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15100214CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10462 MERRIMAN RD I CONTRACTOR: ABLE SEPTIC PERMIT NO: 15100214 OWNER'S NAME: PATAKI MARIE A TRUSTEE 1020 RUFF DR I DATE ISSUED: 10/26/2015 OWNER'S PHONE: 4085681024 ( SAN JOSE, CA 95110 1 PHONE NO: (408)377-9990 is LICENSED CONTRACTOR'S DECLARATION License Class C — 14Z Lic. # 6_7 7S Contractor leo b cr� Q 1rde& Date /0 —2— 9 �f 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 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 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 regulationsperthe Cupertino Municipal Code, Section 9.18. C1r Signature 1/t_l /''/�?VViCDate I 2 �J ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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) 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 source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ INSTALL (1) PROPERTY LINE CLEANOUT AND REPLACE 23 FT. OF SEWER LINE **CUPERTINO SANITARY - BACKFLOW REQ/D PER CSD** Sq. Ft Floor Area: I Valuation: $4750 kPN Number: 34229060.10462 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 D ZLOYUU FROM LAST CALLED INSP �CfT� ON. Issued by: " I Date: 10100 0 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(x) 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. O}}aa��ner oF auVi�Qqrized agent: /O Nr u N14g0(A Date: / J 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 Professional GENERAL PERMIT APPLICATION )5jC)0g)q' COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinO(d)CUDertino.org ® PLU'i:B CT ❑ 1'ECF-AN:C.AL ❑ ELECTRICAL ❑ br,1SCELLA?,-EOUS PROD-r,CiADDRESS 10462- ,J i APN Ma O462- A 0010 r r l m�! � a r U 1 /� t OVkTtRNAJvM M4 ri C PGS r� rt //�� I PHONE 4L/ J r a v2- L IJ" T a r g �(/� ! 'Q 4 1'4Oi Q/I00 / I STREET ADDRESS CITY, STATE, ZIP C. U (�� F -.X CONTACT N.iJE PHOKE E-M-kLL STREET a.DD=- S Jam I CITY, STAT E, ZIP FAX OF?. --a ❑ OV,':"-R-BLIIL.DER ❑ OV t AGENT ❑ COMP ACTOR ❑ CON-IRACTOR AGENT ❑ ARCHIT ECT ❑ r vGi\:cR ❑ DF -,`ELOPER ❑ Tc? .STT CONT RACTORNa1rt o r lla ro�s LICETSE?SU,SER 47 7 4 7s LICENSE TYP C /jz I BUS. LIC' 2/40-7 /4O-7 CON3,SyYNAI�s A bI �I / / a., r I E -NAIL F.kx4,% 19z t oa STR ET ADDRESS J /� 0 n �`l� D Y I CITY, STATE, ZIP 5^ N JO re CA 9 f1/ N II A PHONE 4 0 S 77 U / , -RCHITECTrNGDNEER NAME LICENSE 1\U> IBER BUS. L1 Cyn COM A-NYNAIyM E-M.AIL ( FAX STREET ADDRESS -- CITY, STATE, ZIP - T�7 USE OF ❑ SFD or DIIPLEX ❑ 1✓,ULTI-FA1,-ZLY PROJECT LN WILDL AN'D ❑ YF -S PROTECT AI ❑ YES IS Ti's BLDG AN ❑ YES BUlIS�L'.'G: ❑ CO1'r"=CLAL URB/--).' D\=ACE AREA ❑ NO FLOOD ZONE ❑ NO EMFLIR HOME? ❑ NO DESCRIPTION OF F'ORIC _ ew propedy_ 11'ef Cleanou 23 knear je-e� 70TAtVALUAT?0 J4 `7�0. O V RECFIti''`D3 By my signature below, I certify to each of the following: I am the property owner or authorized anent to act on the pr erty owner'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 is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildingconstruction. I authorize representatives of Cupertino to enter the above --identified property for inspection purposes. Signature of Applicant/.Agent: Q VC-1—Ma rQ (< 2 Date• % (/ — `— 6 �' f SUPPLEIMENTA-L LXFORMATION REQUIRED Y of cE LSE�r x �` yy * Ol£RiiEOOUTER� xz R a ''J }} Y' v}k• Y "' ",tX, nN §`�` z x MINOR r r nt A'fEPMiSC-4PP_2011.doc revised 06/21/11 .CQ ^� CITY OF CUPERTINO 15100914. FEE ESTIMATOR—BUILDING DIVISION iaADDRESS. 