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15090169I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20800 VALLEY GREEN DR APT 404 CONTRACTOR: 20800 VALLEY GREEN PERMIT NO: 15090169 DRIVE OWNER'S NAME: 20800 VALLEY GREEN DRIVE PO BOX 1368 DATE ISSUED: 09/25/2015 OWNER'S PHONE: 4082530200 CARLSBAD, CA 92018 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ UNrr 404 - INSTALL NEW 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: t. 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. 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. APPLICANT CERTIFICATION 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 ente 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, U OWNER -BUILDER DECLARATION 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 compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) j (2! I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: i. 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. 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. 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 Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 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 sgace regulations per the Cupertino Municipal Code, Section 9.18. Dated 2S - i �- Sq. Ft Floor Area: I N aluation: $S00 APN Number: 32609040.404 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DED INSPECTION. i ed ate: 7- S l� RE -ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. or authorize nt: Va4L 44g -n,Date: 2 I - / I- �T CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTINO GENERAL: PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDINGDNISION MEP 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 • Mbuildin9Ca7cupertino om L1 PLUMBING ❑MECHANICAL DELECTMAL PROJECT' ADDRESS MISCELLANEOUS Z. OWNERTIAMis r ar APN b 32, v % � �� S PHONE V E-MAIL STREET ADDRESS j _Uda Z U G� !/ /`. CrTY, STATE -ZIP .FAX CONTACT NAME PHONE � STRL•ET V a Y E•MA1L ADDRESS 2— /' C' YC�t�t r CITY. STATA ZIP FAX OWNER ❑ OWNER -BUILDER ❑ OWNERAGEur ❑ CONTRACTOrt ❑CONrR(?1 ACTORAGT ❑ CON'MACTORNAME _ ARCHQSCi ❑EN GQJEER ❑ DEVELOPER C3 TENANT )_ 1 L LICENSENUMBER ` t� LiCFNSETYPE Bus. uc a COMPA NAME Gj E-MAIL • STREET ADDRESS FAX A �' C QTY. STAu. ZIP PHONE ARCHITEMENGINEER NAME LICENSENUMBER COMPANYNAME =FAX. EMAIL • STREET ADDRESS QTY. STATE, ZIP USE OF ❑sFDarDUp -EX ❑ MUL7r-FAM�Y PHONE aUILDINM ❑ COMMERCIAL PRpSECTpiWBDL1Np ❑YES URBAN INI;:RFACEAILEA PROJECT ut ❑ YES IS THE BLDGAN 0 yES DESCRIPTION OF WORK � NO NO FLOODZON❑ IE EICHI ER HOME? - ❑ NO---------------- L� V V TOTAL VALUATION: .: :; ^moi::: `...: _i`��.-'.__:•-: application my signature below, I certify to each of the following Iain the property owner or authorized agent to act on the property owner's bchal£ I have read this application and the information I have provided is cormrL I have read the Description Of WOrk and verify it is accurate 1 agree to comply with aIt applicable beat ordinances and state Taws ustating to building construction. I au rize representatives of Cupertino to enter the above -identified property for i ection Signature of Applicant/Agent: nsP purposes. Date: SUPPLEMENTAL INFORMA N REQUIRED r _ . M•CPA- ischipp 201 Ldoc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 20800 VALLEY GREEN DR DATE: 09/25/2015 REVIEWED BY: MELISSA UNITS AN: 326 09 040 BP#: *VALUATION: $500 xPERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY Multi -Family Dwelling USE: Building is 3 Stories 0 Yes (2) No PENTAMATION 1 RMAP1 PERMIT TYPE: WORK I UNIT 404 - INSTALL NEW WASHER/DRYER HOOK UPS SCOPE Suppl. Insp Fee APPLIANCE / EQUIP TYPE FEE ID Tlwnb. Plan Check QTY UNITS BP FEES [1ec•. Permit Fee, Other Appliance/Equip 1BAPPLOT "Mier Elec. Insp.Fee: 2 # $144 Permit Fee: Suppl. Insp Fee PME Unit Fee: $144.00 PME Permit Fee: $48.00 _T_T Construction Tax. Administrative Fee: (ADMIN $45.00 Work Without Permit? 0 Yes (F) No $0.00 TOTALS: Travel Documentation Fee: ITRA VDOC 1 $144.00 Strong Motion Fee: IBSEISMICR NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Dictrirt. etc )_ These fees are hosed on the nreliminary information available and are onlv an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution II -053 Eft' 711 /13) Mech. Plan Check Rolhrs $0.00 Tlwnb. Plan Check Elec. Plan Check Mech. Permit Fee: IMPERMIT Plumbs Permit Pee [1ec•. Permit Fee, Other Mech. Insp. 10._01 .0 hrs $48.00 Ozlzer Plum/; Insp. "Mier Elec. Insp.Fee: PME Plan Check: $0.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Dictrirt. etc )_ These fees are hosed on the nreliminary information available and are onlv an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution II -053 Eft' 711 /13) FEE QTY/FEE MISC ITEMS Plan Check Fee: SupP1. PC Fee PME Plan Check: $0.00 Permit Fee: Suppl. Insp Fee PME Unit Fee: $144.00 PME Permit Fee: $48.00 _T_T Construction Tax. Administrative Fee: (ADMIN $45.00 Work Without Permit? 0 Yes (F) No $0.00 ,ldvanc'•ed Planning Fees: Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC 1 $1.00 SUBTOTALS: 1 $286.50 $0.00 TOTAL FEE: 1 $286.50 Revised: 07/02/2015 OWNER -BUILDER DISCLOSURE FORK( COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 2 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CU P E RTI N O, (408) 777-3228 • FAX (408) 777-3333 • buildin 4Co)cuoerlino ora 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 2 0 (/ �r. /C � APN BP# OWNER NAME 0\NNER ^'RESS DESCRIPTION OF WORK: 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. 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 thelnsurance limits of myay not insurance coverage for injuries to workers on my property. i- Lir 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. S'L' _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 o name instead of my own. r her C— � V1 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. 