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16010038CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10632 JOHNSON AVE CUPERTINO CA 95014 28 025) CONTRACTOR: PERMIT NO: 16010038 (375 DIEP PHIL AND LAM NGAN/HOMEOWNER BUILDER 1745 CAPE ASTON CT SAN JOSE, CA 95133- ;.1128 OWNER'S NAME: DIEP PHIL AND LAM NGAN DATE ISSUED: 04/01/2016 OWNER'S PHONE: 415-609-4251 l PHONE NO: LICENSED :D CONT ACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic. # Contractor DIEP PHIL AND LAM NGAN/HOMEOWNER B 1 Df R Date —BLDG —ELECT _ PLUMB — MECH _ RESIDENTL4,L ^ COMMERCIAL 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. JOB DESCRIPTION: I hereby affirm under penalty of perjury one of the following two declarations: DEMO (E) DETACHED GARAGE (275 SF) AND ADD (N) 1. I have and will maintain a certificate of consent to self -insure for Worker's ATTACHED GARAGE (530 SF) 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. Sq. Ft Floor Area: Valuation: $52500.00 APPLICANT CERTIFICATION certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct, i agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 375 28 025 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature" Date 4/1/2016 Issued by: ABBY AYENDE Date: 4/1/2016 OWNER -BUILDER DER DE LARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS - following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is a. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. ,I n; sale (Sec.7044, Business & Professions Code) . / I, as owner of the property, am exclusively contracting with licensed Signature ofApplicant contractors to construct the project (Sec.7044, Business & Professions Code). Date: 4/1/2016 _ 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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER Compensation, as provided for by Section 3700 of the Labor Code, for the performance ofthe work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the A4/ I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous Additionally, I shall not employ any person in any manner so as to become subject to the material. should use equipment or devices which emit hazardous Worker's Compensation laws of California. If, after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I exemption, I become subject to the Worker's Compensation provisions of the w ll maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date: 4/1/2016 1 certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes, (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 16010038 10632 JOHNSON AVE CUPERTINO CA 95014 (375 28 025) SUNNY CONSTRUCTION 2845 MOORE PARK AVE, SUITE 204, SAN JOSE OWNER'S NAME: DIEP PHIL AND LAM NGAN DATE ISSUED: 04/01/2016 OWNER'S PHONE: 415-609-4251 PHONE NO: (415) 609-4251 LICENSED D ONT A TOR' DECLARATION BUILDING PERMIT INFO: License Class B Lic. #896497 Contractor SUNNY CONSTRUCTION Date —BLDG _ELECT _PLUMB MECH RESIDENTIAL COMMERCIAL 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. JOB DESCRIPTION: DEMO (E) DETACHED GARAGE (275 SF) AND ADD (N) I hereby affirm under penalty of perjury one of the following two declarations: ATTACHED GARAGE (530 SF) t. 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 Def l : Adding Truss Calcs - Issued 5/19/16 performance of the work for which this permit is issued. �')21/ * 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 Sq. Ft Floor Area: Valuation: $52500.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances 375 375 28 025 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature 5/19/2016 Issued by: ABBY AYENDE Date: 04/01/2016 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: 1. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 5/19/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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. HAZARDOUS MATERIALS DISCLOSURE z. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District 1 Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Saf de, Sections 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date: 5/19/2016 / I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 5/19/2016 CONSTRUCTION PERMIT APPLICATION 49 COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255" (40 8) 777-3228 -FAX (408) 777-3333 - building(akuoertino.org ��O �r©� 3 S _ CUP>=RTfHO #I I 71 IvEW CONSTRUCTION ❑ ADDITION ❑ALTERATION / Ti ❑ REVISION / DEFERRED OR ONTAL PEPUZT T PROJECT ADDRESS I APN R OWINTERNAMEi PHONE E-h�i4IL STREET.ADDRESS^C q fP/ kD' I C]'iY, STVZ, C� I FAX 7 e h� J S Q, CONTACT NAhSE PHONE STREET ADDRESS CITY, STATE, ZIP FAX ❑ OtV?.ER ❑ OWT'ER.BUILDER ❑ oANER 6.GENT ❑ CONTRACTOR ❑ CONTRACTORAGENT ❑ ARCHITECT ❑ ENGLKEER ❑ DEVELOPER ❑ T. -NA' CONTRACTOR N.AOXE A, �l � _ r LICENSE J a _J LICENSE ME � BUS. LIC W h COPAIvY NA,�E hI E-MAIL Fe�� STREET ADDRESS rt CITY, STATE, ZIP PHONE -P Q ^A() —1 ARCHITECT/ENGII.tER NAME I LICENSE 1,7UMBER I BL'S. LIC n COMPANY NAME E -MI AIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK ----- EXISTING USE PROPOSED USE CONSTR ME n STORIES USE TYPE OCC. SQ.FT. VALUATION (S) E?7STG NEW FLOOR DEhlOTOTAL AREA I AREA ARE NET AREA BATHROOM KITCHEN OTIiiR REh40DEL.4RE.4 REMODEL AREA REMODELARE.A PORCH AREA DECK .<.R':A TOTAL DECKTORCH AREA GA. aGE AREA: U DETACH ❑ ATTACH n DR%ELLTNG UNITS: IS A SECOND KNIT ❑ YES SECOND STORY ❑ 1`ES BELNG ADDED? ❑ NO ADDITION? [-]NO PRE-.APPLIC.4T10N ❑ )'ES IF ZS, PROVIDE COPY OF IS THE BLDG AN ❑ :'r5 RECEI� ED B7 r TOTAL VALUATION: ❑ 0 PLA?TTG APPROVAL LETR OPLA`TINGaPPiR I By my signat'are below, I certify to each of the followine: I am the property owner or authorized aeent to act on the prope:Ty ow ne.'s bel;alf. 1 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 relatioto building construction. I authorize rep, _sentatives of Cup_: Lino to enter the above-identi`ed prope for inspection purposes. Signature of Applicant/Agent: lm Date:__ f b%� SUPPLEMENTAL 11�rORMATION REQUI CHECK 71 SLI P New SFD or MLlltifamily dwellings: Apply for demolition permit for — — existing building(s). Demolition pernit is required prior to issuance of building permit for new building. _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure fonn 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. ' Bldg :pp_?011.doc revised 06/21/11 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildin-ma-)cupertino.oro CUPERTIN9 1 ❑ NEW CONSTRUCTION - ADDITION ❑ ALTERATION/ TI REVISION / DEFERRED ORIGINAL PERMIT # 3F PROJECT ADDRESS 16 � r — 2/12C APN # 5-75 v (� L•� OWNERNAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME '�Ct LICENSE NUMBER LICENSE TYPE � BUS. LIC # N�crcen� 6 4 COMPANY NAME E-MAIL FAX ZUNL, C�NsiRu ��R9, STREET ADDRESS CITY, STATE, ZIP PHONE _1141 uss4c-All aA qL ctr,'- CV\ 2 -1() - (i ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK _ EXISTING USE PROPOSED USE CONSTR TYPE # STORIES 1 USE TYPE 77 SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH []ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? []NO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY:TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property 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 rela wilding construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQLMMD PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW _ 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. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 1:1 STANDARD El PUBLIC. WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ ❑ SEWER submittal of Building Permit application. ytA IOR SANITARY DISTRICT ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21111 J CUPERTIma n x-sw cnws-mnmK COMMUNIT Y DEVELOPMENT PEPAR-1 %11ENT - BUILDING DIVISION 10300 TORRP AVENUE - CUPERT INO, CA 95014-3265 (408) 777-3228 - FAX (408" 777-3333 - buildinoOcuop-.