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B-2016-2181 CITY OF CUPERTINO BUILDING PERMIT BUH.DING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2181 20990'VALLEY GREEN DR APT 602 CUPERTINO,CA 95014-1829(326 09 053) HOMEOWNER/BUILD ER OWNER'S NAME: KORET VC I LP DATE ISSUED:06/22/2016 OWNER'S PHONE:408-253-0200 PHONE NO: LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic.# Contractor HOMEOWNER/BUILDER Date X BLDG _ELECT —PLUMB X 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: APT 602-WASHER AND DRYER HOOK UP 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. 2. I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$500.00 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 26 Number: Occupancy Type: 3 and state laws relating to building construction,and hereby authorize 326 09 053 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 C INSPECTION. Signature Date 6/22/2016 Issued by:Abby Ayende Date:06/22/2016 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) }� 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:6/22/2016 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 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, hapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,a 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date:6/2212016 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'SDECLARATION I understand my plans shall be used as public records. Code,Section 9.18. Licensed Signature Date 6/22/2016 professional GENERAL PERMIT APPLICA 1[CN MEP �+ COMMUNITY DEVELOPIJiEN T DEPART NEN T•BUILDING DIVISION 10300 T ORRE AVENUE•CUPERTINO,CA 85014-3255 (408)777-3228• FAX(4-08)777-3333•build ino(a)cuoerino.ora m I %J; CUPERTIKO- ❑PLUh4311v-G ❑1✓MC1i4AZC.�I. ❑ELEC T RICA? ❑h iISCELLANOLiS -2,01(c1--`,101 PRO=- ADDRESS ,, /,r I �" 3 ot=~�.�>;.a.1✓�E ."/ �J` I "{01,� Q S ' � La✓��-rt, . . T. �N STP.=..=T.=-DDR SS - d cr,Y tiTAr,ZiP , r'X C v J"`Dl s CO1.iACT)\i'!S /�1 e, PiIO.� `3 . 1 STRr:.•_T A�?Pa=P- CITY,Tiry Z"iP n r FAX 04.7=R ❑ OVdl.=?=nUiTDM ❑ OWNEZAGr7.'T 11I? C01. SCTOR ❑COArt?.ACTORAGER1 ❑ AaC—IrECT ❑�vGL'—R ❑ DATLO? ❑ ='Zh-T CONTR4r-rr%P lets / �` I LICM-4sF"u-USER . I LICEnSRiYr� f3 BUS.LICr qj�s d C0110A2.Y I.A.] - F-1✓-k' FAX Q 4Y </t STREET ADDRESSAT,ZIP CITY.STI301.t it ARCrnTECTIiNGD.-LRNAh� I LICENSE AUA43ER I SLS.LIC CON.PANY\,AJC- � E-24ML I r°y V STRE-7AJDR SS CITY,STATF,ZIP PHONE USE Ur ❑SFD c DUPLr ❑ 1✓l LTl-rA1 fII Y I-PROisCT N ReDLAND ❑ Y S I TitO�=CI IN ❑YES 135 THc 5I DG AN ❑ =S BULTDL'`G: (]cobvmr—La-. URBAYL'.=IE FACHARES I'm FLOOD ZONE ❑No MCrIL':RHOM-27 ❑ No D.SCMMON OF'RORR .. .5--�� r�`_ �'�.cw�3�''.•car" �� 3�--:' TOTAL VA.LUATIO'Q: SOO I R CEI `I? a yc� y 4 _ gea r t�� ✓.i�' By my sips-tLze below,I ce,OY to each of the following: I am the property owner or autbonzed agent to act on the prope,Lowner's behalf. I have read this application and the informa-60D I have provided is correct. I have read the Desc' :on of WorY,and verify itis accurate. I agree to comply with all applicable local ordi-ances aad state laws-elating ioobbuildLQ eonst'iaction. I P ib Hae representatives of C pD*tino io enier the above-identi-Zed property for iamection purposes. Si fah re of Applicantl.,-cent: Date: '2- S - SU-PPLE?,�IEItTAL L�TtORM�1 ONREQUiRED R- 01TER-7hEOi R n � � 'Of 1-tamm I �- MW n -MEP2,47sctivp_2011.doc rei,sed 06121/11 OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION ."am 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 (408)777-3228- FAX(408)777-3333-buildinana cuDertino.oro - CUPERTIM4 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 O NER ADDRES OWNER NAME DESCRIPTION OF WORK-'______Z' " We are providing you with an Owner-Buiider Ackhm0edgment and Information Veri�ication Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as'he Owner-Builder. We will not issuea 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.) 5 0/1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an"Owner- Builder" building permitthat 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 homeowner's 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. S 1/ 2. 1 understand_building permits are not required to be signed by property owners unless they are responsible for the construction and are not hieing a licensed Contractor to assume this responsibility. j3. 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. ld 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. I 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. 5 L' 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. 5J7. 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. 8. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial 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 L -- r 9. 1 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, Industrial Accidents. I also understand I may and the California Division of In Y 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. _ 5-I 10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. LLI-11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will atride 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 information-I-have-provided on this form. Licensed contractors are regulated by-jaws 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 a6y financial loss you may sustain as a.result of a complaint-Your only remedy against unlicensed Contractors maybe in civil court. Itis also important for y . _ employee of that individual or firm is injured.while working you.