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15090017G CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10430 PINEVILLE AVE CONTRACTOR: CLAYTON JOHNSON PERMIT NO: 15090017 ENTERPRISES, INC OWNER'S NAME: LUND LEONARD H AND MARGARET R 331 WRIGHT AVE DATE ISSUED: 09 /02/2015 OWNER'S PHONE: 4084257289 MORGAN HILL, CA 95037 PHONE NO: (408) 205 -0611 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑ CONVERT PORCH AREA TO HABITABLE SPACE (76 SQ License Class c I y Lic. # 15 -7D to T); INTERIOR REMODEL (150 SQ FT); BATHROOM REMODEL Contractor ate (60 I hereby affirm that I a ice d under the provisions of Chapter 9 SQ FT). (commencing with Section 70 ) 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 performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: 540000 ave and will maintain Worker's Compensation Insurance, as provided for by APN Number: 36913039.00 Occupancy "l'ype: ection 3700 of the Labor Code, for the performance of the work for which this 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 L} d b /�i Date: / f Issued granting of this permit. Additionally, the applicant understands and will comply y : �� with all no s cc re ions per the Cupertino Municipal Code, Section 9.18. RE- ROOFS: Signature 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. ❑ ONN NER- 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 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 5505 5533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent Dater 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 CONSTRUCTI N LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 CUPERTINO (408) 777 -3228 • FAX (408) 777 -3333 • building(aZicupertino.org / ✓� 6 oz)l 7 F1 NRW C!ONSTR11CTION h/ l ADDITION F1 ALTERATION/T1 M REVISION /DEFERRED ORIGINAL PERiMYP # PROJECT ADDRESS 1043Q7Pineville Avenue, Cupertino, CA 95014 7 APN # 369- 13-039 OWNER NAME Margaret Lund PHONE 408- 425 - 7289 E -MAIL STREET ADDRESS 10431 Pineville Avenue, Cupertino CA 95014 CITY, STATE, ZIP FAX CONTACT NAME Clayton Johnson PHONE 408- 205 -0611 E -MAIL clayjohnson @premierebuilders.com STREET ADDRESS 2253 Banyan Court, Gilroy, CA 95020 CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT 10 CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ lllti,\ \l CONTRACTOR NAME Clayton Johnson Enterprises Inc LICENSE NUMBER LICENSE TYPE BUS. LIC # B, Cato COMPANY NAME Clayton Johnson Enterprises Incorporated E-MAIL claylohnson @premierebuilders.com FAX 655- 205 -6011 STREET ADDRESS 2253 Banyan Court CITY,STATE, ZIP Gilroy, CA 95020 PHONE 408 - 205 -0611 ARCEI TE(TIENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK Master bedroom remodel and with a 76 sq. ft addition. EXISTING USE PROPOSED USE CONSTR TYPE # STORIES R1 -10 R1 -10 Wood 1 USE TYPE OCC. SQ.FT. VALUATION(E) EXISTG NEW FLOOR DEMO TOTAL AREA 1412 AREA 1488 AREA 150 sq. ft. I NET AREA 1926 BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA 150 PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: 30 200 I 230 EDETACH 438 ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY YES 1 BEING ADDED? 0NO ADDITION? JaNO PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECErYTD B TJOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICBLER HOME? El NO n By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to build' nstructi . I onze representatives of Cupertino to enter the above- identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLE ME O TIO REQUIRED PLAN CHECK TYPE ROUTING SLAP ❑ OVER - THE- CQUNTER ❑ BUILDING PLAN REVIEW _ New SFD or Multifamily dwellings: App or demolition permit for existing building(s). Demolition permit is required prior to issuance oQuilding permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FTRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ submittal of Building Permit application. SANITARY SEWER DISTRICT ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION 6MADDRESS: 10430 Pineville Ave DATE: 09/02/2015 REVIEWED BY: Sean PC FEE 1D 1 ApN; Bp #; "VALUATION: 1$40,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex 2nd Unit? 0 Yes No 0 Yes (!)No PENTAMATION 1 R3SFDADD PERMIT TYPE: USE: OTC. 60 s.