-ino.o I - F-1 A M)TT70V F-1 A T T - A -TTOM I T, T M V; iJMZMV I PROIEU ADDREMS A11,H eA S- PHONE S 11�1 &XDRESS CITY, SIA.IM, ZIP �Ax cal, AST NAME P"ox'-- 1.013. S-1?ZM-ADDRESS STATE, 80 1 e4igy, eA FAIX TF - El flitTv dCatvi CoNrk"cro-z' cotiuCTOR ,.c-mvr VA-?' iaCT E] M4 M-= D DEV-1-LOM-Ee, TE2tAN-1 CONT&kc-IORN-A-VE IICF-NISB BM Lic (OY2AWY NAINS FAX STREU ADDRESS -71P MIME AR LIAM- foo LICENSENnINME& C, � -3 BUS. Lic 1W'm B-I"M FAX STIRall t -.DD?? -S5 MY. STATE� ZIP c PPO'NE /C 5 DESCIUZION Or 44 ff Z- MSMING USIZE PROPOSED USE YPRI AZTo I I USE I TYPS occ. $Q -n. V.kT-TJ-A-r-oh, (S) RXi"W FLOORDEN-10 ,1--RZATCr-- APA fl AREA TOTI-J- BEMGADDED1 ©NO AD D.No BAITRUUM NIJ R-ENGDE-T.ILRE4, REMODEL JSFA UA [CR RM 10DEL,42EN t`-17--,,IaA TOTAL DECXRR A' .,4 ,N- E g VVEL.WGUR-1-is- LSA -OND bsl:�- 'rr ©EES szcO\-D sTORY DY :-:s BEMGADDED1 ©NO AD D.No DYES TF] S, FRov:oz- COPY C7r ISTFEBLDGAN. DYES L '- TOT-ALVATMA7,1014: PLAN-VGjAPPLLE r-INO Lam--, &Tcffl �R HO?,Tl- OINO cif my siomature below, I cerfiffyto each 01 - the ,'follovinc I m- the property mvner or authorim-cl agent to act on the.. Aperty owmer's behal z-1 i ba .g read -his application and the iformation I h-ve provided is con-ect. 1 ;ave ;end the Desm.ption ofWokand verify it is Ff-rurate. I agreeto-comply-,;,.ith all applicable local ordinmces and �c b�ffldin-- construction. I aumhorma repr m- i of per—no to enter the. ibov-:-identi-n-qd propeTty for L^:-Tection P=Fosts- New SFD or j76zin2 5' d prior to issui'=Me of bui d- existin-a building(s). Demolition permit for new bu—ilding'. Commercial Bifts: Provide a cornpleted Hazardous Materials Discjosqi-ire - as, T'ou'rs iffmny Ha=dous Meterials; are being cd. as Part oftns pr Copy of Flaming Approval S rte= Or Nf-=tin--- -Wi7h Planning Pn�'Zr to submittal o fc Building Pemit ko p H cat ion raviscd 06121111 CITY OF CUPERTINO wo - W FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10632 Johnson Ave DATE: 01/06/2016 APN: 375 28 025 BP#: TYPE OF CONSTR. REVIEWED BY: Phuong EVALUATION: $52,500 *'PERMIT TYPE: Building Permit PC FEE ID PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: _ II-B,111-B,IV,V-B 2nd Unit? , Yes !' No OTC.? 0 Yes (j)No PENTAMATION PERMIT TYPE: 1 U WORK Demo a de*ached garage 275 SF and add(N)attached arae 530 SF .SCOPE _ _ OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA (S.f.) PC FEES PC FEE ID BP FEES _ BP FEE ID U (Private Gar/Ag Bldg) II-B,111-B,IV,V-B 530 $0.00 I U1PLNCK ' $1,290.00 1 UIINSP $0.00 PME Plan Check: $0.00 Pen -nit Fee: $1,290.00 Suppl. Insp. Feer Reg. Q 01 0 0 hrs $0.00 PME Unit Fee: $0.00 PME Perfmit Flee: TOTALS; 530 $0.00 $1,290.00 FT- -h. >. t:: Lo, p r ,?. i'.;1?..? . ee 0,, a r 1 , h. hUIP . i t, .,.t .'IE€#t %; ?Y>z;. t.t: 1; s;; El 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't mJo. FEE ITEMS (Fee Resolution .1.1-0 3 Lf. 711/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Reg. OT 0.0 hrs $0.00 PME Plan Check: $0.00 Pen -nit Fee: $1,290.00 Suppl. Insp. Feer Reg. Q 01 0 0 hrs $0.00 PME Unit Fee: $0.00 PME Perfmit Flee: $0.00 Fee: 0 Work Without Permit? Yes • No $0.00 Advanced. Plannin Fee; IPLLONGR $74.20 Select a Non -Residential Building or Structure � � vY . > f , , rct { �c��tr��t�.tati.>v. Fr. ;.s Strong Motionfee: IBSEISMIC;R $6.83 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $3.00 SUBTOTAL. $1,374.03 $0.0.0 TQTL FEE : $1,374.03 Revised: 10/01/201 CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: joc,.0 PERMIT OWNER'S NAME: DIF-? PWL V- L -Am N(Q PHONE# ,qO;� — 1(94- GENERAL CONTRACTOR: 2L(Wt`t--( &6Ke,:,7MUeTi0M MLP BUSINESS LICENSE # ADDRESS: a qQ" . CITY, /ZIPCODE: g:T *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINEDA'CITY OF CUPERTINO- BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the foll�wing information: -V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Date CUPERTINO Owner Name _ Address � 06 WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 77 -322 FAX (408) 777-3333 • buildinQCa.cupertino.orQ b" I fl pA,...,;+,.t„ C*�C15'al 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. QK 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. g 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. 