B-2017-1918 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1918
10796 CRANBERRY DR CUPERTINO,CA 95014-4975(362 02 009) AFFORDABLE WATER
HEATERS AND
PLUMBING INC
28358
CONSTELLATION RD
VALENCIA,CA 91355
OWNER'S NAME: KIM WOO KYUNG AND NAM SIK DATE ISSUED: 11/07/2017
OWNER'S PHONE:408-781-2225 PHONE NO:(855)345-9087
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-36 Lie.#627368
Contractor AFFORDABLE WATER HEATERS AND PLUMBING INC Date xBLDG _ELECT X PLUMB
09/30/2018 MECH JX 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 JOB DESCRIPTION:
license is in full force and effect. REPLACE 50 GAL WATER HEATER-INSIDE'CLOSET
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
+rmance of the work for which this permit is issued.
''have and will maintain Worker's Compensation Insurance,as provided for by
0,1 Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$2200.00
ii
permit is issued.
APPLICANT CERTIFICATION '
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 362 02 009
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 PERMIT EXPIRES IF WORK IS NOT STARTED
City of Cupertino against liabilities,judgments,costs,and expenses which WITHIN 180 DAYS OF PERMIT ISSUANCE OR
may accrue against said City in consequence of the granting of this permit.
Additionally, e a•• r ant understands and will comply with all non-point 180 DAYS FROM LAST CALLED'INSPECTION.
source regula,ons -r •- Cupertino Municipal Code,Section 9.18.
A, Issued by:Abby Ayende
ignature Date 11/7/2017 Date: 11/07/2017
1
OWNE•-B t ' DECL: t • O. RE-ROOFS:'"
. , .
, .
I hereby affir I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed.If a roof is
following two re: s: installed without first obtaining an inspection,,I agree to remove all new materials for
1. I,as owner of the property,or my employees with wages as their sole inspection. ,
compensation,will do the work,and the structure is not intended or offered for
sale(Sec.7044,Business&Professions Code) Signature of Applicant:
2. I,as owner of the property,am exclusively contracting with licensed Date:11/7/2017 '
contractors to construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 HAZARDOUS MATERIALSDISCLOSUREperformance of the work for which this permit is issued. I have read the hazardous materials requlrenients under Chapter 6.95 of the
2. I have and will maintain Worker's Compensation Insurance,as provided for by . California Health&Safety Code,Sections 25505,25533,and 25534. I will
Section 3700 of the Labor Code,for the performance of the work for which this 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 se equipment or.devices which emit hazardous
air contaminants as defined by t:: :• •` a AirQuality Management District I
shall not employ any person in any manner so as to become subject to the f
will maintain compliance with th upert•o Municipal Code,Chapter 9.12 and
Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Co.=, • ons 25505,25533,and 25534.
' 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 ner or authorized agent: 1,11
be deemed revoked. Date:11/7/2017 ;,\.
APPLICANT CERTIFICATION CO S R A• Lt ND G,kG L
I certify that I have read this application and state that the above information is I hereby affirm that there is a onstr ctio 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 permi is iss -d(•ec.'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.
CONSTRUCTION PERMIT APPLICATION
x,, ,,,,,7,;.,,,,.:
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
: $ ZOIC -/q/�
4��Y�Ds"" (408) 777-3228 • buil din gC?�cupertino.org PEMIT*:B-
CUPERTINO REV# DEFF
❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.1. I IEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS L n,7§-ye:0, �/� - r APN A
WN R.pI.9�SQE. - K� /Y �/V l PHO /f ® 7scsi—222rAIL
STREETUUURESS /X`/ST E,ZIP
r1".‘0 ' ' 415_0_0_ ______•
IRLCON CTOR NAME 0 OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
S ot- `' Z�wG 1\- v o{ LL L)4L I�-t�Mc L92
C-ZIP
�'I� SS
E-WAIL P NE BUS.LIC.i
0 AR ITECT ❑OWNER_❑OWNER AGENT 0 CONTR.ACTOR.AGENT❑ENGINEER 0 DEVELOPER 0 TENANT
CONTACTNAME 1? E-MAIL tp e. aiA, fJ W ev.;
S ADDR S ZIP ci_tojtolp)2isi wLc�p. 1� c) (ye c � ; j q 3-6420
DECRIPTONd
req /aci 501/04)-1-°'' L-4 - Tifr0 asp
A INGLE-FAMILY/DUPLEX 0 MULTI-FAMILY ❑.INDUSTRIAL ❑COMMERCIAL I
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES A TOTAL NET SF USE TYPE OCC ,SQ,FT, VALUATION'(5)
1 i ,
REMODEL REMODEL KITCHEN . REMODELOTHR GARAGE ❑ATTACHED ,
BATHROOM SF SF SF SF
. ❑DETACH ED
EXISFIRE ISPRINKLERS 0 NO EICHLER 0 YES SECOND STORY ADDITION DYES
NO0 NO I
DWELLING SECOND DWELLING ❑yES 0 ATTACHED 0 DETACHED OTHER
UNITS F UNIT ADDITON: ❑NO S F
POOLS ❑FIBERGLASS 0 VINYL-LINED 0 GUNITE ❑PREFABRICATED
POOL-SF SPA-SF I SPA ATTACHED OYES 0 NO I TOTAL-SF
RE, -22:„: w
UATION:
Commercial or Mudli-Family Buildhus with Public Swiauvine Pools requires Department of Environmental Heath approval oI
RE-ROOF EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES LI WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY)
REMOVE/REPLACE❑NO IF NO PLYWOOD ❑1/2 0 3/8" ' PLYWOOD TYPE: PITCH: ROOF CLASS
DYE F OF LAYERS THICKNESS❑5/8" OTHER DOHS 0 CDX OTHER .12 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF DASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 OTHER
! *Provide a signed copy of the Cupertino's Tear-Off Policy ' SF Cot SQUARES
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 verify it is accurate. I agree
1 to comply with all applicable local ordinal: ce - d state laws relating to building construction. I authoriz representatives of Cupertino to
enter the above-identified property for i l is• .urposes. I acknowledge and authorize all information ntai ed on this application form
to be made available for public record�� I j� �f
Signature of Applicant/Agent: Date: -
SUPPLEMENTAL INFORMATION RI• RE
*New SFD/Second Dwelling Units/Mul. - ly Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings: Provide a comp_ :. Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
*Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application.
*HOA-Provide a letter of approval from the Home Owner's Association
I.' BldgApp_20)7.doc revised 08'01/17
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/ SMOKE / CARBON MONOXIDE ALARMS
{ OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO
(408)777-3228•FAX(408)777-33 `P ;'z. cu o_,i:nQ ora ,
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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 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,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
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 alarms) 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.
r r�,,. n i7 p
+;" rrs /? 711 Crcuk4l y OYlj24i of-pb� Permit No. fj f 2 Q) 7 / q 1r
i have read and agree to comply with the terms and conditions of this statement
Sfprlat irer,Nat,Ge
Contractor Name:
/1--F , r- 4Y:I
, b/e wa71-P v Signature C2-e/ Lic.# ..I,2 73 c cr Date: .I1.41.7
1-/e a 7`-e rcr
Smoke and COfornr.doc revised 01/10/2017