15090065CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7401 PLUM BLOSSOM DR
CONTRACTOR: ARUMILLI RATNAJEE
PERMIT NO: 15090065
AND RAMAVANI J TR
OWNER'S NAME: ARUMILLI RATNAJEE AND RAMAVANI J TR
7401 PLUM BLOSOM DR
DATE ISSUED: 09/10/2015
OWNER'S PHONE: 4085617510
CUPERTINO, CA 95014
PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
REMOVE (E) WOOD SHAKES AND INSTALL WITH (I) COMP
License Class Lie. #
SHINGLES (NO NEW PLY) - 25 SQ'S
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.
Sq. Ft Floor Area:
Valuation: $9400
I hereby affirm under penalty of perjury one of the following two declarations:
t. 1 have and will maintain a certificate of consent to self -insure for Worker's
APN Number: 36610082.00
Occupancy Type:
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
2. 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
permit is issued.
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
180 DAYS FROM LAST CALLED INS EC ION.
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
`
l r1
upon the above mentioned property for inspection purposes. (We) agree to save
Issued by: /� 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
ROOFS:
all non -point source regulations per the Cupertino Municipal Code, Section 9.18.
All roofs shall be inspected prior to anyy roofing material being installed. If a roof is
Signature Date
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
r—
Signature of Applicant:
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
ALL ROOF COVERINGS O 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
I, as owner of the property, am exclusively contracting with licensed contractors to
California Health & Safety Code, Sections 25505, 25533, and 25534. I 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(x) 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. 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
Ow er orkauthorized a nt:cr
Date: I `L` -- \ S
permit is issued.
a. I 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
Compensation laws of California. If, after making this certificate of exemption, I
I hereby affirm that there is a construction lending agency for the performance of work's
become subject to the Worker's Compensation provisions of the Labor Code, I
for which this permit is issued (Sec. 3097, Civ C.)
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 theCu a ino Municipal Code, Section 9.18.
f' 1
�� , i \0 2a I
Signature , "t Date
REROOF PERMIT APPLICATION 150q0065•
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • build ingacupertino.ora
PROJECT ADDRESS 7— l o I PLUM
U M ll D q` o� D�
_-A
APN #` &&It) C
A
OV<RJER NAME AZ ' 7A v � l-� P]� � 01 1 LU PHONE r Q - 7 � 14 E�M�J� 7 + �i I L 1 /
C
%,L ,Lf -Di �LV$LbsSD M/�
STREET ADDRESS 1 1�
CITY, STATE, ZIP CvT A7-1 N %c� FAx
CONTACT NAME r /fi r �fI U 1
-' ^7
PHONE Ir N I
c�
E-MAIL
A
STREET ADDRESS
CITY, STATE, ZIP ` ' �1 1
FAX
❑ OWNER MOWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC. #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECT/ENGINEERNAME
LICENSE NUMBER
BUS. LIC: #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF �sFD or Duplex El Multi -Family
STRUCTURE: ❑ Commercial
ROOF AREA:
�r
VALUATION ^ Q
�-•!/ J �
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES WM'OOD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY)
REMOVE /REPLACE YES
❑ NO
IF NO,
I #LAYERS:
PLYWOOD ❑ %- ❑
THICKNESS: ❑ 5/B'•
PLYWD ❑ OSB
TYPE: ❑ CDX
PITCH:
• 12
ROOF
CLASS: A
PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
ICC -ES REPORT #
DESCRIPTION OF WORK 9 (V J� k I
- J �j�
�'T6! S L
N k N G C S
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 ha a provided is correct. I have read the De cri tion of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating t buildin construction. I a thorize repres t fives of Cupertino to enter the above -identified property for inspection purposes.
r 1
Signature of Applicant/Agent: '� Date: `G
SUPPLEMENTAL INFORMAT N REQUIRED
—If building is associated with a Home Owner's Association, provide letter
of approval from HOA.
Provide Planning approval to verify if there any restrictions.
— Provide copy of Manufacturer's Installation Specifications.
Provide signed copy of Cupertino's Tear -Off Policy.
"' P=
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ISA3Ni�TII�G•P I2EViE - �
ReroofApp 2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION ISMOOE6'
191
ADDRESS: 7401 PLUM BLOSOM DR.
