B-2016-2124CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-2124
19503 STEVENS CREEK BLVD UNIT 317 CUPERTINO, CA 95014 (316 49 087)
PALISADE BUILDERS
INC
CAMPBELL, CA 95008
OWNER'S NAME: PAGONIS ALEXANDER E
DATE ISSUED: 06/14/2016
OWNER'S PHONE: 408-621-1393
PHONE NO: (408) 429-7700
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRACTOR Lic. #838046
X BLDG
Contractor PALISADE BUILDERS INC Date 05/31/2018
— —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:
REMODEL BATHROOM; MASTER BATHROOM - MEP (90 S.F.)
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
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
1 z. 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: $20000.00
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
316 49 087
316
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 saidCi in consequence of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the appli nt u erstands and will comply with all non -point
source regulations p the tmtcipal'Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 611412016
Issued by: Abby Ayende
aw
ARATI()N
Date: 06/14/2016
OWNE -BUILDER EC
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:
i. 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)
z. 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: 6/14/2016
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
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
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
a. 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
material. Additionally, should I use equipment or Oevices which emit hazardous
shall not employ any person in any manner so as to become subject to the
air contaminants as defined by the Bay Area Air t ality Management District I
Worker's Compensation laws of California. If, after making this certificate of
s pal Code, Chapter 9.12 and
will maintain compliance with the Cuperti Muf5,
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sectio 255 5533, 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: 6/14/2016 — -- - -
I certify that I have read this application and state that the above information is
CoTR TI NLDING 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 6/14/2016
Professional
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408)777-3228, ^ FAX (408) 777-3333 • building(a)cupertino.org
b-zolu -2,1"Lfl
❑ NEW CONSTRUCTION - ❑ ADDITION u ALTERATION / Ti ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECTDRE
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OWNER NAME
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PHONE
E-MAIL
PA�ONiS@ 61k, A L.0
STREET ADDRESS1915c):5
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CONTACT NAME I
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STREET ADDRESS M v D
CITY, STATE, ZIP„ 4 MP ' /I E6W FAX40.5 42 r :�DL
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
_CONTRACTORNAMF�� -50 ` 19C •
►►NrLAIM�E II�LTT!/CJUN
LICENSE NUMBER
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LICENSE TYPE
BUS. LIC
6 30 — -
2_56
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E-MAIL
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FAX 4Ob *2q - 3+01
STREET ADDRESS
18)-+,5 S. TAS M vE 2400
CITY, ZIP
CA ST TE, HMP CA 50D
PHONE
4- -T+00
ARCIIITECT/ENGINEF_RNRME
-- �I-� M�soN----
LICENSE NUMBER
— 4DR21
BUS. LIC #
COMPANY NAME
_ L.S. klAW9+A460 iATM.
E-MAIL
1.5MA0461K MaS�Nq.IG-�iC.co
FAXLL
825283- f
STREET ADDRESS
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CITY, TATE, ZIP
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DESCRIPTION OF WORK
E�1_4C (AIMS DA/<IA64e Q SUS-FLDofP, UN 0 9E Sl-bW EK PAt4 -rua • — • _
RW C-0 WATEK _DAMACaE> WOOD FRAME. AFZDOND 2' X 4 Veli DOW L-oeATIED or4
� tEFJOV, vel-ALt- f '�—:}4OW FEr, AKeA . —.
EXISTINGUSE
- PROPOSED USE CONSTR.
TYPE
# STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG ---
NEW FLOOR
DEMO
—
TOT
-
_---
AREA
AREA
AREA
BATHROOM
REMODEL AREA -` 10 �
KITCHEN
REMODEL AREA
OTHER
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
--
E] ATTACH
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEING ADDED? ONO
ADDITION? E]NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
PLANNING ADPL# NO PLANNING APPROVAL LETTER
IS THE BLDG AN El YES
EICHLERHOME? ❑NO
RECEIVED BY-7,TOTAL
.,. `
VALUATION:
/�� ♦�� M
By my signature below, I certify to each of the follow' Ig: 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 provide s co r ct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relatinesentatives of Cupertino to enter the above-idetified property for inspection purposes.
Signature of Applicant/Agent: _0 ... _ Date: (D 20 lip
SUPPLEMENTAL INFO A ION REQUIRED
ria>5`cHECI
RoirriNc SLIP:
❑ _ OVER riiE cotlNTIER
❑ 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.
, 0,f DVPRESS
PLANNING PLAN REVIEW.
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
'El '� STANDARD
❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑: LARGE :;
❑ > iRD DEPT
Copy of Planning Approval Letter or Meeting with Planning prior t0
Q `' \(AJOR
❑ SANITARY$ER'ER DISTRICT
submittal of Building Permit application...
