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15110132CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10545 DEODARA DR CONTRACTOR: COOL'S CUSTOM PERMIT NO: 15110132 OWNER'S NAME: HOPKINS CHARLES V AND ETHEL B P O BOX 1974 DATE ISSUED: 11/18/2015 OWNER'S PHONE: 4085258690 LOS GATOS, CA 95032 PHONE NO: (408)353-9692 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ BATHROOM REMODEL (61 SF) License Class,' Lic. #+ 911-779 Contractor 00, OOkS CLX! o,6 '1 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: 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 Sq. Ft Floor Area: Valuation: $31000 performance of the work for which this permit is issued. 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 APN Number: 31630044.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accr9p ag ' t said City in consequence of the �� 1I granting of thi it. Addition , t plicant understands and will comply Issued by: Date: with all non- oint ource regul ons the Cupertino Municipal Code, Section RE-ROOFS: 9.18. Lw Signature Date : l ` 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. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally, should I e equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined b th Bay Area Air Quali anagement District I performance of the work for which this permit is issued. will maintain compliance wit th Cupertino Munici Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health &Safety Code, S cti s 25505, 2 3, 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agen, Date: a0 permit is issued. 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 C STRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CUPERTWO- CONSTRUCTION PERMIT APPLICATION CONi10UNl IY DEVELOPKIiEN T DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE o CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 - buildino(c—�cuDertino.orq ❑ NEW CONSTRUCTION LJ ADDITION PROIBCf ADDRESS ALTERATION / TI Jam, REVISION / DEFERRED ORIGINAL PERI E T .A PN n o� I o 13R- OPiNER NAIL ; P 301r-- E -1J 4IL STREET ADDRESSI0' Do� I CIiY, STATE, ZCuQe,`� ��ol'A I FAX 1/ LlJ CONTACT N' VI SoY1 PHONE �o �3�5 -3613 E-MAII1 do f 0 grid d' GP -1 STREET ADDRESS OCITY, STATE,; IPP q90� FAX a� CA o'5 6S El 0W1dER ❑. OWh-rP.-B=E-R ❑ Oq'hcR AC Nr COISIRACTOR ❑ COIZMACTOR AGENT ❑ ARCHITECT ❑ --NG"\—=?, ❑ DE1 =LOPE ❑ TENANT CONTRACTORNAN= .1 I LICENSENU,tBER.7 �� q I LICENSE TYPE I BUS. LiC R COIJPANY a 5 Cu' a ehfl E -NAIL I Caol5 vs avh ile�.Zo91. �e FAX I ^ L0- 353 - 753 a STREET ADDRESS C) 6x CITY, STATE, n, Z -1P S1 ©� CA CAV r I PriOI�t [� JI ARC:11ITECT/ENGNEER NAI.,E LICENSE NTilhSER BUS. LIC R C01�IPANY NA1tfF I E-N.f_TL FAX STREET ADDRESS I CI Fr, STATE: t; ZIP I P iONB DESCR7TION OF WORK A w 2. P-� 10 LAA- FiY fa a n CA✓ G I Y'\ EMSTING USE PROPOSED USE CONSTR. TYPE 4 STORES I USE I TYPE OCC. SQ.FT. VALUATION (S) F � YI . _TG NEW FLOOR DEI"0 TOTAL AREA AREA A.RrA . ham' AREA BA -11-2,00M OTr�R REMODEL AREA REMODEL AREA RrMODEL ARE.A PORCH ARTA DECK AREA TOTAL DECIUPOP.CH p.R=A G.=RAGE AREA: Lj DETACH ❑ ATTACH 4 DWELLD\lG UNITS: IS A SECOND UNrr ❑ YES SECOND STORY ❑YES BEING ADDED? ❑NO ADDITION? ❑NO pRE ;enar IC.0.TION ❑ 1'=S IFYES, P ;IDE COPY OF IS THE BLDG AN ❑a 1 hC� TOTAL VALUATION: PLAN`NNGa.PPLR ❑NO PLA? 