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15090158 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1469 PRIMROSE WAY CONTRACTOR:CLEAR DRAIN PERMIT NO: 15090158 PLUMBING OWNER'S NAME: CHAU JENNY TRUSTEE PO BOX 826 DATE ISSUED:09/23/2015 OWNER'S PHONE: 9196226854 LOS GATOS,CA 95031 PHONE NO:(408)358-3242 9 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ /' INSTALL(N)GAS LINE FROM METER TO KITCHEN License Class ff� �b Lic.# �:1-r � oz// Contractor C_, Ua LSIrQ, ►n Date ZT ('S' 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:$I600 I hereby affirm under penalty of perjury one of the following two declarations: r. I have and will maintain a certificate of consent to self-insure for Worker's APN Number:36617002.00 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 •L Section 3700 of the Labor Code,for the performance of the work for which this PERMIT EXPIRES IF WORK IS NOT STARTED permit is issued. WITHIN 180 DAYS OF PERMIT ISSUANCE OR APPLICANT CERTIFICATION 180 DAYS FROM LAST CALLED INSPECTION. 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 q 12 to building construction,and hereby authorize representatives of this city to enter Issued by: , Date: 1111 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 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 installed without first obtaining an inspection,I agree to remove all new materials for Signature _cp—�..--` Date P/`L j inspection. Signature of Applicant: Date: ❑ OWNER-BUILDER DECLARATION ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: t. I,as owner of the property,or my employees with wages as their sole HAZARDOUS MATERIALS DISCLOSURE compensation,will do the work,and the structure is not intended or offered for I have read the hazardous materials requirements under Chapter 6.95 of the sale(Sec.7044,Business&Professions Code) California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain 2. 1,as owner of the property,am exclusively contracting with licensed contractors to compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& construct the project(Sec.7044,Business&Professions Code). Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air I hereby affirm under penalty of perjury one of the following three declarations: contaminants as defined by the Bay Area Air Quality Management District I will r. I have and will maintain a Certificate of Consent to self-insure for Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation,as provided for by Section 3700 of the Labor Code,for the Health&Safety Code,Sections 25505,25533,and 25534. performance of the work for which this permit is issued. O or uized agent: 2. I have and will maintain Worker's Compensation Insurance,as provided for by — Date:��� Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. CONSTRUCTION LENDING AGENCY 3. I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Worker's 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 Lender's Address revoked. ARCHITECT'S DECLARATION APPLICANT CERTIFICATION I understand my plans shall be used as public records. 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 Licensed Professional to building construction,and hereby authorize representatives of this city to enter 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 CONSTRUCTION PERMIT APPLICATION A415F COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228 • FAX (408)777-3333 • building(c�cuoertino.org ( l ❑NTEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT 4 PROJECT ADDRESS { w I APN 9 3.C6 ,-- t -o o-2 OWNER NAME S Y � � rte i PHONE nl (Z � E-MAIL STREET ADDRESS, ! �n w i CITY, STATE,ZIP r I FAX CONTACT NAME O PHONE� E-MAIL V-1,61 k 0 STREET ADDRESS oy'(:.,Cr'b Cid CITY,STATE,ZIP FAX OWNER ❑. OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑"ENGINEER ❑ DEVELOPER ❑ T`ENAN'T CONTRACTOR NAME LICENSE N-M2ER LICENSE TYPE BUS.LIC k o� P -ST801J COMPANY NA1,1E, E-MAIL FAX I l STREET ADDRESSQ CITY�STOATE,ZIP Q PHO1y0 r 120 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LICR J COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK a o vim. C, v,Lw q 4s Lto, � �,• 11 , w�r�cr Ek7STING USE PROPOSED USE CONSTR TYPE S STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NEI'AREA _ BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH.AREA GARAGE AREA: ODETACH ATTACH R DWELLING UTS: IS A SECOND UNIT ED I SECOND D STORY OYES _ - -- BEING ADDED? ❑NO 1 ADDITION? ❑NO - PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES PLANATNG.A1\O PPI.» ❑NO PLANNING APPROVAL LETTER I EICHLER HOME? ❑ _ - - TOTAL VALUATION: By my signature below,I certify to each of the fellowins: I am the property oN-vner or authorized anent to act on e prope net's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it' acct agree to comply with all applicable local ordinances and state laws relating to 7ding const tion. I authorize representatives of Cupertino to e> yEht�a,�ovae-ide ified pro rty for inspection purposes. Signature ofApplicant/Agent: Date: U` SUPPLEME AL Ir ATION