£ $645.00 WORK Convert porch area to habitable space 76 sq ft); interior remodel 150 sq ft); bathroom remodel 60 s SCOPE ft). OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE 1D BP FEES BP FEE ID R -3 (Custom) II- B,111- B,IV,V -B 0 $0.00 other 1,lec. Insp. Li $0.00 PhImb. Insp. l'i'e 1, e Insp. Fee $0.00 60 s.£ $645.00 Remodel, Bath (< =300 sf) IREMRESBAT Permit Fee: Hourly Only? C) Yes Q No $0.00 Suppl. Insp. Fee Q Reg. 0 OT 0,0 hrs $0.00 =1 s.f. Remodel, Other $431.00 IREMRESOTH PME Unit Fee: $0.00 PME Permit Fee: $0.00 Consirilcl ion Tax: TOTALS: 0 $0.00 Administrative F'ee: $0.00 MECH, HOURLY 0 Yes 0 No PLUMB, HOURLY 0 Yes E) No ELEC, HOURLY 0 Yes Q No Alech..Plan Check Plumb. Plan Check 1 1 l-'7ec. Plan Check I AI��' °mit Fee: Plumb. Permit Fey I'lec, Permit Fcc ��rac; 1 <<<:. tirsp. Chhc:rPlurnb.Irt.�p. other 1,lec. Insp. Li ch. !n p. Fee: PhImb. Insp. l'i'e 1, e Insp. Fee NOTE: This estimate does not include fees due to other Departments (f. e. Planning, Public Works, Fire, Sanitary Fewer District, School o0,. ► These ro— are hayed on the nreliminary infarmatinn available and are onlv an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11 -053 Elf' 711113) FEE QTY /FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes 0 No $0.00 1 hours $143.00 Plan Check, Hourly ISTPLNCK Suppl. PC Fee: 0 Reg. 0 OT 1 0.0 1 hrs $0.00 PME Plan Check: $0.00 60 s.£ $645.00 Remodel, Bath (< =300 sf) IREMRESBAT Permit Fee: Hourly Only? C) Yes Q No $0.00 Suppl. Insp. Fee Q Reg. 0 OT 0,0 hrs $0.00 =1 s.f. Remodel, Other $431.00 IREMRESOTH PME Unit Fee: $0.00 PME Permit Fee: $0.00 Consirilcl ion Tax: Administrative F'ee: 1 1 E) Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: $0.00 Hours $286.00 Inspections ISTINSP Inspection, Hourly G 0 Travel Documenlution f "eer: Strong _Motion Fee: IBSEISMICR $5.20 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: $7.201$1,505.00 TOTAL FEE: $1,512.20_1 Revised: 07/02/2015 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014 -3255 Telephone: 408 - 777 -3228 Fax: 408- 777 -3333 JOB ADDRESS: (O -3p PERMIT # d ? OWNER'S NAME: Zee PHONE # Zo GENERAL CONTRACTO • j s.� USINESS LICENSE # ADDRESS: CITY /ZIPCODE: *Our municipal code requires afi businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. Ila I am not using any subcontractors: ignature ate Please check applicable subcontractors an plete the following information: Owner / Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date CALGREEN RESIDENTIAL CHECKLIST — MANDAiWEI`jED ITEMS COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION SEP 0 2 2015 CUPERTINO ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 BY (408) 777 -3228 • FAX (408) 777 -3333 • build i ng(a)cuperti no.org PURPOSE: The 2013 CalGreen Code applies to additions or alterations of existing residential buildings where the addition or alteration increases the building's conditioned area, volume, or size and also applies to all new low -rise residential buildings, high -rise residential buildings, or both. Existing site and landscaping improvements that are not otherwise disturbed are not subject to the requirements of CALGreen. Project Name: Project Address: 10 Project Description: '16 67 0 G�,/�/ f ,� _RTINO I building Depllill"nt Instructions: 1. The Owner or the Owner's agent shall employ a licensed profeserienced'wlhh the California Green Building Standards Codes to verify and assure that all requkV�v�Jlk��l�L�OIVSRI planned and implemented in the project. � / 2. The licensed professional, in collaboration with the owner and the de ptaf "tional-" ifffniti/orf mn 2 of this checklist, sign and date Section 1 - Design Verification at the end of this checklist and have the checklist printed on the approved plans for the project. 