14120004 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7558 HEATHERWOOD DR CONTRACTOR:_' IIlfX7,4 /u✓ila/n1 ERMIT NO: 14120004
/ t
OWNER'S NAME:
PHONE NO:
2 NELICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL E]
REPLACE(E)SEWER LINE&INSTALL 2(N)CLEANOUTS
License Class ^� Lic.# S"4S Ur S� (CUPERTINO SANITARY)
Contractor.S,,4 P_-r74.) L✓nrVIX1 a Date
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.
Ihereby 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
p rformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$3000
ave 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:35928042.00 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 WPERMIT 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 180 DA SF ROT ST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply `6v: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18.
�✓ RE-ROOFS:
Signature
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(a)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 Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 2553 .
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent- Date:!
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
U
GENERAL PERMIT APPLICATION EP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
RRE AVENUE•CUPERTINO, CA 95014-3255
10300 TO 1
(408)777-3228•FAX(408)777-3333•buildincl a�cupertino.ord 1 misc
Gl1RERTINO
PLUMBING []MECHANICAL [—]ELECTRICAL ❑\MISCCELLANEOUS
PROJECT ADDRESS „i �. APN#
OWNER NAMEa V GAt� PH`, E/ E-MAIL
STREET ADDRESS A CITY, S4T'AnEQZIP v[i(!y 7 FAX
CONTACT NAME$111 - PHONE D� �- �C�S(j,.� E-MAIL
STREET ADDRESS CITY,STATE, ZIPFAX
�O , e- (/
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT VICONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAMEp LICENSE NUMBER �Q� LICENSE TYPE BUS.LIC#
COMPANY NAME / E-MAIL / FAX T ✓ �S y�
STREET ADDRESS1�i /,7`„ )� CITY,ST ,,ZIP _ PHONE
ARCHITECT/ENGINEER NAME W f LICENSE NUMBER WB7US.LIC# `C
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OFSFD or DUPLEX [IMULTI-FAMILYPROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: COMMERCW. URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? E:1 NO
DESCRIPTION OF WORK
\ !i y
TOTAL VALUATION: 3l �� EGEIVED BY: -
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the pr perty 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 with all applicable local
ordinances and state laws relatin ilding construction. au/,o'ze representatives of Cupertino to enter the
/aboove-ide/nttified/property for inspection purposes.
Signature ofApplicantJAgen Date:1A
—/ —
SUPPL MENTAL INFORMATION REQUIRED of PICS USE ONLY
W OVER-THE-COUNTER
F '❑ EXPRESS
UW
5 ❑ STANDARD
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LARGE
p a,;
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MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 7558 HEATHERWOOD DR DATE: 12/01/2014 REVIEWED BY: MELISSA
APN: 359 28 042 BP#: *VALUATION: $3,000
PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Duplex PENTAMATION 1 RPSS
USE: P PERMIT TYPE:
WORK REPLACE E SEWER LINE & INSTALL 2 N CLEANOUTS CUPERTINO SANITARY
SCOPE
APPLIANCE/EQUIP TYPE FEE ID. QTY UNITS BP FEES
Sewer, Sanitary 1PRSEWER 1 # $25
TOTALS: $25.00
il'am �
; Q " ftNO �
P ' '
lkcif 1"Itm(Tree. Plumb.Plan Check 0.0 hrs $0.00 Alec.t'r<'r ��=ack
P''Pwit Fee: Plumb.Permit Fee: IPPERMIT
L
, Other Plumb Insp. 0.0 hrs $48.00 0dl er 1�c c.Insl".Phimb. Ita,�Vp, Fee: I�-ret.-_help.
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-for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Ef. 7/1/13) FEE QTY/FEE MISC ITEMS
Plea,, Check Fee:
PME Plan Check: $0.00
Permil Fee:
PME Unit Fee: $25.00
PME Permit Fee: $48.00
// Y
Administrative Fee: 1ADMIN $45.00
Work Without Permit? 0 Yes 0 No $0.00
",RV61/'Ho'ming Fees:
Travel Documentation Fee: ITRAUDOC $48.00 A
Stron Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
$167.50 $0.00m �r w TQAL FEE: $167.50
Revised: 10/01/2014
CUPERTINO
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • building(aDcupertino.org
y �
Address �✓�O
RECEIVED
DEC 0 8 2014
BY
1 yl r aOo Zj'l
)n Monoxide: /
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
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.
l have read and aaree to with thSlrrms and conditions of this statement
Owner (or Owner Ag nt's) Name:
A��
v
Si nat
.........:..... .................. ...............................
Date /*!" _ ....
Cont actor Name:
:� rr�Nj,v�•vT f
i natur
M
Smoke and CO form.doc revised 03118114
CUPERTINO
Owner Name
Address
RECEIVED
WATER- CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(4082777 -3228 • FAX (408) 777 -3333 • building(akupertino.org
DEC 0 8 2014
BY
;w�/-
Please refer to the attached California Civil Code Sections 1101.1 - 1101.8 which are part of this Certification form.
1. Is your real property a registered historical site?
❑ Yes Civil Code Sections 1,101.1 thro 1101.8 do not apply. Sign below and skip the rest of the form.
Owner' Signatur^e:�.�
EY No Go to Question 4E/
Date: / L ` 1/—/>01-'
2. Does your real property licensed plumber certifying that, due to the age or configuration of the property or its
plumbing, installation o 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 qLthe form.
Owner' Signatu Date:
No Go to Questi
3. Is water service pe ly disconnected for your building?
❑ Yes Civil C e Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form.
Owner' Signature: Date:
�No Go to Question /L '� `/
4. Is your real property b 'an 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 fonn.
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.
J& 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 - 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.
SB407 2014. doe 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 1101.8, the current
California Plumbing Code and California Green Building Standards Code, and manufacturer's installation requirements, and
that the water - conserving i)lumbinR fixture s&aaw�th the require- ments'as indicated in the table below.
Owner's (or Owner Agent's) Signatuye�,/�l/ �---- Date: /---Y ''1 y
Upon completing and signing tb&OC`�e2`i"ificate, please return it to the Building Division in order to final your permit.
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.
SB407 2014. doc revised 03118114
Non - Compliant
Water- Conserving Plumbing Fixture
Fixturel
(Fixture Complying with Current Code Applicable to New Construction)
—Plumbing
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.
SB407 2014. doc revised 03118114