B-2016-2297CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:I
CONTRACTOR:
PERMIT NO: B-2016-2297
10247 VISTA KNOLL BLVD CUPERTINO, CA 95014-1033 (326 13 129)
A R S AMERICAN
RESIDENTIAL
SERVICES OF
CALIFORNIA INC
MEMPHIS, TN 38120
OWNER'S NAME: HELVEY R CURTIS AND WANG EVA M C TRUSTEE
DATE ISSUED: 07/12/2016
OWNER'S PHONE: 408-736-0450
PHONE NO: (901) 271-9700
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class GENERAL FNGINEERING CONTRACTOR Lic. #Z65-155
ContractorA R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC
X BLDG —ELECT X PLUMB
—
— MECH X RESIDENTIAL— COMMERCIAL
Date 07/31/2018
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
JOB DESCRIPTION:
license is in full force and effect.
INSTALL (1) PROPERTY LINE CLEAN OUT
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.
I have and will maintain Worker's Compensation Insurance, as provided for by
Sq. Ft Floor Area:
Valuation: $8095.00
ection 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT ICANT CERTIFICATION
I certify that I have read this application and state that the above
Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
3
326 13 129
26
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 indemnify and keep harmless the
PERMIT EXPIRES IF WORK IS NOT STARTED
City of Cupertino against liabilities, judgments, costs, and expenses which
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
may accrue against said City in consequence of the granting of this permit.
Additionally, the applicant understands and will comply with all non -point
180 DAYS FROM LAST CALLED INSPECTION.
source regulations per the Cupertino Munici od_ e_. Section 9.18.
wx
Issued by: A
Signature , Date 07/12/2016
Date: 07/12/201
OWNER -BUILDER DECLARATION
RF. -ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of the
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
following two reasons:
1. I, as owner of the property, or my employees with wages as their sole
inspection.
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business & Professions Code)
Signature of Applicant:
2. I, as owner of the property, am exclusively contracting with licensed
Date: 07/12/2016
contractors to construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I hereby affirm under penalty of perjury one of the following three declarations:
r. 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
HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued.
I have read the hazardous materials requirements under Chapter 6.95 of the
2. I have and will maintain Worker's Compensation Insurance, as provided for by
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
Section 3700 of the Labor Code, for the performance of the work for which this
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle, hazardous
permit is issued.
3. I certify that in the performance of the work for which this permit is issued, I
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
shall not employ any person in any manner so as to become subject to the
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
Worker's Compensation laws of California. If, after making this certificate of
the Health & Safety C de, Sections 25505, 25533, and 25534.
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
Owner or authorized agent:.
be deemed revoked.
Date: 07/12/2016
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
Lender's Name
to enter upon the above mentioned property for inspection purposes. (We) agree
to save indemnify and keep harmless the City of Cupertino against liabilities,
Lender's Address
judgments, costs, and expenses which may accrue against said City in
ARCHITECT'S DECLARATION
consequence of the granting of this permit. Additionally, the applicant understands
I understand my plans shall be used as public records.
and will comply with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
Licensed
IERAL PERMIT APPLICATION
GEK
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION MEP
10300 TORRE AVENUE o CUPERTINO, CA 95014-3255
CUP'~RTENOsc (408) 777-3228 - FAX (408) 777-3333 e building(akupertino.org
L.PLUNIBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANTEOUS
PROJECT ADDRESS � 1 )P„� � � � n� � u� APT. ,. -3
OWNERNAAg t PHONE _ �- E-MAIL
STREETPDDRESS q /'� {/,^m // / CITY, STATE, ZIP.
FAX
CO TACT NAM!, PHOT ®� 'L�z-Cg0,C E-NiAILT 'Cr/�%�TIFAX�,I S WL�� Q��S -t
STREET.4DDRES 230. Y v • CITY, STATE, ZIP Qr c CA -q �/ 3 r
❑ OWNER ❑ C MNER-BUILDER ❑ OWNERA.GEN'T XCONIRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CO- T R NAM
cc,�(s1�r
oy
LICENSE NUMBS
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LICENSE YPE
BUS. LIC
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COMPANY NAME
E -MAID
Coo,
FAX
STREET DRESS
30� �� U
CITY, STATE, ZIP
S o� , CA ` F/3/
PHONE
o - 17 � ay `r �
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC 4
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX ❑ MULTI-FAMILYI PROJECT LN WILDLAND ❑ 1'ES
BUILDING: ❑ COMMERCIAL � URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ YES I
FLOOD ZONE NO
IS THE BLDG AN ❑YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK 9ro-o
TOTAL VALUATION: <KO
By my signature below, I. certify to each of the following: I am the property orized agent to act on rty ea�this
application and the infonnation I have provided is correct. I have read the Description of Work and verify it is curate. � ee t mply with all appliordinances and state laws r ating tobuildinP ction. I authorize representativ s of Cupertino to enter the abo -den ` properly for inspection
Siarrature of ApplicanbAger Date:
T
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE' USE OIvLI '
C a .2 y Y
EaPRE$S z • fi '
r� 2-114
U
A,fEPAlfisc-4pp_2011.doc revised 06121/11
:CARBON MOROXXIDE ALAARMS
MO E It,
OWNL. CE FICATE OF GOMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT - 1BUILDINGDIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - buil-ding.(d)-cupertino.orci
FURPOST
n -us affidavit is a self -certification for the installation stallation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R814, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
inspections are required,
GENERAL M -FORMATION,
Existing single-family and multi -family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When en the valuation of additions, alterations, or repairs to existing dwelling units exceeds
$I00D.001 CR.0 Section R,314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarrns, and/or Carbon
Monoxide Alarms be installed in the following locations:
AREA SMOKE AIURU CO, ANE AFM
Outside of each separate sleeping area in the immediate vicinity of the X
On every level of a dwelling, unit including basements X
X
Within each slee2ing, room t
X
Carbon, Monoxide alarms are not reqn-ired in dwellings which do not contain fuel -burning appliances and that
dortqtHave aRattached ga-rage . Carbonriftoitoxid!eal,,arfnscombinedwith-.smokeatTarm'sslriaITcom.,Plywith,,
CIC Section 429.6 and shall be approved by the Office of the State Fire Marshal.