'GAPPROV.LL=iIT-R EICALERHOME? ❑>'O By my signature below, I certi" to each o Lhe following: I am - pprop, o er or -� "orized agent to act on the prope, owner's behalf. I have read this application and the information have p vided is cor,,ct. I ve Tea e seri '' n of'Work and verijT it is accurate. I agree to comply -with all applicable local Ordinances and state laws relati, to b idin_ coamtrUcti, I autho' r r- tetives -of Cupertino to enter the above-identi-flPropety for inspection purposes. Signature ofADD] icant/AEent: Date: i 1 21i SUPPLED AL Il�FORMATION R �QUIRrD _ New SFD or ?`1u I nnily duTellings: Apply for demolition permit for O��R THE=COL�T£R { s emolition ermit :s require prior to iss Q existin bI ilding(s) Qi) P d p uance of building B7TIIDL�GPL4A RFS=L�,r � permit for new building. —_- r Ek�AESS — _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure T���e�2D �` pLEL7c_woRlts _ �_ . orm if any Hazardous Materials are being used as part of this project. �-� _ k _ LG> LST — _ Copy of Planning Approval Letter or Meeting with Plarsi ng prior to - . `��-SJ�'r�'ITa.SYSEiiRDIS?`12IGT submittal ofBuilding application. r_g Pernit app -NL470R — ,f _ •r - __ `F• �_ __ _ — h�.Eta�7Fi07�'A�iEI�T4S:.F'iE.41tiT'Fi _.� Bla'g.�pp_2011. doc revised 06/21/11 147 115 32 81 15 A DEVELOP �]R ESV # 3 IaG \4 -E 0 DIVISIO CM R # 2 APPROVED CUPERTINO -i,s s-:. plans and specifications MUST be kept at the Building Department b sit�. during construction. It is unlawful to make any changes or alterations on same, or to deviate NOV 2 0 2015 -�eeflrorn, without approval from the Building Official. The Stamping of this plan and specifications SHALL NOT EWED FOR CODE COMPLIANCE -e held It,) permit cr to be an approval of the violation any pro, "S"l—nce or State Law. Review 01 any City Ordiria.Q _It� Y-\ DATE Review BY, VA t ew PERMIT # C.) ............ .................... OFFICE UP 15- USA CAE I N ETRY` - Description: Bath Room Approved by: Date: 10/16/15 Job Number: 10736 Hopkins PhilFSheet 9 of 10 C LP— pq J06 Building Department NOV 18 2015 REVitma) FOR CODE COIVIPLIAE Reviewed By: Client: -Hopkins USA CAE I N ETRY` - Description: Bath Room Approved by: Date: 10/16/15 Job Number: 10736 Hopkins PhilFSheet 9 of 10 CITY OF CUPERTINO BUILDING PERMIT. BUILDING ADDRESS: 10545 DEODARA DR CONTRACTOR: COOL'S CUSTOM PERMIT NO: 15110132 OWNER'S NAME: HOPKINS CHARLES V AND ETHEL B 4718 MERIDIAN AVE #131 DATE ISSUED: 11/18/2015 OWNER'S PHONE: 4085258690 SAN JOSE, CA 95118 PHONE NO: (408)353-9692 N . LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] '' License Class �� Lic. # -LAS 1 POO BATHROOM REMODEL (61 SF) - NO ELECTRICAL WORK 1 p Cj Contracto► r O 1 Date I �J r f { h I 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: 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 Sq. Ft Floor Area: Valuation: $31000 erformance of the work for which this permit is issued. ave 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 APN Number: 31630044.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITIIIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection ses. (We) agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and kee less the City of Cupert' o ainst liabilities, judgments, costs, and expe es w ich may accrue agains ai City in consequence of the Issued by: Date: 1 granting of thi pe it. Additional e a li t understands and will comply with all non -p 'int ource regulat' ns per a upertino Municipal Code, Section RE -ROOFS: 9.18. Q / Signature Da 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. