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15100178CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20776 GREENLEAF DR CONTRACTOR: MARK R LONG PERMIT NO: 15100178 CONSTRUCTION, INC. OWNER'S NAME: CARPENTER BROCKWAY A AND LISA L TRU 15976 LINDA AVE DATE ISSUED: 10/21/2015 " OWNER'S PHONE: 4082033416 LOS GATOS,A 95032 PHONE NO: (408) 348-4038 LICENSED CONTRACTOR'S DELL TION INSTALL B DESCRIION: RESIDENTIAL E] COMMERCIAL ❑ DOWS; 1 (N) BAY WINDOW AND I SLIDER License Class_ Lic. # DOOR (NO STRUCTURAL CHANGES) AND INSTALL (N) LIGHT i)r� i FIXTURE IN KITCHEN. Contractor ®l±{ r Lot4Csy Date tO 2-1 [ j 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: t I have and will maintain a certificate of consent to self -insure for Worker's Sq. Ft Floor A ea: Valuation: $30000 pompensation; as provided for by Section 3700 of the Labor Code, for the i erformance of the work for which this permit is issued. APN Number: 32630176.00 Occupancy Type: . 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 CEIFICATION PERMIT EXPIRES IF WORK IS NOT STARTED RT I certify that I have read this application and state that the above information is WITHIN 180 DAYS OF PERMIT ISSUANCE OR correct. I agree to comply with all city and county ordinances and state laws relating 180 DAYS FROM LAST CALLED INSP CION. to building construction, and hereby authorize representatives of this city to enter r upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep ss City of Cupertino against liabilities, judgments, Issued by: Date: " costs, and expenses hich ay acc against said City in consequence'of the granting of 's pe it. I. - itionall a applicant understands and will comply with all non -poi lata ns p e Cupertino Municipal Cot, Se ion 9.18. RE -ROOFS: Signature Date i® �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 t. 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 HAZARDOUS MATERIALS DISCLOSURE 2. I, as owner of the property, am exclusively contracting with licensed contractors to I have read the hazardous materials requirements under Chapter 6.95 of the construct the project (Sec.7044, Business & Professions Code). California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance witl� the Cupertino Municipal Code, Chapter 9.12 and the Health & I hereby affirm under penalty of perjury one of the following three declarations: Safety Code, Section 25532(a) should I store or handle hazardous material. 1. I have .and will maintain a Certificate of Consent to self -insure for Worker's Additionally, should I use equipment or devices which emit hazardousair contaminants as defined by the Bay Area Air Quality Management District I will Compensation, as provided for by Section 3700 of the Labor Code, for the � performance of the work for which this permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 2. I have and will maintain Worker's Compensation Insurance, as provided for by Health & S e t ode, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this O er autho ed ent; �r permit is issued. Date: s. 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 CONSTR CTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I I hereby affirm that there is a construction lending agency for the performance of work's become subject to the Worker's Compensation provisions of the Labor Code, I I for which this permit is issued (Sec. 3097; Civ C.) must forthwith comply with such provisions or this permit shall be deemed Lender's Name revoked. Lender's Address APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is ARCHITECT'S DECLARATION correct. I agree to comply with all city and county ordinances and state laws relating I understand my plans shall be used as public records. to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We) agree to save Licensed Professional 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 CupertinoMunicipal Code, Section 9.18. Signature Date I NMI J II CONSTRUCTI SS//jam,f PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 1' : (4 08) : An ... ,.,�v�iivry t_ l AL)U111ON VJ ALTERATION/ TI LJ REVI PROTECT ADDRESS 20776 Greenleaf Drive, Cupertino, CA 95014 APN # OWNER NAME Brock & Lisa Carpenter PHONE 408-203-3 STREET ADDRESS 20776 Greenleaf Drive CITY, STATE, ZIP TYPE OCC. SQ.FT. Cul CONTACT NAME Mark Long PHONE DEMO R. 408-348-4 STREET ADDRESS 15976 Linda Avenue CITY, STATE, ZIP AREA AREA 0 sq ft AREA Losf Q