15110062-OLCITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21799 ALMADEN AVE
CONTRACTOR: PRINCIPLE ROOFING,
PERMIT NO: 15110062
INC
OWNER'S NAME: SHE-WEI & TAI-YI SHIAO
10160 STERN AVE
DATE ISSUED: 11/10/2015
OWNER'S PHONE: 4087868752
CUPERTINO, CA 95014
PHONE NO: (408) 898-7298
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL
REMOVED SHAKE ROOF, INSTALLED OSB SHEATHING &
License Class Lic. #
COMPOSITION SHINGLES-23 SQRS
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.
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: 0
Valuation: $12800
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 flee performance of the work for which this
APN Number: 35715092.00
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 accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code, Section
9.18.
RE-ROOFS:
Signature Date
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. 1 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 the Bay Area Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
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
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
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 77.7-3228 • FAX (408) 77773333 • building(a-cupertino.org
Owner Name A l.i GE .5#1` i �d Permit No. Z
Address 2- I -7-19 ,A I-RAvIc-►J .o•✓L liw%�lz-I-{ �.iG � e3p
L. Is your real property.a registered historical'site?
ZeIs Civil Code Sections 1101.1 Sections do not apply. Skip the rest of the form and sign bottom of form.
o 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. pluming, fixtures is not technically feasible?
El Yes Civil Code Sections 1101.1 through 1101-:8 do not apply..
El The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign: bottom of.form.
RNo 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.
Wf No . Go to Question 4....
4. Is your real property -built and available for use or occupancy on or before January 1, 1994?
El .No My real property is built and available for use oroccupancy. after January 1, 1994. ..
Civil Code Sections 1101.1 through.1.101.8 do not apply.: Skip the rest of the form and sign bottom of form.
j(Yes My real property is built and available for use or occupancy on or before January 1,,1994.
Civil Code Sections 1101.1 through. 1.101.8 apply. Check one of the three following statements and sign
bottom of form..
5. Phase check ONE of.the following:
f 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).
❑ Myproperty 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 1.101.5.
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).
1, as the owner or owner'. s agent of this property, certify under penalty.of perjury:thatmon-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: IeA� Date: I
Upon completing and signing this Certificate, please return it to: the Buildmg;vivision in oraer to imat your nuuamg permit.
SB407 2015.doc revised 08/26/15
BUILDING PERMIT CANNOT -BE FINALED AND COMPLETED UNTIL THIS
CERTIFICATE HAS BEEN.
SIGNED AND RE'T'URNED TO THE. BUILDING 'DIVISION
= - --
1. If the existing plumbing fixture water usage/clow rate is equal to or lower inan the ilgure snown, IL IS 110L IU4UIIGU LU UU U1Jgia c;U.
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
:2013 CPC. Ch. 4
2013 CPC Ch. 4
2013 CPC Ch. 4
Fixture Type
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/clow rate is equal to or lower inan the ilgure snown, IL IS 110L IU4UIIGU LU UU U1Jgia c;U.
SB407 2015.doc revised 08/26/15
SMOKE i CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT:- BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228.E FAX (408).777-3333 • building(aD-CUpertino.org .
Permit No. l 5 l i ow ��-
Address 9� �M'a'��J ✓� # of Alarms Smoke: Carbon Monoxide: Z
PERMIT CANNOT BE FINALED AND COMPLETED -UNTIL -THIS CERTIFICATE:
''HAS, BEEN, SIGNED. AND RETURNED TO THE, BUILDING DIVISION
PURPOSE
This affidavit is a self -certification for, the installation of all req uired.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 ever level of a dwellin unit including basements
X
X
Within each sleeping room
X
Carbon Monoxide alarms.are not required in dwellings. which do:riot.contain fuel -burning appliances and that
do not have an attached. garage...Carbon monoxide, alarms combined with sn !oke. 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
1 ;-,.n m 4 -4 onrao fn rmmnhi Mfifh fkA fnrmc nnrl rnndifinnc of this-ctafamant
Owner (or Owner Agent's) Name:
Zj
6 Sl ll� C7
Signature ..................... Date:
Contractor Name:
Signature............................... :.................... :............... Lic.#...................................... Date: ...................
Smoke and CO form.doc revised 03/18/14
1