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B-2016-2180 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2180 20975 VALLEY GREEN DR APT 253 CUPERTINO,CA 95014-1860(326 09 041) 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 _PLUMS 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 253-WASHER AND DRYER HOOK UPS I hereby affirm under penalty of perjury one of the following two declarations: m. 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 09 041 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 PERMITSUANCE 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 6/22/2016 Issued by:AbbyAyende Date:06/22/2016 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RF-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 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 pection. compensation,will do the work,and the structure is not intended or offered for ins sale(Sec.7044,Business&Professions Code) jV/_ 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 m. 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 V-Section performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE S '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 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. Health&Safety Code,Section 25532(a)should I store or handle hazardous 3. 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 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,C ter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 5534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date:6/22/2016 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.) to enter upon,the above mentioned property for inspection purposes. (We)agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally,the applicant understands ARC'HITECT'S DECLARATION and will comply with all non-point sourc regulations per the Cupertino Municipal I understand my plans shall be used as public records. Code,Section 9.18. Licensed Signature Date 6/2212016 professional GENERAL PERMIT APPLICATION MEP CONiN�Uf�ITY DEV�_OPIJ�EN i DEP„R i MEN i •BUILDING DIVISION 10300 T ORRE AVENUE• CUPERTINO, CA 950141-3255 (4D8)777-3228• FAX(408)777-3333•build ing6Dcuoerino.org t eUPERTthiO � ,� a?O ❑PLumBN6 [I MECHANICAL ❑ELECTRICAL ❑hTS -ELLA-NEOUS PF:ornCT ADDP.i sS A?N- r dr. A q.14 OP�TcRl�P1J�.. �iOlv� =-1✓..-1L AQ -T ) J!V -1 eV `� �V S T REST ADDRESS �1 CITY STAT:,ZiP �j {,may FAX L4� J�r I �` �� /! // J (/L d I F a CONTACT 1iS1✓E PRO� E-VAU. T �- a �,of r 1�� I f3 STIt.ET AD1114z- t I CITY,S fir{i= ZIP FAX did e �i� C �/ I OV,?� ❑ 01Aq E,BLtZ7? ❑ ow:N- AG?+T ❑ cm,—SCTOR ❑CONTO SCTOR AGENT ❑ ARC?.1?-£CT ❑D Gi=.=?2 ❑ D-VELD?%—t ❑ -,EZANrr CO?.^ner�DT56Lr �V�Y 6'i �` M'LJ I LICLt�SL�ZJ� tR. 6/ r I LIC`^�Ilss-nn- y� I BUS.LIC' C011/,PAZ`YT.111'E G < ,( -31 STREET ADDRESS ScCITY,STATE,ZIP pHO—S 4/ .t e:� d- A. — I z� A.RC1riTI CTIE]1 GN-EERN.4NE I LICENSE MI OER I BUS.LIC Vr y„te. STRu'"rT DI DRSS I CITY,STATE,ZIP I PONE USE GF LISiD.rmPL=X ❑ witzi-FAAu.Y I-PROTECTNWILDLA-1-0 ❑ Y-=S I ?ROi:CTLN ❑YFSI LS7AFBLDG AN ❑ YES MMI BG: Coja.MCLaD MB ANIII.i1tFACHAR=4 2"o FLOOD ZONZ- ❑ 2d0 aICHLBELHOMM ❑TO DESCRIPTION''OF WORK FtLY� G' �! l t i' !0 f 1 1 - TOTAL VAI UAT10'\*: C 3T�I1k a z ;vN_,aT � = By my signatLre below,I cern y to each of the following: I am the r)roperty owner or autborrzed agent to act on the property 6N mar's ehalz. I have read this application and the information I have provided is correct. I have read the Description of Work and ver;Ly it is accurate. i agree to comply with all applicable local o.d=anceS a1d State lali's-relating'LOObjLllCLg constrLCilOn. I aLth i•?e representatiVes of CLL---,L,7o to enter the above-identified propefty for 1usDection purposes. Signa Lre of ApplicandA--ent: L/ Date: Z d f SUTP PLEMENTAL LNrORvt�1e0N REQUL ED mc ETCE LSE D�L�a =; ' ECilt t = �OVER'T.h"E�OU�TPR,-�.�` ;.�s= -n...:.....�.�.»_-,-..�...�.•-.a�...._.�cam:,--_-.�`�... h 2147—Phiisc4DpjOl Ldoc revised 06121/11 OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTIdiENT•BUILDING DIVISION r_-AN 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 1A (408)777-3228- FAX(408)777-3333•buildina0cuoertino.ora – CUPERTINO 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 I.-APN..,ADDRESS _: . _.. Bpx• - OWNER NAME 0 NER ADDRES DESCRIPTION OF WORK: c� �y' We are providing you with an Ownet-Builder AcknoVAl dgment 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.) / (/1. 1 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 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. 5 V2. I 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. V 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license n"umbers on permits and contracts. _ —1/ 5. 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 ly 6. 1 understand if I am considered an"employer" under state and federal law, I must register with the state and F 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. VJ7. 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 perormed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is perormed under contract with a licensed general building Contractor. S 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) avnerBuilderForm 2010.doc revised 04114/10 r 'aL9. I 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 vrmf✓.cslb.ca.gov for more information about licensed contractors. _ 5'1/ 10. 1 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. 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. X12. 