OWNER ❑ OWNER -BUILDER 0 OWNER AGENT ® CONTRACTOR 000NTRACTORAG CONTRACTORNAME Mark R. Long LICENSE NUMBER 858663 coMPANYNAME Mark R Long Construction Inc. E-MAIL cuttermi STREET ADDRESS 15976 Linda Avenue CITY, STATE, ZIP Los ARCHITECT/ENGINEER NAME COMPANY NAME STREET ADDRESS DESCRIPTION OF WORK RepLagqg 8 wind, conventional framing techniques. LICENSE NUMBER j i E-MAIL i CITY, STATE, ZIP i tce trim & siding_aroun__d wi i "nr nAll-MI l kAUUINA L PERMIT # 326-30-176 E-MAIL BrockCarpenter@Mac.com CA 95014-1819 FAx WA, E-MAIL cuttermils@aol.com CA 95032 F`� WA 13 ARCHITECT 13 ENGINEER CI DEVELOPER ❑ TENANT LICENSE TYPE B BUS. LIC # 28921 'Isom FAX wA CA 95032 PHONE 408-348-4038 BUS. LIC # FAX PHONE EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES US], S TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA 0 sq ft AREA NET AREA BATHROOM KITCHIN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ! ATTACH I #DWELLINGUNITS: ISASECONDUNIT YES SECONDSTORY QYES BEING ADDED? 12NO ADDITION? [ONO i PRE -APPLICATION ®YES IF YES, PROVIDE COPY OF IS THEBLDG AN Q YES IVF, $y; - q' VALUATION: PLANNING APPL # ONO PLANNING APPROVAL LETTER EICHLER HOME? ONO - s _ - L:%o®(f) b--�-�•� ��_� •_ = w..•.y — � .. � iu,iuwmg: i am me property owner or autnonGed agent to act on the property owner's behalf. I have read this application and the information ave Ovide is ne I have read the Description of Work and verify it is accurate. I ee to comply with all applicable local ordinances and state laws relatin ildin tract' . I authorize representatives of Cupertino tol enter the abov -Iden "fled property for inspection purposes. Signature o€Appiicant/Agent: Date: �Q11 _ 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. 171 _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure n form if any Hazardous Materials are being used as part of this project. 13 _ Copy of Planning Approval Letter or Meeting with Planning prior to In submittal of Building Permit application. €E -COUNTER n BUILDING PLAN REVIEW ❑ PLANNING PLAN REVIEW W E PuBLIc WORKS F1 FIRE DM 0 SANITARYSEWERIIISTRICT BldgApp 201 L doe revised 06/21111 CITY OF CUPER FEE ESTIMATOR - DUILD a' ADDRESS: 20776 Greenleaf Dr. DATE: APN: 326 30 176 BP#: VPERNIIT TYPE: Building Permit PLAN CHECK' USEM�Y SFD or Duplex WORK Install 6 Windows; 1 N Bay Window and 1 Slider Dooi SCOPE fixture in Kitchen. vo 0001% G DIVISION 21/2015 1 REVIEWED BY: PAUL *VALUATION: $30,000 'E: Addition PENTAMATION PFRMiT TVPF. 1GENRES tlec{a. I'tra,z C'hcck. I, Erib. Pian ; h ek Elec. Plan Check 0.0 hrs $0.00 Mech. P'erip lr I='ee: Phin1h, F e r ildt FN : Elec. Permit Fee: IEPERMIT Other t l"rz..l`t'`I'. Other I'itsr d) .hap, Other Elec. Insp.0.0 hrs $48.00 Aiech. Insp. Fee: Perim,". Mup. Fee: � 1:iec. h"Isp. Fee_. NOTE: This estimate does not include fees due to other Departments (Le. Planni ag, Public Works, Fire, Sanitary Sewer District, School DRtrirt_ vtr 1 Th- f ... &_-i __ si-- ___,_______ __.__ __r_ ___ _ .. .. a _ FEE ITEMS Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FTE wruacc the "ept for aaan-t info. MISC ITEMS Plan Check Fee: $0.00 F_8_11# $431 a00 Window / Sliding Glass Door 1WINREP Replacement Suppl. PC Fee: Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 1 $72.;00 Electrical IBREMFMT Fixtures, Lighting Permit Fee: $0.00 Suppl. Insp. Feer Reg. 0 OT ]70,01hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $48.00 I I-I� f)1Z,5'l3"ZlCliC3n Tax: Administrative Fee: !ADMIN $45.00 Work Without Permit? 0 Yes No $0.00 Advanced Planning Fee:.: $0.00 Select allon-Residential Building or Structure , Travel Documentation Fee: ITRA VDOC $48.00 Strong? Motion Fee: IBSEISMICR $3.90 � Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 CIBTaTs $146.90 $503.00 $649.90 Revised: 10/01/2015 CITY OF CUPERTINO BUILDING PERMIT [WILDING ADDRESS: 20776 GREENLEAF DR CONTRACTOR: MARK R LONG PERMIT NO: 15100178 CONSTRUCTION, INC. OWNER'S NAME: CARPENTER BROCKWAY A AND LISA L TRU 15976 LINDA AVE DATE ISSUED: 10/21/2015 OWNER'S PHONE: 4082033416 LOS GATOS, CA 95032 PHONE NO: (408) 348-4038 f7- LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL INSTALL 6 WINDOWS; I (N) BAY WINDOW AND 1 SLIDER DOOR( O • � Lic. # License Cl ?] STRUCTURAL CHANGES) AND INSTALL (N) LIGHT FIXTURE IN KITCHEN. �as r I' ns 1 k,VA L 7 f a'L+ Date (S� REVISION # I - INSTALL 2 (N) WINDOWS IN MASTER BEDROOM, LIKE FOR Contractoil l LIKE (NO