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I h//eby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by t ay Area Air Qu Management District I performance of the work for which this permit is issued. will maintain compliance with h Cupertinou ' pal Code, Chapter 9.12 and 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 the Health & Safety Code, Sec i s 25505,53 and 25534. Owner or authorized agent: Date: permit is issued. 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date 1 CUPERTINO, GC)NSTRUC T ION PERMIT APPLICATION COMMIUNI lY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - buildino(a-cuoertino.ora �"--D I 1013a ❑ NEW CONSTRUCTION ❑ ADDITION . ALTERATION / TI ❑ REVISION / DEFERRED 0RIGINAL, PERMIT T ' PROi-r,Cf ADDRESS I Q � � J � e I APN n r � 2 b '� b M%NER NAIL ? HOIv= ` -,5a5- 869 B-14AIL STREET ADDRESSI ©S, , Y I CITY, STATE, ZIP i+ u ^ /� �S� `� I FAX �� CONTACT NAVEPHONE Mel�V�� -V;� yog-5�5-5 96 I MAIL STREET ADDRESS y r� LAI e f oiA CITY, STATE, ZiP Cupejjl"Y�O IF - a T sol i 1 I FAX OWNER ❑. 0111ti19P,-BUII D R ❑ OWIMR AGENT ❑ CON MACTOR ❑ CON-MACTOR AGWr ❑ ARC: -CT ❑ M4GL'\T-.R ❑ DE\ =LOPZR ❑ TZNIAh,T CONTRACTOR ' K' .LICEENSENi 12 Cool I sky /�O ��jj ( I LICENSE I SUS. LIC R Col✓3A2'YA1 � NI F E -N SIL QD01 S C U ' P�,^1ede-l;AA I ct c001S L1ksE . CC31 FAX 405-353- 983 STREET ADDRES CITY, STA T n, ZIP -7 L.05 Go cA ' SQ3� PHONE I - 265 96q o x l�d-S o ARCIU-1 LICENSE NUINSER I BT -'S. LIC R COI✓PANY NAME ( E-MAIL I FALX STREET ADDRESS I CITY, STATE, ZIP PHOTiE DESCRIPTION OF WOPK�C)o _ �( a ! SF E?OSTING USE PROPOSED USE CONSTR TYPE :' STORIES USE I TYPE OCC. SQ.FT. I VALUATION (S) EXISTG NTFW FLOOR DEI,60 TOTAL AREA AREA AREA nETARE A BATf•MOOM CHEN 0 i KER RE2\40DEL AREA 7,10DELAREAREMODEL AREA PORCH AREA DECK AREA TOTAL DECKTORC:-I AREA GARAGE A.R2A: Lj DETACH ❑ ATTACH 4 D) ELLING UNUTS:I IS A SECOND UNIT ❑ YES SECOND STORY ❑1=S BEING ADDED? ❑NO ADDITION? I,]NO PRE -APPLICATION ICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES h QED $Y T r _ _ TOTAL VALUATION: NO PLAT'1GAPPROVALL PLA.'R\TnGA.PPL-, ❑ZnTR I ❑?'0 EICHLERHOMF?IN - 2 f._ I ^ O� 3 By my signature below, I cern-ry to eac property o�N-ner or authorized agent to act n t e prope,- ty ov,-ner's behalf. I have read this application and the information I h ve is ecead the Description ofWork and verij' it isa curate. Iagreeto complywithallapplicablelocal fofthefollowing:4ae ordinances and state laws relating b iin 'ruct,rize representatives'of Cupertino to enter the above-identT Ied roperty for inspection purposes. SignahreofApDlicant/Agent: Date: 1� f-' T i SL'PPLEI�IJ;1\T L II�FOR_��IATION REQUIRED _,.=P,7�� CI�CK�,1PEr - _ _-,,_�OTIII�G_`SLIP�s�_ t.<_iz• - New SFD or Multifami d«-ellingS: Apply for demolition permit for existing building(s). Dem tion permit is required prior to issuance of building OSER TIS COL'tTEE2 _ - __ c� BUIIDL'�GPLas R� _ - permit for new building.- PL,4'��-L�GPLd�,P,E�ZEF� _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure T4 �4RDr #"`a L pLE1aGo> xs - for l if any Hazardous Materials are being used as part of this project. = — — Y� - - wz i� ZARG$ LKkIFiEDEPT _ Copy of Planning Approval Letter or 1\feetirg with Planning prior to — r =!