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15100111CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21350 COLUMBUS AVE CONTRACTOR: MIKE COUNSIL PERMIT NO: 15100111 PLUMBING INC OWNER'S NAME: SHEADE MARC R 1915 O'TOOLE WAY DATE ISSUED: 10/14/2015 OWNER'S PHONE: 4082555276 SAN JOSE, CA 95131 PHONE NO: (408) 272-4900 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ (E) WATER HEATER WITH (N) WATER HEATER { _REPLACE L � , WITH EXPANSION TANK License Class 1C� Lic. # (0_1q 01 o 4: Contractor Date/ I hVebya rm that I am licensed under the provisions of Chapter 9 (cog with Section 7000) of Division 3 of the Business & Professions Coat my license is in full force and effect. Sq. Ft Floor Area: Valuation: $3071 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 APN Number: 36205008.00 Occupancy Type: Compensation, as provided for by Section 3700 of the Labor Code, for the formance 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 D ALLED INSPECTION. 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 ate: /49/ 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 if this permit. Additionally, the applicant understands and will comply with RE -ROOFS: all non -p i source r tions per the Cupertino Municipal CoA%., Secti n 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, I agree to remove all new materials for inspection. Signature of Applicant: Date: ❑ WNER-BUILDER DECLARATION I here affirm hat I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER the foil wing o reasons: �. I, as o of the properly, 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 2. 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(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 compliance with the Cupertino Municipal Code, Chapter 9.12 and the Safety Code, Sections 25505, 25533, and 25534. performance of the work for which this permit is issued.2. toeah I have and will maintain Worker's Compensation Insurance, as provided for by agent: G isSection 3700 of the Labor Code, for the performance of the work for which this Date: permit is issued. 3. 1 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 a 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 t s permit is issued (Sec. 3097, Civ C.) Lender's me must forthwith comply with such provisions or this permit shall be deemed revoked. Lender's Address APPLICANT CERTIFICATION ARCHITECT'S DECLARATION 1 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 the Cupertino Municipal Code, Section 9.18. Signature Date CUPER-LINO GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMi�ENT DEPARTMENT - BUILDING DIVISION 10300 T ORRE AVENUE • CUPERTINO, CA 85014-3255 (408) 777-3228 - FAX (408) 777-3333 - buildinc(cbcuoeriino.or_q m 1 l �Q I/ 6 l PLUNING ❑ l✓lECKk3\'IC AJ.. ❑ ELECIRiCAL ❑ MH S CELLANE OUS PROJECT ADDRESS ? l 0 Co k v m 1 L n o -p I .apN :3 b 2 - o -g-- t -o/7 o ov*w R NAIME 1 P'_qPHOT L/ V 'L D STREET ADDRESS CITY, STATE, ZIP S cc A\j F!aair4i C14 01,5019 FAX no CONTACT NA -ME &\ V L -l_ tel- I Ply 0 O i STREET ADDRESS CITE', STATE, ZIP I FAX ❑ ONWR ❑ OV^\T1R-3UI,..DZR ❑ 01';1A_rMAGFNT )dCONTRACTOR ❑ CON-IRACTCRAG?LNT❑ .A_RC:=1 CT ❑ HNGL\'=R ❑ D-EVELOPER ❑ �_ e,J�-r CONTRACTOR.1 al\r ,/� j v ( LICENSE >`Z?\SERo q � � � i LICENSE TYPE �! � / I BUS. Liciiii COMPANY NIA1,�E I ENTAIL I F.kX S T R11FET ADDR_SSl Is 0 CIT 4 STATE, ZIP PHONE RC.YUECT/ENGD,7_ER N.AJv E I LICENSE 2\'U1\=R I BUS. LIC COI✓,P? N Y N aMF I E-MAIL �—' �--- ` FAY, STUET ADDRESS CITY, STATE, ZIP � PHOI\L LTSE )F _j :Dor DUPLEX ❑ MUILTI-FA1M.Y PROJECT LN W LDI-AN � ❑ � aS I PRO!: -CT IN ❑ -''ES IS 7M BLDv' AN ❑ �S BUIL YG: �� Cc',',, tCI L�.ritRi'AC'e t,Ftt 4 ❑ ::O I I FLOOD ZONE ❑ NO i EICITLERHOME? ❑ NO DESUIPTION OF WORK --� G►,n f1 S G� TOTAL VALUATION: 3 By my signature below, I certify to each of the following: I am the property owner or aLthorized age ct the , rty o�� nor' ehalf. I application and the informationprovided is correct. I have read the Description of'Work and veri it rate. I z o comply �' ith all applicable local ordinznres and state la",s relating t ding constPlctioa. I authorize representatives of Cupertino to enter thea en ii e' propel,y for inspection purposes. Si=a-mre of Applicamt/Agent: Date: i ti 1 E S i� $ 7'PLEM 'TAI, D\`FORvIATION REQUIRED n x :.. OFFICE I SE.O>\TLl',sy , ,; �' OVE37HE COU'�TrFt `~ az -'. 1� a• `-��,��+J`'.