STRUCTURAL CHANGES) - ISSUED 11/4/2015 1 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 andMill 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: $30000 peance of the work for which this permit is issued. ave and will maintain Wo'rker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this APN Number: 32630176.00 Occupancy Ty PC: 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 WITBIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned propeFty for inspection purposes. (We) agree to save 180;YS FROM LAST CALLED INSP C SON. indemnify,and keep harmless the City of Cupertino against liabilities, judgments,costs, and expenses which may accrue against said City in consequence of thegranting of this pe Additionally, the applicant understands and will comply Issued by:.VLV Ww Date: with all non-po' sourulations per the Cupertino Municipal Code, Section RE -ROOFS: 9.18. a Signature Date —1 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 l 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 isnot 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 (See. 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 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 1 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO 1 (408) 777-3228 • FAX (408) 777-3333 • building uDetno.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI REVISION / DEFERRED ORIGIN. L PERMIT PROJECT ADDRESS APN � 74 �' e��ef�r- ,kl l CA 32J,-30 OWNER NAIYM �PHONE .� E -?✓SIL < �s C�.r e�-3rack-C Nr a e�� e4let, e,ke� co•�, STREET ADDRESS r CITY, STATE, ZIP FAX 2111-7 Ut C e -A 41 tS-Q CONTACT NAME PHONE E-MAIL , L l task �. L'd^J lqd�', '3`7$ - 4t03S Ck`ltrw��S @ a()1, STREET ADDRESS -16 CITY, STATE, ZIP FAX S C- 32 AJ/A 13 OWNER ❑. OWNER -BUILDER ❑ OWhLRAGENT ;KCON7RACT0R ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGLIZtnR ❑ DEVELOPER ❑ TENAIT CONTRACTOR NAME MarlL p IS N LICENSE NU14BER / I LICENSE TYPE 3 V G/ BUS. LIC 9Z� � 2-f COMPANY NA ,1E EMAIL FAX STREET ADDRESS Ave, CITY, STATE, ZIP Ws C, Jt -SCA gSd PHONE _ .;NY ' - YO3b ARCHITECT/ENGI EER NAME LICENSE NUMBER BUS. LIC COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE; ZIP PHONE DESCRIPTION OF WORK _ ,v� n / 2 k� c ; � NPI 1 W 1-A,) L -J s (U I" 1 c• i�• 6! IAC i ^^ t . LI EXISTING USE PROPOSED L'SE CONS TR -TYPE # STORIES I USE TY -PE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA - BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH P.RBA GARAGE AREA: El DETACH - ❑ ATTACH I DWELLING U TTS: 1S A SECOND UNIT ❑ YES SECOND STORY EYES BEING ADDED? E3 NO ADDITION? NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ 1'ES - DIVED Bl s TOTAL V-U.STION; PLANWTNG ADPL R ❑ NO PLAhT*D\1G APPROVP.L LETTER EICHLER HOME? ❑ NO By my signature below, I certify to each the ollowing: I am the property owner or author' ed agent to act on the property owner's behalf. I ha ,e read this application and the information I h ve rovide is orre I have read the Description of Work and verify it is accurate. I agree to comply With all applicable local ordinances and state lays relating iidi cons cti . I authorize representatives of Cupertino to enter the above -id entiA d property for inspection purposes. 1 Signature of ApplicantlAgent: Date: SUPPLEMENTAL INT ORMATION REQU DWPM PiAx c cx� E-:- oL c sL>P New SFD or Multifamily dwellings: Apply for demolition permit for a-- � fl�7RTH�C'OU'�TER -_ � BUILDL'�GPL4NREVILiv existing building(s). Demolition permit is required prior to issuance of building11-10`21 permit for new building. � 4 R _ Os8 �TLnt;PL REQ LEFT Provide Hazardous Materials DisclosuresTDARD ..❑ _ Commercial Bldgs: a completed D k UEL7CFFORT.S w form if any Hazardous Materials are being used as part of this project. "9 LD M � g DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application, ❑ OR r . - rI� e . - ILSANITARY SENT R DISTRICT Bld,-App_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION 191 ADDRESS: 20776 Greeenleaf Dr. DATE: 11/04/2015 REVIEWED BY: PAUL 11F'rfr. f'erm(r.l'ee: APN: 326 30 176 BP#: 15100178 *VALUATION: *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: Fee: PENTAMATION 1 GENRES PERMIT TYPE: WORK Revision #1 - Install 2 N Windows in Master Bedroom Like for Like No structural changes) SCOPE $0.