3. Prior to final inspection by the Building Department, the licensed professional shall complete Column 3 and sign and date Section 2 - Implementation Verification at the end of this checklist and submit the completed form to the Building Inspector. Column 2 Column 3 MANDATORY FEATURE OR MEASURE Project Verification Requirements Planning and Design - Site Development 4.106.2 Storm water drainage and retention during construction. A plan is developed and implemented to manage storm water drainage during ❑ El construction. 4.106.3 Grading and paving. The site shall be planned and developed to keep surface water away from buildings. Construction plans shall indicate how E site grading or a drainage system will manage all surface water flows. OFFICE COPY Page 1 of 5 CalGreen_2014.doc revised 11104114 A4.2 ENERGY EFFICIENCY General 4.201.1 Low -rise residential buildings shall meet or exceed the minimum d ❑ standard design required by the California Energy Standards. A4.3 WATER EFFICIENCY AND CONSERVATION Indoor Water Use 4.303.1 Water conserving plumbing fixtures and fittings. Plumbing fixtures (water closets and urinals) and fittings (faucets and showerheads) shall comply with the following: ❑ 4.303.1.3.2 Water Closets. The effective flush volume of all water closets shall not exceed 1.28 gallons per flush. Tank -type water closets shall be certified to the performance criteria of the U.S. EPA WaterSense Specifications for Tank -type Toilets. ❑ 4.303.1.3.2 Urinals. The effective flush volume of urinals shall not exceed 0.5 gallons per flush. ❑ 4.303.1.3.1 Single Showerheads. Showerheads shall have a maximum flow rate of not more than 2.0 gallons per minute at 80 psi. Showerheads shall be certified to the performance criteria of the U.S. EPA WaterSense Specification for showerheads. ❑ 4.303.1.3.2 Multiple Showerheads serving one shower. When a shower is served by more than one showerhead, the combined flow rate of all showerheads and /or other shower outlets controlled by a single valve not exceed 2.0 gallons per minute at 80 psi, or the shower shall be El designed to allow only one shower outlet to be in operation at a time. ❑ 4.303.1.4.1 Residential lavatory faucets. The maximum flow rate of residential lavatory faucets shall not exceed 1.5 gallons per minute at 60 psi. The minimum flow rate of residential lavatory faucets shall not be less than 0.8 gallons per minute at 20 psi. ❑ 4.303.1.3.2 Lavatory faucets in common and public use areas. The maximum flow rate of lavatory faucets installed in common and public use areas (outside of dwellings or sleeping units) in residential buildings shall not exceed 0.5 gallons per minute at 60 psi. ❑ 4.303.1.4.3 Metering faucets. Metering faucets when installed in residential buildings shall not deliver more than 0.25 gallons per cycle. ❑ 4.303.1.4.4 Kitchen Faucets. The maximum flow rate of kitchen faucets shall not exceed 1.8 gallons per minute at 60 psi. Kitchen faucets may temporarily increase the flow above the maximum rate, but not to exceed 2.2 gallons per minute at 60 psi, and must default to a maximum flow rate of 1.8 gallons per minute at 60 psi. 4.303.2 Standards for plumbing fixtures and fittings. Plumbing fixtures and fittings shall be installed in accordance with the California Plumbing Code, r(' u and shall meet the applicable standards referenced in Table 1401.1 of the California Plumbing Code. Page 2 of 5 CalGreen_2014.doc revised 11104114 Outdoor Water Use 4.304.1 Irrigation controllers. Automatic irrigation systems installed at the time of final inspection shall be weather - based. ❑ 4.304.1.1 Controllers shall be weather- or soil moisture -based controllers that automatically adjust irrigation in response to changes in plants' needs as weather conditions change. ❑ 4.304.1.2 Weather -based controllers without integral rain sensors or communication systems that account for local rainfall shall have a separate wired or wireless rain sensor which connects or communicated with the controller(s). Soil moisture -based controllers are not required to have rain sensor input. A4.4 MATERIAL Enhanced Durability and Reduced Maintenance 4.406.1 Rodent proofing. Annular spaces around pipes, electric cables, conduits, or other openings