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1501016414 it, CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10541 STOKES AVE CONTRACTOR: KUMAR HEMANT AND PERMIT NO: 15010164 GUPTA RASHI OWNER'S NAME: KUMAR HEMANT AND GUPTA RASHI 10541 STOKES AVE DATE ISSUED: 05/22/2015 OWNER'S PHONE: 4082346316 CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ADD 862 SQ FT TO REAR AND FRONT OF SFDWL, License Class Lic.# REMODEL THROUGHT OUT KITCHEN (300 SQ FT); CONVERT (E) Contractor Date LIVING TO BEDROOM W/ BATH (150 SQ FT); CONVERT (E) I hereby affirm that I am licensed under the provisions of Chapter 9 REV # 1 - MOVE FURNACE TO ATTIC & KEEP (E) WALL (commencing with Section 7000) of Division 3 of the Business & Professions IN GARAGE - ISSUED 9/2/15 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 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 Sq. Ft Floor Area: Valuation: $150000 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 of the Labor Code, for the performance of the work for which this APN Number: 32648032.00 Occupancy Type: 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 WITHIN 180 DAYS OF P + T ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS F ED INSPECTION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may acci-ue against said City in consequence of the Z granting of this permit. Additionally, the applicant understands and will comply ss / with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. RE-ROOFS: Signature Date 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 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, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, 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 of the work for which this is issued. air contaminants as defined by the Bay Ar a it Quality Management District I will maintain compliance with a Cuperti o unicipal Code, Chapter 9.12 and performance permit I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the of the work for which this the Health & Safety Code, See i s 25505, 55 , and 25534. UA& '-2-permit performance Date.-9.-2- Owner or authorized agent: ate: permitis 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I 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 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 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may ace against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionall , t e applicant understands and will comply with all non-poin ource regula 'ons p r the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date v , CUPER"iINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(8cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION 7 ALTERATION / TTR17V1 FVT.STON / T)FFFRRFI) ORIGINAL PERMI��O �6y' ca 5 `i 1Z. C.0 PROJECT ADDRESSC1� v r #+ OWNER NAME �toQ°—zAP:3 E-MAIL �t� �c�(�'� �t' �i�lA1►-°�v�l STREET ADDRESS Crr�Yi ,ST/A�TE, ZIP FAX CONTACT NAMEP NE 3Ul^ESI` E-MAIL QV) PAH E—M ftN T qtM�'+—' lQt�1 STREg_qDRFSS S CITY TATE, ZIP FAX ►v R Vt OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONT CTOR NA. -MSE LICENS NUMBER Y> LICENSE TYPE BUS. LIC # l9 i L-1 'tom R L COMPANY NAME E-MAIL ��� ' FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEERNIME i C ` LICENSE NUMBER -1 y� - 1 BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZI.P PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA J AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKMORCH AREA GARAGE AREA: DETACH ❑ ATTACH I # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YE " BEING ADDED? ❑ NO ADDITION? �— PRE-APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YLS,TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO By my signature below, I certify to each of the following: am the property owner or authorized erty owner's beha ead this is application and the information I ha e rovided is orrect. ave read the Description of an verify it is accurate. I agree to comply with all 'applica -lc-local ordinances and state laws relating to b Iding ction. I uthorize representatives o Cupertino to enter the above -identified property for inspection purposes. 1 Signature of Applicant/Agent: Date: Y SUPPLEMENTAL INFORMATION REQUIRED New SFD or Multifamily dwellings: Apply for demolition permit for ❑ _IV 4 ❑ building(s). Demolition OVER THE-COTJNI'ER S BUILDING.PLA`NREVIEW r existing permit is required prior to issuance of building ,t permit for new building. EXPitEs`s W l 4 1 " ❑ PLANNINGPLANREVIEW ,7 �3' Commercial Bldgs: Provide a completed Hazardous Materials Disclosure srANDnRD "'b046 ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. +, ❑ ,LARGE ' f ❑ FIREDEY' 123 r` ; Copy of Planning Approval Letter or Meeting with Planning prior to Ssk i t _ submittal of Building Permit application. 