B-2016-1859CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1859
23564 OAK VALLEY RD CUPERTINO, CA 95014-6552 (342 57 016)
K O A FERREIRA INC
MOUNTAIN VIEW, CA
94041
OWNER'S NAME: WALKER JOHN F AND SANDRA I TRUSTEE
DATE ISSUED: 05/02/2016
OWNER'S PHONE: 6504301703
PHONE NO: (650) 430-1703
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRACTOR Lic. #762650
Contractor K 0 A FERREIRA INC Date 08/31/2016
X BLDG —ELECT —PLUMB
MECH X 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:
INSTALL (NEMA) EV OUTLET MOUNTED BETWEEN GARAGE
I hereby affirm under penalty of perjury one of the following two declarations:
DOORS
1. 1 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
erfornance of the work for which this permit is issued.
ve 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: $500.00
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
information is correct. I agree to comply with all city and county ordinances
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
342 57 016
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 unders rids and will comply with all non -point
source regulations per the Cup ino Municipal Code, Section 9.18.
180 DAYS FRO
Signature G Date 05/02/2016
Issued by: MELISSA N :����
Date: 05/02/2016
OWNER -BUILDER DECLARATION
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
t. 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. 1, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 05/02/2016
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
performance of the work for which this permit is issued.
HAZARDOUS MATERIALS DISCLOSURE
2. 1 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
s. 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 I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance witkthe upertino MicipaI Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health &SafetSections O5, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agen
APPLICANT CERTIFICATION
Date: 05/02/2016
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 05/02/2016
professional
ALTERNATIVE ENERGY PERMIT APPLICATION ROM
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3226 • FAX (408) 777-3333 • buildinala cuoertino.org
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PROJECT ADDRESS I APN 3 � 2 o /�
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PHO? E-MAIL
I '� 436` ?ate
STREET ADDRESS
23.549'7' �.alc e-'
CITY, STATE, ZIP//
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I FAX
CONTACT NAME
PHO7` E -N
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STREET ADDRESSqq
CITYTATF ZIP
I FAX
❑ o WINE ❑ O%MEER-BIM DER ❑ ON N- R AGENT CoNr,-kACTOR ❑ COI`TRACTOR AGENT ❑ ARC?uTCT ❑ ENGATTE.R ❑ DEVELOPER ❑ i'_NF Nl
CONTRACTOR NAh4E
F/Z�ErR.a-�¢vcr�
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LICENSE TYPE
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BUS. LIC R
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STREET ADDRESS
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CITY, STATE, AP
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BUS. LIC R
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or Duplex ❑ Multi -Family
PROJECT IN WILDLAND
PROJECT IN
STRUCTURE: ❑ Commercial
URBAN INTERFACE AREA ❑ Yes ❑ NO
FLOOD ZONE ❑ Yes ❑ NO
❑ SOLAR PANELS
1':�n'--LECTFIC VEHICLE CHARGING STATION
❑ SOLAR WATER HEATING
❑ OTHER:
FDX SOL.1R FA ELS: NUMBER OF PANELS/UNITS:
KILOWATTS (COh4hfERCIAL ONLIO:
. I
TOTAL VALUATION: SU® I c.
DESCRIPTION OF WORK
2.0 ✓
/mac rp /e e
VI
By my signature below, I certif , to each of the following: m the proper), owner or authorized agent to act on the property owner's behalf have read this
application and the information I have pro •' ec have
,-cad the Description of �Tro;k and verify it is accurate. I agree to comply with all applicable local
ordinances and state 1a-ws relating to b i ding true.' n. I authorize
representatives of Cupertino to enter the above -identified propefty for inspection purposes.
S ignature ofApplicant/Agent:. �.�i2
Date: 5�7 2'-/4
UPPLE? dE'N1TAL I-NFOR4:4TION RE UIRED
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REVIEWED FOR CODE COMPLIAN
Reviewed By:
OFFICE- CO
o
SMOKE ]CAR BON MONOXIDE ALARMS
OWNER CERTWIC"E OF COMPLIANIGE
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE CUFERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333. building(a)cupertino.om
PURPOSP,
n-iis 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.
GENIRAL 1N, FORMAT IONT
Existing single-family and multi-fairdly 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 8314 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
hedroorn,(p)
X
X
On every level, of a dwelling unit including basements
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 Sectiioi, L, 420.6 and shall, be approved by the Office of the State Fire Marsh, al.
Power Supply: In, dwelling, units with, no commercial power supply, alarms) may be solely operated.
In exisfinmg, d1wel, hIng units, alarms are permitted to be solely battery operated where repairs or a, 01,
not result in the removal of wall and ceiling, finishes or there is i, to, access by means of attic, bas�,,. , Ia ,
space. Refer to CRC Sectiart, 8314 and CBC Sections 907.2.11.4 and 420-.6.2. An electrical permit 4, or
alarin—s, wl-dicll must be connected to the buillding. wiring.
