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15100103I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 20092 JOHN DR OWNER'S NAME: GARCIA GEORGE F TRUSTEE CONTRACTOR: � ��.�� `, _,�„� PERMIT NO: 15100103 119i f C,4h� r' t'in-0I � DATE ISSUED: 1013/2015 I OWNER'S PHONE: 4082528931 I n )t)WF (). (,A (?c4T-V) I PHONE NO: lit(hF5-f`'] V'_R LICENSED CONTRACTOR'S DECLARATION License Class S>Lic. # ��(2 S 7 Contractor 7CV` T(011F (!C)119P Date le2C3 e �--, 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: 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 Operformance of the work for which this permit is issued. 1�_I jiave 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 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 p rmit. Additionally, the applicant understands and will comply with all non -point rce regula ' the Cupertino Municipal Coder ode ecti n 9.18. Signature Date l ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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 sale (Sec.7044, Business & Professions Code) 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: 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 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. s. 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 source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL BATHROOM REMODEL (40 S.F.) - REPLACE TUB, SHOWER VALVE, SHOWER WALL TILE FLOOR TILE, NEW TOILET AND REPLACE EXTERIOR BATHROOM WINDOW Sq. Ft Floor Area: I Valuation: $8500 APN Number: 36934025.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAS FROM LAST CALLED INSPECTION. Issued by: L Jt.tt.. u 1 Date: 10143 X1,5 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„ SQctions 25505, 25533, and 25534. Own r authoria e ate: 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 Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professi CUPERTINO ❑ NEW CONSTRUCTION CONSTRUCTION PERMIT APPLICATION 151001C)3 COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 - building (aDcupertino.org ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT PROJECf ADDRESS � /� APN # t� OWNER NAME PHONE E M L f qui' , &-0,14 STREET ADDRESS CIT, STATE, ZIP FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX 13 OWNER ❑ OWNER -BUILDER ❑ OWN -FR AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER :5g O/ 3 I LICENSE TYP BUS. LIC # COMPANY NAME .� E-MAIL FAX STREET �ADD S �"-- CITY, STS �P ��'� :.�P�JD �'�`i -1�� 30 PHO NE�i$'- S� ARCHITECT/BNGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET P.DDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK Vey ` G EXISTING USE I PROPOSED USE CONSTR. TYPE # STORIES I I USE TYPE I OCC. I SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMOTOTAL AREA AREA AREA NTEAREA - BATHROOM KITCHEN OTHER REMODEL AREA i /DECK REMODEL AREA REMODEL AREA PORCH AREA AREA TOTAL DECK/PORCH f.RBA GARAGE AREA: DETACH ❑ ATTACH I # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑YES BEING ADDED? NO ADDITION? []NO PRE -APPLICATION IF YES, PROVIDE COPY IS THE BLDG AN ❑❑ YID $y = V 9L N: PLAI�'I�TNG APPL R NO PLANt\�'G APPROVAL LETTER NO E I EICHLER HOME? i�TO NO -_ _ - e- ` ,!(✓/�� 13y my signature below, I certify to each of the following: 1 am the property owner or authorized agent to act on the property owner's behalf. have read this application and the information I have pr vided is correct. I have read the�escription of'Work and verif}, it is accurate. I agree to comply with all applicable local ordinances and state laws relating to ding cArlstruc ' I orize re resentatives of Cupertino to enter the above-identif d pr erty for inspection purposes. Signature of Applicant/Agent: Date: �� SUPPLEMENTAL INTFORMATION REQUIRED New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO 151 CO t03. oilFEE ESTIMATOR - BUILDING DIVISION ADDRESS: 20092 John Dr DATE: 10/13/2015 REVIEWED BY: PAUL APN: 369 34 025 BP#: *VALUATION: 1$8,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM USE: PERMIT TYPE: WORK Bathroom Remodel 40 S.f. - Replace Tub Shower Valve Shower Wall Tile Floor Tile New Toilet and SCOPE Replace Exterior Bathroom Window NULL: 1 his estimate does not includeJees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc. )_ Thece fees are hncpd nn the nrvliminary infnrmntinn nvnilnhlo and nry nnhy nn octimiyto !'nntn�t tho Wont fnr nddr� �/ infra FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) Alech..Plan Check Plumb. Plan MISC ITEMS ilcch, Permit fee: Plumb. Permit Fee: /, c. I'er-alit Ft Either _Mech. frap. Other Plumb bash, Other Elec. Insp. Suppl. PC Fee: Reg. OT0. 0 hrs NULL: 1 his estimate does not includeJees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc. )_ Thece fees are hncpd nn the nrvliminary infnrmntinn nvnilnhlo and nry nnhy nn octimiyto !'nntn�t tho Wont fnr nddr� �/ infra FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE IDEIs.f. MISC ITEMS Plan Check Fee. $0.00 $645.00 Remodel, Bath (<=300 sf) IREMRESBAT Suppl. PC Fee: Reg. OT0. 0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. OT 1 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C 'ollstrue't ion 'rox: A(llninhvirclth,e Fee: Work Without Permit? 0 Yes No $0.00 Advanced. Planning Fee: $0.00 Select a Non -Residential Building or Structure Q i r(tvel Doc°umenlcction Fees. Strom Motion Fee: IBSEISMICR $1.11 Select an Administrative Item Bldg Std s Commission Fee: IBCBSC $1.00 SUBTOTALS: $2.11 $645.00 TOTAL FEE: $647.11 Revised: 10/01/2015 11n ele) 4e�- -2 S 2^ COMMUN!TY DEVELOPMENT DEPARTMENT BUILDING DIViSION - CUPERTINO APPROVED This set of plans and specifica1lons MUST be kept at the job site during construction. It is unlawful to make any changes or aiterations on same, or to deviate therefrom, without approval from the Building Official. The stamping of this plan and snPcifications S11-''k.L _. NOT be he'd to permit or, to be an .:.t-proval of `il i J; .; _:n .1ity 0,dinence or State Law. L�� ooY� l ( LE1 7/ L&-7 OFFICE COPY LU V Z 4 a_ o o N w l+�f Q ` F... 0L m U O 3 Q UJ w LU k 13� Stfo w BIZ RECENED OCT 13 2015 CUPERTINO Owner Name WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(d_)cupertino.org W // S OA J Permit No. Address A*0 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. KNo 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 110 1. 1 through 1101.8 apply. Check one of the three following statements and sign bottom of form.. 5. P1 ase 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 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 comply with the requirements as indicated in the table on the following page. Owner or Owner Agent's Signature: 0zJ_G Date: vYvii wuiYi� uii�, aiiu 3i8111116 11ll3 t Gl 11111 QLG, PlUct,'5c , cLu, ii IL w LIX .DUHUIng IJivision in oraer to Ilnai your twilaing permit. SB407 2015.doc revised 08/26/15 BUILDING PERINIIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE HAS BEEN SIGNED AND RETURNED TO THE BUILDING DIVISION R 1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shown, it is not required to ne upgraded. SB407 2015.doc revised 08/26/15 Non -Compliant Water -Conserving Plumbing Fixture Plumbing Fixture (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 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 ne upgraded. SB407 2015.doc revised 08/26/15