in plates at exterior walls shall be protected against the passage of rodents by closing such openings with cement mortar, concrete masonry or similar method acceptable to the enforcing agency. Construction Waste Reduction, Disposal and Recycling 4.408.2 Construction waste management plan. Where a local jurisdiction does not have a construction and demolition waste management ordinance, a construction waste management plan shall be submitted for approval to the enforcing agency. Building Maintenance and Operation 4.410.1 Operation and maintenance manual. At the time of final inspection, an operation and maintenance manual shall be provided to the building ❑� ,- occupant or owner. A4.5 ENVIRONMENTAL QUALITY Fireplaces 4.503.1 General. Install only a direct -vent sealed- combustion gas or sealed wood - burning fireplace, or a sealed woodstove. Pollutant Control 4.504.1 Covering of duct openings and protection of mechanical equipment during construction. Duct openings and other related air 0 ❑ distribution component openings shall be covered during construction. 4.504.2.1 Adhesives, sealants and caulks. Adhesives, sealants and caulks ®s ❑ shall be compliant with VOC and other toxic compound limits. 4.504.2.2 Paints and coatings. Paints, stains and other coatings shall be ❑ compliant with VOC limits. 4.504.2.3 Aerosol paints and coatings. Aerosol paints and other coatings shall be compliant with product weighted MIR Limits for ROC and other toxic El compounds. Page 3 of 5 CalGreen 2014.doc revised 11104114 4.504.2.4 Verification. Documentation shall be provided to verify that ❑ compliant VOC limit finish materials have been used. 4.504.3 Carpet Systems. Carpet and carpet systems shall be compliant with n{ LLJJ ❑ VOC limits. 4.504.4 Resilient flooring systems. Eighty (80) percent of floor area receiving resilient flooring shall comply with the VOC- emission limits defined in the Collaborative for High Performance Schools (CHPS) Low - emitting ❑ Materials List or be certified under the Resilient Floor Covering Institute (RCFI) FloorScore program. 4.504.5 Composite wood products. Particleboard, medium density fiberboard (MDF), and hardwood plywood used in interior finish systems shall �' ❑ comply with low formaldehyde emission standards. Interior Moisture Control 4.505.2 Concrete slab foundation. Required vapor retarders and capillary ❑ breaks are also required to comply with CalGreen Section 4.505.2.1. 4.505.3 Moisture content of building materials. Moisture content of building ❑' 1:1 materials used in wall and floor framing is checked before enclosure. Indoor Air Quality and Exhaust 4.506.1 Bathroom exhaust fans. Exhaust fans which terminate outside the u ❑ building are provided in every bathroom. Environmental Comfort 4.507.2. Duct systems are sized and designed and equipment is selected using the following methods: 1. Establish heat loss and heat gain values according to ACCA Manual J or equivalent. ❑ 2. Size duct systems according to ACCA 29 -D (Manual D) or equivalent. 3. Select heating and cooling equipment according to ACCA 36 -S (Manual S) or equivalent. SPECIAL INSTALLER AND Qualifications 702.1 Installer training. HVAC system installers are trained and certified in ❑ ❑ the proper installation of HVAC systems. 702.2 Special inspection. The Licensed Professional responsible to verify CALGreen compliance is qualified and able to demonstrate competence in the ❑ ❑ discipline they inspect and verify. Verifications 703.1 Documentation. Verification of compliance with CALGreen may include construction documents, plans, specifications, builder or installer certification, inspection reports, or other methods acceptable to the enforcing El ❑ agency which show substantial conformance. Implementation verification shall be submitted to the Building Department after implementation of all required measures and prior to final inspection approval. Page 4 of 5 CalGreen_2014.doc revised 11104114 CALGREEN SIGNATURE DECLARATIONS Project Name: Project Address: Project Description: SECTION 1 - DESIGN