6/21/2017 Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building(a)cuoertino.ora ❑ NEW CONSTRUCTION ADDITION ❑ ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT n PROJECT ADDRESS V j APN 35-4- 22,045 45 OWNER NAME PHONEo f.7�ja 0 / j j • E-MAIL a y ` STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME r PHONE � /0 E-MAIL STREETADDRESS CITY STAZE,ZIP FAX en D ❑ OWNER ❑ OWNER -BUILDER OWNERAGEN•r ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMELICENSE I lma ZZ LICENSE TYPE BUS. LIC # COMPANY NAME T E- FAX 40 STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECTIENGINTEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK1`%% (� ! � ( _ % /? // T cS `JI2. 7 O'� x z: 4 EXISTING USE PROPOSED USE CONSTR. TYPE k STORIES I USE TYPE OCC. SQ.FT. VALUATION (S) ExISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH ❑ ATTACH I 4 DWELLING UNITS: IS A SECOND UNTr ❑ YES SECOND STORY ❑ YES BEING ADDED? ONO ADDITION? ONO I J_ PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES - IVE BY -: TOTAL UA_)T�I ��rrr PLANIN'AIG APPL # ❑ NO PLAI.'NING APPROVAL LETTER EICHLER HOME? ❑ NO V By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on thA 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 witb all applicable local ordinances and sate laws relating to building construction. I authorizeZXntatives of Cupertino to enter the above-ide tifred pro rty for inspection purposes. Signature of Applicant/Agent: az-^1 , 11 —mac Date: SUPPLEMENTAL INTORMATION REQL�2EDRovTrr.csl New SFD or Multifamily dwellings: Apply for demolition permit for ❑y 6 ERTHE-COUNTER ; ❑ BIIIIDII�GPLANREVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ .rLANTtAGyL REVgW Bldgs: Provide a completed Hazardous Materials Disclosure❑ STA.KDARD ❑LBLICwoR�s _Commercial form if any Hazardous Materials are being used as part of this project. TARGE' ❑ FTREDEPT- _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. ❑ MAJOR ❑ S 4MTARI SE�i ER DISTRICT ." , B1dgApp_2011.doc revised 06/21/11 CUPERTINO Owner Name WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building a_cupertino.org Address TSB RYiril� Allg ME= 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. -1� 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 form 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 fonn and sign bottom of form. +F—No Go to Question 4. 4. Is ur reaI property built and available for use or occupancy on or before January 1, 1994? No M real roe is built and available for use or occupancy after January 1 1994. y property rh' �� p Y D' , 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. li lease check ONE of the following: My property is a single family residential real property. See Civil Code Section 1101.4. On 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-conseiving 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-coinpliant 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-coinpliant 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 the water -conserving plumbing fixtures comply with the requirements as indicated in the table on the following Daae. Owner or Owner Agent's Signature: 61 Lin Lin T•poc�_ Date: 6 - 13- _ yp � J Upon completing and signing thi\Certificate, please return it to the Building Division in order to final your building permit. SB4072015.doc revised 01/05/17 SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE FILE COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION V l ` j CUPERTINO10300 TORRE AVENUE CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333•buildinq(a cupertino.orq PERMIT CANNOT BE FI NALED UNTIL TI S CERTIFICATE HAS BEEN eitATPLE'iTE-I,,SIGNED AND I2E TURNEb TO THE � �into �3IVISTON` TM, ' = _:BSD 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 intenor 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 I i 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 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 lo(.3,g liftpert A\ Ave a CiAlt1' A0 Permit No g—,1017 —0176 Specify Number of Alarms _ #Smoke Alarms #Carbon Monoxide Detectors t have read and agree to comply with the terms and conditions of this statement Owner(or Owner Agent's)Name: 6 Signature .6L, La'v Contractor Na e: I Date: Signature .R.4%: Lic.# Z 64'Date: / .2//2 Smoke and CO form.doc revised 01/10/2017