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15080088CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10390 HENEY CREEK PL CONTRACTOR: 'CC lftA7 PERMIT NO: 15080088 OWNER'S NAME: LO JHY-DOU AND YUAN S DATE ISSUED: 08/11/2015 OWNER'S PHONE: 4088738090 PHONE NO: LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑ INSTALL (1) PROPERTY LINE CLEANOUT & BACK FLOW License Class_ � Lic. # Q 51 g DEVICE Contractor �t T Date T_ —A — t l�- I hereby affirm that I am licensed under the provisions of Chapter 9YA * l° F4+ (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: $9000 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: 34248035.00 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 WITIIIN 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 F LLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, City in the costs, and expenses which may accrue against said consequence of granting of this permit. Additionally, the applicant understands and will comply Y with all non -poi :; rce regulations per the Cupertino Municipal Code, Section 9.18. Signature a Date ' I— (5 - OOFS: All roofs shall be inspec o 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 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 B Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the u rtino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sectio 25 05, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: a _.t/& Date:'S —i 1 —(�5 permit is issued. IV 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 CUPERTINO GENERAL PERMIT APPLICATION M E F j"k COMMUNITY DEVELOPMiENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildina(a cuoertino.org (1-- 0 O 0MISU f D o0 PLUTA4BING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS� A"1cN���� L 11 K ��c 6 �.r��w-r�rj OVJh'ERNAI,IE Jh �/ – DU � PH E E•1✓i4II�-qt4l _ _ q 15-54 U STREET ADDRESS CITY, STA ZIP � y0 i � FAX unl? (/ c C.� CONTACT NAME PHO. E-vLA1L -� - v 2 -oy32 ANo CGc..A4---cot-, e i o ST'R'EET .ADD/R�ES�S�� �,, c� ^ I _ C�CMt'z4� �.4/2kl,�Jw'(I ITEN/%lr(fA CITY, STATE, ZIP C-4 F O—SSS ❑ o) wm ❑ owi,–R-BUILDER ❑ OW`.NTER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEQ ELOPER ❑ TENANT CONTRACTOR N?ash LICENSE TUMBER` LICENSE TYPE tJ'114: U /'j'C BUS. LIC COMPANY N.AI� is UM c i' 'T-ELvq EMAIL ct1 CCL •m FAX Z cc t _905 - 70 ZS STREET ADDRESS 1 1 50 0,4mog-0 CITY, STATE, ZIP 9'+-4-506 PH NE - 5-7505 ARCHITECT/ENGINEER. NAME LICENSE NUMBER BUS. LIC COMPANY NAME E-MAIL FAY, STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ny MULTI-FARZLY PROJECT D,' wIISJLAI.TI) ❑ YES PROJECT IN ❑ YES IS THE BLDG AN ❑ YES BUILDING: ❑ COMMERCIAL URBAN P.'TERFACE AREA ❑ NO FLOOD ZONAL ❑ NO EICHLER HOME? ❑ NO DESCRIPTION OF WORK ^ 2 PWC -414 y i\#Ak (k( --AA) 001 4- i. %A Ck TOTAL VALUATION: goo <_ By my signature below, I certify toe ch of the following: I am the property owner or authorized agent to act on t1h er s behalf. I have rea application and the information I h 'e ovided is correct I have read the Description of Rork and veri. urate. I agree to comply with all applicable local ordinances and state laws relzting u ing construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: (� ` STiPPLEMENTAL LNTFORMATION REQUIRED 1✓ IEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION im[ADDRESS: 10390 HENEY CREEK PL DATE: 08/11/2015 REVIEWED BY: MELISSA UNITS APN: 342 48 035 BP#: *VALUATION: 1$9,000 °PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: # PENTAMATION 1 RPS PERMIT TYPE: WORK INSTALL N PROPERTY LINE CLEANOUT & BACK FLOW DEVICE SCOPE APPLIANCE / EQUIP TYPE FEE ID Plumb. Plan Check0.0 hrs $0.00 QTY UNITS BP FEES Elec, Permit Fee: Sewer, Sanitary 1 PRSEWER Other Elec. Insp. 1 # $25 PME Unit Fee: $25.00 PME Permit Fee: $48.00 Administrative Fee: 1ADMIN $45.00 Work Without Permit? 0 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 preliminary information available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-053 Eft 7/1/13) I lcch..Plan Check Plumb. Plan Check0.0 hrs $0.00 Eiec. Plata Cheek Aleck P 'ee: Plumb. Permit Fee: IPPERMIT Elec, Permit Fee: ')t(aer 1:1ect:. Insp.F-1 I Other Plumb Insp. I �0.0�s $48.00 Other Elec. Insp. PME Plan Check: $0.00 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 preliminary information available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-053 Eft 7/1/13) FEE QTY/FEE MISC ITEMS )Ian Check Fee. `Ilrppl. PC Fee PME Plan Check: $0.00 PME Unit Fee: $25.00 PME Permit Fee: $48.00 Administrative Fee: 1ADMIN $45.00 Work Without Permit? 