15080145CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10394 GLENVIEW AVE
CONTRACTOR: ABLE SEPTIC
PERMIT NO: 15080145
OWNER'S NAME: RICHARD J DENESHA
1020 RUFF DR
DATE ISSUED: 08/19/2015
OWNER'S PHONE: 8606081065
SAN JOSE, CA 95110
PHONE NO: (408)377-9990
® LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
REPLACE/REPAIR (E) SEWER LINE & PROPERTY LINE
License Class `1r2 Lic. # G�' yc
CLEANOUT
t��
6 j 1 (a ( t3
Contractor ?AU_ __ Date
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that m license is in full force and effect.
ySANITARY
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: $3000
erformance 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: 36911021.00
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 O 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 LED INSPEC ION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
a� /
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
RE -ROOFS:
Signature Date �� Sr
All roofs shall be any roofing material being installed. If a roof is
inspected prior to
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(x) 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
Owner or authorized agent: Date:
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
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building aacupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION
❑ ALTERATION / TI ❑ REVISION / DEFERRED
P VO L"
ORIGINAL PERMIT #
PROJECT ADDRESS ON
N G Ir , / 1ew Ave
APN # / _ Z/
OWNERNAME I-7 O'O_C /� DCI 'l� U ► 1 o J �
PHONE I V�)
E-MAIL
STREET ADDRESS ,^ (�1 'j vl I
CITY, STATE,ZIP VWi kI GT 6 3 a
FAX
CONTACT NAME S V I01 IVa
PHONE 3 0
E-MAIL �-C
STREET ADDRESS i /
CITY, STATE, ZIP 1n 1, "I k-)
FAX ! (i o
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME I l� I I
I IrpNSE NUMBERU]ILA
LICENSE TYPE
BUS. LIC # 2 I I \1
` �J
COMPANY NAME `
E-MAIL I (
FAX
STREET ADDRESS /
1!j I
CITY, STA ,ZIPAV� C t
PHONE 4 \ (� � � l �7
v'
vo
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL 'v
FAX A I
f v
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
eruct r
AIK
EXISTING USE
PROPOSED USE CONSTR
TYPE
# STORIES
USE TYPE OCC.
SQ.FT.
VALUATION (S)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK ARE A�TOTNL
DECK/PORCH AREA
GARAGE AREA DETACH
❑ ATTACH
# DWELLING UNITS: D UNIT ❑ YES
SECOND STORY ❑ YES
BEING ADDED? ❑ NO
ADDITION? ❑ NO
PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF
IS THE B
IS THE BLDG AN ❑ Y TION:
A I
PLANNING APPL # []NO PLANNING APPROVAL LETTER
HOME? N / O p G
wner's behalf. I have read this
13y my signature below, I certify to each of the following: I am the property owner or authorized agent to acZ.�,e-identifi
application and the information I have provided is correct. 1 have read the Description of Work and verify it to comply with all applicable local
ordinances and state Taws relating to building construe authorize representatives ofCupertino to enter d property for inspection purposes.
Signature of Applicant/Agent: Date: �1
SUPPLEMENTALNMRMATION REQUI
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER-THE-COUNTER
BUILDING PLAN REVIEW
_ New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
❑ ExPREss
❑ PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
1:1 STANDARD
El PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑ LARGE
❑ FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
El MAJOR
El SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doc revised 06/21/11
1) CG C!
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R%
..�� CITY OF CUPERTINO
1%"s(!�i FFF ESTIMATOR — BUILDING DIVISION
Lk-S'
ADDRESS: 10394 GLENVIEW AVE
DATE: 08/19/2016
REVIEWED BY: MELISSA
UNITS
APN: 369 11 021
BP#:
"VALUATION: 1$3,000
*PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Du lex
USE: p
#
PENTAMATION 1 RPSS
PERMIT TYPE:
WORK
REPLACE/REPAIR E SEWER LINE & PROPERTY LINE CLEANOUT
SCOPE
S111 -2p/. Insp Fec
APPLIANCE / EQUIP TYPE
FEE ID
Plumb. Plan Check kJo hrs $0.00
QTY
UNITS
BP FEES
Elec
Sewer, Sanitary
1 PRSEWER
Other Elec. Insp.
