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15100029 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10730 MINETTE DR CONTRACTOR:MOSHER HOWARD E PERMIT NO: 15100029 AND DONNA L OWNER'S NAME: MOSHER HOWARD E AND DONNA L 10730 MINETTE DR DATE ISSUED: 10/05/2015 OWNER'S PHONE: 4085699682 CUPERTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ INSTALL(N)PROPERTY LINE CLEANOUT"SUNNYVALE License Class Lic.# SANITARY" 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. 1 hereby affirm under penalty of perjury one of the following two declarations: Sq.Ft Floor Area: Valuation:$800 1. 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 U'\ \u m her:37531040.00 Occupancy Type: performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance,as provided for b% 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 APPLICANT CERTIFICATION WITHIN 180 DAYS OF PERMIT ISSUANCE OR I certify that I have read this application and state that the above information is 180 DS FROM LAST CALLED INSPECT ON. 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 ii A upon the above mentioned property for inspection purposes. (We)agree to save Issued hN: �L v Jt t,�L�►'` Date: f 0/5 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 RE-ROOFS: all non-point source regulations per the Cupertino Municipal Code,Section 9.18. All roofs shall be inspected prior to any roofing material being installed.If a roof is Signature Date installed without first obtaining an inspection,1 agree to remove all new materials for inspection. OWNER-BUILDER DECLARATION Signature of Applicant: Date: 1 hereby affirm that 1 am exempt from the C'ontractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER the following two reasons: 1,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) 1 have read the hazardous materials requirements under Chapter 6.95 of the 2 1,as owner of the property,am exclusively contracting with licensed contractors to California Health&Safety Code,Sections 25505,25533,and 25534. 1 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(a)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. 1 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 mpl nce with the Cupertino Municipal Code.Chapter 9.12 and the performance of the work for which this permit is issued. health&Safety Code,Sections 25505,25533,and 25534. 2. 1 have and will maintain Worker's Compensation Insurance,as provided for by Ohne horized agent: ction 3700 of the Labor Code,for the performance of the work for which this te: az 0� permit is issued. 3. 1 certify that in the performance of the work for which this permit is issued,I s IIrhereby CONSTRUCTION LENDING AGENCY not employ any person in any manner so as to become subject to the Worke s Compensation laws of California. If,after making this certificate of exe do irm that there is a construction lending agency for the performance of work's become subject to the Worker's Compensation provisions of the Labor Cc e,I is permit is issued(Sec.3097,Civ C.) Lenders 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 l have read this application and state that the above information is I understand my plans shall be used as public records. convect.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 whic y accrue against said City in consequence of the granting of this pe ' .Addi onally,the applicant understands and will comply with all non-point so a regula'ons per the Cupertino Municipal Code,Section 9.18. Signature Date( 101-0 GENERAL PER«11T APPLICATION 15 .. MEP '! 1004 CON110UNITY DEVELOPYiENT DEPART10ENT• BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 (406)777-3228• FAX(408)777-3333• buildinOeCUDertino.or4 CUPERTI N0 MISC PLTJIrR: ING ❑I-ECFANICAL ❑ELECTRICAL�C ❑bIlSCELL.� �EOUS PRorcTADDF_Ss © 7� i�✓�Cf �,/ �� r z { I O OV✓AtR NAME � P C - C/,S�y L ����` L.I✓n 5TRii7 hDDRES /er) CIT STA41 c,ZIP CONTACT P� S ! /�8 2 E-b.LA IL cI ATE, v�L n� FAX ❑ OR EEt JQ GVH cR-BUnD�t !❑ CF^.'rR ACF!.7 ❑ C0\7?LACTOR ❑CO'TRACTORAmE'T ❑ ,SRC:-.7—nCT ❑ ENGL\::tR ❑ *D_,_LnFE ❑ 7BNKN7 CONTRACTOR N:ADCE LICENSE NU1.SER LICENSE ME BUS.LIC f COWATY NA.N.E I E-MAIL FAX STRZET ADDRESS CITY,STATE,ZIP PHO\'E ARCI-DTECTrNGD'MR NAME LICENSE I UI�=R BUS.LIC COjy2AlY N.ANE E-MAIL FAY STREET ADDRESS CITY,STATE,ZIP PHONE USE OF rWFD of DUPLEX El1.1ULT1-FA1.CI.Y PROTCT L'q A'1LOLA.,7D ❑ `s PROTIN V`.' CT ES Is THE BLDG AN ❑ BU=IN'G: ❑C01,0,MCIAL URBAN'WrERFACEARES ❑ NO FLOOD ZONE- ❑ N'0 EICFLERHOME1 ❑ NO DESCP.IPTION OF WORM T— t v i TOTAL\'.ALUATION: 0 / '] 0�5 ` C By my signature below,I certify to each o e following I ain the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have ovided is torr t. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to uiMing cons .ion thorize re re f Cupertino to enter the above-idea ifed roperty for inspection purposes. Si�nz re of?.pplicanU.Ase� Date: /-0 S �� SLPPLEA NTAL.INFORMATION REQUIRED C,—rrc7 USE ONLY Ll EXFnF_$ L A/EPMiscApp_2011 doc revised 06121/11 CITY OF CUPERTINO I°j�00C FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10730 Minette Dr. DATE: 10/05/2015 REVIEWED BY: PAUL APN: 375 31 040 BP#: 'VALUATION: $800 PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY SFD or DuplexPENTAMATION 1RPSS USE: PERMIT TYPE: A WORK Install N property line cleanout "SUNNYVALE SANITARY" SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Sanitary 1 PRSEWER 1 # $25 TOTALS: $25.00 Plumb. Plan Check 0.0 hrs $0.00 I.ic­ i Plumb. Permit Fee: IPPERMIT Other Plumb Insp. 0.0 hrs $48.00 0111(1-1 NOTE: This estimate does not include fees due to other Departments(i.e. Planning, Public {forks, Fire,Sanitary Sewer District,School District,etc. . Theseees are based on the prelimina information available and are only an estimate. Contact the De [ or addn'l info. FEE ITEMS flee ResohNion 11-053 1,'/1 l 13) FEE QTY/FEE MISC ITEMS sur Ch". "Ilppl. PC PME Plan Check: $0.00 PME Unit Fee: $25.00 PME Permit Fee: $48.00 ri111/17! . ail 1UX: Administrative Fee: !ADMIN $45.00 Work Without Permit? O Yes (F) No $0.00 ,:""d Plcnlluir,ti Travel Documentation Fee: ITRA6DOC $48.00 A Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item BldgStds Commission Fee: IBCBSC $1.00 SUBTOTALS: $167.50 $0.00 TOTAL FEE: $167.50 Revised: 07/02/2015 OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 950143255 CUPERTINO (408) 777-3228 - FAX (408)777-3333 •buildinonacuoertino.oro _ Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS I APN E P# � C/ ,_l _ d�• OWNER NAME OWNER A E 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.) 