B-2017-1218CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1218
20085 CEDAR TREE IN CUPERTINO, CA 95014-2004 (316 34 004)
ALLIED AIRE
SERVICE INC
MILPITAS, CA 95035
OWNER'S NAME: SONASETH MURTAZA S AND MUNIRA TRUSTEE
DATE ISSUED• 07/25/2017
OWNER'S PHONE: 408-691-2427
PHONE NO: (408) 934-8844
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO -
License Class C-10: C-20: C-38 Lic. #260035
Contractor ALLIED AIRE SERVICE INC Date 07/31/2017
X BLDG _ELECT _PLUMB
X MECH X RESIDENTIAL _ COMMERCIAL
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.
JOB DESCRIPTION
REPLACE FURNACE (ATTIC) AND A/C (SAME LOCATION
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
Compensation, as provided for by Section 3700 of the Labor Code, for the
S
yerformance 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
Sq. Ft Floor Area:
Valuation: $20000.00
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. I agree to comply with all city and county ordinances
316 34 004
316
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
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 a lic t under ands and will comply with all non -point
source regulati s per he Cu ino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
"F1
--S gnafbre Date 7L25/2017
Issued by AbbyAyende
Date: 07/25/2017,
OWNER-BLTIf DER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:All
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: 7/25/2017
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1. 1 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 maintain Worker's Compensation Insurance, as provided for by
HA?ARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
2. and will
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
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
Health & Safety Code, Section 25532(a) should I store or handle hazardous
3. I certify that in the performance of the work for which this permit is issued, I
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
air contaminants as defined by the Ray Area Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the u pal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Co an 534.
Labor Code, I must forthwith comply with such provisions or this permit shall
---?
be deemed revoked. (
Owner or authorized agent:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
Date: 7/25/2017
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
Lender's Name
to enter upon the above mentioned property for inspection purposes. (We) agree
to save indemnify and keep harmless the City of Cupertino against liabilities,
Lender's Address
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
ARCHITECT'S DECLARATION
and will comply with all non -point source regulations per the Cupertino Municipal
I understand my plans shall be used as public records.
Code, Section 9.18.
Licensed
Signature Date 7/25/2017
Professional
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building( cupertlro.oro
PLUMBING ❑ MECHANICAL ❑ ELECTRICAL n MISCELLANEOUS
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PROJECT ADDRESS
a�vCiBS L�4Pc2 L. 4
7APN # 9-1,410
OWNER N.A"*'E 1 " • A R kzA / rl f 1
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E-MAIL
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CONTACT NAME cc,�-�aa�+/Dg�np,11
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PHONE
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STREET ADDRESS
CITY, STATE; ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR 0 CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER 13 DE IELOPER ❑ TENANT
CONTRACTOR NAME
a 1 C j -%Illi_'!
LIC SE NUMBER
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LICENSE TYPE
C-1-04 iffy
BUS. LIC #
COMPANY NAME (�M.
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ARCIRTECT/ENGINEER NAME
LICENSE NUMBER.
BUS. LIC
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF SFD or DUPLEX ❑ MULTT-FAMTLY PROJECT TN WILDLAND ❑ YES
BUILDING: ❑ COMMERCIAL URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
�1PLA GL x G �u21t�rKC SY S jL-M f iJ u- tnl`
TOTAL VALUATION: Um
t
RECEIVED BY: a
By my signature below, I certify to each o the following: I am the property owner or authorized agent to act on the property otvn is beh lf. I have read this
application and the information I have p v ded t corr read the Description of 4�%ork and verify it is accurate. I agree to comply with all applicable Local
ordinances and state laws relating to b nl ' g c stru . I authorize presentatives of Cupertino to enter the above-identifie property for inspection purposes.
Signature of Applicant/Agent: Date: 7
SUPPLEMENTAL R\TFORMATION REQUIREDoFFicE
usE oitiTi.
y
❑ Oi'ER-THE COUNTER
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❑ STATvD,
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4AJOR:
TufEPMiscApp_2011.doc revised 06121/11
\ .10 SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO44-
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 110
(408)777-3228• FAX(408)777-3333•buildino(a cupertino.orr ,i
Wt�PERMIT CANNOT}BE FINALED UNTIL THIS CERTIFICATE HAS BEEN >
.��� `COMPI EELED SIGNED AND RETURINED TO THERBUILDINhGDIVI•SIO x.:
404
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e - _�� ' 17,:5,' & ;L g'� :2r, �.. �t �
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 multifamily 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 land 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 specified below have been tested and are operational, as of the
date signed below.
Address: 2 0 09 5 CE.7)4R 7-R LN i G Ui'ER—r` No i CA-%0lijPermit No.
•
Specify Number of Alarms: #Smoke Alarms: EME #Carbon Monoxide Detectors:.),1 - I
I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name: p�
Signature.......... Date: �Z6/,`7
Contractor Name:
Signature Lic.# Date:
Smoke and CO formn.doc revised'12/15/16
Abby Ayende
07/25/17
07/25/17
B-2017-1218
Abby Ayende
Abby Ayende
07/25/17