15060066 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21251 GARDENA DR CONTRACTOR:DRAIN DOCTOR PERMIT NO: 15060066
OWNER'S NAME:
SANTA CLARA,CA 95054 PHONE NO:(408)370-3082
vp LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
p INSTALIROPERTY LINE CLEANOUT
License Class a Lic.# C"'��r" Cr�"��
Contractor I Date
I hereby affirm th t 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
erformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$4750
I ave and will maintain Worker's Compensation Insurance,as provided for by
%ection 3700 of the Labor Code,for the performance of the work for which this APN Number:32643035 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 FROM LAST 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
granting of this permit. Additionally,the applicant understands and will comply Y: Date: /
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18.
RE-ROOFS:
Signature Date r 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
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
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)
1,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 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 (02%
Owner or authorized agent: Date:
permit is issued. =a
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 MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPER F[ht0 (408)777-3228• FAX(408)777-3333•buildino(Doupertino.oM
PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑1,4ISCELLANEOUS
PROJECT ADDRESS I APN n y 3
OWNER NAME �
FAX
CONTACT NAME �q,�,A PHONE E-MAIL
STREET ADDRESS Q y ^ CITY,STATE,ZIP FAX
El O'AIM ❑ OWITEERR--BUIUIIDER ❑pOWA(TERAGGENT ❑ CONTRACTOR CONfRACTORAGENT ❑.ARC=CT ❑ENGINEER ❑ DEVELOPER ❑ TE3AN7
CONTRACTOR NAME LICENSE NUJ flir4 Lt — LICENSE TYPE BUS.LIC
COMPANY NAME / E-MAIL FAX
STREET ADDRESS �p t a_ �]� CITY,STATE,ZIP �( PHONECA
Q� p
ARCHTT'ECTIENGINEER NAME LIICC_ENSE NUMBER 1 BUS.LIC# >
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ MULTI-FATffi.Y I PROJECT IN WILDLAND ❑ YES T PROJECT IN ❑ YES IS THE BLDG AN ❑YES
B= G: ❑Cohe'MCIAL URBAN INTERFACE AREA ❑ NO
NIFLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK R
P � 4 J (-
TOTAL VALUATION: S9
eN
By my signature below,I certify to each of the following: I am the property owner or authorized agentt a ave read this.•u
application and the information I have provided is correct. I have read the Description of Work and verify it' e. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Sig-nature of Applicant/Agent: f Date:
SUPPLEMENTAL INTFORMA7 REQUIRED
6!
CO[T�TER 3 ;
U
LN
GE�' �, '�,c� n
MEPAfiscApp=�011.doe revised 06121/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 21251 GARDENA DR DATE: 06/09/2015 REVIEWED BY: MELISSA
APN: 326 43 035 BP#: ''VALUATION: 1$4,750
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1 RPS
,WORK INSTALL N PROPERTY LINE CLEANOUT
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Sewer, Sanitary 1PRSEWER 1 # $25
TOTALS: $25.00
n cy
Xh,ch. Plan Check Plumb.Plan Check 0.0 hrs $0.00 Elec.Plan Check
L1ec/�. Perrnil Fier. Plumb.Permit Fee: IPPERMIT L;lec. Permit lee:
Other rilech.Insp. Other Plumb Insp. 0.0 hrs $48.00 Orlier h.lec.Insp.
14ech.Insp. Fee: Phs nb. Insp. Fee: Elect.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). Theseees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/132 FEE QTY/FEE MISC ITEMS
Plan Check Fee:
sgppl. .P(� 17ee
PME Plan Check: $0.00
Permit.Fee:
Supp/. Ins, Fee
PME Unit Fee: $25.00
PNM Permit Fee: $48.00
Construction .Tax:
Administrative Fee: IADMIN $45.00
Work Without Permit? 0 Yes. (j) No $0.00
AdvancedPlanning Fees:
Travel Documentation Fee: ITRAVDOC $48.00 A
Strong Motion Fee: IBSEISMICR $0.62 Select an Administrative Item
Bldp-Stds Commission.Fee: IBCBSC $1.00
SUBTOTALS: $167.62 $0.00 TOTAL FE'E- $167.62
Revised: 05/07/2015
�F
CUPERTINO
Owner Naine
Address z12S1
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT ° BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(
Permit No.