0 Yes (F) No $0.00 Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICR $1.17 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $168.17 $0.00 TOTAL FEE: $168.17 Revised: 07/02/2015 SMOKE / CARBON MONOXIDE ALARMS FILE OWNER CERTIFICATE OF COMPLIANCE -J COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 'j3�A 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinc;Ocupertino.org r Address 10390 Heney Creek PI Cupertino # of Alarms $moke: 5 Carbon Monoxide: PERMIT CANNOT BE FINALED AND COMPLETED UNTIL TIRS CERTIFICATE HAS BEEN ,SIGNED AND RETURNED TO THE BUILDING DI VISION 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 907.2.1.1.2 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 Alan -ns andior Carbon Monoxide Alarms be installed in the following locations. �i 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 f Within each sleeping room I X Signature_ t3c:# ..:'.1.?..g. Date:. 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: I i 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 8314 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 Build ng 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 and conditions of this statement Owner (or Owner Agent's) Name ` Patrick Tan •- �7" 8113/1. Contractor Nam --e:: p }...... Dc�t i.J tl� w S Signature_ t3c:# ..:'.1.?..g. Date:. V Smoke and COform.doc rerised 03,118,41 WATER -CONSERVING PLUMBING FIXTURES FIL F A149 OWNER CERTIFICATE OF COMPLIANCE -_ 2 �' (s - COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION n77— CUPERTINO 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - building(acupertino.org Owner Nanic" Robert Lo C/O Trans -Continental Permit No. l_�-o F OoE� Address 10390 Heney Creek Place, Cupertino, CA 95014 PERMIT CANNOT BE MNALED AND COMPLETED UNTIL THIS CERTIFICATE HAS BEEN SIGNED AND RETuRNEDTO THE BUILDING DIVISION Please refer to the attached California Civil Code Sections 1:101.1-1101.8 which are part of this Certification form. Is your real property a registered historical site? C1 Yes Civil Code Sections 1101.1 through I IOIA'do not apply. Sign below and skip the rest of the form. Owner' Signature: '14-4 Date: 8/13/2015 N No 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? 0 Yes Civil Code Sections 1101.1 through 1101.8 donot apply. 0 The licensed plumber's certification has been provided to the Building Division. Sign below and skip the rest of the form, Owner' Signature: Date: 8/13/2015 X No Go to Question 3, Is water service permanently disconnected for your building? 0 Yes Civil Code Sections 1101.1 through 1101.8 donot apply. Sign below and skip the rest of the form. Owner' Signature: Date: 8/13/2015 X No Go to Question 4. ls�pur real property built and available for use or occupancy on or before January 1, 1994? 0 ]4o 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. y property is a single-faniilv 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). 0 My property is a midlifamily 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), 0 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 not)- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. SB407 2015.doc revised 021041I5 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 pedury 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 110 1.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's installation requirements, and that the water -conserving plumbic fixtures com 1Y with the requirements as indicated in the table below. mr's (or OwnerAgent's) Signature. ' $/13f2015 Upon completing and signing this Certificate, 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 inaa Cno ugurc mlowu, n is Di- <c,yu„C — w ..i.5 ,58407 2015.doc revised 02JO4115 Non -Compliant Water -Conserving Plumbing Fixture (Fixture Complying with Current Code Applicable to New Construction) Plum bin Fixture! Maximum Water Usage/ 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 gallonstflush (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 Showerheads Gallonstflush 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 si Faucets — Exceed 2.2 gallons 1.8 gallons per minute @ 1.8 gallons per minute 1.8 gallons per minute (a 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 inaa Cno ugurc mlowu, n is Di- <c,yu„C — w ..i.5 ,58407 2015.doc revised 02JO4115