5. 1 understand if I employ or othenv✓ise 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 yr 6. 1 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 me to serious financial risk. �7. f 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. 3 ✓ 8. 1 understand as an Owner -Builder if I sen 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. Oi+aiejBziildeiFm7n_2010_doc revised 04114110 may. I Revenue Service, the United States Small Business Administration, understand I may obtain more information regarding my obligations as an "employer" from the Internal 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.csib.ca. contractors, gov for more information about licensed X10. l am aware of and consent to an Owner -Builder buildingpermit my name, and understand am the party legally and financially responsible for proposed constucion acctiviity attthe site address listed above, that f 11. I 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 othe information I have provided on this form. Licensed contractors are regulated by laws designed to protect hef 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. 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 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 verify the property owner's signature_ Property Owner's Signature: Date: % Z.i -i-t -------------------------------------------------------------------------------------------------------------------------------------------- (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 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: Oli+l7elBitilde;-Foi717_2010.doc revised 04/14/10 CUPERTINO WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT a BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(c)-cupertino.org Owner Name L� L3 S // Permit No. f Address 2C/ ©0 t/ /Y ` ey- J,,-, 1. Is your real property a registered historical site? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do no apply. Skip the rest of the form and sign bottom of form. XNo 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. kNo Go to Question 3. 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not ap y. Skip the rest of the forn and sign bottom of form. [! ,' No Go to Question 4. 4 C5�W 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 forn and sign bottom of form. kYes My real property is built and available for use or occupancy on or before January 1, 1994. d Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign bottom of form.. lease 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- compl' 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 al t n 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 irnprovements). I, as the owner or owner's agent of this property, certify under penalty of perjury that non-compliant plumbing fixtures will be ZD replaced prior to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 110 1. 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. , Owner or Owner Agent's Signature: Z� ^ Date: - i V Upon completing and signing this Certificate, please return it to theBuilding Division in order to final your building permit. SB407 2015. doc revised 08/26/15 1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shown, it is not required to be upgraded. SB4072015.doe revised 08/26115 Non -Compliant Water -Conserving Plumbing Fixture (Fixture Complying with Current Code Applicable to New Construction) —PlumbingFixture Maximum Water Usage/Flow Rate Fixture Type Water Usage 2013 CPC Ch. 4 2013 CPC Ch. 4 2013 CPC Ch. 4 Flow Rate 2013 CALGreen Div. 4.3 2013 CALGreen Div. 4.3 2013 CALGreen Div. 5.3 Single -Family Multi -Family Commercial Residential Residential Water Closets Exceed 1.6 Single flush toilets: 1.28 gallons/flush (Toilets) Gallons/flush Dual flush toilets: 1.28 gallons/flush effective flush volume (the composite, average flush volume of two.reduced flushes and one full flush Urinals Exceed 1.0 0.5 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. Faucets — _ Exceed 2.2 gallons Maximum 1.5 gallons per Within units: 0.5 gallons per minute @ 60 Lavatory per minute minute @ 60 psi; minimum Maximum 1.5 gallons psi Faucets 0.8 gallons per minute @ per minute @ 60 psi; 20 psi minimum 0.8 gallons per minute @ 20 psi In common and public use areas: 0.5 gallons per minute @ 60 psi 1.8 gallons per minute 60 psi _ Faucets — Exceed 2.2 gallons 1.8 gallons per minute @ 1.8 gallons per minute 1.8 gallons per minute @ 60 Kitchen per minute 60 psi @ 60 psi psi Faucets May temporarily increase May temporarily.. up to 2.2 gallons per increase up to 2.2 minute @ 60 psi, and must gallons per minute @ default to maximum 60 psi, and must 1.8 gallons per minute @ default to maximum 60 psi 1.8 gallons per minute Where faucets meeting @ 60 psi the above are unavailable, Where faucets meeting aerators or other means the above are may be used to achieve unavailable, aerators or reduction. other means may be used to achieve. reduction. 1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shown, it is not required to be upgraded. SB4072015.doe revised 08/26115 SMOKE I CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE . CUPERTINO, CA 95014-3255 (408) 777-3228 a FAX (408) 777-3333 • building(a.cupertino.org / iI iioP. � /�0rD/� i W=ress Z- Ci PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE HAS BEEN fiI(YNED 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-bu Zing appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke Ne�ly ply wi a 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) mayy 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 - A Si nafu�e........................................................... D.. .e ::Ci... -t rs�r Name: a SigiafUr'e'. Lic # ::Date: Smoke and CO.form.doc remised 03/18/14