VERIFICATION Complete all lines of Section 1 — "Design Verification" and submit the completed checklist (Columns 1 and 2) with the plans and building permit application to the Building Department. The owner and design professional responsible for compliance with CalGreen Standards have revised the plans and certify that the items checked above are hereby incorporated into the project plans and will be implemented into the project in accordance with the requirements set forth in the 2013 California Green Building Standards Code as adopted by the City of Cupertino. Owner's Signature Date Owner's Name (Please Print) 1 Z I i ,-- Design Pr essional's Signat //u--re,, Date Design P fessional's Name (Please Print) Signa ur of L' se l5rofessional responsible for CalGreen compliance Date Name of Lic nse Professional responsible for CalGreen compliance (Please Print) Phone v < f d &� Email Addr ss for License Professiona responsible for CalGreen compliance SECTION 2 - IMPLEMENTATION VERIFICATION Complete, sign and submit the competed checklist, including column 3, together with all original signatures on Section 2 to the Building Department prior to Building Department final inspection. I have inspected the work and have received sufficient documentation to verify and certify that the project identified above was constructed in accordance with this Green Building Checklist and in accordance with the requirements of the 2013 California Green Building Standards Code as adopted by the City of Cupertino. Signature of License Professional responsible for CalGreen compliance Date Name of License Professional responsible for CalGreen compliance (Please Print) Phone Email Address for License Professional responsible for CalGreen compliance Page 5 of 5 CalGreen_2014.doc revised 11104114 CUPERTINO 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(aDcupertino.org is �6 Permit No. I7 600 7 Address # of Alarms Smoke: Carbon Monoxide: PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE HAS BEEN S„ IGNED AND RETURNED TO THE BUILDING DIVISION 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 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 with the terms and conditions of this statement Owner (or Owner Agent's) Name: � �. . U,u!' Si nature......... ........ ..........................Date: Contractor Name: ✓ j Qft �,r' (r Signature ... .... llq� . Lic.# ®G........... Date:.1....?< Smoke and COform.doc revised 03118114 CUPERTINO Owner Name Address WATER- CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014 -3255 f0 5 lb I'll Lb (408) 777 -3228 - FAX (408) 777 -3333 - buildinga-)cuoertino.or4 Permit No. r V CAPO / 7 1. Is your real property a registered historical site? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. 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. Skip the rest of the form and sign bottom of form. )I No Go to Question 3. 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. &� No 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. Skip the rest of the form and sign bottom of form. �. 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. Check one of the three following statements and sign bottom of form.. Please check ONE of the following: 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. 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, as the owner or owner's agent 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 on the following page. IOwner or Owner Agent's Signature: _ Date: Z-27—"7 I Upon completing and signing this Certificate, please return it to the Building Division in order to final your building permit. SB4072015.doc revised 08126115 BUILDING PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE HAS BEEN SIGNED AND RETURNED TO THE BUILDING DIVISION 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. SB4072015.docrevised 08126115 Non - Compliant Water- Conserving Plumbing Fixture Plumbing Fixture (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 onl 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. SB4072015.docrevised 08126115