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15070085-Unit 44111% S'. CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20800 VALLEY GREEN DR APT 441 CONTRACTOR: 20800 VALLEY GREEN PERMIT NO: 15070085 DRIVE OWNER'S NAME: 20800 VALLEY GREEN DRIVE PO BOX 1368 DATE ISSUED: 07/13/2015 OWNER'S PHONE: 4082530200 CARLSBAD, CA 92018 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL APT 441 - INSTALL (N) WASHER/DRYER HOOK UPS License Class Lic. # Contractor 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. 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 Sq. Ft Floor Area: Valuation: $500 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 APN Number: 32609040.441 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXP WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN SOF 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 18 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 Issued b Date: J granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino 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. xv 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 I, 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) 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 CupertinoMumc' al Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Se 25505, 25533, d 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized ent: Date: permit is issued. 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 a Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date GENERAL: PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIV MEP 10300 TORRE AVENUE • CUPERTINO. CA 95014-3255 DIVISION GU P9 tT1 W 0 (408) 777-3228 - FAX (408) 777-3333 •12!Lk nq�inD ora WE Isc /5U?DO'V PROTECT ADDRESS la u • +.c. i ic,t�nL �jMISCELLA�N}EOUS � C / e, APN A 7 / / Q OWNER NAME U /V < � G CJ PH t E-MATL STREETADDRESS2-0 �©ac D (� Y CITY. ATE. Zip. p CONTACT NAME a PHONE STREU ADDRESS A ( EMAIL 1 CITY. TE, ZIP FAX OWNER -00WNFA-DUILDER ❑ OWNERAGENT❑ COMRACTOR ❑ CONrRACTORAOENi [3COMMCTORNAME ARCMTECr ❑ ENGINEER ❑ DE ZLOPER ❑ TENANT �'ty� COMPANY NAME t LICENSENUMHER / E^ _ 11CFNSETYPE HUS. LICK 2 J `j E-MAIL STREET ADDRESS1. / ARCHITECCIENOINEERLAAME 1 V STATE ZIP PHONE 7— LICENSENUMBEIL COMPANYNAME - - BUS. LIC 9 _ EMAIL _ STREET ADDRESS FAX CITY. STATE. ZIP USE OF ❑ SPD cr DUPLEX ❑ MULTI -FAM] Y PHONE Dut m*.. ❑COMMERCIAL PADIECT tN W)ZDLApID ❑ YES IMBA14INTERFACE AREA PROTECTIN ❑ YES ISTETFBLDG AN ❑ YTS DESCRIPTION OF WORK ❑ NO FLOOD ZONE ❑ NO EICHLER Rom" ❑ NO AIMMWAVIAMN TOTAL VALUATION. I� By my signature below,I certify to each of the following. Iain the property owner or authorized agent to act on the property owner's be KI have read this application and the information I have provided is correct I have read the Description of Work and verify it is accurate T agree to comply with all applicable local ordinances and slate laws rciating to buildin construction. I authori r resentatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent. Date. ` �Q — / �^ • SUPPLEMENTAL INFORMATION OU1R1 TI A'fEPI ftQ4PP Z011.doc revised 06/11/11 CITY OF CUPERTINO lil FEE ESTIMATOR — BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 20800 VALLEY GREEN DR #441 DATE: 07/13/2015 REVIEWED BY: MELISSA UNITS APN: 32609040.441 BP#: S D&8� *VALUATION: $500 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY Multi -Family Dwelling USE: Building is >3 Stories ® Yes e No PENTAMATION 1 RMAP1 PERMIT TYPE: 19 WORK APT 441 - INSTALL N WASHER/DRYER HOOK UPS SCOPE APPLIANCE / EQUIP TYPE FEE ID /'i<a,r;;. , :, ,J <. Q1 -N' UNITS BP FEES 1lernlit Fce: Other Appliance/Equip 1 BAPPLOT 2 # $144 s'trrrl�l. C!a.�/�.f'cc PME Unit Fee: $144.00 PME Permit Fee: $48.00 Administrative Fee: IADMIN $45.00 Work Without Permit? 0 Yes (j) No $0.00 TOTALS: A Travel Documentation Fee: ITRA VDOC $144.00 Strong Motion Fee: 1BSEISMICR NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the Dreliminary information available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-053 E . 711113) Mech. Plan Check 0.0 hrs $0.00 /'i<a,r;;. , :, ,J <. 1'r u: ; Mech. Permit Fee: 11PERMIT 11I1rmn. Pern it Fee: 1lernlit Fce: Other Mech. Insp.0.0 hrs $48.00 O!,; r Allard., Irrsp, PME Plan Check: $0.00 NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the Dreliminary information available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS ,"Iun Check Fee: " ppl, PC' Fee? PME Plan Check: $0.00 s'trrrl�l. C!a.�/�.f'cc PME Unit Fee: $144.00 PME Permit Fee: $48.00 Administrative Fee: IADMIN $45.00 Work Without Permit? 0 Yes (j) No $0.00 /. i`l'hrnnirr 1-ees: A Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $286.50 $0.00F__ TOTAL FEE: 1 $286.50 Revised: 07/02/2015 OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (406) 777-3228 - FAX (408) 777-3333 - bLAdin0(&cuoertino org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE OWNER NAME ON OF yCl'Es9 �� ��✓ !'`�/ I APNy� BrrDTUO8—T .e,— 42043' .> /` We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) �1.1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. 1, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on m y property. My homeowner's insurance provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of myay not insurance coverage for injuries to workers on my property. 5JZ 2. I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. S.11 3. 1 understand as an "Owner -Builder' I am the responsible party of record on the permit. I understand 'that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit ame instead of my own. filed in his or her L-(& I understand Contractors are required by law to be licensed and bonded in California and to list their Ii numbers on permits and contracts. cense 55. 1 understand if I employ or otherwise engage an y psons, total value of my construction is at least five hundred dollars ($500),1 including labor andher than Californiaiicensed materiiials, 1 maContray bes' and the considered an "employer" under state and federal law. U_6. I understand if i am considered an "employer" under state and federal law, l must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. S V 7. f understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. .L,--18. