15060168I.
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21095 LAURETTA DR
CONTRACTOR: SAFE STEP WALK-IN
PERMIT NO: 15060168
TUB CO INC
OWNER'S NAME: CARR JOHN N AND CYNTHIA L
15262 PIPELINE LN
DATE ISSUED: 06/25/2015
OWNER'S PHONE: 4082570378
HUNTINGTON BEACH, CA 92649
PHONE NO: (714) 373-8545
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑
at`5
IN MASTER BATHROOM, REPLACE (E) WALK-IN
License Class Lic. # 3 DU
SHOWER
Contract %rt.� Date G 1�/
WITH (N) WALK-IN TUB (SAME LOCATION). INSTALL (N)
DESIGNATED 20 AMP BREAKER & ASSOCIATED
I hereby affirm that I am licensed under the provisions of Chapter 9
OUTLET(S)
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
1 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: $15900
rformance of the work for which this permit is issued.
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: 32655010.00
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 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
�S
granting of this permit. Additionally, the applicant understands and will comply
s ed
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
RE -ROOFS:
� j_ /�
Signature �7'! 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.
❑ 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. 1 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 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
h
Owner or authorized agent-Z_KD a tc:�o l
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
iCUPERTINO
GENERAL PERMIT APPLICATION E P
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 •FAX (408) 777-3333 • buildino(a)cupertino.org I-S��e��XKSM Isc
ffPLUNSING ❑MECHANICAL [,ELECTRICAL F-1 MISCELLANEOUS
PROJECT ADDRESS Z 10 � 5 ( r
, 7 ;Z I APN # 3 _ 5— -0/ v
OVA NER NAIL `
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E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
I FAX
CONTACT NAM
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P ONE
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E-MAII
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ UNNER ❑ ORINER-BUILDER ❑ OWNER AGENT
G;CONTRACTOR ❑ CONTRACTOR AGENT ❑ . ARCHITECT ❑ ENGL\mm ❑ DEVELOPER ❑ 1ENAN1r
CONTRACTOR NAME ,• , , /
S v S hFt� LC -I., �(i�
LICENSE SER
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BUS. LIC
COMPANY NAMEE-
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FAX
ST DRESS
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373 -B 5'45
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC
COM2ANY NAME
E-MAU-
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF PfFD or DUPLEX ❑ MULTI -FAM LY I PROJECT IN WILDLAN'D ❑ YES
BL=r-qG: ❑ COMMERCIAL URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ YEs
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK ff --
- � C tS+l n �T�c.� l/L-1 Vl r�Gi,J� � W C �'� 9�S0.1(.L- l✓� ��
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TOTAL VALUATION: t l
By my signature below, I certi to each of the following: I am the property owner or authorized agent to act on the wner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of W, k and verify it is accurate. I agree to comply with all applicable local
ordinances and state lad's relating todin�constru�ction. authorize representatr o upertintontertheabove-identified property for inspectionposes.
Signature ofApplicant/Agent: �Date: tG' 25 ' /
SU-PPLEAIENTAL u FORMATION REQUIRED
y OF�TCEUSEOALIa I :
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09�Rve
A,IEPMisc,4pp_2011.doc revised 0621/11
CITY OF CUPERTINO
PIRWO FEE ESTIMATOR- BUILDING DIVISION
ialADDRESS:
20195 LAURETTA DR
DATE: 06/25/2015
REVIEWED BY: MELISSA
tleei
APN: 326 55 010
BP#: 0/(0
*VALUATION: 1$15,900
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE: p
Plumbing
IBPFIXTURE
PENTAMATION 1 RPFIX
PERMIT TYPE:
WORK
IN MASTER BATHROOM REPLACE E WALK-IN SHOWER WITH N WALK-IN TUB SAME
SCOPE
LOCATION). INSTALL (N) DESIGNATED 20 AMP BREAKER & ASSOCIATED OUTLET(S)
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 Drelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 7%T
_71Plumb.
Plan Check 0.0 1 hrs $0.00
Elec. Plan Check 0.0 1 hrs $0.00
tleei
FPlumb. Permit Fee: IPPERMIT
Elec. Permit Fee: IEPERMIT
Other rtlech. Insp.
Other Plumb Insp. 0.0 hrs $48.00
Other Elec. Insp.El hrs $48.00
=#
$10.00
Plumbing
IBPFIXTURE
Fixture set on One Trap
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 Drelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 7%T
/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
=#
$10.00
Plumbing
IBPFIXTURE
Fixture set on One Trap
Suppl. PC Fee: O Reg. ® OT
1-0.0-1---
hrs
$0.00
PME Plan Check:
$0.00
3
$48.00
Electrical
1 IBREMRECEP j
Recep/Switch/Outlets
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. Q OT
0.0 1
hrs
$0.00
= Electrical
$143.00 1BREMMISC
Special Circuits
PME Unit Fee:
$0.00
PME Permit Fee:
$96.00
T
�_...
F
Administrative Fee: 1ADMIN
$45.00
0
E)
Work Without Permit? Q Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a
1
Non -Residential
Building or Structure
i
Travel Documentation Fee: ITRA VDOC
$48.00
Strong Motion Fee: IBSEISMICR
$2.07
Select
an Administrative Item
Bldy, Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$192.07
$201.00
TOTAL FEE:
$393.07
Revised: 05/07/2015
CVPERTINO
Owner Name
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 •FAX (408) 777-3333 • building
0-cupertino.org
Address Zl
No.
I 5C)4�of 1'v
PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE
HAS BEEN SIGNED AND RETURNED TO THE BUILDING DIVISION
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 forin.
Owner' Signature: Date:
K -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?
❑ 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: -
KNo Go to Question 3.
Date: -7, 7 -/4-
3. Is water service permanently 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: /�, ,
&r -No Go to Question 4. 02p '
Date: -7 7 _ �'
4. Is your real property built and 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 form.
Owner' Signature: (a/` Date: --) - 7 - Z,
9Yes 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.
5"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
improvements).
❑ My property is a commercial real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or unprovements shall require non- compliant
plumbing fixtures to be replaced with water -conserving plumbing fixtures.
SB407 201 S. doc revised 02104115
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 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 California Green Building Standards Code, and manufacturer's installation
requirements, and that the water -conserving plumbing fixtures comply with the requirements as indicated in the table below.
Owner's (or Owner Agent's) Signature: Date:
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 than the figure shown, it is not required to be upgraded.
SB407 2015. doc revised 02/04/15
Non -Compliant
Water -Conserving Plumbing Fixture
PlumbingFixture
(Fixture Complying with Current Code Applicable to New Construction)
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 2015. doc revised 02/04/15