14090212 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21431 COLUMBUS AVE CONTRACTOR:CABINET&STONE EXPO PERMIT NO: 14090212
INC
OWNER'S NAME:
SAN JOSE,CA 95131 PHONE NO:(408)573-7888
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL r] COMMERCIAL
WATER DAMAGE REPAIR(520 S.F.)REPLACE 2 VANITY
License Class (5 Lic.# 480 Cf c1 SINKS,FAUCETS&TILE FLOOR&PARTIAL SHEETROCK
IN
Contractor UPSTAIRS MSTR BATHRM&DRYWALL IN DOWNSTAIRS
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.
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:$16000
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:36204009 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 DAYS OF PERMIT 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 1 CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accru against said City in consequence of the
granting of this permit. Additional ,the app ant understands and will c Y Date:
with all non-point source regula' ns per th upertino Municipal Code,Section
9 18.
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
1,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)
1,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(x)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 Ai Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino unicipal ode,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 2550 ,
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized �3 /
permit is issued.
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
9 18,
Signature Date
CONSTRUCTION PERMIT APPLICATION
� O
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333•building
(a cupertino.org
CUPI=RT[Nd \
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS LAPN# 3 6 Z Q O
( C L Ay6, G i
OWNER NAME
CONTACT NAME la-0
ONE E-MAIL
$ 3
STREET ADDRESS CITY,STATE,ZIP FAX
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C3OWNER ❑ OwNER-BUILDER ❑ OWNER AGENT CONTRACTOR 13CONTRACTOR AGENT ❑ ARCHITECT ElENGINEER ElDEVELOPER El TENANT
CONTRACTOR NAME LICENSE BEER TLI
CENSE TYPE BUS.LIC#
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COMPANY NAME E-MAIL FAX
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STREET AD PRESS CITY,STATE,ZIP G l H OCJ
1 J ' S �'oSG- 4,66
ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS
CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK _ s
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EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER 5Z�
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH
❑ATTACH
#DWELLING UMTS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES
BEING ADDED? []NO ADDITION? [:]NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES _ E _ t '" °?`t z; TOTAL VALUATION:
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO ;'s _ z '' 161
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By my signature below,I certify to each of the following: I a e property owner or authorized agent to act on the pr owner's behalf. I have read this
application and the information I have provided is correct. I 1 ve read the t<seri tion of Work and verify it is acc e. I agree to comply with all applicable local
ordinances and state laws relating to building constru onze re es@ntative upertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date ! 3b 'Zo 1 t�
SUPPLE TAL INFO ATION REQUIRED kIcK.i�rE h nouiuscsLlr '
—. �a, gh5 '.,�'ks'ai dwv'y-`rc,,
_New SFD or ultifamily dw gs: Apply for demolition permit for R� �o�uJVTER � BUu,DING pLart REvrEw` F t
existing buildin s). Demolition permit is required prior to issuance of building ' 4 �
permit for new but ding. ExrxEs§ tib za p7 SING P�AN REyIEW$ 3
R �>
PUBO C WORKS
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure i7 sTvDARDy
form if any Hazardous Materials are being used as part of this project. ^3
_Copy of Planning Approval Letter or Meeting with Planning prior to � R t$t = r[7} sAl\ITARY sEwExD15TRreT s
submittal of Building Permit application. ' L `
BldgApp_201 1.doe revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 21431 COLUMBUS AVE DATE: 09/30/2014 REVIEWED BY: MELISSA
APN: 362 04 009 BP#: "VALUATION: 1$16,000
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION 1 R3SFDRE
USE: PERMIT TYPE: i
WORK WATER DAMAGE REPAIR 520 S.F. REPLACE 2 VANITY SINKS FAUCETS &TILE FLOOR &
SCOPE PARTIAL SHEETROCK IN UPSTAIRS MSTR BATHRM & DRYWALL IN DOWNSTAIRS FAMILY p
a
. a,.
Plan C7�ieck CYech P/an
cI_ P,,r orrt Fee.- Plumb, P,,rmir Pee:
llc1. n.�,., other Plumb fnYp. oii?er°Llec. InST".