DATE: 09/10/2015
REVIEWED BY: PAUL
Alech. Permit Fee:
APN: 36610 082
BP#:
*VALUATION: $9,400
°PERMIT TYPE: Minor Building Permit
PLAN CHECK TYPE: Re -roof
PRIMARY
USE: SFD or Duplex
PIumb.."l,feeh.%FIec
PENTAMATION
PERMIT TYPE: 1SFDWLR00
WORK
Remove E wood shakes and Install with N Comp Shingles No New PI - 25 S 's
SCOPE
uppL Inssp I'ec
FEE ID ROOF AREA
s.f.
1REROOFFRES 2,500
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 preliminary information available and are onlv an estimate. Contact the Dept for addn7 info.
FEE ITEMS (Fee Resolution 11-053 UL 7/1/13)
_FTch. Placa Chi
Numb. flan OWLr F
I iec. New C-
Alech. Permit Fee:
Plumb. Permit Fee:f;7ec.
Permit Fee:
'itherAlech. In,p.
Other Pluml, I -Li
Other Elec. Insp.
PIumb.."l,feeh.%FIec
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 preliminary information available and are onlv an estimate. Contact the Dept for addn7 info.
FEE ITEMS (Fee Resolution 11-053 UL 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Phin Check I' c:
Lipp/. PC Fee
PIumb.."l,feeh.%FIec
Permit Fee:
.00
uppL Inssp I'ec
"imb./Meelt.iElec
Iarmb./Llecla.%Edec Permit Fee:
construction Tax:
t`t;IJJ'ttttt.t'tr'tttn, , Fec:
Work Without Permit? 0 Yes (F) No
$0.00
dvanced Plcxnning Fees:
I t'ccvel Docrumenlalion Fe(? :
Strong Motion Fee: IBSEISMICR
$1.22
Select an Administrative Item
1 l f�f�
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$427.22
$0.00 TOTAL FEE:
1 ',$427-2'21
Revised: 07/02/2015
R.
REROOF TEAR -OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - buildingO)cuaertino.oro
PROJECT ADDRESS �'rO 1 P L
APN#
OWNER NAME( �`� .. AR V M 1 L_L �
PHONE 4. � 561 � �
E-MAn. �� � �1 � Y M
J � �r � �
STREET ADDRESS l�7 \4 0I
( I
CITY, STA ZI`Pf � � Q � � �
FAX
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC. #
COMPANY NAME
EMAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re -roof project shall comply with all applicable provisions of the 2013 California Codes.
2. An inspection request can be scheduled ul) to one business day before the requested inspection date.
Please schedule inspections online or call (408) 777-3228 from 7:30-3:30pm (Mon-Thurs) or 7:30-
2:30pm (Friday) to schedule inspection. For Tear -Off and Nailing Inspections, you must also call on the
day of the inspection only after that phase of the work is completed. The building inspector will be
available within one hour. The hours for this service are: 7:30-10:30am and 12:30-3:30 (Mon-Thurs)
and 7:30-10:30am and 12:30-2:30 (Friday). Final Inspections will be given a two hour window.
3. Tear -Off Inspection is required. Any and all dry -rotted wood shall be replaced prior to this inspection.
Unless new plywood roof sheathing is proposed throughout, all the nails/fasteners shall be either
completely knocked -down or removed prior to this inspection.
4. If plywood is installed, a plywood Nailing, Inspection is required.
5. Roofing shall not be applied without first obtaining all prior inspection and written approvals from the
building inspector. Any roofing which is applied without first obtaining an approved inspection will
require the removal of all new material down to the sheathing so a proper inspection can be performed.
6. A Final Inspection and approval shall be obtained from the building inspector when the re-roofmg is
completed. To receive a final sign -off, the following items will be verified:
a. Flat roofs shall have a minimum of 1/4" per foot of slope and demonstrate there is no ponding.
b. Listings from approved testing agencies for all pre -manufactured products used shall be
available on-site to review at the time of the inspection.
c. Proper spark arrestor installation, vents painted, gutter/downspouts installed, debris removed.
