15090054CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10315 CALVERT DR
CONTRACTOR: TRENCHFREE INC
PERMIT NO: 15090054
OWNER'S NAME: JENNIFER GRIFFIN
PO BOX U
DATE ISSUED: 09/09/2015
OWN R'S PHONE: 6509671830
SAN JOSE, CA 95151
PHONE NO: (408) 726-7926
12/ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
REPLACE (E) SEWER LINE & INSTALL CLEANOUTS AS
NEEDED (SUNNYVALE SANITARY)
License Class (,3/-/6/Al/Lic. # �7/D/�
len C' 1 f/ f e DateWoChasipter
Contractor
I hereby affirm that I am licensed under the provisio9
SUN W4 %J OLE
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
Sq. Ft Floor Area:
Valuation: $4860
I hereby affirm under penalty of perjury one of the following two declarations:
i. I have and will maintain a certificate of consent to self -insure for Worker's
APN Number: 37517020.00
Occupancy Type:
Compensation, as provided for by Section 3700 of the Labor Code, for the
p ormance of the work for which this permit is issued.
ave 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
permit is issued.
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 ERMIT ISSUANCE OR
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
1 F LED INSPECTION.
correct. I agree to comply with all city and county ordinances and state laws relat'
to building construction, and hereby authorize representatives of this cityaaiZiWef—
upon the above mentioned property for inspection purposes. (We) agree to save
I y: Date:
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 with
RE -ROOFS:
all non -point source regulations per the Cupertino Municipal Code, Section 9.18.
All roofs shall be inspected prior to any roofing material being installed. If a roof is
Signature "L' G Date 9�/
installed without first obtaining an inspection, I agree to remove all new materials for
i/
inspection.
Signature of Applicant: Date:
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
the following two reasons:
t. 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
HAZARDOUS MATERIALS DISCLOSURE
sale (Sec.7044, Business & Professions Code)
I have read the hazardous materials requirements under Chapter 6.95 of the
2. I, as owner of the property, am exclusively contracting with licensed contractors to
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
construct the project (Sec.7044, Business & Professions Code).
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
I hereby affirm under penalty of perjury one of the following three declarations:
Additionally, should I use equipment or devices which emit hazardous air
1. I have and will maintain a Certificate of Consent to self -insure for Worker's
contaminants as defined by the Bay Area Air Quality Management District I will
Compensation, as provided for by Section 3700 of the Labor Code, for the
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
performance of the work for which this permit is issued.
2. 1 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
Owner raut ed agent
mt � M Dater.
permit is issued.
a. 1 certify that in the performance of the work for which this permit is issued, I shall
CONSTRUCTION LENDING AGENCY
not employ any person in any manner so as to become subject to the Worker's
I hereby affirm that there is a construction lending agency for the performance of work's
Compensation laws of California. If, after making this certificate of exemption, I
for which this permit is issued (Sec. 3097, Civ C.)
become subject to the Worker's Compensation provisions of the Labor Code, I
Lender's Name
must forthwith comply with such provisions or this permit shall be deemed
revoked.
Lender's Address
APPLICANT CERTIFICATION
ARCHITECT'S DECLARATION
I certify that I have read this application and state that the above information is
I understand my plans shall be used as public records.
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
Licensed Professional
upon the above mentioned property for inspection purposes. (We) agree to save
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 with
all non -point source regulations per the Cupertino Municipal Code, Section 9.18.
Signature Date
'
CUPERTINO
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildina(a.cupertino.ora [ �,— Q
PLUI`MING ❑ MECHANICAL
❑ ELECTRICAI
MISIC
I—] MISCELLANTEOUS
PROJECT ADDRESSt)J/J Q Iver
/ r AP -3 2- -5- r C) -L-
OWNER N
OWNERNAI✓E rl (`('f h
t`4
PxotvE7- 30 tMSIL er SOL' G/Of.A�
J
STREET ADDRESS �A
"
CITY, STATE, ZIP FAX
COA'TACT NAME
PHONE D Z6_ 2f E MAII
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OPR.'r'F.t ❑ cwt. -R -BUILDER ❑ ORN'ERAGEN'T
�Z_CO?.TRACTOR ❑ CO?.TRACTORAGEt,�T ❑ ARCF.ITECT ❑ FvG=.R ❑ D_FVEIAPER ❑ TENANT
CONTRACTOR NAI,M
LICENSE NUMBER 9 7/ O/ . �ICEZ E E
BUS. LIC 0
COMPANY N.A,,M
E-MAIL
,Ser la �17c ,
FAX
275137 2 -
STREET
STREET ADDRESS /� �
/[
CITY, STATE, ZIP � � � n`
C' 7
PHONE
.ARCHITECT/ENGINEER NAME.