Fe':, P/ztrrt,. hul). Fee
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Theseees are based on the prelimina information available and are only an estimate. Contact the Dept./or addn'l info,
FEE ITEMS (Fee Resolution 11-053 E . 7/1/131 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = s.f. Remodel,Other
Suppl. PC Fee: (j) Reg. 0 OT 0.0 hrs $0.00 $503.00 1REMRESOTH
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee: Reg. 0 OT0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
(.'onswuction Tax-
Work Without Permit? ® Yes (j) No $0.00 E)
Advanced Planning Fee: $0.00 Select a Non-Residential E)
Travel Dtat°uinvalati trt Fees: Building or Structure C)
Stro z Motion Fee: IBSEISMICR $2.08 Select an Administrative Item
Bldp,Stds Commission Fee: IBCBSC $1.00
` ������ n $3.08 $503.00 TO Z FE; $506.08
Revised: 08/20/2014
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OFFICE COPY
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COMMUNITY DEVELOPMENT DEPARTMENT �U�
BUILDING DIVISION - PERTINO
APPROVED �������J\er►e
This set of plans and specifications MUST be kept at the
;cb site during construction. It is unlawful to make any
changes or alterations on same, or to d6viate
t'lerefrom, without approval from the Building Officiai. RECEIVED
the Stamping of this pian and specifications SHALL NOT
Le held to permit or to be an aporo,.c l of the violation
any provi '-S--"f-Iny QiLy,-(areinance or State Lay. SEP 3 0 2014
R M I T # Z BY
CUPERTINO
Address
SMOKE / CARBON MONOXIDE ALARMS 1
OWNER CERTIFICATE OF COMPLIANCE 1 J
�L
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION /0 - 23'
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 \
(408) 777 -3228 • FAX (408) 777 -3333 • building(a__)cupertino.org [� Gy
Permit No. 7 au u Z
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
bedroom(s)
X
X
On every level of a dwelling unit including basements
X
X
Within each sleeping room I
I 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 agree to comply with the terms and conditions of this statement
Owner (or Owner Agent's) Name:
1�9 .,,,✓ i r 1 / i / I Sianature.... ...... ,.e!c4.C, s.,. r ` 4. ................ ............................... Date: ..G . .. .
DM
Smoke and COform.doc revised 03118114
CUPERTINO
Owner Name
Address
WATER- CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE f
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • buildingO)cupertino.org
T I L
Z3- /y
OZ-12-
Please refer to the attached California Civil Code Sections 1101.1 - 1101.8 which are part of this Certification form.
1. Is your real properly a registered historical site?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form.
Owner' Signature:
No Go to Question 2.
Date:
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 110 1. 1 through 1101.8 do not apply.
❑ The licensed plumber's certification has been provided to the Building Division.
Sign below and skip the rest of the form.
Owner' Signature:
0 No Go to Question 3.
Date:
3. Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form.
Owner' Signature:
No Go to Question 4.
Date: I /'i. �'2.0)V
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. Sign below and skip the rest of the form.
Owner' Signature: Date:
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. Refer to the attached.
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 rraultifamily 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.
SB40 7 2014. doc revised 03118114
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/We, the owner(s) of this property, certify under penalty of perjury that non - compliant plumbing fixtures have been replaced
with water - conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 through 110 1.8, 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 below.
Owner's (or Owner Agent's) Signature: Date:
Upon completing and signing this Certificate, please return it to the Building Division in order to final your permit.
Non - Compliant
Water- Conserving Plumbing Fixture
Plumbing Fixture
(Fixture Complying with Current Code Applicable to New Construction)
Maximum Water Usage/Flow Rate
Fixture Type
Water Usage
2013 CPC Ch. 4
2013 CPC Ch. 4
2013 CPC Ch. 4
/Flow Rate
2013 CALGreen Div. 4.3
2013 CALGreen Div. 4.3
2013 CALGreen Div. 5.3
Single - Family
Multi - Family
Commercial
Residential
Residential
Water Closets
Exceed 1.6
Single flush toilets: 1.28 gallons /flush
(Toilets)
Gallons /flush
Dual flush toilets: 1.28 gallons /flush effective flush volume (the composite,
average flush volume of two reduced flushes and one full flush
Urinals
Exceed 1.0
0.5 gallons /flush
Gallons /flush
Showerheads
Exceed 2.5
2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of
gallons per minute
U.S. EPA WaterSense Specification for Showerheads
(A hand -held shower is considered a showerhead.)
For multiple showerheads serving one shower, the combined flow rate of all
showerheads and /or other shower outlets controlled by a single valve shall not
exceed 2.0 gallons per minute @ 80 psi, or the shower shall be designed to
allow only one shower outlet to be in operation at a time.
Faucets —
Exceed 2.2 gallons
Maximum 1.5 gallons per
Within units:
0.5 gallons per minute @ 60
Lavatory
per minute
minute @ 60 psi; minimum
Maximum 1.5 gallons
psi
Faucets
0.8 gallons per minute @
per minute @ 60 psi;
20 psi
minimum 0.8 gallons
per minute @ 20 psi
In common and public
use areas: 0.5 gallons
per minute @ 60 psi
1.8 gallons per minute
60 psi
Faucets —
Exceed 2.2 gallons
1.8 gallons per minute @
1.8 gallons per minute
1.8 gallons per minute @ 60
Kitchen
per minute
60 psi
@ 60 psi
psi
Faucets
May temporarily increase
May temporarily
up to 2.2 gallons per
increase up to 2.2
minute @ 60 psi, and must
gallons per minute @
default to maximum
60 psi, and must
1.8 gallons per minute @
default to maximum
60 psi
1.8 gallons per minute
Where faucets meeting
@ 60 psi
the above are unavailable,
Where faucets meeting
aerators or other means
the above are
may be used to achieve
unavailable, aerators or
reduction.
other means may be
used to achieve
reduction.
1. If the existing plumbing fixture water usage /flow rate is equal to or lower than the figure shown, it is not required to be upgraded.
SB4072014.doc revised 03118114