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
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PLUTA4BING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS� A"1cN���� L 11
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❑ 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�
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EMAIL
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FAX
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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:
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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