15060100 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 6397 COTTONWOOD CT CONTRACTOR:NELSON PLUMBING PERMIT NO:15060100
OWNER'S NAME: CHEN KUO HWA&CHONG MAN L 1272 CASTLEMONT AVE DATE ISSUED:06/15/2015
OWNER'S PHONE: 4084390317 SAN JOSE,CA 95128 PHONE NO:(408)280-5311
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL E]p�. -�'
f REPLACE(E)MAIN WATER LINE
License Class—
//��pp g - Lic.# &A
Contractor/V 4,6,t, pa1visions
to 1 � l�
I hereby affirm that I am licensed under t 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:$2400
have and will maintain Worker's Compensation Insurance,as provided for by
ction 3700 of the Labor Code,for the performance of the work for which this APN Number:36918016.00 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 D ANCE 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 LED INSPECTION.
indemnify an ep harmless the City of Cupertino against liabilities,judgments,
costs,and a pen es which may crue against said City in consequence of th
granting o this ermit. Addif ally,the applicant understands and will comply Issue to
with all n n-po' t source reg ions per the Cupertino Municipal Code,Section
91 8.
AS—
c RE-ROOFS:
Signatu Date S- / 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 un er Chapter 6.95 of the
California Health&Safety Code,Sections 25505,2 3,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municip ode,Chapter 9.12 and the
declarations: Health&Safety Code,Section 2553 )should I re or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I e e uipmcut devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by e B Area Quality Management District I
performance of the work for which this permit is issued. will maintain compliance wit the C ertino nicipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code, ctions 505,2 3,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which thisrr
permit is issued. Owner or authorized ag t: Date** ' �—
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 C N UCTION 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
918.
Signature Date
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228 • FAX(408)777-3333 •building
(a
CUPIwRTINO �cupertino.org m/����
6
PLUMBING MIECHANTICAL [—]ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS �j ® �n G APN#
OWNER NAME C^ U V " � EMAIL
STREETADDRESS CITY, TE_71p - may I FAX
CONTACT NAMEI j I �^ ( P 60 ,5311 E MAIL
STREET I S ( 1 i ( CITY,S A ZIP � FAX
Q OWI,TER ❑ OR'NER-B=ER �❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑.ARCHITECT ❑ENGINEER ' ❑ DEVELOPER ❑ TENANT
CONTRACT R.rY�^S� f 9q LICEN � LIGE f BUS.LIC 4
COMP J l' E- '1 FAX
Son Plao,_L
ST SS CITY,S TE,ZIj
ARCHITECT/ENGINEER NAME LICSE NUMBER BUS.LIC n
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONTE
USE OF ❑SFD or DUPLEX ❑ MULTI-FAAffi,Y PROJECT IN WIIALAND ❑ YES PROJECT IN ❑ YES IS THE BLDG AN ❑YES
BL=LNIG: ❑COMMERCIAL URBAN INTERFACE AREA' ❑ INTO FLOOD ZONE ❑NO EICHLERHOMET ❑ NO
DESCRIPTION OF WORK
TOTAL VALUATION': 2 Ve� V 'RECE x vy'
.r.
By my signature below,I certify/havrovide
the f lowing: I am the prope wner or authorized agent to ac on the property owner's beh e read this
application and the information I s correct I have read e escription of'Work and verify it is accurate. I agree to Ith all applicable local
ordinances and state laws relatinng nstruction. I autho ' e resentatives of Cupertino to enter the above-id e rope! Inspection purposes.
Signature of Applicant/Agent: Date:
SUPP MENTAL INFOR. TION REQUIRED �� oz�Ext si ba�� � a;
01
�. �a I Ai2GE �
MEFh4iscApp_01I.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
DDRESS: 6397 COTTONWOOD CT DATE: 06/15/2015 REVIEWED BY: MELISSA
PN: 369 18 016 BP#: "VALUATION: $2,400
;';PERkMITPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION 1 RPW
USE: PERMIT TYPE:
WORK REPLACE E MAIN WATER LINE
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Water Service 1 BPWSVCS 1 # $25
TOTALS: 1 $25.00
Mech. Plan Check Plumb.Plan Check 0.0 hrs $0.00 E/ec..Plan Clie.ck
Afech. Permit Fee: Plumb.Permit Fee: IPPERMIT idea Pemdf Fee:
Other dlech. Insp. Other Plumb Insp. 0.0 hrs $48.00 OtherElec.InsT.