0�. 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 my property. My homeowner's insurance may not provide coverage for those kijuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for inlCmes to workers on my property. I 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. u=s. 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 insteadof my own. VD16. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts, WI understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the otal votal 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. ^ZV" 5. 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 me to serious financial risk. tj_� 7. I 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. 01)6. 1 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. 0wnerBui1derFOrm_2010.doc revised 04/14/!0 • N I understand I may obtain more information regarding my obligations as an "employer" from the Internal evenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or wvAv.cslb.ca.gov for more information about licensed contractors. �0. I 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. Wall 1. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide applicable laws and requirements that govern Owner-Builders as well as employers. 2. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed con�ractors 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 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 notarzation, or other verification accepts','(; to "a c,`y.lay be raquirec to be presented v✓hen the cermit is issued to verify the p perty owner's sin -e. Property Owner's Signature: Date: --------------------------------------------------------------------------------------------------------------------------------------------- (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s)to act as my agent(s)to apply for, sign, and file the documents ces ry to obtain an Owner-Builder Permit for my project. /� Scope of Construction Project (or Description of Work): e7,v r✓C.� �o Project Location or Address: � Name of Authorized Agent: ���/� � Tel No Address of Authorized Agent: p i515 ;� 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 properly owner's drivers 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: �_�� on Date: OwnerBuilderForm_2010.doc revised 04/14/10 SMOKE / CARBON MONOXIDE ALARMS ' OWNER CERTIFICATE OF COMPLIANCE N 1� i COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228• FAX (408)777-3333• building(a.cupertino.org ermitNo. ���OoOz9 Address —_ �4 �30 �//9 e ��• #of Alarms Smoke: Carbon Monoxide: 1 PERMIT CANNOT BE FINAL.ED AND COMPLETED UNTIL TIUS CERTIFICATE HAS BEEN SIGNEi2 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: Ill 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 Owner(or Owner Agent's)Name- S'- Si nature.... . ..... ..........Date:/... .... ... . Contractor Name: Sinature...................................................................Lic.# ......................................Date: ................... Smoke and CO form.doc remised 03/18/14 WATER-CONSERVING PLUMBING FIXTURES Min OWNER CERTIFICATE OF COMPLIANCE , COMMUNITY DEVELOPIAENT DEPARTMENT• BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 � (408�777 28/f• FAX(408)777-3333 • buildina(a_)cupertino.orc Owner Name oh Pei-mit No. ( C/v Address 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. IP-190 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. o 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. ,P-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. ,�2-les 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. Please check ONE of the following: SSeMy 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 irnprovements). ❑ 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 comply with the requirements as indicated in the table on the following page. Owner or Owner Agent's Signature: Date Upon completing and signing this Cenificate,please return it to the Building Division in order to final your building permit. SB4072015.doc revised 08/26/15 BUILDING PERMIT CANNOT BE FINALED AND CONIPLETED UNTIL THIS CERTIFICATE HAS BEEN SIGNED AND RETURNED TO THE BUILDING DIVISION Non-Compliant Water-Conserving Plumbing Fixture Plumbing Fixturel (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 2013 CALGreen Div. 4.3 2013 CALGreen Div. 4.3 2013 CALGreen Div. 5.3 /Flow Rate Single-Family Multi-Family Commercial Residential Residential Water Closets Exceed 1.6 Single flush toilets: 1.28 gallons/flush (Toilets) Gallons/flush Dual flush toilets: 1.28 gallons/flush effective flush volume (the composite, average flush volume of two reduced flushes and one full flush) _ Urinals Exceed 1.0 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. 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. SB407 201 S.doc revised 08/26115