15070180I
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1129 YORKSHIRE DR
CONTRACTOR: TRENCHFREE INC
PERMIT NO: 15070180
OWNER'S NAME: DELOOF ERNA L AND RICHARD E
PO BOX U
DATE ISSUED: 07/27/2015
OWNER'S PHONE: 4084645415
SAN JOSE, CA 95151
PHONE NO: (408) 726-7926
GJLICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E]
License Class G3%i 0 Z Li.. # 01 G
REPLACE (E) 50 S.F. (+/-) MAIN WATER LINE
&40t4 DiAl-_ Q Tr/ 2AT-/1 f'
Contractor Date
1 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: $2500
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: 36207017.00
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
180 DAYS FRO ED 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 y
I a e:
with all non-point source regulations per the Cupertino Municipal Code, ec ion
9.18.
FS:
Signature Date 2� ��
All roofs shall be ins a any roofing material being installed. If a roof is
installed without first o taining 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
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)
I, 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 1
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, 25 3, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date: ®1-/ L41 1a
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
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
WW -
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildino(a)CUDertino.org mitsu
[O PLUAEBING ❑ MECHANICAL ❑ ELECTRICAL 7 MISCELLANEOUS
PROJECT ADDRESS I
M i� �N " Z `� 0 I
OWNERNAMF. � `t"
De PHON �� EMAIL
��t'
STREET.ADDRESS f
�1
1 I CITY, ST�TE, ZIP �O tLt
rr�
I FAX
CONTACT NAME �(�^
cj
D,N PHO: — E-MAIL
V�
.r.L fr��c;� cv-►
STREETADDRESS 6/
((yy
CITY, STATE, ZIP
n
FAX
❑ 01iNUL ❑ O)N-,-R-BTIIDER
❑ OW.',TERAGENT [PI CONTRACTOR ❑CO?TRACTORAGENT ❑ ARC=,ECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CO?;TRACTOR N 1 L �[
�j
/� Vl LICENSE NUh�ER G4-�W(i„�1.�p LIC,EN TYPE l
_=(+1 `V ` v'` (/ (/
(J
BUS. LIC r /� (O, j
COMPANY N.AI✓£
E-MAIL
STREET ADDRESS I 0 ` ^
(,(f
J
( u
CITY, STATff C / 1 1 �
PHON ' A 2,6
7 `(
ARCHITECTrKGTEER N.hAIE
LICENSE NUMPER
BUS. LIC n
COMPANY N;TA vM
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONTTE
USE OF ❑ SFD w DUPLEX ❑
B=NIG: ❑ COMMERCLAL
MULTI-FAI IZLY PROJECT LN wILDLAND ❑ YES PROTECT IN ❑ YES
URBAN INTERFACE AREA ❑ 1"0 FLOOD ZONE ❑ I.'0
IS THE BLDG AN ❑ YES
EIC:HLERHOME? ❑ NO
DESCRIPTION OF WORK
ke
t al ppro�dm 0,( SO f. 0 ldrfn i 10111
TOTAL VALUATION: J
T*rte r w N x
f. I have read
By my signature below, I certify to each of the following: I am the property owner or autho ' e agent t on the pro �p�ropeity
application and the information I have provided is correct I have read the Description of Work and verify it is acc . Iwith all applicable local
ordinances and state lays relating to building construction. I authorize representatives of Cupertino to enter the abov r inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL II\'FORMATION REQUIRED
!..'.F133CMLY
y” C)' CO i
f
ATEPMiscApp_,2011.doc remised 06/21/11
CITY OF CUPERTINO
I/�JI FEE ESTIMATOR - BUILDING DIVISION
im,ADDRESS:
1128 YORKSHIRE DR
DATE: 07/27/2015
REVIEWED BY: MELISSA
UNITS
APN: 362 07 017
BP#:
I "VALUATION: 1$2,500
*PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
#
PENTAMATION 1 RPWS
PERMIT TYPE: 14
WORK
REPLACE E 50 S.F. +/- MAIN WATER LINE
SCOPE
1"rappL Insp Fee
APPLIANCE / EQUIP TYPE
FEE ID
Plumb. Plan Check 0.0 1 hrs $0.00
QTY
UNITS
BP FEES
Flec•. Permit Fee:
Water Service
1 BPWSVCS
Other Elec. lusp.