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-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. itis 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`obtain a perm t-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 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 city may be required to be presented when the permit is issued to verify the property owner's si nature. Property Owner's Signature: z Date: ------ -------------------------------------------------------------------------------------------------------------------------------------- (NOTE: The following Authorization.Form is required to be completed by the properly ov✓ner 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: Tel No Address of Authorized Agent: i 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 owners 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 ?010.doc revised 04114/10 Buildinnr Department City Of Cupertino 10300 Torre Avenue Cupertino, 'A95014-3255 Telephone: 408-777-3228 CUPERTINO Fat 408-777-3333 CONTRACTOR/SUBCONTRACTOR LIST , JOB ADDRESS: �C�' �. PERMIT# 91 ' OWNER'S NAME: PHONE#( GENERAL CONTRACTOR ' BUSINESS LICENSE ADDRESS: CITY/ZIPCODE: ' w a1 . - *Our municipal code requires all businesses working in the city to-have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTO, S HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: (`'� ZZ/f/A Signature Date Please check applicable subcontractors and complete the following information: 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 FILL SMOKE / CARBON MONOXIDE ALARMS t OWNER CERTIFICATE OF COMPLIANCE raA61 COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION CUPETINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333• buildingCftupertino.om Permit No. 2t516-Z 1 k Address #of Alarms Smoke: f Carbon Monoxide: ,PERMIT CAlY1i0113R HNALED AND COMPLETEDUNTZL HiS CEI T FICATE �5 BEEN �� ,, � TL1R E�3 Tfl HE B D� I r N �n 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 intekior 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 X X bedroom(s) On every level of a dwelling unit including basements X i X Within each sleeping room X Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burnin a liances and that q g � pp 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 per 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. I have read and agree to comply with the terms Qnd conditions of this statem nt Owner(or Owner vn,Y-4 nt's)Name: �'ASignature6) rrl ... .._. ..... '.1........ .. ........ .... ..... . Contractor Name: Sinature...................................................................Lic.#....,.................................Date: ................... Smoke and CQp fonn.doc revised 03118114 0F1 WATER-CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION U F T1Nt5' 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333 building(a.cupertino.org Owner Name jnET Permit No P e_ I6 al 5rd— Address �Q U/ 1 1� �� / �.1�/Z✓ /' �� 1. Is your real property a registered historical site? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not appl . 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 tcKthe 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. ANo Go to Question 3. 3. Is water service permanently disconnected for your building ❑ Yes Civil Code Sections 110 1.1 through 110 1.8 do not aply. Skip the rest of the form and sign bottom of form. §(No Go to Question 4. 4. Is your real property built and available for use or occupancy on or before January 1, 1994? ❑ No My real property is built and available for use or occupancy after January 1, 1994. Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the.form and sign bottom of form. Ves 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: EX 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). El My property is a commercial real property. See Civil Code Section 1101.5. On and after January 1,2014,specified building alterations or improvements shall require non-compliant' plumbing fixtures to be replaced with water-conserving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvements). I,as the owner or owner's agent of this property,certify under penalty of penury that non-compliant plumbing fixtures will be replaced prior to date specified above with water-conserving plumbing fixtures in accordance with Civil Code Sections 110 1.1 through l 101.8,the current California Plumbing Code and California Green Building Standards Code,and manufacturer's installation requirements,and that the water-conserving plumbing fixtures comply with the requirements as indicated in the table on the following page. 41 Owner or Owner Agent's Signature: Date: a1 Upon completing and signing this Certificate,please return it to the Building Division in order to final your building pennit. SB40 7 2015.doe revised 08/26115 �u�LDGx �c�o�B Fx . » c�l�rEz��Tr Tx 1 vui ,r a-.�•.r;;• „umrrrurv :vxp"uoxrexxmrvn.: YXm ..w..ws_ .a..;xc+w:m�.awr ««nH._:...! :..ruasx. c-frs 1.,wr rau +r,,.. .w.axr�trc.:..0 «�ar•ess•,.Wim.': Non-Compliant Water-Conserving Plumbing Fixture Fixture Complying Plumbin Fizture� ( with Current Code Applicable to New Construction) Maximum Water Usage/Flow Rate Fixture Type 2013 CPC Ch.4 2013 CPC Ch.4 2013 CPC Ch. 4 Water Usage /Flow Rate 2013 CALGreen Div.4.3 2013 CALGreen Div.4.3 2013 CALGreen Div. 5.3 Single-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, avera e'flush volume of two reduced flushes and one fullflush 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. SB467 2015.doe revised 08126115