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. Ox"»e;BuildelFwzn 2010.doc remised 04114110 understand I may obtain more information regarding my obligations as an"employer" from the Internal Revenue Service, the United States Small Business Administration, the Califomia Department of Benefit Payments, and the California Division of Industrial Accidents. i also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or contractors. www.csib.ca.gov for more information about licensed L60. I am aware of and consent to an Owner -Builder building permit applied for in m name, am the party legally and financially responsible for proposed construction activity at the site ddress listed above that I 11: I agree that, as the party legally and financially responsible for this proposed construction by all applicable laws and requirements that govern Owner -Builders as well as employers. acfivity, I will abide J 12. 1 agree to notify the issuer of this form immediately of any additions del etions, or information i have provided on this form. Licensed confractors are regulated by laws designed toeoroo any hf the public. if You contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. if You obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DlREC710NS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A co PY of the property 'sform notarization, or other verification acceptable to the city may be required to be pr senfedownerwhen then iverpermit is issued to veil the PrOP2rIZ owner's signature. Property Owner's Signature: Date: -- -----e foil - - - - - ------ ---- ---- -----regi ------------------------ - ---------- --- ------------------------ --- -- - gent o he following Aufhorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder). AUTHORIZATION OF AGENT TO ACTON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which i understand is m authorize the followy personal ing persons) to act as my agent(s) to apply for, sign, and file he do umentspnec s'sarylto orb ain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No i declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be preseriled when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: Olsnei$srildeiFO17)7^2(710.doc revised 04114/10 ►a�m7 Address SMOKE / CARBON MONOXIDE ALARMS PEWNIIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE ��: HAS BEEN SIGNED AND fZF,TURNFD TP -THE BUILDING DIVISION 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 w $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 I 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. I have read and agree to comply with the terms and conditions of this statement �/(/_ Owner (or Owner Agent') Name: Ohl/J,l SaY1401 h C/4") Si nature.......... . . .. .L ............. �... ................................. Contractor Name: Sinature...................................................................Lic.#...................................... Date: ................... Smoke and CO form.doc revised 03118114 '.' .. r On or before January 1;' 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving Plumbing fixtures throughout the building (regardless of improvements). whether property undergoes alterations or 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, that. the water -conserving plumbing fixtures comply with the r uirerrients as indicated in the table below. and Owner's (or Owner A e t' S' 1 g n s) ignature. — Date: Upon completing and s ening this Certificate, please_ return it to the Building Division in order to final your permit.. Fixture Type - Water Closets (Toilets) Urinals Showerheads .Faucets — Lavatory Faucets Non -Compliant Plumbing Fixtu Water Usage /Flow Rate Exceed 1.6 Gallons/flush Exceed 1.0 Gallons/flush Exceed 2.5 gallons per minute Exceed 2.2 gallons per minute e1. Water -Conserving Plumbing Fixture _ (Fixture Complying with Current Code Applicable.to New ..Construction) Maximum Water Usage/Flow Rate 2013 CPC Ch. 4 2013 CPC Ch. 4 2013 CPC Ch. 4 2013 CALGreen Div�43 2013 CALGreen Div. 4.3 2013-CALG�een Div. 5.3 - Single -Family Multi -Family Commercial Residential Residential Single flush toilets: 1.28 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) 0.5 gallons/flush 2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of U.S. EPA WaterSens6 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. Maximum 1.5 gallons per Within units: minute @ 60 psi; minimum Maximum 1.5 gallons ps5 gallons per minute @ 60 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 Faucets — Exceed 2.2 gallons 1.8 gallons per minute60 Kitchen per minute 60 psi @ psi 1.8 gallons per minute 1.8 gallons per minute @ 60 Faucets May temporarily increase 0 psi Marta yttemporarily Psi up to 2.2 gallons per minute @ 60 psi, and must increase up to 2.2 gallons per minute @ default to maximum 60 psi, and must - 1.8 gallons per minute @ default to maximum 60 psi Where faucets meeting 1.8 gallons per minute @ 60 psi - the above are unavailable, Where faucets meeting aerators or other means the above are may be used to achieve reduction. unavailable, aerators or other means may be used fo achieve uction . 1. If the existing plumbing fixture water usage/flow rate is equal to or lowerdthan the figure shown, it is not required to be u Qraded. Pb SB4072014.doc remised 03/18/14 N WATER-CONSERVfNG PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 CUPERTINO J�(408) 777-3228 •FAX (408) 777-333-S-- buildingPcupertino.org Owner Name r S Permit No. / SD 7 -,06 A Address 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 1101.1 through 1101.8 do not apply.' Sign below and skip the rest of the form Owner' Signature: Date: No Go to Question 2. G 2. Does your real property have a licensed plumber certifying that, e 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 1101.1 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: Date: _ (�NO Go to Question 3. 7 �G Is water service penny ienil.y 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: / Date: No Go to Question 4. �� 4. Is your real property built and available for use or occupancy orCor before January 1, 1994? ❑ No My real property is built and available for use br 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: �'�7 (f C Date: 7i r� Yes My real property is built and available for use or-occu ancy on or before January 1, 1994. /\ Civil Code Sections 1101.1 through 1101.8 apply. Refer to the attached. My property is a single fancily 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-cornpliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless of whether property undergoes alterations or iimprovements). A., Mypropeity 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. doc nevi sed 03/18/14