10462 Merriman Rd DATE: 10/26/2015 REVIEWED BY: PAUL UNITS APN: 342 29 060 BP#: *VALUATION: 1$4,750 °PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: SFD or Duplex # PENTAMATION PERMIT TYPE: 1 RPS WORK Install N Property Line Cleanout and Replace 23 Ft. of Sewer Line **CUPERTINO SANITARY - SCOPE BACKFLOW REQ/D PER CSD** APPLIANCE / EQUIP TYPE FEE ID Plumb. Plan Check 0.0 hrs $0.00 QTY UNITS BP FEES Elec. Permit Fee Sewer, Sanitary 1 PRSEWER Other E/c:c. Insp. 1 # $25 Sewer, Building 1 PRSEWER >,>qpl. 1n'p P'cc' 1 # $25 PME Unit Fee: $50.00 PME Permit Fee: $48.00 �' onsiruelion Ka.- `cut:Administrative AdministrativeFee: ]ADMIN $45.00 Work Without Permit? ® Yes (F) No $0.00 TOTALS: Travel Documentation Fee: ITRA VDOC $50.00 Strong Motion Fee: ]BSEISMICR NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolulion 11-053 EL 7/1113, Alech. Plan Check Plumb. Plan Check 0.0 hrs $0.00 I7ec. flan nCheck Filech. 1'ernnil lee: Plumb. Permit Fee: IPPERMIT Elec. Permit Fee hher 1lech. Insp. Other Plumb Insp. 0.0 hrs $48.00 Other E/c:c. Insp. ]ech. Imp. Fee: 'Plumb. Insp. Fee_ h/ec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolulion 11-053 EL 7/1113, FEE QTY/FEE MISC ITEMS 1 hol Check 1, ec PC Vci- F—T PME Plan Check: $0.00 l >,>qpl. 1n'p P'cc' —T PME Unit Fee: $50.00 PME Permit Fee: $48.00 �' onsiruelion Ka.- `cut:Administrative AdministrativeFee: ]ADMIN $45.00 Work Without Permit? ® Yes (F) No $0.00 It/VCIYICed .PlanFIin P'ees,: Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: ]BSEISMICR $0.62 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $192.62 $0.00 TOTAL FEE: 1 $192.62 Revised: 10/01/2015 CUPERTINO Owner N Address WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT e BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 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. /CR No Go to Question 2. 11 �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. 5r No Go to Question 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. K es 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 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 Signaturtm:i- _ 1 Date,' _ �� -,�-O �5 Uyvi, UUMPicLiiig d11U „giut,g Luu�i SGL LuttL;aLc, ptcase return rL Lo Lne rsurramg invrsron in oraer to anal your building permit. SB407 2015.doe revised 08/26/15 BUILDENG BERAUT CA:NTINOT BE FRS ALED AND COlITLET ED DTII, TSS CERTIFICATE HAS BEEN SJGNti AND -RETURNED TO THE BUILDING DIVISION'. 1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shown, it is not requires to oe upgraueu. SB407 2015. doc revised 08/26/15 Non -Compliant Water -Conserving Plumbing Fixture Fixture (Fixture Complying with Current Code Applicable to New Construction) —Plumbing 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 requires to oe upgraueu. SB407 2015. doc revised 08/26/15 SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF CO PUANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(d)cupertino.org C71 ;4 /) ;icuAra>r , DO ! ---;) e drw s % �� '�, � I ►'Y1 Gt �Gl. " o rttan Saricilce:�_ � a��lia ifM:on PERMIT CANNOT BE FINAILEDD AND COMPLETED UNTIL THIS CERTIFICATE HAS BEEN RTGNE) AND RETI.IRNED TO THE, BUILDING DItrISION 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 -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 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 O.,W�W-OWerAgents)Name: ................................................................................................................. Confractb Name: Sir.4fu e .. ................................................ ................. 'Lic.4,;..................................... Date:................... Smoke and CO form.doc remised 03/18/14 /S