4 M{�ox i „+` s �z ❑ snNlrAr}sEyvERnlsrRrcr ;A ++_ _ 0 �:ENYIROA'MENTAL'HEALTIi., ;= BldgaApp_201 1. doc revised 06/21/11 CITY OF, CUPERTINO FEE ESTIMATOR 1 BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These ees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 E,{f. 7/1/13) 10541 STOKES AVE DATE: 09/02/2015 REVIEWED BY: MELISSA JimADDRESS: APN: 362 48 032 BP#: 15010164 *VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: Numb. hasp. Fee: PENTAMATION 1GENRES PERMIT TYPE: A WORK REV # 1 - MOVE FURNACE TO ATTIC & KEEP E WALL IN GARAGE - ISSUED 9/2/15 SCOPE Suppl. Insp. Feer Reg. 0 OT NOTE: This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These ees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 E,{f. 7/1/13) Lleclr. 1'Iirn CheckPIun;G. P1an C'heofc 151ec.. Plan Checl( Yeah. Permil Fee: Plumb. Permit hee: I Iec. PerwiT Fee: Other Heck Insp. Other Plumb Insp.Li Urluer I..Slec. lizsj7. Lj 114ech. Imp. Fee: Numb. hasp. Fee: Elec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These ees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 E,{f. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? () Yes C) No $0.00 hours Plan Check, Hourly $286.00 ISTPLNCK Suppl. PC Fee: (E) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction 7-67X: Administrative Fee: 0 G Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee. $0.00 Select a Non -Residential Building or Structure 0 Travel Documenlalion Fees: Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 ,SUBTQTAhS : $0.00 $286.00 TOTAL FEE `= $286.00 Revised: 07/02/2015 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10541 STOKES AVE CONTRACTOR: KUMAR HEMANT AND PERMIT NO: 15010164 GUPTA RASHI OWNER'S NAME: KUMAR HEMANT AND GUPTA RASHI 10541 STOKES AVE DATE ISSUED: 05/22/2015 OWNER'S PHONE: 4082346316 CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ADD 862 SQ FT TO REAR AND FRONT OF SFDWL, License Class Lie. # REMODEL THROUGHT OUT KITCHEN ( 300 SQ FT); CONVERT (E) Contractor Date LIVING TO BEDROOM W/ BATH (150 SQ FT); CONVERT (E) 1 hereby affirm that 1 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 fall force and effect. 1 hereby affirm under penalty of perjury one of the following two declarations: 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 tite performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $150000 1 have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 32648032.00 Occupancy Type: Section 3700 of the Labor Code, for the performance of the work for which this 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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter 180 DAYS ED INSPECTION. 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 may accrue against said City in consequence of the Date: granting of this permit. Additionally, the applicant understands and will comply — with all non -point source regulations per the Cupertino Municipal Code, Section 9 18. RE -ROOFS: Signature Date 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. DECLARATION OWNER -BUILDER Signature of Applicant: Date: 1 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 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, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, 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 1 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 nicipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sect n 25505, 2 53 and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: 5" ZZ k 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 CONSTRUCTION LENDING AGENCY Compensation laws of Califomia. If, after making this certificate of exemption, [ 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 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 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. grunting of this permit. Additi ally, the applicant understands and will comply with all non oint source p-" 'ons per the Cupertino Municipal Code, Section Licensed Professional 9 18. !� Signature - Date _�gt:19;jT y CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION .\ 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(c)cupertino.org \! f;Zl FO AT rCDA-rinT.IITI F -I RI;VI1,I(1N/I)FFF.RRED ORIGINAL PERMIT 9 1J Nt.w WNJIKUI-11UN------- AD k1�0Wi I APN N / if 2' O 3 PROJECT ADDRESS O 2`Gt --)f6) Ia v l EMAIL OWNERNAME PHONED / I v M � STREET ADDRESS,, r kv- CITY, STATE, ZIP FAX C� go _Kk CONTACT NAME LEPHONE410 - O l ^-t E-MAIL �� S'-woo. � 0O. CSM STREET ADDRESS - QTY, 5 ATE,ZIP( `902 r' ��J FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER .AGENT ❑ CONTRACTOR/ ❑ CONTRACTORAGENr .