1
#
$25
Permit Fee:
S111 -2p/. Insp Fec
PME Unit Fee:
$25.00
PME Permit Fee:
$48.00
Construction Tax:
Administrative Fee: IADMIN
$45.00
Work Without Permit? 0 Yes O No
$0.00
TOTALS:
Travel Documentation Fee: ITRA VDOC
$25.00
Strong Motion Fee: 1BSEISMICR
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
n.*- :. 1 TL ,L , ! , &--in" Oka nra/iLninnnr infnrMatian availahly and are only an estimate. Contact the Dent for addn7 info.
FEE ITEMS (Fee Resolution 11-053 Eff' 7'1!132
1, r'Tca.r (h,r /
Plumb. Plan Check kJo hrs $0.00
Elec. Plan Check
Plan Check Fee:
Plumb. Permit Fee: IPPERMIT
Elec
gore, ira,p
Other Plumb Insp.0.0 hrs $48.00
Other Elec. Insp.
}. hasp. Fee:
Elec. Insp. Fee:
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
n.*- :. 1 TL ,L , ! , &--in" Oka nra/iLninnnr infnrMatian availahly and are only an estimate. Contact the Dent for addn7 info.
FEE ITEMS (Fee Resolution 11-053 Eff' 7'1!132
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
Suppl, P(C' F'ee
PME Plan Check:
$0.00
Permit Fee:
S111 -2p/. Insp Fec
PME Unit Fee:
$25.00
PME Permit Fee:
$48.00
Construction Tax:
Administrative Fee: IADMIN
$45.00
Work Without Permit? 0 Yes O No
$0.00
ldvanced Planning Nees:
Travel Documentation Fee: ITRA VDOC
$48.00
Strong Motion Fee: 1BSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: 113CBSC
$1.00
SUBTOTALS:
$167.50
$0.00 TOTAL FEE:
$167.50
Revised: 07/02/2015
Address
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 - building(a cupertino.org
IS0VQ11S
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
I X
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: 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 comply v✓ith the terms and conditions of this statement
Owner (or Owner Agent's) Name:
Signature.................................................................................................................. Date:...................
Contractor Name:
v`T '•C Signature...0(................................ Lic.#.*7Ty% 5............Date: "/
Smoke and CO,form.doc revised 03/18/14
z z; /' - "'v"Po
Wax
CUPERTINO
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCEL
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE ° CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(d�cupertino.org
Owner Name 6a, ,� 0 Permit No.
Address C7 t64L 1.4
PERAIIT CANNOT BE FINALED AND CONIPLETED UNTIL THIS CERTIFICATE
HAS BEEN SIGNED D AND RETURNED TO THE BUELDING 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 form.
An Owner' Signature:
W -No Go to Question 2.
Date: 9, X tY-
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:
�No Go to Question 3. 0Ly6_____
Date: a ;v / 5
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: Date: b '2,Y- . t5
No Go to Question 4. 0-11_�
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 110 1. 1 through 1101.8 do not apply. Sign below and skip the rest of the form.
Owner' Signature: 0AaDate:
s My real property is built and available for use or occupancy on or before January 1, 1994. 2—
Civil
Civil Code Sections 1101.1 through 1101.8 apply. Refer to the attached.
❑ 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,
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 improvements shall require non- compliant
plumbing fixtures to be replaced with water -conserving plumbing fixtures.
SB407 2015.doc remised 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 T
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 110 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�plumbiplVfixtures comply with the requirements as indicated in the table below.
Owner's (or Owner Agent's) Signature: LA-%. - Date: Z5r - Gr '>
Upon completing and signing this Certificat`e�, 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 tower than the figure snown, itis not requncu w uc upgi
SB407 20 i S. doc revised 02/04/15
Non -Compliant
Water -Conserving Plumbing Fixture
Plumbing Fixture
(Fixture Complying with Current Code Applicable to New Construction)
Maximum
Water Usage/Flow
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 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- -�-a
1. If the existing plumbing fixture water usage/flow rate is equal to or tower than the figure snown, itis not requncu w uc upgi
SB407 20 i S. doc revised 02/04/15