-ton yunderstand that if an unlicensed our property,you may be heContractorld liable for damor ages. if - you obtain a permit.as Owner-Builder and wish to hire Contractors, you will be responsible for verifying whether or note those Contractors.are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS:Please complete the following constructloh 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 city may be required to be presented when the permit is issued to veru the pro erty owner's signature.,_ Property Owner's Signature: Date: lv 2//� --------------------------------------------------------------------------------------------------------------------------------------------- (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the propeity 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: Tel No Address of Authorized Agent: I declare under penalty of perjury that 1 am the property owner for the address listed above and I personally gilled out the above information and certify its accuracy. Note:A copy of the property owner's drivers license, form notarization, or other verir7cation 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 0411"110 Buildin cy Department City Of Cupertino 103 0 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUP ERT I N O Fax: 408-777-3333 t , CONTRACTOR/ SUBCONTRACT O L JOB ADDRESS: Z ew d, :. " PERMIT# - - zi el OWNER'SNAME: t PHONE# �Q� GENERAL CONTRACTOR: , e_e_ BUSINESS LICENSE# ADDRESS: 1!1 . �' CITY/ZIPCODE: a1 *Our municipal code requires all businesses working in the city to have a City of Cupertino usiness license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum-/Wood Glass/Glazing Heating Insulation Landscaping Lathing Masonry Painting!Wallpaper Paving Plastering Plumbing Roofing Septic Tank - Sheet Metal Sheet Rock Tile Owner!Contractor Signature Dat SMOKE/ CARBON MONOXIDE ALARMS OF OWNER CERTIFICATE OF COMPLIANCE 10 016, COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION t CUPER INO 10300 TORRE AVENUE-CUPERTINO,CA 95414-3255 (408)777-3228-FAX(408)777-3333 4 buifdina(a cuoertino om R Permit No. Address '.' .. #of=' lalrms Satiate: Carboa�Monoxide: '� PERMIT CANNI OT BE FINALED AND COMPLETED UNTIL TEAS CERTIRCATE HAS BEEN SLQ,FD AND RET HNi D 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 R314,201:3 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 ui re that Smoke Al dwelling units exceeds $1000.00,CRC Section 8314 and CBC Sections 907.2.11.5 and 420,6 require ax�s anchor Carbon Monoxide Alarms be installed in the following locations: .AREA SMOKE ALARM y CO ALARM Outside of each separate sleeping"area in the immediate vicinity of the X X bedroom(s) On every level of a dwelln unit ncludin basements Within each sleeping room 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[r 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 8314 and CBC Sections 907.2.11A and 420.6.2.An electrical permit is required for alarms which must be connected to the building wiring. i 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 datesigned below. I have read and agree to comp!qqmp!Z with the terms and conditions of this statement Oluner(or Owner Agent)Nair.e: r 4 d`-4 si nature,.. ........ ..... ......... ..... .. ...... .,...................... Date: f'oW,ractOr Name: Y _ iI Sr nature.. .UCC .Date: , Smoke and COforni.doc revised 03IJ8114 F' ELM - WATER-CONSERVING PLUMBING FIXTURES 3 10 OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION CCJPERT[N4 10300 TORRE AVENUE•CUPERTINO,CA 95(}94-3255 (4n8)777-3228•FAX(408)777-3333•buildlin ccr ertino.or Owner Name Address 2Cf R'�ILI&VIK& ell, IV 1. Is your real property a registered historical site? Yes Civil Code Sections 1101.1 through 1101.8 do no.apply. Skip the rest of the form and sign;botfom offozm. ( 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? Cl Yes Civil Code Sections 1101..1 through 1101.8 do not apply. 0 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 coater service permanently disconnected for your building? CI Yes Civil Code Sections 1101.1 through 1101.8 do not ap :y. Skip the rest of the form and sign bottom of form. No Go to Question 4. , 4 4. Is your real property built and available for use or occupancy on or before January 1, 1994`1 0 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. Slip the rest o€the form andsign 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 throug1i 1101.8 apply. C�eck one of the three following statements and sign bottom of form.. 5. lease check ONE of the following: My property�Single-family residential real property. See Civil Code Section 1101.4. On and after January 1,2014,building alterations or improvements shall require all noon-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). d Myproperty is a muliz,fancily residential real property. See Civil Code Section 1101.5. On and after January 1,2414,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). Myproperty is a conunerc at 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 unprovements). 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 withYwater-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 fbll21Ajrig page, Owner or Owner Agent's Signature: 'Date: Upon completing and signing this Certificate,please return it to theSuildingDivision in order to final your building permit. SB4072013.doc revised OW6115 BUILDING PERMIT CANNOT,SE FINALED AND COMPLETED U1�TIL�IIIS GERTIFICA�'E HAS BEI+N SIGNEb QI�Tp 1ZFTLTRI�Ti'D Ta$T�3Iy BUI)�.�INGD,TYISIO.N Non-Compliant Water-Conserving Plumbing Fixture Plumbing Fixturel (Fixture Complying with Current Code Applicable to New Construction) Fixture Type Maximum Water Usage/Flow Date Water Usage 2013 CPC Ch.4 2013 CPC Ch.4 2013 CPC Ch.4 /Flow Rate 2013 CALGreen Div.4.3 2013 CALGreen Div.4.3 2013 CALGreen Div. 5.3 Single-Family Multi-Family Commercial Residential Residential Water Closets Exceed 1.6 Single flush toilets: 1.28 gallons/flush (Toilets) Gallons/flush Dual flush toilets: 1.28 gallons/flush effective flush volume(the composite, average flush volume of two reduced flushes and one full flush Urinals Exceed 1.0 Gallons/flush 0.5 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. SB401 2015.doe revised 08126115 I