B-2016-2263 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2263
22069 WALLACE DR CUPERTINO,CA 95014-0127(326 02 039) 7&K ROOFING CO
MILLBRAE,CA 94030
OWNER'S NAME: PARCEL JAN DATE ISSUED:07/05/2016
OWNER'S PHONE;408-857-7727 PHONE NO:(415)681-4307
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class ROOFING Lic.#765115
Contractor J&K ROOFING CO Date 96/30/2017 X BLDG ELECT X PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencingMECH 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:
REPLACE 40 GALLON WATER HEATER-GARA 3E
I hereby affirm under,penalty of perjury one of the following two declarations:
i. 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.
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:$4600.00
APPLICANT CERTIFICATION
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 326 02 039
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 re lations per the Cupertino Municipa�Code, ection 9.18. 180 DAYS FROM LAST CALLED SPECTION.
�-� Date (�(( Issued by:AbbyAyende
Date:07/05/2016
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
i. I,as owner ofthe properly or my employees with wages as their sole installed without first obtaining an inspection,I agree to ren iove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec7044,Business&Professions Code)
2. 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:
I hereby affirm under penalty of perjury one of the following three declarations: AL •ROOF COVERINGS TO BE CLASS"A' OR BETTER
i. 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 D S L SURE
2. 1 have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements un er 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 25505,25 33,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Coi e,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 stor or handle hazardous
material. Additionally,should I use equipment or devic s which emit hazardous
shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quali Management 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 25505,255 ,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:
certify that I have read this application and state that the above information is CONSTRUCTION LENDING A SCY
correct.t 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,Ci C.)
to enter upon the above mentioned property for inspection purposes, (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATIO
Code,Section 9.18. 1 understand my plans shall be used as public records
Licensed
Signature Date Professional
y
GENERAL PERMITLI TEON
11P7�
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING=
DIVISION I EP
10300 TORRE AVENUE e CUPERTINO,CA 95014-3255
ECIC RT[NO=
(408)777-3228 a FAX(408)777-3333 m building(c)cupertino.orgI S C
r1l � . 6�
PLUMBII�iG ❑IMECHA?vICAL ❑ELECTRICAL ❑MISCELLANEOUS t.11
PROJECT ADDRESS APN 01 031
OIVNERNAME - I PHONE E-hi It
STREET ADDRESS CITY, STATE,ZIP FA,1
CONTACT A'FVE PHONE E-MAIL
S
STREET ADDRESS CITY,STA E,ZIP FAX
k2o �dr IONC C '? V 13
❑U�VT'ER ❑ OWNER-BUILDER ❑ 01AWER.AGENl' ❑ CONTRACTOR P CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVEL PER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC
COMPANY NP.NlE �J !�f� y7 E-MAIL
�` `QAr
- 4a
STREET ADDRESS CITY,ST - E,ZIP PHONE
OGvY3c �n �f C-�C�Y Z
ARCI TECT/ENGINEER N:�ME LICENSE NUMBER I BUS.LIC 3
COMPANY N?AAE E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT n\\VILDLAND ❑ YES PROJECT RA ❑YES I IS THE BLDG AN ❑1'ES
BL'ILDNG: ❑COMMERCIAL ' URBAATINTERFACEAREA ❑ NO FLOOD ZONE ❑N0 EICHLERHOME' ❑ NO
DESCRIPTION OF WORK
TOTAL VALUATION:
RECEIVED B3
By my signature below,I.certify to each of the following: I am the property owner or authorized agent to act on the property ov ner behal I have re ad this
application and the information I have provided is coirect. I have read the Description of INIork and verify it is accurate. I agree to comply with all app icable local
ordinances and state laws rel ing to building construction.. I autho s ntatives of Cupertino to enter the above-identified property for inspectior purposes.
Signature of Applicant/Agent: Date: L(p
SUPPLEMENTAL INFORMATION REQUIRED
' OFFICE LSfi ItLI;;
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A1EPAliscApp_2011.d00 rel ised 06121111
SMOKE / CARBON MONOXIDE.ALARMS
MR
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPE1 T1t4CS 10300 TORRE AVENUE CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildingC&-cupertino.org
Permit No.
Address � ,y' /1'x'p r, �ta-�� #of Alarms Smoke Carbon Monoxide
(y..
PERMIT CANNOT BE FINALED AID COMPLETED UNTIL THIS CERTIFICATE
.\ EN SI
.. ., � $FT_LtI�D8 BUILDING SIOI�T \ ,
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 interior access for
inspections are required.
I
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.ever .level of a dwelling unit including basements X X
Within each sleeping room X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply:In dwelling units with no commercial power supply; alarm(s)may be solely battery operated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic,basement or crawl
space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2.An electrical permit is required for
alarms which must be connected to the building wiring.
As owner of the above-referenced property,I hereby certify that the alarm(s)referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes.The alarms have been tested and are operational,as of the date signed
below.
1 have read and agree to co ply with the erms and conditions of this statement
Owner(or Owner Agent's)Name:
-S ...Date:
.
Contractor Name:
Sinature...................................................................Lic.#......................................Date: ...................
Smoke and COform.doc revised 03/18/14
i
I
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE zs �lll�A
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
UPERTINCl
(40 777-3228• FAX(408)777-3333•buildingC7a cupertino.orQ
Owner Name `��'-a �Tza2�
Permit No. _
Address
1. Is your real property a registered historical site?
❑ Yes . Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
No Go to Question 2.
2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the property or its j
plumbing,installation of water-conserving plumbing fixtures is not technically feasible?
Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Jepe,,41' 0:-7
The licensed plumber's certification has been provided to ffie Building Division.
��! .
Skip the rest of the form and sign bottom of
form.
No Go to Qudistion 3.
3. Is water service permanently disconnected for your building?
ElYes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
I` 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.
[ 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 residbntial real property. See Civil Code Section 1101.4.
Ori 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).
0 My property is a multifamily residential real property. See Civil Code.Section 1101.5;
On and after January 1,2014,specified building alterations or improvements shall require non-compliant
plumbing fixtures to be replaced with water-conserving plumbing fixtures.
On or before January 1,2019,all non-compliant plumbing fixtures shall be replaced with water- .
conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or
improvements).
❑ My property is a commercial real property..See Civil Code Section 1101.5.
On and after January 1,2014, specified building alterations or improvements shall require non compliant
plumbing fixtures to be replaced with water-conserving plumbing fixtures.
On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving
plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvements).
1,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 thatthe water-conserving urrbing fixtures comply with the requirements as indicated in the
table on the followin age. 1 y
Owner or Owner Agent's SignaturDate:
e:
Upon completing and signing difsZert4icate,please"return it to the Building Division in order to final your Vailding permit.
SB4072015.docrevised 08126115
BI7ILDING PER7VIIT CANNOT BE FIN
AND CO1VIl'LETED UNTIL THIS
CER'I'�TCA�'E HAS�BEEN� �AND RF�T,TTRTFI�TO THE:BUItLDI.NG,DIVISION
Non-Compliant Water-,'Conserving Plumhing�Fixture ' j
Plumijin Fixturel : (Fixture Complying.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 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
Gallons/flush 0,5 gallons/flush
Showerheads Exceed 2.5 2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of
- u gallons per mii,iute— °-. —EPA WaterSense-Speesficadon-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 oniv 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 i
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 gailbns 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.
58407 2015.doc revised 08/26115