❑ ENVIRONMENTAL HEALTH "
BldgApp_2011.doc revised 06121/11
M
CDM
F 1
1E0Nff 0 9
ISTR0PQLITAN'
June 10, 2016
RE: Building Repairs at 1.9503 Stevens Creek Blvd.
To Whom it May Concern:
The Metropolitan at Cupertino COA gives: authorization to Palisade Builders, Inc. and/or Douglas Ross
Construction to conduct building repairs at 19503 Stevens Creek Blvd. The repairs are necessary to address a
water leak found at Unit #317. Please let �n.e know if you have any questions.
Sincerely,.
On behalf of the Metropolitan at
Josh Bench
I Assocdation Manager
:upettino COA
Comass Management Group, Inc.
77 Las Colinas Lane, San Jose, CA 95119
Ph: 408} 226-3300 0 Fx: 408-226-3406
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 • buildinq(Wcupertino.orq
L
GA 960/* Uhlt'f #r_ SIS-- Permit No. -Es-IM-212-14
Address A
bLYD � &ffl�i!IQ # of Alarms Smoke: 2 Carbon Monoxide:
PURPOSE
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section 8314, 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.
1 have read and aaree to comply with the terms and conditions of this statement
Owner (or Owner Agent's) Name:
Signature.......... ........................................ A ..... :................ ..................... .................. Date_: ...................
Contractor Name:
?M5AW_ bUjLbeT%5, 1#4f-.
Signature MWO!�. fWjIVTA .:................ ..Lic.# .... gd (P.. Date:
Smoke and COform.doc revised 03118114
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(a,cupertino.org
Owner Name At_E:AAt4t>EK ,F• PAbnOgi®, Permit No. T- 2d06— i2 '
n
Address �� 5�3 S Y NS �P-f K• `�Lti 1 j UF6fT 31�", P '1��N(� � l� 4 q5-01*.
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.
1 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.
ANo 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.
C3 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:
❑ 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-coinpliant 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 Standar Code, and manufacturer's
installation requirements, and that the water -conserving plumbing fixtures comply with tlr e ur
s as indicated in the
table on the following pane. i 1
Owner or Owner Agent's Signature: P,414*AD_ b0 LDkZj INC. - MANUR- fn,�Ph10a - !tdW 1 Date: /0.5 6 /� (o
Upon completing and signing this Certificate, please return it to the Building Divi)* � a r._' ' `ur buildin j permit.
SB4072015.doc revised 08126115
Non-Compliat
Water-Conserving Plumbing Fixture
Plumbin Fixture I (Fixture Complying with Current Code Applicable to
New Construction)
Fixture Type
Maximum Water lJsa elFlow Rate
Water usage
/Plow Rate
2013 CIBC Ch. 4 2013 CPC Ch. 4 2013 CPC Ch. 4
i 2013 CAl Green Div. 4.3 2013 CALGreen Div. 4.3 2013 CALGreen Div, 5.3
Single -Family Multi-Family Commercial
Water Closets Exceed 1.6
Residential residential
(Toilets) Gallons/flush
Single flush toilets: 1.28 gallons/flush
Dual flush toilets: 1:28 gallons/flush effective flush volume (the composite,
UrinalsExceed 1.0 '
average flush volume of two reduced flushes and one full flush
Gallons/flush
Showerheads Exceed 2.5.
0.5 gallons/flush
gallons per minute
2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of
I U.S. EPA WaterSense
Specification for Showerheads
(A handheld 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
Faucets — Exceed 2.2 gallons
Lavatory
allow only one shower outlet to be in operation at a time!-
Maximum 1.5 gallons per Within units: 0.5 gallons per minute @ 60
per minute
Faucets
minute @ 60 psi; minimum Maximum 1.5 gallons psi
0.8 gallons per minute
g P @ per minute @ 60 psi;
20 psi minimum 0.8 gallons
per minute @ 20 psi
E
In common and public
use areas: 0.5 gallons
per minute.@ 60 psi
1.8 gallons per minute
Faucets — Exceed 2.2 talions
Kitchen
p
60 psi
1.8 gallons per minute @ 1.8 gallons per minute 1.8 gallons per minute @ 60
per minute
Faucets
i 60 psi - @ 60 psi psi
{
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
t 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
1 reduction." other means may be
iused to achieve
reduction.
I . if the existing plumbigg fixture water
usage/_low rate is equal to or lower than the figure shown, it is not required to be upgraded.
SB407 2015.doc revised 08/26/15