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15040224 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20800 VALLEY GREEN DR APT 419 CONTRACTOR:20800 VALLEY GREEN PERMIT NO: 15040224 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 E] COMMERCIAL APT 419-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 419 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 WIT AYS 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 AYS F T CALLED INSPE�C, O�NN indemnify and keep harmless the City of Cupertino against liabilities,judgments, 9�dCdjj costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply Iss Dat.. with all non-point source regulations per the Cupertino Municipal Code,Section 918. 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. 01 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, usiness&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. 1 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,Sec' sJ5#505533.a d 25534. Section 3700 of the Labor Code,for the performance of the work for which this �' fo� permit is issued. Owner or authorized a e> Date: h 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. Signatur / / Date S _� GENERALPERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT- EP BUILDING DIVISION �01�M 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUP511TINb (408)777'3228•FAX(408)777-3333•buildinq(o)cupertino ora MISC PROJECT PLUMB TN ❑MECHANICAL ❑E-LECTRICAL MISCELLANEOUS ADDRESS.� Ila "NO 32 - OWNERNAME U S PHONE E-MAIL 717- .L ' STREET ADDRESS �+�.O 9 CITY TATE,Z1P. FAX 1 7 CONTACT NAME� r � •� �d�C �l NE Cl� Ppb E-MAIL STREET ADDRESS lLa CITY,S 7E, ZIP �FAX .Y, OWNER '❑ OWNER-BUQ.DER ❑ OWNER AGENT ❑ CONrRACTOR ❑CONTRACTOR AGrNT ❑ ARCHITECT ❑ENGRJEER ❑ DEVELOPER ❑TENANT CONTRACTORNAMEre 5 jn/ Z LTCENSENUMBER E� LICENSETYPE BUS.LTC/I CDMPANYNA*� 71 L.- A ^� E-MAIL FAX J� j �J �* STREET ADDRESS G CRS,"$T:ATE,ZIP 7 G f5_1A,Y— PHONE ARCHITECTIENGINEER NAME LICENSENUMBER e�L BUS.LIC U COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI•FAMTLY PROJECT IN WILDLAND ❑ YES PROTECT IN YES IS THE BLDG AN ❑yEg ii❑-,, DUB-DING: []COMMERCIAL 'URBAN INTERFACE AREA ❑ NO FLOODZONE L.1 NO EICHLERHOMEI ❑NO DL•SCRIPnoN OF WORK rbc. .�•' yY y . TOTAL VALUATION: � By my signature below.I certify to each of the following. 1� ':�"��:-i��'��.�'f:� g the property owner or authorize agent to a c property Y is behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and ver' It is accurate. I e to comply with all applicable local ordinances and state laws relating to building construction. 1 au h size representatives of Cupertino to enter the above-i entified property for inspection purposes. Signature ofApplicanUAgen /jlij�i '� �� j�� -a Date: SUPPLEMENTAL INF-ORMATIO REQUIRED :: .: : •-:�.• :r::::;. ��:� `:•9'OFFTCfi:USii O1VLB�i`- '�''�'rs ','T.. J.•JJc{4'.;. ij�%fir:7�`4f;!.a"t:a�: vrircovNrE :•,,>?�:��°� �)�%;EXPRESS- r:c:;.l,;.•y'�,;�� '�� •�:! �...:��.., -.::r::i+_�i..•:�;.ry. /J•Ji Siff j ...STANDARD L 1i iii:'a.e v I.3.,•. .ix • ":L��%`? .'�„:`TAR !'� ^�.e. MEPAliscApp 2011.doc revised 06/21/11 CITY OF CUPERTINO 13 FEE ESTIMATOR— BUILDING DIVISION TAIEN: DDRESS: 20800 VALLEY GREEN DR DATE: 04/29/2015 REVIEWED BY: MELISSA 32609040.419 BP#: *VALUATION: $500 ^PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY Buildina is PENTAMATION USE: Multi-Family Dwelling >3 Stories 0 Yes Q No PERMIT TYPE: 1RMAP1A WORK APT 419 - INSTALL N WASHER & DRYER HOOK UPS SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Other Appliance/Equip 1 BAPPLOT 2 # $144 TOTALS: $144.00 3 t s Mech.Plan Check0.0 hrs $0.00 f'Iaii b.Ph:n C;Irnr: i le::. I czn Chr;r: Mech.Permit Fee: IMPERMIT i'?ait;=:..%'s::^,a„a I t irrc..1'.>=";r it Fee: Other Mech.Insp. 0.0 L!:j 0hert'trr,;€ jyt,;r3, NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These fees are based on the preffininar information available and are only an estimate. Contact the Det for addn'I info. FEE ITEMS (Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS Hun C`/de k.Fee'e PME Plan Check: $0.00 Permit Fyee: PME Unit Fee: $144.00 PME Permit Fee: $48.00 T-F Administrative Fee: IADMIN $45.00 Work Without Permit? 0 Yes (F) No $0.00 Travel Documentation Fee: 1TRAVDOC $48.00 A Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS. : $286.50 $0.00 TOTAL FEE $2 ” 86 50 Revised: 04/01/2015 OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION Nx 10300 TORRE AVENUE-CUPERTINO. CA 95014-3255 CUPERTIN0. (408)777-3228- FAX(408)777-3333-buildino0cuoertino ora Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself a improvements specifieds the builder of the property at: SITE ADDRESS All OWNER NAME 0 9z) � O�N�R ADDRESS A v 1 DESCRIPTION OF WORK: �yr� 42 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, initialed 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:Pleasa read and initial each statement below to signify you understand or verify this information.) 3_JJ_1- I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- Bwlder"building permit that erroneously implies that the property owner is providing his or her own labor and material personally. 1, 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 insurance provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my may not insurance coverage for injuries to workers on my property. understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. � V"3. I understand as an"Owner-Builder" I am the responsible party of record on the permit. I understand that I ma protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her y name instead of my own. 5 (/4. 