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15040218 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20800 VALLEY GREEN DR APT 416 CONTRACTOR:20800 VALLEY GREEN PERMIT NO: 15040218 DRIVE OWNER'S NAME: 20800 VALLEY GREEN DRIVE PO BOX 1368 DATE ISSUED:04/29/2015 OWNER'S PHONE: 4082530200 CARLSBAD,CA 92018 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL APT 416-INSTALL(N)WASHER&DRYER HOOK UPS License Class Lie.# Contractor 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 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:$500 I 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:32609040 416 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 DAYSPERMIT 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 DA M L 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 3d C- granting of this permit. Additionally,the applicant understands and will comply rsued by: e: with all non-point source regulations per the Cupertino Municipal Code,Section 9 18. OOFS: Signature Date All roofs shall be inspe 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) ,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 Munic'pal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Se/c' s 25505,2553d 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent'-__L Date: ermit is issued. 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 1 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 a Cupertino Municipal Code,Section Licensed Professional 9 18. ZiW* Signatur Date z - GENERALPERMtT APPLICATION 40'1�' MEPCOMMUNITY DEVELOPMENT DEPARTMENT•BUILQING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUP513TINb (408)777-3228'FAX(408)777-3333•buildinG Gncupertino orG MISC ❑PLUMBING ❑MECHANICAL []ELECTRICAL MISCELLANEOUS PROJECT ADDRESS�� G� OWNER NAME U 135 PHONE E-MAIL STREETADDRESS ` ds Z , 7 r CITY,-STATE ZIP. FAX� — CONTACT NAME (1� 01-r- 1C<NE E-MAIL '9 STRELET ADpRESS — ., L��//� C C1TY,S SITE. ZIP [ALL :7 Y. l y/Di FAX OWNER '❑ OWNER-BUILDER ❑ OWNER AGENT [:]-CONTRACTOR ❑CONTRACTOR AGENT ❑ AARCWTECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME P C�� le Z LTCENSENUMBER f LICENSETYPE BUS.LIC H COMPANY N' �•ZZ *� E-MAIL cJG�t . L FAX 4'fL' _�l,/C STREET ADDRESS, C�-y�TATE,Z[P ^� ` < �Yt Y _ Cr: C 5��Y_ PHONAL ARCHITEC UENGINEER NAME LICENSE NUMBER BUS.LIC N COMPANY NAME E-MAIL FAX STREET•ADDRESS CRY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMMY PROJECT IN WI.DLAND ❑ YES PROJECT INF❑,YFs IS THE 13LDG AN ❑YES BUILDING. ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOODZONE LJ NO EICHLERH026E7 ❑NO - DESCRIPTION OF WORK ' TOTAL VALUATION: By my signature below,I certify to each of the following: the property owner or authorized agent to act on the property er's behalf. I'have read this I application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. gree to comply with all applicable local ordinances and state laws relating to building construction. I au lr fizc representatives Of Cupertino to enter the above-identified property for inspection purposes. Signature of Appl icantlAgen Date: SUPPLEMENTAL INFORMATIO REQUIRED COIJJ`IfE(t`p�-..;i%i:; .s:.:. .. r .:sz• _ Yee '-: ,L. :ii'•:;i Y:'`j C: • �i-Z.. _ •ter:�•,-0y3�•f`•R°.�J^:-i'l•:�l�;i..:..l..r.__,N�. ' it�-a y;:;•_-•::,'="�'. t :, �" hfEPMiscrlpp 2011.doc revised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION WIPERMIT DDRESS: 20800 VALLEY GREEN DR DATE: 04/29/2015 REVIEWED BY: MELISSA PN: 32609040.416 BP#: *VALUATION: $500 PE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY Multi-Family Dwelling Buildina is PENTAMATION 1 RMAP1 USE: 3 Stories 0 Yes Q No PERMIT TYPE: A WORK APT 416 - INSTALL N WASHER & DRYER HOOK UPS SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Other Appliance/Equip 1BAPPLOT 2 # $144 TOTALS: $144.00 Mech.Plan Check 1-0—.01hrs $0.00 Plumb.r hvi t:r£:c /ief,.Mal-t:'t,r:£:i, Mech.Permit Fee: 1MPERMIT i'lritnn..l'r:rlrliZ t",c: E'lec.Permit E:e: Other Mech.Insp. Ehrs $48.00 t si3F??'PFtP•i L% 17.5'73. 01.,e r.l.,Je:'.lrnp,, 0 19er:n.lnsp,Fee .1'.'rllr.•I3..It-sl3.. er>: Eler:. t,r.sr 10e: 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 preffininar information available and are on an estimate. Contact the De t for addn'l info. FEE ITEMS (Fee Resolution 11-053 Ef. 7/1113) FEE QTY/FEE MISC ITEMS /Flan Check./'eco: .upq.d. PC'1`ee PME Plan Check: $0.00 pt'.rmil 1'f.e: PME Unit Fee: $144.00 PME Permit Fee: $48.00 C;r3rrtcrrac:;'ic�ti Tax: Administrative Fee: IADAflN $45.00 Work Without Permit? 0 Yes Q No $0.00 Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTQTAL,S $286.50 $0.00 TOTAL FEE:,, $286.50 Revised: 04/01/2015 OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 CUPERTIN0: (408)777-3228• FAX(408)777-3333•buildino ancuoertino oro Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS f ?_0_,ro t l/ .ice � �J , `� APN �� `'l � BP# OWNER NAME O}Na R ADDRESS DESCRIPTION OF WORK: �yt�A�, �v r ®� o We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initiated your understanding of each provision, signed,and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.) �41. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- Builder"building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I,as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on m y property. My homeowner's provide coverage for those injuries. i am willfully acting as an Owner-Builder nd am aware of the limits of my a- not insurance coverage for injuries to workers on my property. , V' 2. 1 understand building permits are not required to be signed b the construction and are not hiring a licensed Contractor to 2.SSume this re sponsb ltperty y unless they are responsible for �3. I understand as an"Owner-Builder'1 am the responsible party of record on the permit. I understand that I ma protect myself from potential financial risk by hiring b licensed Contractor and having the permit filed in his or her y name instead of my own. 54. 1 understand Contractors are required by law to be licensed and bonded in California and numbers on permits and contracts. to list their license 5. I understand if 1 employ or othenvise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer'understate and federal law. —4. 