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B-2016-2225CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2225 10850 E ESTATES DR CUPERTINO, CA 95014.4534 (369 22 005) OWNER-BUILDER OWNER'S NAME: HOFLAND LYNN M AND ROSANNE I DATE ISSUED: 06/28/2016 OWNER'S PHONE: 408-507-1914 PHONE NO: LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic. # Contractor OWNER-BUILDER Date X BLDG X ELECT _ PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing MECH X RESIDENTIAL COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is,in full force and effect. JOB DESCRIPTION: UPGRADE MAIN SERVICE PANEL FROM 100 TO 200 AMPS I hereby affirm under penalty of perjury one of the following two declarations: 1. I have and will maintain a certificate of consent to self-insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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: $6000.00 APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 369 22 005 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 ISN T STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT IS CE OR Additionally, the applicant understands and will comply with all non-point ' source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROMLAS CALL D P TION. Signature Date 6/28/2016 Issued by: Alex Valleluna Date: 06/28/2016 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 be' ag 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 compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) Signature ,4) I, as owner of the property, am exclusively contracting with licensed ofApplicant: contractors to construct the project (See.7044, Business & Professions Code). Date: 6/28/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. 1 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 DISCLO URE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements unih r Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health &c Safety Code, Sections 25505, 255 3, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Cod , Chapter 9.12 and the j r I certify that in the performance of the work for which this permit is issued, I Health &Safety Cade, Section. 25532(x) should I store r handle hazardous /3--, = shall not employ any person in any manner so as to become subject to the material Additionally, should I use equipment or device air contaminants as defined by the Bay Area Air Quality which emit hazardous anagement District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sections 25505, 2553 3, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked."_ t =Owner or authoriled.agert APPLICANT CERTIFICATION Date: 6/28/2016 1 certify that I have read this application and state that the above information is CONSTRUCTION LE E N I hereby affirm that there is a construction lending agen CY y for the performance correct, I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of thiscityof 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'Ss p li ARATI Code, Section 9.18. I understand my plans shall be used as public records. Licensed <Signature Date 6/28/2016 Professional ra GENERAL PERMIT APPLICATION EE P COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 GUpERTINQ (408) 777-3228•'FAX (408) 777-3333 • buildinaacuoertino.ora M SIC V) 2-u PROJECT ADDRESS )® �•ys® �/.-. y s APN# \jam` - OWNERNAME �Jf� L,�o/[Q%� ` PHONY ®!)�J�?^ �l�.. E-MAII, �O?'.(7�Af��ck..� CCt crn STREET ADDRESS D r $,$"D � G,5/L1ci��S' - a CrrY, S�TE,ze��'no FAX .. /�/�; CONTACT NAME f -. PHONE ' t( _ E-MAIL,...... _ (! - - STREET ADDRESS CITY, STATE, ZIP - FAY KOWNER Mr OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECTS ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL _ FAX . STREET ADDRESS - CITY, STATE, ZIP PHONE - - - ARCHITECUENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL. FAX STREET ADDRESS CITY, STATE, ZIP -. - PHONE - USE OF SFD of DUPLEX ❑ MULTI -FAMILY BUILDING: ❑'. COMMERCIAL PROJECT IN WILDLAND ❑ YES URBAN INTERFACE AREA NO PROJECT IN ❑ YES. FLOOD ZONE ❑ NO IS THE BLDG AN EICHLERHOME? ❑ YES ❑ NO DESCRIPTION OF WORK ,Ca/ ;G,0, /OD a.►� o Od ap, Serv:c eo e - a ete- /`!! a C e A C2ee. ah el qlA m &di �/`C/, G i1t Gem TOTAL VALUATION: IiEGEIEDBi By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on th pro e 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 accur e. gree to comply with all applic ible local ordinances and state laws relating to build* construction. I authorize rep ntatives of pertino to enter the above-identified—property for inspection p oses. Signature of Applicant/Agent: ;Date: SUPP MENTAL INFO ON REQUIRED OFFICE IisE a MEPMscApp_2011.doc revi ed 06/21/11 �v OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 9 FAX (408) 777-3333 • building aQcupertino.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the improvements specified at: SITE ADDRESS b �y�a i j jam• d 7APN / l� BP# �� p� h� OWNER NAME ,J h n h OWNER ADDRES O Z�c4TdUACC , . DESCRIPTION OF WORK: Ia s+, Zoo cr �o �D .SCrUi We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make) your responsibilities and possible risk you may incur by having this permit issued in your name as the Owr will not 'issue a building permit until you have read, initialed your understanding of each provision, returned this form to us at our official address indicated. An agent of the owner cannot execute this r 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 informG y-4, A01. I understand a frequent practice of unlicensed persons is to have the property owner obtain an " Builder" building permit that erroneously implies that the property owner is providing his or her own labc personally. 1, as an Owner -Builder, may be held liable and subject to serious financial risk for any injurie an unlicensed person and his or her employees while working on my property. My homeowner's insure provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits insurance coverage for, injuries to workers on my property. I understand building permits are not required to be signed by property owners unless they are the construction and are not hiring a licensed Contractor to assume this responsibility. ±3. I understand as an "Owner -Builder" I am the responsible party of record' on the permit. I underst protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in name instead of my own. 4.. 