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B-2016-2043 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2043 20397 VIA SAN MARINO CUPERTINO,CA 95014-6332(316 01201) ANTHONY LEWIS INCORPORATED SAN JOSE,CA 95125- 1618 OWNER'S NAME: WIDJAJA JOSEPHINE ET AL DATE ISSUED:05/27/2016 OWNER'S PHONE:510-517-7416 PHONE NO:(408)217-8621 LICENSED CONTRACTOR'S DECLARATION BUILDING PERNIIT INFO: License Class B.C-10 Lic.#851107 Contractor ANTHONY LEWIS INCORPORATED Date 08/31/2017 X BLDG X ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH X RESIDENTIAL_COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: (N)EV CHARGING STATION(50 AMPS);(I)SUBPANEL(100 AMPS) I hereby affirm under penalty of perjury one of the following two declarations: -OUTSIDE i. 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. I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 ofthe Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$2500.00 APPLICANT CERTIFICATION 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 316 01 201 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 Date 5127/2016 Issued by:Abby-Ayende a Date:05/27/2016 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 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: 25/ 7/2016 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 I 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&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:5127/2016- 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. I understand my plans shall be used as public records. Licensed Signature Date 5/27/2016 Professional ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUP RTINO (408)777-3228•FAX(408)777-3333•building(@cupertino.org -21� - a0q PROJECT ADDRESS. 0T \� �0, � n � �� J'7 V IV\6.Clno APN# OWNERNAME Sj C` i ,6.�nnNnle �,OS'{" PHONE � -1�lG E-MAIL STREET ADDRES CITY,STATE,ZIP FAX �AMC- �,s 9a��T C�P�c1No C� gSot+l CONTACT NAME HO E-MAIL t�au.l N�eve,n STREET ADDRESScc,��TY,STATE,ZIP FAX i43F6 Aute ca,s Ave Jar h)s$ C A 126 ❑OWNER ❑ OWNER-BunDER ❑ OWNERAGENT ❑ CONTRACTOR )9j'CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE�BER LICiNtSE TYPE BUS.LIC# A�r�k1�o (-�ewls 'COMPANY NAME E-MAIL, FAX ��o L.e.W;s �,�.e, ocle�� antl�o lew�sAc.coh'1 STREET ADDRESS CITY,STATE,ZIP PHONE 437 AUw4c Av. Ser3ase_ CA °SQ-b ARCIJITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC COMPANYNAME E-MAII FAX STREET ADDRESS CITY,STATE,ZIP,-," PHONE USE OF ❑ SED or Duplex 0 Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ Conuriercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ NO ❑SOLAR PANELS ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANF,LS. NUMBER OF PA/NELSIUNITS:. KILOWATTS(COMMERCIAL ONLY): TOTAL VALUATION: Z�SOp DESCRIPTION OF WORK Ct 4--ro V& (I ) 50A 910V cifr 4 1ra�_l t A Sul,?..-t RrdiVEDBY: ` ?r By my signature below,I certify to each of 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 relating to b ' ing don. I authorize representatives of Cupertino to enter the above-id e 'tied property for inspection purposes. Signature of Aliplicant/Agent: -e Date: S -, 1 G PPLEMENTAL INFORMATION REQUIRED OFLCEUSE'ONLY OYER-THE COUNTER ?x '.,,STANDARD �t C,- ,�LARGE_• a. Q MAJOR y PVApp 2011.doc revised 03116111 ED RECEIV m"' yr Z13 a 1 � k 0 E ' I ft Q 15- DI 511— I - cUP r � { j APPROVES This set of plans and sppcificatigns MIUST be kept at the job - site during construction. It is unlawful tomake ar y i ! changes or alterations on same, or to deviato therefrom, without approval from thro BuiRding official. The-Starnoing of this plan and specific tioris SHALL NO +\.