1 understand if I am considered an"employer" under state and federal law, I must register with the stat federal government,withhold payroll taxes,provide workers' compensation disability insurance, and contribute tond unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. S /7. I understand under California Contractors'State License Law, an Owner-Builder who builds residential structures cannot legally build them with the intent to offer them for sale, unles allworrk istperfor performed by licensed subcontractors and the number of structures does not exceed fourwithin any calendar year, or all of the work is performed under contract with a licensed general building Contractor. 8. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. OwnerBinldetForn:_20I0.doc revised 04/14/10 understand I may obtain more information regarding my obligations as an "employer, from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of industrial Accidents. i also understand I may contact the California Contractors'State License Board (CSLB) at 1-800-321-CSLB (2752)or www.Gslb.ca.gov for more information about licensed contractors. 10. 1 am aware of and consent to an Owner-Builder building my name, and understand am the party legally and financially responsible for proposed construction activit applieity atforithe site address listed above.that! f11. I agree that, as the party legally and financially responsible for this proposed construction activit I by all applicable laws and requirements that govern Owner-Builders as well as employers. y, wi11 abide � '12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes.to a ny the information I have provided on this form. Licensed contractors are regulated by laws designed to protect he public. If You contract with someone who does not have a license, the Contractors'State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint.Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. if you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers'compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS:Please complete the following construction lending agency information.) i hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued,this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to veri the propelZ owner'ssi nat Property Owner's Signature: - - Date: --------------------------------------------------------------------------------------------------------------------------------------------- (NOTE. The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which i understand is my personal responsibility, I hereby authorize the following person(s)to act as my agent(s)to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project(or Description of Work): Project Location or Address: Name of Authorized Agent: Tel No Address of Authorized Agent: I declare under penalty of perjury that i am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Dale: OttillelBldldelFol777_2010.doc ierised 04/14/10 SMOKE ! CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 •FAX (408) 777-3333 • building(a)cupertino.org m,— / �q J po.-mid l�Tn 1 �Al-,/ 6 2/ Address PURPOSE tallation of all required Smoke and Carbon Monoxide Alarms for This affidavit is a self -certification for the ins 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 amd 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 R3.1.4 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 X X bedroom(s) On ever level of a dwellingunit includingbasements X X Within each sleeping room X Carbon Monoxide alarins 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) referenc be, h nave been installed in accordance with the manufacturer's instructions and in compliance wit l r �i�� uilduna and California Residential Codes. The alarms have been tested and are operationa , as t e si ne� below. I have read and agree to comply with the terms and conditiou of this statement Owner (or Owner Agent') Name: I,,^ IVl �' /'6 Signature.......... Date: ..`f)l.. c 4 v l CEI . .......... ............ . Contractor Name: l Signature.................................................... ..........Lic.#...................................... Date: .................. Smoke and Co form.doc revised 03/18/14 M WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION C U P E RT! N O 10300 TORRE AVENUE • CU PERTINO, CA 95014-3255 x(408) 777-3228 • FAX (408) 777-3333 building C-CUoertino org Owner Name Address Please refer to the attaclnea Ualitorma Civil Code Sections 1101.1— 1101.8 which'are part of this Certification form: 1. IS your real property a registered historical site?. ❑ Yes. pp Y c p Civil Code Sections 1101.1 through 1101.8 do nota 1 ��SiQrr below and ski the stqb$ Owner' Signature: Da J �No Go to Question 2. ��-�C�� 2. Does your real property have a licensed plumber certifying that, due to the age or configuration plumbing, installation of water-conservingof the property or its 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: Date: No Go to Question 3. 3. Is water service permanently disconnected for your building? �J ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form. Owner' Signature: Date: [No Go to Question 4. 4. Is your real property built and available for �Useor occupancy on or b fore January 1, 1994? ❑ No My real property is built and available for use br 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. Owner' Signature: 64WA v� Date: G. Yes My real property is built and available for usJanuary 1, 1994 d 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 7zzultfainily 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 prop ertyis 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 plurmbing fixtures. SB4072014.doorevised 03/18/19 0 r On or before January 1, 20.19," all non-compliant plumbing features 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 have been replaced 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 below. Owner's (or Owner Agent's) Signature: /�7 Date: Upon completing and signing this Certificate, please. return it to the Building Division in order to final your permit.. :._._. ..Non -Com liant p ... .. Water -Conserving Plumbing Fixture_ _ (Fixtu.re Cbimplylng with Current Code Applicable.to New -Construction) Plumbin Fixturel, Maximum Wafer Usage/Flow Rate Fixture -Type- 2013 CPC Ch. 4 -7 2013 CPC Ch. 4 2013 CPC Ch. 4 -Water Usage 2013 CALGreen Div. 4.3 2013 CALGreen Div. 4.3 2013-CALG�een 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. - - Exceed 2.2 gallons Maximum 1.5 gallons per Within units: 0.5 gallons per minute @ 60 .Faucets 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 tern porarily 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 @ 6.0 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 nxture waier usageieicw eaLc It, cLIuai w Ui iU�'�i ui- iuv �.bu=� _� ••--, - _ .. .. 1__.__ ._ __ _ro______ SB4072014.doc revised 03118114