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.. 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 nage. . /I , / / I Owner or Owner Agent's Signature: Date: p I Upon completing and signing this Certificate, please return it to the"Building Division in order to final your building permit. SB407 2015.doc revised 08/26/15 BUILDING PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE HAS BEEN SIGNED AND RETURNED TO THE BUILDING DIVISION 1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the tigure shown, it is not required to be upgraded. SB407 2015. doe 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 si 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 tigure shown, it is not required to be upgraded. SB407 2015. doe revised 08/26/15 CUPERTINO Address PURPOSE SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.org IL Jewfi C-4, �� l PERMIT CANNOT BE FINALED A Permit No. COMPLETED UNTIL THIS CERTIFICATE IIAS BEEN SIGNED AND RETURNED TOTHE 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 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 cormected 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. / have read and agree to comply with the terms and conditions of this statement Owner (or Owner Agent's) Name: FH lD � ?Date: Signature ............. Contractor Name: Signature................................................................... Lic.#...................................... Date:................... Smoke and CO form.doc remised 03/18114 Ino OWNER -BUILDER DfSCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - bulldin0(8CUDertino.org CUPERTINO Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: APIC.. C P# SITEADDRESS X32 B f� 7 ..v ...:......;. Z3- 02S y OWNER NAME 0. IN DDRE DESCRIPTION OF WORK: 0 1 '... ,-'r-Kqr4- We are providing you with an Ownet-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. Ale will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) ' w ' / 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. /WVh 2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. ,/(W_)3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. 4.1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. A'10 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. --VP�76. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. ,-� 7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. -/?Q_8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OxjnerBuilderForm 2010.doc revised 04/19/10 9. 1 understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-B00-321-CSLB (2752) or wvnv.cslb.ca.gov for more information about licensed contractors. --W 10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the parry legally and financially responsible for proposed construction activity at the site address listed above. 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information l have -provided on this form. Licensed contractors are regulated by Jaws designed to protect.the.public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a. result of a complaint -Your only remedy against unlicensed Contractors maybe in- civil court. If is also important for you -to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or note those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: 'fd ����� wLender Address 2i2- �cfl- aI� Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the pen -nit is issued to verify the property owner's signature. Property Owner's Signature: Date: - --------------------------------------------------- ------- ------------------------------ ---------------------------------------------------- (NOTE: The follov✓ing Authorization Form is required to be completed by the property ov✓ner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the propend owner's signature. Property Owner's Signature: _ -- Date: GxmerBuilderForm 2010.doo revised 04114/10