1 understand Contractors are required by law to be licensed and bonded in California an numbers on permits and contracts. d to list their license y V 5. 1 understand if I employ or otherwise 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"under state and federal law. 5—J6. 1 understand if I am considered an"employer" under state and federal law, 1 must register with the Stat federal government, withhold payroll taxes,provide workers' compensation disability insurance, and contributeetond unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. S 4. f 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 alls worrk single-family by licensed subcontractors and the number of structures does not exceed four within 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. 011j77e)BiiildelFol712_2010-doc revised 04/14/10 IV-9: l understand I may obtain more information regarding my obligations as an "employer' from the Internal Revenue Service, the United States Small Business Administration, the Califomia 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.cslb.ca.gov for more information about licensed contractors. �10. 1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand am the party legally and financially responsible for proposed construction activity at the site address listed above.that 1 r j Z11. I agree that, as the party legally and financially responsible for this proposed construction activit by all applicable laws and re.quirements that govern Owner-Builders as well as employers. y, I will abide !Z1 2. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information 1 have provided on this form. Licensed contractors are regulated by laws designed to protect the 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 ro ert owner's signature. Property Owner's Signature: Date: ls" --- -------- ------ ------ ------ ----- ---- -------------------------------------------------------------------------------- ------------ he 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: Date: OirneiBuildeiFonn_2010.doc r-erised 04/14/10 SMOKE/CARBON J 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 Dcupertino.org Permit No. 2®�SC�O (��,,� Address � .PPl� /�,t- � # of Alarms Smoke Carbon Monoxide: -- 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 R31.4 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 Outside of each separate sleeping area in the immediate vicinity of the X CO ALARM X X X On ever level of a dwellin unit includingbasements Within each sleeping ingroom 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, alarin(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 agree to Owner (or Owner Agen 's) Name: c5��Ld��,f Signature ..... Contractor Name: with the terms and conditions of this statement Date: nature................................... ................................ Lic.#...................................... Date: .................. Smoke and CO form.doc revised 03118/14 MATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCEFILE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION , CUPERTINO 10300TORREAVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333'' building a(D,cuoertino.org Owner Name V Permi No. Address Please refer to the attached California Civil Code Sections 1101.1— 1101.8 which are part of this Certification form: . 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. Owner' Signature: Date: �No Go to Question 2. 2. Does your real propertyhave a licensed plumber certifyir(g 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: Date: X`1 0 Go to Question 3. / -1,2 3. Is water service pennanentl.y disconnected forg our building? '� U� J Y El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form. Owner' Signature: Date: /XNo Go to Question 4. 4. Is your real property built and available for use or occupancy on or b4f5rc 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 noottaa ply. Sign below and skip the rest of the form. Owner' Signature: Date: — `' f XY es M real property / y p p rty is built and available for use or.occupanon or before January 1, 1994. Civil Code Sections 110 1. 1 through 110 1. 8 apply. Refer to the attached. ❑ Myproperty 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 Nvith water -conserving plumbing fixtures (regardless of whether property undergoes alterations or improvements). ❑ My property is a »culti'amily 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). ❑ Myproper-ty 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. SB4072014.docrevised 03/18/14 e r On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures . throughout the building (regardless of . whether property undergoes alterations or improvements). I/We, the owner(s) of this property, certify under penalty of perjury that non-compliant plumbing 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 requir ments as indicated in the table below. Owner's (or Owner Agent's) Signature: _ Date: Upon completing and signing this Certificate, please return it to the Building Division in order to final your permit.. :..:•....::...-. ..Non -Compliant .:. - ...Water -Conserving Plumbing Fixture _ Fixturel, . (Fixture Complying with Current Code Applicable.to New -Construction) '0 - 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_—.7 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 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 @ 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. It the existing plumbing nxture water usagUMUw 1aLc to cquai w Ui JU"'�j L11.0 Ll— ,..b �••� ••�• 1- �--rc•----- SB4072014.doc revised 03/18/14