+�r ARCHITECT &ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC k COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER1O L�74.4 BUS. LIC 4 COMPANY NAME r LCy E-MAIL` O- c O ` ^ FAX STREET ADDRESS .� 3 K 7 CITY TATE, ZAP 15 t �� PHONE L� DESCRIPTION OF WOR} � 6 O S I l'r O O ! i Ok=y O �� VV I l�(_M2E_2J �I vvt vz-•' 1 � ✓r2 y l7 � EXISTING USE PROPOSE USE CONSTR TYPE k �/ty' `{ k STORIES ( USE TYPE OCC. SQ.FT. VALUATION (S) TkA � (� M� 4/ 1' EXISTG AREA I / /� / CG NEW FLOOR AREA p_ / /7 �i ` DEMO AREA TOTAL NET AREA /I �Z (� (� LY�1 �I , f U(Q �G� O O O O BATHROOM REMODEL AREA KITCHEN REN40DEL AREA OTHER REMODEL AREA T V,.,, . t ., -ki POACH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: ® DETACH ATTACH 9 DWELLING UNITS: IS A SECOND UNIT ❑ YES BEING ADDED? 5� 0 SECOND STORY ❑ YES ADDITION? ANO 1 rC�� PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING APPROVAL LETTER IS THE BLDG AN 1'ES EICHLER HOME? O� .RECEIVEIj BY < TOTAL VALUT?I ION: PLANNING APPLX XNO 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 relating to buildin const ction. I authorize representatives of Cupertino to enter the above -identified property for Inspection purposes Signature of pplica Agent: Date SUPPLEMENTAL INFORMATION REQUIRED ❑ pVER ... COU1\TER - still DING PLAN itEYlEw 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. b ❑ E�.PitEss PLANI\INGPLAT REVIEI\ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure sTai.nARD r`uniicwoiucs _ form if any Hazardous Materials are being used as part of this project. ❑ LA)iGE FIRE DEPT I: _ Copy of Planning Approval Letter or Meeting with Planningrior to p ❑� p7AJOR t ASANITARY SER'ER'DISTRICT submittal of Building Permit application. - .�0 EA }!IItON'111ENTALHEAI;TH- - B1dgApp_2011.doc I-evised 06/21/11 w_1'9Vffi CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 10541 stokes ave DATE: 01/28/2015 REVIEWED BY: Mendez PC FEE ID APN: - BP#: 522A2Z -"VALUATION: 1$150,000 PERMIT TYPE: Building Permit PLAN CHECK TYP : Addition PRIMARY USE: SFD or Duplex 2nd Unit? Yes 0 No OTC '? 0 Yes No PENTAMATION 1R3SFDADD PERMIT TYPE: A WORK add 862 sq ft to rear and front of sfdwl remodel throu ht out kitchen 300 sq ft); convert e living to SCOPE bedroom w/ bath (150 sq ft); convert (e) bedroom into bathroom (100 sq ft); panel upgrade 200 amp OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA (s.L) PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,III-B,IV,V-B 862 $2,654.00 IR3PLAICK $1,666.00 IR3INSP $0.00 PME Plan Check: $0.00 250 J s.f. $431.00 Remodel, Other I REHRESOTH Permit Fee: Hourly Only? 0 Yes 0 No $1,666.00 Supp1. Insp. Fee:Q Reg. 0 OT 0 0 hrs $0.00 200 amps Electrical $48.00 IBELEC200 Services PME Unit Fee: $0.00 PME Permit Fee: $48.00 TOTALS: 862 $2,654.00 _FT0 $1,666.00 1VI'ECH, HOURLY 0. Yes 0 lv'o `PLUM'BHOURLY Q Ye's., 0 lYo ' ELEC,,HOURLY Q Yes 0 No MISC ITEMS Elec. Plan Check 0.0[hs $0.00 $2,654.00 Elec. Permit Fee: IEPERr1L117' Remodel, Kitchen (<=300 sf) IREMRESKIT Other Elec. Insp.hrs $48.00 0.0 0.0hrs $0.00 NOTE: This estimate does not includefees clue to other Departments (i.e. Planning, Public lForks, Fire, Sanitary Sewer District, School District, etc.. These fees are based on the pieliminar information available and are only an estimate. Contact the Dept for atddn'I in b. FEE ITEMS (ITee Resolution 11-053 Ef, ,'•.%//13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,654.00 300 s.f. $645.00 Remodel, Kitchen (<=300 sf) IREMRESKIT SuppI. PC Fee: Q Reg. 0 OT 0.0hrs $0.00 PME Plan Check: $0.00 250 J s.f. $431.00 Remodel, Other I REHRESOTH Permit Fee: Hourly Only? 0 Yes 0 No $1,666.00 Supp1. Insp. Fee:Q Reg. 0 OT 0 0 hrs $0.00 200 amps Electrical $48.00 IBELEC200 Services PME Unit Fee: $0.00 PME Permit Fee: $48.00 _FT0 0 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: IPLLOAGR $120.68 Select a Non-Residential0 Building or Structure O i Travel Documentation Fee: ITR.4VDOC $48.00 Strong Motion Fee: 1BSEIS�IICR $19.50 hrs $0.00 Inspections Inspection, Hourly Blda Stds Commission Fee: IBCBSC $6.00 SUBTOTALS: $4,562.18,$1,124.00 TOTAL FEE: $5,686.18 Revised: 01/06/2015 \� »\ . � � \� � � � � � � \�� � � � } ( � \� � \ \ y .