J
Please refer to the attached California Civil Code Sections 1101.1— 1101.8 which are part of this Certification form.
1. Is your real properly 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•
C))zibr atziia .
Go to Question 2.
wu
/S-
2. Does 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.
ti�1�vner' Srgnatrli�e` '-• � ��,// . _.
JAZJNo Go to Question 3
3. Is water sei vice 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.
QvzurSrgr�ate
� -NoY,. Go to Question 4 l
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.
{«?caner'Szgriatue `: Die
WY -es. Myreal property is bur for use or occupancy on or before 10anuary 1, 1994.
Civil Code Sections 1101.1 through 1101.8 apply. Refer to the attached.
A- My 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,
0'17, X1.1 -non-compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless
of whether property undergoes alterations or improvements).
,do*l 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).
❑ Myproperty is a co7mnercial 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.
SB40 7 2 015. doe 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).
I/We, the owner(s) of this property, certify under penalty of perjury that non-compliant plumbing fixtures wil li rp1' go'
prior to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101�1'`tluough
1101.8, the current California Plumbing Code anCalifornia Green Building Standards Code, and manufacturer's installation
requirements, and that the water -conserving pluming fixtures comply with the requirements as indicated in the table below
(3w e "s (or Owner Agent's) Signature: Date: �_'_A M
Upon completing and signing this Certificate, plead return it to the Building Division in order to final your permit.
It -the existing plumbing fixture water usage/flow rate is equal to or lower than'the figure shown, it -isnot required-to-be_up ad 3e.
SB4072015.doc remised 02/04115
fo Corripl an,
Water -Conserving Plumbing Fixture
l'lumbin Fixture
(Fixture Complying with Current Code Applicable to New Construction)
a
7 �
:.;
Maximum Water Usage/Flow Rate
Fixture Type
Water Usage
2013 CPC Ch. 4
2013 CPC Ch. 4
2013 CPC Ch. 4
�r a
/Flow Rate -_
2013 CALGreen Div. 4.3
2013 CALGreen Div. 4.3
2013 CALGreen Div. 5.3
Single-FamilyMulti-Family
Commercial
Residential
Residential
Water Closets
Exceed 1.6
r Single flush toilets: 1.28 gallons/flush
(Toilets)
'Gallons/flush '
x 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
Gallons/flush
0.5 gallons/flush
ti
Showerheadscceed
2.5`..
gallons
i 2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of
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
r;
l 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 onlyone shower outlet to be in operation at a time.
Faucets —
EMzceed 2.2 gallons .=',',Maximum
1.5 gallons per
Within units:
0.5 gallons per minute @ 60
Lavatory
per minute ;E=
; 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
r -
per minute @ 20 psi
ril_
i
:_.
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 '-
X1.8 gallons per minute @
1.8 gallons per minute
1.8 gallons per minute @ 60
Kitchen
per minute
:-60 psi
@ 60 psi
psi
Faucets
7-j
.-+ ay temporarily increase
May temporarily
p 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
rr.X1.8
gallons per minute @ ,
clef ault.to,maximum
-;
'60 psi
1 8 gallons per minute
Rr
Where faucets meeting
@ 60,psi
ti
the above are unavailable,
Where, faucets meeting
aerators or other means
the above are `
rmay
be' to achieve
`unavailable aerators or
reduction`
other means maybe
s
used to achieve
It -the existing plumbing fixture water usage/flow rate is equal to or lower than'the figure shown, it -isnot required-to-be_up ad 3e.
SB4072015.doc remised 02/04115