REQUIRED PAJ.c> cxT�PE = xourl _c sLrP New SFD or Multifamily div ellings: Apply for demolition permit for ❑ otR T> coutTER . BUIIDLtePLANREVIER existing building(s). Demolition permit is required prior to issuance of bulldmg _ a permit for new building. ❑ EXPRESS ❑ PLAI�TL\G PLlir,RE}IES} _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure =© STANDARD _ ❑ PUBL C-14 - form if any Hazardous Materials are being used as part of this project. T❑s LARGE= �� � i _Copy of Planning Approval Letter or Meeting with Planning prior to SAI�TlARYSER'ERDISICT submittal of Building Permit application. f> TR - _ - .n ENVII207VMEI�TALHEAI,TA BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION RPERMIT DDRESS: 1469 PRIMROSE WAY DATE: 09/23/2015 REVIEWED BY: PHUONG PN. 366-17-002 BP#: `VALUATION: $1,600 YPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1 RPGA WORK INSTALL N GAS LINE FROM METER TO KITCHEN SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Piping, Gas <=4 Outlets 1 PGASRES 1 # $72 TOTALS: $72.00 Mech.Plan Check Plumb.Plan Check 0.0 hrs $0.00 Eilec.Plan Check XIech, Permit Fee: Plumb.Permit Fee: 1PPERMIT E•lec , •_ . . I: Other Mech.Insp Other Plumb Insp. 0.0 hrs $48.00 <lrher E'tec.Insp. ; I;4r� f"ee� NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These ees are based on the prelimina information available and are only an estimate. Contact the Dept/or addn7 info, FEE ITEMS (Fee Resolution 11-053 Eff 7/1,113) FEE QTY/FEE MISC ITEMS Plan Check Pee: .Sup121. PC Fee PME Plan Check: $0.00 Permit Fee: Sztppl. Ins/ Fee PME Unit Fee: $72.00 PME Permit Fee: $48.00 Construction Tczv: Administrative Fee: IADMIN $45.00 Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fees: Travel Documentation Fee: ITRA VDOC $48.00 Strom Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldp,Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $214.50 $0.00 TOTAL FEE: $214.50 Revised: 07/02/2015 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 • builcfing2a cupertino_orq Permit No. I 1�o ?0) S7,f Address I Y 6 2 Pn',(v,5o rr LJ a�� c/�o/'� #of Alarms Smoke: `{ Carbon Monoxide: PERMIT CANNOT BE FINALED AND CONI PLETED 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 X X bedroom(s) 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 f attic,basement or crawl space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2.An el It is re uired for alarms which must be connected to the building wiring. .7u �o l� As owner of the above-referenced property,I hereby certify that the alarm(s) referenced a has/have been installed in accordance with the manufacturer's instructions and in compliance with the lifornia Building and California Residential Codes.The alarms have been tested and are operational, as of the date signed below. have read and agree to com.pll with the terms and conditions of this statement Owner(or Owner Agent's)Name: M A-Q7H 6u;QTOR 1 signature Si nature..........G' ......................................................Date: Contractor Name: Si natL:re . . . ...................Lic.#... .........Date: .-71Z,5/11 . r ' Smoke and CO form.doc revised 03/18/14 WATER-CONSERVING PLUMBING FIXTURES 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 Owner Name S rr V,,%Q%,A CSU`1 r i yPermit No. ?G I � Address Y 0Sc t,1 S.� C�� !=�a CA �S 0 l y 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. N�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. 1<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.. 5. ,Tease 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 *comnt conserving plumbing fixtures throughout the building(regardless of whether property und 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 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 iinprovernents). 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 Nvater-conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 through 1101.8,the current California Plumbing Code and California Green Building Standards Code,and manufacturer's installation requirements, and that the water-conserving plumbing fixtures comply with the requirements as indicated in the table on the following page. 11 A Owner or Owner Agent's Signature: LLI Date: �! Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit. SR407 2015.doc revised 08126115 BUILDING PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE HAS BEEN SIGNED AND RF.TT R'\'FD TO THE BUILDING DIVISION Non-Compliant Water-Conserving Plumbing Fixture PlumbingFixture (Fixture Complying with Current Code Applicable to New Construction) Maximum Water Usage/Flow Rate Fixture Type 2013 CPC Ch. 4 2013 CPC Ch. 4 2013 CPC Ch. 4 Water Usage /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, Urinals Exceed 1.0 average flush volume of two reduced flushes and one full flush 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 i 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 @ 50 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. I. 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 08126115