As owner of the above -ref erenced property, I hereby certify that the alarm(s) referenced above has/have beei., L,
installed in., accordance with,, the manufacturer's instructions and in compliance with, the California Building
01
and Califorrtia Residential, Codes. The alarms have bee'ni tested and are operational, as, of the date signed
b elow.
tgave, read' and agree to cm, jolv, with, the, terms: and, conditions of this statpmPnt'
Y6
71o6l
............
. ..................... ....................................... ......................
Y6
WATER -CONSERVING PLUMBING FIXTURES
its OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE CUPERTINO, CA 950143255
�, (408) 777-32 8 • FAX (408) 777-3333 • buildin4Ca�cupertino.org
Owner Name, , k � S f'/i n M L Pt/LK E A Permit Non —.),01(0 ~ le
-
AddressQ�306� _OftK � � � COQ&P, [.A10, CA T�;o)
1. Is your real property a registered historical site?
VNes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
o Go to Question 2.
2. Does your real properly 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.
Q 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.
RrNO Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1 1994?
12(No My real properly 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.
0 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.
PlMse 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 no m 'ant
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 wat ,
conserving plumbing fixtures throughout the building (regardless of whether property underg s; eF 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- liant
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 110 1.8, 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 followinu vane. /I . 1 pt , -11 _ r -
Owner or Owner Agent's
Upon completing and signing this Certificate, please return it to the Building Division in order to final your building permit.
SB40 7 2015. doc revised 08126/15
i. a ane existing piumoing fixture water usage/tiow rate is equal to or Iower than the figure shown, it is not required to be upgraded.
SB407 2015.doc revised 08/26/15
ii Non -Compliant
Water -Conserving Plumbing Fixture
I Plumbing_Fixturel
(Fixture Complying with Current Code Applicable to New Construction)
onstruction)
Fixture Type
Maximum Water Usage/Flow Rate
20.13 CFC Ch. 4 2013 CPC Ch. 4 2013 CPC Ch. 4
Water Usage
/Flow Rate
2013 CALGreen Div. 4.3 2013 CALGreen Div. 4.3 .2013 CALGreen Div. 5.3
Single-ami4y Multi -Family Commercial
Water Closets
Exceed 1.6
I Residential Residential
(Toilets)
Gallons/flush
Single flush toilets: 1.28 gallons/flush
Dual flush toilets: 1.28 gallons/flush effective flush volume (the composite,
lJrinals
xceed
F 1.0
average flush volume of two reduced flushes and one full flush
Gallons/flush
0.5 gallons/flush ;
2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of
showerheads
Exceed 2.5
gallons per minute
U.S. FPA WaterSehse 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-
Lavatory
exceed2.2 gallons
per minute
Maximum 1.5 gallons per Within units: 0.5 gallons per minute @ 60
Faucets
minute @ 60 psi; minimum Maximum 1.5 gallons psi
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 —
Kitchen
Exceed 2.2 gallons
1.8 gallons per minute @
1.8 gallons per minute
1.8 gallons per minute @ 60
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.
i. a ane existing piumoing fixture water usage/tiow rate is equal to or Iower than the figure shown, it is not required to be upgraded.
SB407 2015.doc revised 08/26/15
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&cupertino.oEg
PERMIT CANNOT BE FINALEII UNTIL THIS CERTIFICATE HAS BEEN
COMPLETED,. T.D- AND.4MJRNED TO THE BUILDING DIVISION .
PURPOSE
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
inspections are required.
GENERAL INFORMATION
Existing single-family and multi -family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds
$1000.00, CRC Section 8314 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 dwellin 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 specified below have been tested and are operational, as of the
date signed below. //
Address: Z 3 �� `j Olgk V 111-/ Qd e'upE, X, e/ Permit No. % 2,016 - /6?5-9
Specify Number of Alarms: % # Smoke Alarms: -3 # Carbon Monoxide Detectors:
71
I have read and aaree to comply with the terms and conditions of this statement
Owner (or Owner Agent's) Name:
Signature------------------------------------------------------------------------------------------------------------------ Date:
............................................................................ ............. ........... .......................
Contractor Name:
Signature...- ..----------------------------------------------- Lie.# ..... � 26SO.............Date: /U-Ol-t6
Smoke and CO form. doc revised 09/27/16
' COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
+��Pwj 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 ® buildioect€oerlino.orct
Owner Name "RA W A 1!462 Permit No. 13Z,016 ✓ �� q
Address 23 56q OAK Vo41 tE,/ rZj C���a �i•✓® C4
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.
X No Go to Question 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.
19 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.
Ll 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:
CR 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 vaize. /%
I Owner or Owner Agent's Signature:-. Date: 10 -01 -16
Upon completing and signing flus C;ertiticate, please return it to ttie Buitdmg llivision in oraer to nnai your ounamg permit.
SB4072015.doc revised 08126115