Power Size pyha dwelanitswithRo,com,mercia'lpowersupplyalarm(s)ll,naybesalelybatteTyoperated.4g
In exisfinmg, d1weffi-ng, winds, alarms are permitted to be solely battery operated where repairs or alteraioyrjsd
not result inmthe rem, -,oval of waflaiald ceill'ijrL,,g.f,i,,n;isl�esox there is no access bymeans of attic, basement or crawl,
space. Refer to CRC' Section 1 3314 airA CBC Sections tiorts, 907.2.11.4 and 420.61-2. An electricalperimit is required for
a1arinswhlich, must be coimected, to the building wiring.
As owner of the above-referelitced property, Illereby certify that the alarm(s); referenced above has/have been
installed in accordance withl, the mnanufactumrier's instructions aiftd in compliance with the California igdi, 7
in,. -
and Cafifon-%ia Residential Codes;. The alarms: have been tested and are operational', as� of the date signed
below.
I
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
CUP'ERTINO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildino -cuper ino.oro
Permit No.
1. Is your real property a registered historical site?
El 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
plumbing, installation of water -conserving plumbing fixtures is not technically feasible?
El 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.
Zyo Go to Question 3.
3. Is water service permanently disconnected for your building?
El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
LkNo Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
El 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:
lik Myproperty •is asingle-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). -
El' 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
unprovements).
❑ Myproperty 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 110 1. 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.
Owner or Owner Agent's Signatu'r, e Da#
Upon completing and signing this Certificate, please return it to the Building Division in order to final your building permit
SB4072015.doe revised 08126115
CVPERT>INO
PURPOSE
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.org
PERMIT CANNOT BE FINALED UNTIL THIS CERTIFICATE HAS BEEN
COMPLETED, SIGNED. AND RETURNED TO THE BUILDING DIVISI
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.
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 bedroom(s)
X
X
On every 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 specified below have been tested and are operational, as of the
date signed below. ,y
Address: AV,4V? !/;cna Permit No. ' 016 --,;t 11
Specify Number of Alarms: # Smoke Alarms: # Carbon Monoxide Detectors:
I have read and agree to comply with the terms and conditions of this statement
Owner (or Owner Agent's) Name:
Signature. Date:
,rUR�i JS"
R i RFI _
. .. . ,
Contractor Name:
Signature.................................................................. Lie.# ...................................... Date:
Smoke and CO form. doe revised 09/27/16
CUPERTINO
Owner Name/
Address
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) 777-3333 • building(cDcupertino.orq
'e-$
0, C4 95vi
-;Z01 6. 2 2-17
Please refer to the attached California Civil Code Sections 1101.1 — 1101.8 which are part of this Certification form.
1. Is your real property a registered historical site?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form.
Owner' Signature: Date: -7////:2W :2W 7
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.
Sign below and skip the rest of the form.
Owner' Signature: /� 4A 14=4 � _ Date:
KNo Go to Question 3. "/7 /
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:
No Go to Question 4. /
Date: 7//, I 1,0-t -?
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. Sign below and skip the rest of the form.
Owner' Signature: Date:
rYes 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.
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).
❑ 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.
SB407 2014. doc revised 03118/14
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).
UWe, the owner(s) of this property, certify under penalty of perjury that non-compliant plumbing fixtures have been replaced
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 below.
Owner's (or Owner Agent's) Signature: Date: '?Ll Z,Lt ?
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.
SB407 2014. doe revised 03/18/14
Non -Compliant
Water -Conserving Plumbing Fixture
Plumbing Fixture
(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
/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
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.
SB407 2014. doe revised 03/18/14