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Dictriet_ etn )_ Thece feet are hated on the nreliminary information available and are onlv an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Elf. 7/1/13) Alecli. Ph in Ch I'htrnb. Titin Check F.'lec, Plan Check 11F'rfr. f'erm(r.l'ee: 1'lusib. 1'r`f'r.'7if 1'e'z 1 Yt:c. 1'a>rinil Fee. (Aher !W h_hlsj" 01hF'r. 1'hrnti) lrrsp. Other 1'.I"e. In"p. i�relr. Inss, Fee: � r; NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Dictriet_ etn )_ Thece feet are hated on the nreliminary information available and are onlv an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Elf. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? Yes Q No $0.00 F-17 hours Plan Check, Hourly $143.00 1STPGNCK Suppl. PC Fee: Q Reg. OT 0,0 Ihrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Supp/. Insp. Feer Reg. OT 0 ,01 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ("11"sip'uClioll lir;,': F71 _-14/rninistralive F'ee: E) Work Without Permit? Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure A bw el Documentation /�_�: �;: Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: `' $0.00 L$143.00 TOTAL FEE -.T $143.00 Revised: 10/01/2015 CUPERTINO Owner Name WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(alcupertino.om /001 I Address 2-0 Z'74!� Cg1ZR_e+Jk-e4DZ#_W_, C�.D-n 1 el 11 Z � f H Y 1 F/ I 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. K 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. 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. 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.. 5. Please check ONE of the following: V 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. „ , A j IOwner or Owner Agent's Signature: -ly Date: 15-7444- 1( I Upon completing and signing this Certificate, please return it to the Building Division in order to final your building permit. SB4072015.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 figure shown, it is not required to be upgraded. SB4072015.docrevised 08/26/15 Non -Compliant Water -Conserving Plumbing Fixture Plumbing Fixture (Fixture Complying with Current Code Applicable to New Construction) Maximum Water Usage/Flow Rate Fixture Type Water Usage 2013 CPC Ch. 4 2013 CPC Ch. 4 2013 CPC Ch. 4 /Flow Rate 2013 CALGreen Div. 4.3 2013 CALGreen Div. 4.3 2013 CALGreen Div. 5.3 Single -Family Multi -Family Commercial Residential Residential Water Closets Exceed 1.6 Single flush toilets: 1.28 gallons/flush (Toilets) Gallons/flush Dual flush toilets: 1.28 gallons/flush effective flush volume (the composite, average flush volume of two reduced flushes and one full flush Urinals Exceed 1.0 0.5 gallons/flush Gallons/flush Showerheads Exceed 2.5 2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of gallons per minute U.S. EPA WaterSense Specification for Showerheads (A hand-held shower is considered a showerhead.) For multiple showerheads serving one shower, the combined flow rate of all showerheads and/or other shower outlets controlled by a single valve shall not exceed 2.0 gallons per minute @ 80 psi, or the shower shall be designed to allow only one shower outlet to be in operation at a time. Faucets — Exceed 2.2 gallons Maximum 1.5 gallons per Within units: _ 0.5 gallons per minute @ 60 Lavatory per minute minute @ 60 psi; minimum Maximum 1.5 gallons psi Faucets 0.8 gallons per minute @ per minute @ 60 psi; 20 psi minimum 0.8 gallons per minute @ 20 psi In common and public use areas: 0.5 gallons per minute @ 60 psi 1.8 gallons per minute _ 60 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 figure shown, it is not required to be upgraded. SB4072015.docrevised 08/26/15 CUPERTINO Address 12 0 PURPOSE SMOKE / CARBON MONOXIDE ALARMS ■ OWNER CERTIFICATE OF COMPLIANCE ! L E COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION S 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255�f (408) 777-3228 • FAX (408) 777-3333 • buildingna.cupertino.orci Permit No. of PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE HAS BEEN S t ` ') AND RETURNED. TO THE BUILDING DIVISION This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314, 2013 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 aqree to comply with the terms and conditions of this statement (or Owner Agent's) Name: ,so, c o . 2J' Signature .................................... � ......................... Date: Contractor Na e: , , L W4 Signature ..... ... ...................... ......... .... Lic.# ... `.-.P:............. Date --V /fes Smoke and CO form.doc revised 03/18/14