;l.lech.111sp. Fire: Phtrirb. hap. TEe: L'lec.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). Thesefees are based on the prelimina information available and are only an estimate. Contact the Dept-for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 7ff /1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
sulrpl. .PC P'ee
PME Plan Check: $0.00
Permit Fee:
Suppl. 11,75p Fee
PME Unit Fee: $25.00
PME Permit Fee: $48.00
Construction Tax:
Administrative Fee: ]ADMIN $45.00
Work Without Permit? 0 Yes (j) No $0.00
Advanced Planning Pees:
Travel Documentation Fee: ITR,4VDOC $48.00 A
Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS':`; $167.50 $0.00 .TOTAL FEET $167.50
Revised: 05/07/2015
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 • buildino5cuoertino.orq
Address
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 notrequired 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 comoly with the terms and 9nditions of this statement
[0577-n7er(or Owner Agent's) Name:+`r
GA1, f,t• P
Si nature ....... ..................... ' Date&�?1..".....
Contractor Name:
Ne/Son Nlaibinq
Jf �.......
.............Lic.# .../Y
ISign tur........,�............. DatJ
Smoke and CO form.doc revised 03/18/14
CUPERTINO
Owner N
Address
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
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 throw h 1101.8 do not apply. Sign below and skip the rest of the form.
,��,--'Owner?#5�gnature., 17ate �- � ,
�
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.
ner'y'ignature:���.l"' 17ate %/J!
No ` Go to Question 3.
3. Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 1101.1 tArough 1101.8 do not apply. Sign below and skip the rest of the form.
R
W ner'.3Sianatirre:
*0 Go to Question 4.
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.
RRs� ��a 7
eN-Sigr}atur e � _' 17ate
Yes My real properly is built an available for use or occupancy on or before January 1, '994.
Civil Code Sections 1101.1 through 1101.8 apply. Refer to the attached.
OR, 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
OF
fxt%ra be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1,
7Palnoa-compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless
a, 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 improvements shall require non- compliant
plumbing fixtures to be replaced with water -conserving plumbing fixtures. - -
SB407 2015. 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).
I/We, the owner(s) of this property, certify under penalty of perjury that non-compliant plumbing fixtui,79MR511 be r 'paced
prior to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 1%0;1.1 through
1101.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's installation
requirements, and that the water -conserving -olumbing,fixtures sq'mpI with the requirements as indicated in the table below:'—
y �'y ✓, Date: be/ X S`
Owner's (or Owner Agent's) Signature: r�_,Z�J. ��_� __ _
Upon completing and signing this Certificate, please return it to the Building Division in order to final your permit.
1 If the exiking plumbing fixture watei usage/flow rate is equal to or lower than the figure shown, it s rzo�t�reg ti� edrto?lae rpg d.
SB40 7 2015.doc revised 02/04/15
o'nC'oripliant`
"I Water -Conserving Plumbing Fixture
New Construction)
r
Plumbing Fixtur,_.
(Fixture Complying with Current Code Applicable to
'
Maximum Water Usage/Flow Rate
Fixture Type
f
Water Usage
2013 CPC Ch. 4
2013 CPC Ch. 4
2013 CPC Ch. 4
/Flow Rate .4
2013 CALGreen Div. 4.3
2013 CALGreen Div. 4.3
2013 CALGreen Div. 5.3
Single -Family
Multi -Family
Commercial
a,.
fN`
Residential
Residential
Water CIS sets
Exceed 1.6 i`
t
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 4
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
I
dexceed
showerheads and/or other shower outlets controlled by a single valve shall not
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
r
0.8 gallons per minute @
per minute @ 60 psi;
20 psi
minimum 0.8 gallons
per minute @ 20 psi
r,
In common and public
�s
use areas: 0.5 gallons
c
T
per minute @ 60 psi
q.
1.8 gallons per minute 9
Faucets — i_
Exceed 2.2 gallons1
1.8 gallons per minute @
60 psi
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
4^
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
T
w'
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
�— - rr.Ireduction.
other means may be
used to achieve
=�
reduction.
1 If the exiking plumbing fixture watei usage/flow rate is equal to or lower than the figure shown, it s rzo�t�reg ti� edrto?lae rpg d.
SB40 7 2015.doc revised 02/04/15