�SA�TTiYSE�iER�ZSTRIGZs submittal of Building Permit application. NL470R Y B1a'g-,--',PP_2011.doc revised 06/21/11 CITY OF CUPERTINO .. _ FFF ESTIMATOR — RITII,DINO DIVISION ADDRESS: 10545 Deodara DATE: 11/18/2015 REVIEWED BY: Phuong APN: 316-30-044 BP#: 'VALUATION: 1$31,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY USE: SFD or Duplex PENTAMATION PERMIT TYPE: 1 R3SFDRE WORK Bathroom remodel 61 SF - No electrical work SCOPE PME Plan Check: t fet;�a. perm;! Fee,- 0he;.-:,feel?. &-.,p. 1'Jtonb. 1'rr mit Fee: Othef, s'lainb li:sl;£ NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). Thesefees are based on the preliminary information available and are only an estimate contact the ueptjor aaan'l FEE ITEMS (Fee .Resolution 1.1-053 Eff. 711/.13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00!$645. s.f. 0 0 Remodel, Bath (<=300 sf) IREMRESBAT Suppl. PC Fee: Reg. 0 OT 0.0 hrs $0. 00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee,@ Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ("'Onsfruction TCW: G Work Without Permit? 0 Yes (j) No. $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 A Strong Motion Fee: 1BSEISMICR •$4.03 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 SUBTOTALS :' $6.03 $645.00 TQTAL FEE . $651.03 Revised: 10/01%2015 147 115 81 >j< 15 CUPEIR —303/16 T Building Department ` NOV 18 2015 REVIr=7VLU FOR CODE COMPLIANCE 41 n'5 r � G� 5 Reviewed By: Client: Hopkins USA CABINETRY Description: Bath Room — P 0 e` Approved In 32 15 A. WW Y• Date: 10/16/15 Job Number: 10736 Hopkins PhilSheet 9 of 10 NT COMMUNITY D TNOENT BUILDING pIV DIVISION CUPER APPRCRVE® This set of plans and specifications MUST be kept at the fto -3ke any It is unlawful job site during construction. or alterations deviate c tinges t erefrom, without app. °from the Building Official. ons SHALL NOT specifications e Stamping of this plan and pro the violation ..:.Ie'• to permit o.' or State Law. CUPEIR —303/16 T Building Department ` NOV 18 2015 REVIr=7VLU FOR CODE COMPLIANCE 41 n'5 r � G� 5 Reviewed By: Client: Hopkins USA CABINETRY Description: Bath Room — P 0 e` Approved In 32 15 A. WW Y• Date: 10/16/15 Job Number: 10736 Hopkins PhilSheet 9 of 10 CUPERTINO . d ess PURPOSE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 a FAX (408) 777-3333 • building a)cupertino.om '��E_ -7 m c PER -Y IT CANNOT EE .F"INALE-D AND COMPLETED C1NTI1, TIIIS CERTIFICATE AND ` O THE P..t i1-DRgQ D"10IN 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 Califon -da Residential Codes. The alarms have been tested and are operational, as of the date signed below. Smoke and CO'form.doc revised 03/1'8/1'4 CUPERTINO Owner Name WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE F I L Fa COMMUNITY DEVELOPMENT DEPARTMENT m BUILDING DIVISION?` (r 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (40 3) 777-3228 s FAX (408) 777-3333 e building(a)cuper ino.org F— r Permit No. ,, /� �1 g Address 7 c64�-4� �� ill, VL' el1w 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 f!ZNo 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 fore 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. 'ry )d 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. a i Yes 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 throug)out 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 pale. Owner or Owner Agent's Date"' - Upon completing and signing this Certificate, please return it to the Building Division in order to final your uildi g permit. SB407 2015.doc revised 08/26/15