1
#
$25
Permit I"ee:
1"rappL Insp Fee
PME Unit Fee:
$25.00
PME Permit Fee:
$48.00
on iruc°il.on lax:
Administrative Fee: IADMIN
$45.00
Work Without Permit? ® Yes (F) No
$0.00
TOTALS:
Travel Documentation Fee: ITRA VDOC
$25.00
Strong Motion Fee: IBSEISMICR
NOTE: This estimate does not include fees due to other Departments (i.e. 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 addn'1 info.
FEE ITEMS (Fee Resolution 11-033 7/1/13)
;11ech. Plan Check
Plumb. Plan Check 0.0 1 hrs $0.00
1i1ec. Plan Check
ilech. Permit Fee:
Plumb. Permit Fee: I PPERMIT
Flec•. Permit Fee:
i )cher.AA,ch. lnsp,
Other Plumb Insp. 0.0 hrs $48.00
Other Elec. lusp.
Afech. Insp. Fee
PME Plan Check:
1Jec. Insp. Fee.
NOTE: This estimate does not include fees due to other Departments (i.e. 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 addn'1 info.
FEE ITEMS (Fee Resolution 11-033 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Flan Check Fee:
wippl. PC Fee
PME Plan Check:
$0.00
Permit I"ee:
1"rappL Insp Fee
PME Unit Fee:
$25.00
PME Permit Fee:
$48.00
on iruc°il.on lax:
Administrative Fee: IADMIN
$45.00
Work Without Permit? ® Yes (F) No
$0.00
It Mweed .Planning Fees:
Travel Documentation Fee: ITRA VDOC
$48.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$167.50
$0.00 TOTAL FEE:
$167.50
Revised: 07/02/2015
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
�. COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION n
L_ 103QO TORRE AVENUE • CUPERTINO, CA 95014-3255 (� to
CUPERTINO 1�Q
(408) 777-3228 • (4 8) 777-3333 • buildinga-cuoertino.or4
Owner Name L �/ Permit No.
Address �/ �S % /jr—
PER-MIT
C:'LN=NOT BE FINALED AND COMPLETED UNTIL TRIS CER,rIFICATE
HAS BEEN S NET) _t\D IZE"I-I RNID 'I'O '1-11E BUILI)I:NG DI\ ISION
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 0 01. o not apply. Sign below and skip the rest of the form.
Owner' Signature: Date:
ro Go to Question 2.
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 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' Signatur Date:
�911qo Go to Questio 3%1throu
3. 0
Is water service permanentlur ildi g?
❑ Yes Civil Code Secti10 .8 of apply. Sign below and skipthe rest of the form.
Owner' SignatureDate:o Go to Question 4 ) li
4. Is your real properly built and available for use or occupancy on or before January 1, 1994?
❑ No My real property is built and availabjrfor se or occ ancy after January 1, 1994.
Civil Code Sections 110 ou 110 . do not ply. Sign below and skip the r st of the form.
Owner' Signature: Date: `
.1
Yes My real property is built and availab use or ccupancy on or before January 1, 1994.
Civil Code Sections 1101.1 through 01.8 app . Refer to the attached.
y 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
improverxents).
❑ 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.
SB4072015.doc revised 02/04/15
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).
nVe, the owner(s) of this property, certify under penalty of perjury that non-compliant plumbing fixtures will be replaced
prior to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 through
1101.8, the current California Plumbing Code and lifornia Green Building tandards Code, and manufacturer's installation
reauirements, and that the water -conserving plu1WAg, comply witlme requirements as indicated in the table below.
Owner's (or Owner Agent's) Signature: ,fir �i/%/�hl' t� 1t' Date_ 4- -L- z - 4S
Upon completing and signing this Certificate, please return it to the Building Division in order to final your pennit.
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 2015. doc revised 02/04115
Non -Compliant
Water -Conserving Plumbing Fixture
Plumbing Fixture_
(Fixture Complying with Current Code Applicable to New Construction)
_ Maximum Water Usage/Flow Rate
Fixture Type
2013 CPC Ch. 4
2013 CPC Ch. 4
2013 CPC Ch. 4
Water Usage
2013 CALGreen Div. 4.3
2013 CALGreen Div. 4.3
2013 CALGreen Div. 5.3
/Flow Rate
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 na 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
I
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 2015. doc revised 02/04115
!Z 0�0
CUPERTINO
Address
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 cupertino.ora
"150 7 o
WE
i
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.
1 have read and agree to comply with the terms anj conditiAns of this statement
Owner (or Owner Ag t'A Name:
nature ... ..........
1
.... ......... .................................................. .......... Date:
��..............
Contractor Name:
_Signature
Signature....
Lic.#4{... .f..P ��?........... Date:
�. Ft:
Smo%e and COform.doc remised 03/18/14
l