�� K�� 4 l l e held to permit or to be an approval of the violation —{ l G� vj'4 of any prro�sions o any G►ty.Qrdinance or State.LaW. EM I CATi I P RRIVIR GU n Unej [ �1 - 0 x :� A � L "'PY . ��a\5 ��ilir►" C,',E Zo3��a� CA also 1►k � u 3 1 k I i C 7 B u r s I 4�a X n A ii p �'°`'�"� y! p i y I x a w a q $ t � t Hmti 9 f , a fXtI9 *Levvis Inc. ` Eltrlcat RESIDENTIAL ELECTRICAL LOAD CALCULATION SHEET Load Calculation for Existing Dwelling Unit 220.83 1. GENERAL LIGHTING:Table 220.12 Lo -al 0--Sq.ft.x 3 VA=---------- VA Small Appliances:210.11 (C)(1)and(C)(2� 6b0 VA circuits= 4�c� VA dry:220.52(B) t VA x 1 circuit= VA Total: (071 0 VA 2. FIXED APPLIANCES:220.83 The name plate rating of the following: A. All appliances that are fastened in place,permanently connected„or located to be on a specific circuit. Dishwasher (1500)VA Disposer= _ (800)VA Compactor= (99)VA Microwave � � (1300)VA. Spa/Pool Motor= (12,000)VA Attic Fan= (1600)VA Total: VA B. COOKING EQUIPMENT:Table 220.55;Notes Col A VA x %= R VA Col B -7 %-C) VA x I D % 4ZQ VA Col C VA x %= VA Total VA C. DRYER:220.54;Table 220.54 VA x %= VA D. WATER HEATER: VA Total---- --------------- �l VA 1 Anth- 3. APPLYING DEMAND FACTORS: Table 220.83 (A)or(B) 1"8000 VA x 100%=--- Remaininj '� VA x 40%_ VA Total------------------------`-- VA A/C UNIT 1 = 6WjjVA x 100% A/C UNIT 2= __—__--_VA x 100%= VA EVSE= VAx 100%=_ VA Total----- _ Total of A/C Loads and All Other Loads: ��. VA 4. ELECTRICAL SERVICE: Total VA �� VA VA/240 volts= Amps Minimum Conductor size copper GEC copper 2 SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUPERTIN10 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228-FAX(408)777-3333 build ing(a-cupertino.org � 0)`7 , ` Permit No. 2,4 q Address ) 7 kG 0 �ifa IA 5of Alarms Smoke: Carbon Mon xide: -- PERMIT CANNOT BE F'INALPD AND GOMPLETEA UNTIE THIS CERTIFCAT HAS BEEN �SIGNFD RFTITRNFD TH SIN SIGN TO EB + 1plI 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 Carb n 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 COALARM Outside of each separate sleeping area in the immediate vicinity of the X X bedroom(s) On everX 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 con iply 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 CSC 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 ave been installed in accordance with the manufacturer's instructions and in compliance with the CaliforniaBuilding and California Residential Codes.The alarms have been tested and are operational, as of the date signed below. I have read and agree to comply wit terms and conditions of this statement Owner(or Owner Agent's)Name: S Sin .... ........................... ......... ate: . .JIG... Contractor Nare: ..............Lic.#: '�'C'...... ,..... ate: @'1..�. ..... Smoke and CO form.do revised 03/18/14 WATER-CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT`-BUILDING DIVISION CUPERTIN© 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 t� (408)777-3228•FAX(408)777-3333•building(c)cupertino.org Owner Name 'Sgmmie Permit No: 6-7016-'U41 Address 20 9 Vin. S.� Mar„ 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. 'V No Go to Question 2. 2. Does your real property have a licensed plumber certifying that,due to the age or configuration of the prope 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? D Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. IR No Go to Question 4. 4. Is your real property builti and available for use or occupancy on or before January 1, 1994? -JO No My real property is built and available'for use or occupancy after January1,-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 a id sign bottom of form.. 5. Please check ONE of the following: Z 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 plumb' g fixtures to be replaced with water-conserving plumbing fixtures throughout the building.On or before January 1,2C 17,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 irnprovernents 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 improv merits). 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 ma ufacturer's installation requirements, and that the water-conserving plumbing fixtures comply with the requirements as in icated in the table on the following page. 40 Owner or Owner Agent's Signature: Date: /e Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit. SB407 2015.cloo revised 08126/15