1 understand 'Contractors are required by law to be licensed and bonded in California and to list numbers on permits and contracts. LL5.1 understand if I employ or otherwise, engage any persons, other than California licensed Contre total value of my construction is at least five hundred dollars ($500), including labor and materials, I ma 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 t federal government, withhold payroll taxes, provide workers' compensation disability insurance, and co unemployment compensation for each ."employee." I also understand my failure to abide by these laws me to serious financial risk. I understand under California Contractors' State License Law, an Owner -Builder who builds sini residential structures cannot legally build them with the intent to offer them for sale, unless all work is p licensed subcontractors and the number of structures does not exceed four within any calendar year, o is performed under contract with a licensed general building Contractor. 4 �d. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be 1 - any any financial or personal injuries sustained by any subsequent owner(s) that result from any latent com defects in the workmanship or materials. Owner B'uildei-Fornrr. 2010. aware of Builder. We Ined, and ;e unless IN and material sustained by ice may not Df my ;sponslble for nd that I may is or her heir License ;tors, and the be e state and tribute to nay subject le -family rformed by all of the work :ld liable for :ruction revised 04114/10 9. 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 www.cslb.ca.gov for more information about licensed contractors. 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. 1. I agree that, as the party legally and financially responsible for this proposed construction activi y, I will abide by all applicable laws and: requirements that govern Owner -Builders as well as employers. � 2. I 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 proteci 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 L nlicensed 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 obtain 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 covera e. 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 p rmit 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' 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 nat re. Property Owner's Signature: �•-w Date-- PWI�o M, ----------------------------------------------------------------------------------- ----------------------------- --- - ------------ agent - -- - (NOTE: The following Authorization Form is required to becompleted by the property owner only when des ;a- ting an agent of the property owner to apply for a construction permit for the Owner -Builder). TION OF AGENT 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 necessaryo 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 I declare under penalty of perjury that I am the property owner for the address listed above and I personally flied 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 pr perty owner's signature. Property Owner's Signature: Date: OlvnerBuildeTF'077n 2010.do� revised 04114110 A SMOKE I QMHON'10'NOMDE ALARMS RU OW CER FICA -i -,,E "OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT, BUILDING DIVISION t V V 10K TIN 0 10300 TORREAVENUE -CUPERTINO, CA 95014-3255 '(408) 777-3228 FAX','(4'08) 777-3383 ► buildingCcDcuperflno-org VVRPOSA, n-isaffidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections are required. GtN tRAL INVORMATION Existing single4amily 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 $1090.00, CRC Section X314 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 , s-WKE ALARM CO ALA Outside of each separate sleeping area in the immediate vicinity of the bedroom (s) X On every level of a dwellin&, unit including. basements X X Within eacla sleeping roorn I - X Carbon Monoxide alarms are not required in dwellings- which', do not contain fu -el -bun ing appliances and, that do not Naive an, attached garage. Carbon monoxide alarms combined with smoke ,oke alarmis shall comply with CBC Sections 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply: in. dwelling units with, no commercial power sup -ply, alarm(s)i,,nay be sollelybaiu,'erypeated. ra In existm& dwelling, units, alarras are permitted to besolelybattery operated where repairs or alterations do. not res,- uAt 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 83114 and CBC Sections 90,7.2.11.4 and 420.1.6.2. An, electrical perm -ft is required for afaxi; ns which must be coru, Lected to the building wiring. As owner of the above-referelaced property, I hereby certify that the alarin(s) referenced abovehas/have, been, installed in, accor daa, Lce with the manufacturers instmctions 2 an -d in compliance with the California ui d, and California Residential Codes. es. T h,e al. ax m- s have been tested aart d are operational, as of the e date s igil e d below. L_ t Wil e -1 -Al" haveread and ar-e tor�n W 0 ......... .....P HCXq�_j C.d............... ..... C57 LLS19hat6-F6, ............. . ...._.... ......... Lica......................... ............ ....... CUPERTINO Owner N Address WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE CUPERTINO, CA 95014-3255 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. P< 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. " 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. Pq 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. JK 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 properly. 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-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 perjury that non-compliant plumbing fixtures will be replaced prior to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101,1 through 1101.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's installation requirements, and that the water -conserving plumbing fixtures comply with the requirements as indicated in the table on the following page. s IOwner or Owner Agent's Signature: �a J` 0��-f �� Date: a 1_4/2eZ(_ Upon completing and signing this Certrti icate, please return i to the Building Division in order to final your building permit. SB407 2015. doe revised 08/26115 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.doe revised 08126115 Non -Compliant. Water -Conserving Plumbing Fixture Plumbing Fixturel (Fixture Complying with Current Code Applicable to New Construction) Fixture Type Maximum Water Usage/Flow Rate 2013 CPC Ch. 4 2013 CPC Ch. 4 2013 CPC Ch. 4 Water Usage /Flow Rate 2013 CAI -Green Div. 4.3 2013 CALGreen Div. 4.3 2.013 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 commonand public use areas: 0.5 gallons per minute ,@ 60' psi 1.8 gallons per minute 60 psi Faucets — Exceed 22 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.doe revised 08126115