��'F cS x."3»5�2-,lm=. 3 7 r, ."].. a ar : v ss ��47�ct3F2� `m "T 7._ 5��.✓'l.fttJ 3av 3'reYJY'F�Tx-. L•.,. .gym �''� v `tk'h'�Y"ja' ��(�.L k 5' �'gc�'fra t .. MEPA4'isc,4pp_2011.doc remised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 21350 COLUMBUS AVE DATE: 10/14/2015 REVIEWED BY: MELISSA APN: 362 05 008 BP#: *VALUATION: 1$3,071 'PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex PENTAMATION PRWHEATR USE: PERMIT TYPE: WORK REPLACE E WATER HEATER WITH N WATER HEATER WITH EXPANSION TANK SCOPE APPLIANCE / EQUIP TYPE FEE ID Plumb. Plan Check 0.0 1 hr's $0.00 QTY UNITS BP FEES Elec. Permit Fee: Water Heater 1 PRWHEATR (.),her 1:lec. insp. 1 # $29 "c=rmil Fee. :14lrpl. Insp Fee PME Unit Fee: $29.00 PME Permit Fee: $48.00 COn strue-llon l ii:.C: Administrative Fee: IADMIN $45.00 Work Without Permit? Yes 0 No $0.00 TOTALS: Travel Documentation Fee: ITRA VDOC $29.00 Strong Motion Fee: IBSEISMICR NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, tire, Sanitary Sewer District, school Mcfriot otr 1 Thoca fooc tyro hncod an tho nrolimintyry infarmatinn availahlo and tyro nn/v an octimnto_ rnntnr't tho I)nnt fnr addn'l infn_ FEE ITEMS (Fee Resolution 11-053 7/1/13) 11ech..111cm Check Plumb. Plan Check 0.0 1 hr's $0.00 117ec. Plan Check A,1ech. Perma lie Plumb. Permit Fee: 1 PPERMIT Elec. Permit Fee: l)ther.14ech. Insp. Other Plumb Insp. 0.0 hrs $48.00 (.),her 1:lec. insp. ilech. Insp. 1,ee- Plumb. Insp. Fee: lee. Insp. Fee NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, tire, Sanitary Sewer District, school Mcfriot otr 1 Thoca fooc tyro hncod an tho nrolimintyry infarmatinn availahlo and tyro nn/v an octimnto_ rnntnr't tho I)nnt fnr addn'l infn_ FEE ITEMS (Fee Resolution 11-053 7/1/13) FEE QTY/FEE MISC ITEMS Phos Check ree: 5'llppl. 1'CFee PME Plan Check: $0.00 "c=rmil Fee. :14lrpl. Insp Fee PME Unit Fee: $29.00 PME Permit Fee: $48.00 COn strue-llon l ii:.C: Administrative Fee: IADMIN $45.00 Work Without Permit? Yes 0 No $0.00 .4clvr need Planning Fees: Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: 1 $171.50 $0.00 TOTAL FEE: $171.50 Revised: 10/01/2015 CUPERTINO WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 FILE (408) 777-3228 - FAX (408) 777-3333 • building(@cupertino.om Owner Name (a- 75" OA8 pe_ Permit No. Address ^C> o �n—b uS �c C4 9 i'��r-� c rrQ [J C1 ,�C� (fit 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. 59"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? CY 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. 10"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. LV/Y 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: © 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 irnproverments). 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-conservipg lumbing fixtures comply with the requirements as indicated in the table on the following page. y� IOwner or Owner Agent's Signature: Date: Upon completing and signing this terti'ficate, P116ase return it to the Building Division in order to final your building permit. SB4072015.doe revised 08/26/15 BUILDING PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS C-RTIFICATE.HAS BEEN SIGNED AND RETURNED TO THE BUILDING DIVISION 4s,mera:ixv - 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 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 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. SB407 2015.doc revised 08/26/15 PURPOSE SMOKE / CARBON MONOX0E ALARM OWNER CERTIFICATE OF. COMPLIANCE FILE COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION 10300 TORRE AVENUE o CUPERTINO, CA 95014-3255 (408) 777-3228 o FAX (408) 777-3333 • buildinaCcDcupertino.org C_ ;91 0 6vt hc;s44— �nn1�r«rnvM noxic e: PERA11T CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE HAS BEEN S CN , AND flElI I2NED TO THE BUILDING DIVISION 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 CSC 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 CSC 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 uz 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,wllich 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 Q ger or, QuwnerAgen# s;) Name: rSi-nam :e ................ .�-....:. ....... ...., et j �b.'..Zo`... Coctor�Name •��� `� 2 C�ir/� 5 i / / L'1n 6i1�� c� Signa ........... ..............................................fL-.................GI... Smoke and CO forin.doc revised 03/18/14