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B-2017-1195CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1195 7598 SQUIREWOOD WAY CUPERTINO, CA 95014-5055 (362 26 034) HOME DEPOT U S A INC ATLANTA, GA 30339 OWNER'S NAME: HU SHAO-CHIN DATE ISSUED: 07/24/2017 OWNER'S PHONE: 408-707-9308 PHONE NO: (770) 433-8211 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B. C39, C13, C17 Lic. #(102331 Contracto�'HOME DEPOT U S A INC Date 09/30/2018 X BLDG _ELECT —PLUMB MECH X RESIDENTIAL COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7006) of Division Sof the Business & Professions Code and that my license is in,'full force and effect. JOB DESCRIPTION: REPLACE WINDOW (3)- LIKE FOR LIKE TO MEET EGRESS; I hereby affirm under penalty of perjury one of the following two declarations: 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. 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:'$2243.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct.] agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 362 26 034 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. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the applicant understands and will comply with all non -point source regulationsr per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. i e Date 7/24/2017 Issued by: Jasmine Archbold Date: 07/24/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the RF ROOFS: following two reasous: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. 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) 2. 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: 7/24/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER t. Ihave 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 2. 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 an'yperson in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and exemption, i become subject to the Worker's Compensation provisions of the Health & Safety Code, Sections 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. r or authorized agen APPLICANT CERTIFICATION Date: 7/24/2017 I certify that l have read this'application and state that the above information is N TR LE E Y correct. I agree to comply�with all city and county ordinances and state laws I hereby affirm that there is a c c ion 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 harmlessjthe 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. Licensed Signature Date 7/24/2017 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CtJPERTIN4 I (408) 777-3228 • FAX (408) 777-3333 • buildin cupertino.or Q azo/ _ _ 1 ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/ TI ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS 7:5 pI I , VI' 7 I or_� p `1//�, � APN # %s OWNERNAME I A_6&1 �F r PHONE -76?730q E-MAIL 1 ` i4 �C jV • STREET ADDRESS ? sig v l Z,1c %•�� CITY STATE, ZIP c���rz-�, i, ;2 CA 7 S©r . FAX CONTACTNAME JEFF RAINEY PHONE 510-427-4260 E- LJEFFREY.RAINEYQATT.NET STREET ADDRESS 1069 EDGEMERE LANE CITY, STATE, ZIP HAYWARD, CA 94545 7F 510-783-1041 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR '�] CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # 405"6 602331 B,C39,C13,C17 4 fy1 COMPANY NAME E-MAIL FAX HOME DEPOT USA 510-357-3750 STREET ADDRESS CITY, STATE, ZIP PHONE 2456 VERNA COURT SAN LEANDRO,CA 94577 510-877-4550 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK t ,-J 5 t i -if r _F__( _T 1/! / t,I% r� O c�%S .t/l. O EXISTINGUSE PROPOSED USE CONSTR. TYPE # STORIES ®/e N USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODELAREA REMODELAREA PORCR AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREALIDETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT [] YES SECOND STORY []YES BEING ADDED? []NO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YESItE EICHLER HOME? NO ,ED z ' 2" Y T jTAL VALU TLCON: ❑ _ ,^` L� L. 5 By my signature below, I certify to 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 ccurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representativ pertino to enter the above -identified pr7(.2 erty for inspection purposes. �%/ 2 7f Signature of Applicant/Agent: Date: . % SUPPLETAL INFORMATIOQU RQUnCoIrN r u GST [P�r New SFD or Multifamilydwellings: or demolition permit for ;r h,� existing building(s). Demolition permit is required prior to issuance of building. permit for new building. t7 EXPRESS❑ PLANNING PLANREVtEW� _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 7 `STANDARD form if any Hazardous Materials are being used as part of this project. of Planning Approval Letter or Meeting with Planning prior to _Copy submittal of Building Permit application. ❑ 1VJASOR a ❑ANFA2Y Sk WRlf I IIIC C , BldgApp_2011.doe revised 06/21111 \\ SMOKE i CARBON MONOXIDE ALARMS ralLOS S ' )/ OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUPERTINO10300 TORRE AVENUE• CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•building a(�cupertino.orci PERMIT CANNOT BE..FINALED UNTIL TRIS CERTIFICATE IIAS BEEN COMPLETED;.&;IGNED'AN)RETURNED TO T;HE`BUILDING DIVISION PURPOSE This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2016 CRC Section R314,2016 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 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 X X the 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 907.2.114 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: 9-CIP W a..�%y�(Ajb C (AIt /w C1 city e j/f✓7 TA-D Permit No. 1 t Specify Number of Alarms: #Smoke Alarms: I i #Carbon Monoxide Detectors I / ( I � I have read and agree to comply with the terms and conditions of this statement Owner(or Owner Agent's)Name: ;/7�i ietCohcLSignature Date i /i Contractor Name: Signature Lic.# Date: Smoke and COform.doc revised 12/15/16 WATER-CONSERVING PLUMBING FIXTURES . OWNER CERTIFICATE OF COMPLIANCE `( z.sts COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUPERTINO10300 TORRE AVENUE• CUPERTINO,CA 95014-3255 1(408)777-3228•`FAX(408)777-3333• buildingcupertino.orq f i ditC Owner Name me( C A j\f\ � �.� Permit No. .lob IIr—� '�✓ Address 76- A ;ye-(APO i l��1. f ��t d 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. 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? D Yes Civil Code Sections 1101.1 through 1101.8 do not apply. D The licensed plumber's certification has been provided to the Building Division. Skip the rest of the form and sign bottom of form. u'I Pc No Go to Question 3. ' 3. Is water service permanently disconnected for your building? CI Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. /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. II`!' Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. ' 11 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. Please 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). q 0 My property is a multifamily residential real property. See Civil Code Section 1101.5. On and after Janna,y 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). CI 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 11 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 page. 1 Owner or Owner Agent's Signature: 1( l ---- >_ Date: 00.-__A- 7 Upon completing and signing this Certificate,please return it to the Building Division in order to final your building pilit. SB407 2015.doc revised 01/05/17