LICENSE NUMBER
BUS. LIC #'
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX ❑ MULTL-FAhULY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑ YES
BLJILDLNG. ❑ COMMERCIAL URBAN II.TERFACE AREA ❑ NO FLOOD ZONL ❑ NO
IS THE BLDG AN ❑ YES
I EICHLER HOME? ❑ NO
DESCRIPTION OFWORK
SD/ate P_ Sewer-
aleL9�
TOT?.I. VALUATION: O
B
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 r ead this
application and the information I have provided is correct ave read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building ' a_ I utho ' epresentatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED
FF C
I A I
MEPMSCApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
imADDRESS:
10315 CALVERT DR
DATE: 09/09/2015
REVIEWED BY: MELISSA
UNITS
APN: 37517 020
BP#:
'VALUATION: 1$4,860
*PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: SFD or Duplex
#
PENTAMATION
PERMIT TYPE: 1 RPS
WORK
REPLACE E SEWER LINE & INSTALL CLEANOUTS AS NEEDED SUNNYVALE SANITARY
SCOPE
Silq)pl. Insp Fee
APPLIANCE / EQUIP TYPE
FEE ID
Plumb. Plan Check foo hrs $0.00
QTY
UNITS
BP FEES
/Iec. Permit Fee:
Sewer, Sanitary
1 PRSEWER
i )! it tlec. i,tsE,,_Li I
1
#
$25
Permit Fee:
Silq)pl. Insp Fee
PME Unit Fee:
$25.00
PME Permit Fee:
$48.00
Consiruclion Klx:
Administrative Fee: IADMIN
$45.00
Work Without Permit? Yes (F) No
$0.00
TOTALS:
Travel Documentation Fee: ITRA VDOC
$25.00
Strong Motion Fee: IBSEISMICR
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 nreliminary information available and are onlv an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E(L 7/1/13)
dlech. Plan Check
Plumb. Plan Check foo hrs $0.00
l: lee. Plan Check
A?ec1t. Permit Fee:
Plumb. Permit Fee: IPPERMIT
/Iec. Permit Fee:
Other 14ech. lnsp.
Other Plumb Insp. 0.0 hrs $48.00
i )! it tlec. i,tsE,,_Li I
PME Plan Check:
$0.00
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 nreliminary information available and are onlv an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E(L 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
PME Plan Check:
$0.00
Permit Fee:
Silq)pl. Insp Fee
PME Unit Fee:
$25.00
PME Permit Fee:
$48.00
Consiruclion Klx:
Administrative Fee: IADMIN
$45.00
Work Without Permit? Yes (F) No
$0.00
-ldwmeed Planning Fees:
Travel Documentation Fee: ITRA VDOC
$48.00
Strong Motion Fee: IBSEISMICR
$0.63
Select an Administrative Item
Bldg; Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS: 1
$167.63
$0.00 TOTAL FEE:
$167.63
Revised: 07/02/2015
CUPERTINO
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
FIL
(408) 777-3228 • FAX (408) 777-3333 • building(Mcuoertino.ora ?�O
�
Owner Name 1211y M 1(=1�Z CC 2� �' Pel ij -�-- Permit No. ,0s y
Address O k 5 CALVL-:1 -'x' ct,Q Co DG1t1_1m 6
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.
04 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.
�( 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.
g 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.
1X 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 com
ply with the requirements as indicated in the
table on the following vage. in r % ^ N
Owner or Owner Agent's Signature: k J M_� 6nia/6l, Date: -1 /1 toj 1
ITnon comnleting and signing this Certificate_ nlease return it to the Building WTision in order to final vour building hermit
SB4072015.doc revised 08/26/15
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.doc revised 08126/15
Non -Compliant
Water -Conserving Plumbing Fixture
Plumbing Fixture
(Fixture Complying with Current Code Applicable to New Construction)
Maximum Water Usage/Flow Rate
Fixture Type
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 .5 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.
SB4072015.doc revised 08126/15
CUPERTINO
Address
U3 N 0 _r K, t Pt U V(2�
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE ; LE
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building aacupertino.org
r A Permit No.
# of Alarms Smoke:
PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE
HAS BEEN SIGNED AND RETURNED TO THE BUILDING DIVISION
ka+.tz:
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.
I have read and a.4ree to comply_ with the-te�nd conditions 9f fhis statement
Owner (or Owner Agent's) Name:
k, I
�
-�
'91 1(0
V RA hi
Signature ............ Date:
..
Contractor Name:
' k
/�
01:-J
_" I'
Si nature....t .. .... ........... .............................. Lic.# ....7.T.10I6.............. Date: t'
I
Smoke and COform.doc revised 03/18/14
I