7. NOTE: If you call for a tear -off or plywood nailing inspection and the work is not complete, you will be
charged a re -inspection fee. The re -inspection fee shall be paid before another inspection can be
scheduled. .
By my signing below, I certify each of the following is true: I am the property owner or authorized agent to act on the
property owner's behalf. I understand and agree to comply with the re-ro f policy stated above. I also understand that
smoke detectors and carbon monoxin detectors are required to be inst I in accordance with Sections R314 and R315 of
the 2013 California Residential Co r'
Sienature of ADnlicant/Aeent: cti •,� osN t Date:
ReroofPo1icy_M4.doc revised 01/15/14
CUPERTINO
OWNER -BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - building(Mcupertino.org
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 7 l LU �pSS AK APIC. 10 069,
BP#
OWNER NAME
OWNER ADDRESS: _... -1 - . .. . f Lv�
S ,1,+. S C
DESCRIPTION OF WORK: f (A %o �
N C t IL S tV kr,� L
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: Please read and initial each statement below to signify you understand or verify this information.)
1. 1 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 my property. My homeowner's insurance may not
provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my
insurance coverage for injOries to workers on my property.
J�L_2. 1 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.
3. 1 understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may
protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her
name instead of my own.
4_4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license
numbers on permits and contracts.
itL-5. I 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.
�6. I understand if I am considered an "employer" under state and federal law, I must register with the state and
federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to
unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject
Da
mme to serious financial risk.
`Q ' 7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family
residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed 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.
AL -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.
OwnerBuilderForrn2010.doc revised 04/14/10
49. 1 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 1 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 that I
am the party legally and financially responsible for proposed construction activity at the site address listed above.
4L_11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide
by all applicable laws and requirements that govern Owner -Builders as well as employers.
12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
in ormation l have -provided on this form. Licensed contractors are regulated bylaws 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 maybe in civil court. Itis 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 maybe 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 drivers license,
form notarization, or other verification acceptable to the city may be retqired to be presented when the permit is issued
to verif the property owners si ature. r -
Property Owner's Signature: -, Date: lb j
-
--------------------------------------------------------------------------------------------------------------------------------------------
(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:
Address of Authorized Agent:
Tel No
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 owners driver's license, form notarization, or other
verification acceptable to the city may be required to be presented when the pen -nit is issued to verify the property owners
signature.
Property Owner's Signature:
Date:
OwnerBuilderForm 2010.doc revised 04/19/10
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()cupertino.org
FIL E
ZE=e
Permit No. DO C N'
Address 7 4 r, SO # of Alarms Smoke: 7 Carbon Monoxide: 2..
PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE
HAS BEEN SIGNED 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.
I have read and agree to comply with the terms and conditions of this statement
�DJOwner (or Owner Agents) Name:
IP4
Signature ............. ` 1 ......................................... Date: 1
Contractor N me:
I CpQC I /t��,GlS 1A ? 3 30
Signature...... ................................... Lic.# .......•••1............... Date: 1. .......
Smoke and CO form.doc revised 03/18/14
WATER -CONSERVING PLUMBING FIXTURES FILE
OWNER CERTIFICATE OF COMPLIANCE
50h§ I
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
C U P E RT I N O 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building a(-cuoertino.org 1 �O C O
Owner Name �T rJ A E F ,� U 1 L L Permit No. 1,
Address ^7 4 C Q LU5��.�i C �` rV -A
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.
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.
K 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:
T%' 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 cot ply with the requirements as indicated in the
table on the followingpage.
Owner or Owner Agent's Signature: Date: 2
Upon completing and signing this Certificate, please retu4 it to the Building Division in order to final your building permit.
SB407 2015. doc revised 08/26115
BUILDING PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS
- - �-�-"Cit,`RTIFICATE HAS BEEN SIGNED ,NED AND RETURNED TO THE BUILDING DIVISION
1. It the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shown, it is not required to be upgraded.
SB407 2015.doc revised 08/26/15
Non -Compliant
Water -Conserving Plumbing Fixture
Plumbing Fixturel
(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
Gallons/flush
0.5 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. It the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shown, it is not required to be upgraded.
SB407 2015.doc revised 08/26/15