>\� � \� \��� \ . � �^� � � � � : �: �� r � \� «. f� :� 3 © \ y� � « : �����\j \� �� ^ � \� \ \: � � � ��� � � � � » \ � � �� ^� 77 . \\�}�� «\��� � � \ � \�\ ���\�� � � C» � ~� \ � � ) � � � : CUPERTtNO 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,,) 7/77-3333 - building(c cupertino.org t 1 , + Owner Name yc W t V T i,/ Q 14/ fz_ Pennit No. 1 Q I U 1 (ILA Address �TL {'S"� �T Illiy C. A PEwAnT CANNOT BE FINALED AND COMPLETED tiNTIL THIS CERTIFICATE Please refer to the attached California Civil Code Sections 1101.1 - 1101.8 which are part of this Certification form. Is your real property a registered historical site? ❑ Yes Civil Code Sections 1101.1 thro h 11 1.8 do not apply. Sign below and skip the rest of the form. Owner' Signature: Date: 1 p 2 p - ❑ 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 be n provided to the Building Division. Sign below and skip the re t of the form. Owner' Signature: I Date: ' p 0- � S ❑ No Go to Question 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form. Owner' Signature: �, ��/ Date: t0 - 2 J - 15 ❑ No Go to Question 4. 111111JJJ���... 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 f use or occupancy after January 1, 1994. Civil Code Sections 1101.1 thr1101 8 do not apply. Sign below and skip the rest of the form. Owner' Signature: V"S Date: b - 20 ❑ 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. Refer to the attached. ❑ Myproperty is a single fanily residential real property. See Civil Code Section 1101.4. On and after January 1, 2014, building alterations or improvements shall require all non-cornpliant 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 unprovements). ❑ Myproperty 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. EB40 7 2 015. doc revised 02/04/15 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/We, the owner(s) 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 fixture in accordance with Civil Code Sections 1101.1 through 1101.8, the current California Plumbing Code and California reen B 'lding Standards Code, and manufacturer's installation requirements, and that the water -conserving Bing fixtures omply th the requirements as indicated in the table below. Owner's (or Owner Agent's) Signature Date: - —� Upon completing and signing this Certificate, please return it to the Building Division in order to final your permit. 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.doc revised 02/04/15 Non -Compliant Water -Conserving Plumbing Fixture Plumbing Fixtured (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 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 psi 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.doc revised 02/04/15 CUPERTINO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a.cupertino.org — 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: SITE ADDRESS'TO'�S '� sia7..... A N�.� + Lfr 0� 2 BP` s Q I d 6 OWNER NAM OWNOER ADDRESS )SUVA KZ OUPEAT No CA 9 5a ( DESCRIPTION OF WORK: We are providing you with an Owner -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. We 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.) IJ, I. I 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 homeowners 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. 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. 3. 1 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 n mbers on permits and contracts. 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. 6. 1 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. W7. 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. Ay 8an.Iunderstand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for incial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04/14/10 At9. t 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 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. 10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I U he party legally and financially responsible for proposed construction activity at the site address listed above. 11. I 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 formation l have provided on this form. Licensed contractors are regulated by laws 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 may be in civil court. It 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 obtaih a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not 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: Lender Address: 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 ity may b equired to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: --,2z u is --------------------------------------------------------------------------------------------------------------------------------------------- (NOTE: The following Authorization Form is required to be completed by the property owner 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 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 property owner's signature. Property Owner's Signature: Date: OwnerBuilderForm 2010.doc revised 04/14/10