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B-2016-2309 CITY OF CUPERTINO BUILDING PERMIT BUIL,DINGADDRESS: CONTRACTOR: PERMIT O:B-2016-2309 20422 VIA PALAMOS CUPERTINO,CA 95014-6330(316 01 187) P W D-NORTHERN CALIFORNIA RETAIL INC LOS ALTOS,CA 94022 OWNER'S NAME: CALDWELL BARBARA AND HANSEN RONALD T TRUSTE DATE`13 UED:07/13/2016 OWNER'S PHONE:408-390-1406 PHONE NQ(51.0)292-2920 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lic.#939798 Contractor P W D-NORTHERN CALIFORNIA RETAIL INC Date 11/30/2017 X BLDG —ELECT _PLUMB _ T _ I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL OMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: REPLACE DOOR;LIKE FOR L KITCHEN 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. l `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:$9567.44 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: Occupanc r Type: and state laws relating to building construction,and hereby authorize 31601 187 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,c s,and expenses which PERMIT EXPIRES H WORK IS NOT STARTED may accrue against said City in co equen f the granting of this permit. WITHIN 180 DAYS PERMIT IS, UANCE OR Additionally,the applicant under a ds will the with all non-point source regulations per the C no unicipal Code,Section 9.18. 180 DAYS FROM LA T CALLED SPECTION. Sin tune - Date 7/13/2016 Issued by:Abby Avende Date:07/13/2016 ,2 OWNER—OWNER-B DER L TION I hereby oJmAeasons: at I am exempt from the Contractor's License Law for one of the ?­ROOFS: following All roofs shall be inspected prior to a ay roofing material be' g installed.If a roof is 1. 1,as owner of the property,or my employees with wages as their sole installed without first obtaining an ins jection,I agree to remc ve all new materials for compensation,will do the work,and the structure is not intended or offered for spection. sale(Sec.7044,Business&Professions Code) 2. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:7/13/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERING TO BE CLASS"A" R 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 M TERIALS DISCL SURE 2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materi is 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 Cod ,Sections 25505,25533,and 25534. I will maintain compliance with the Cup rdno Municipal Code,Chapter 9.12 and the permit is issued. s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 2 532(a)should I store r handle h ardous material. Additionally,should I us equipment or devices whi azardous shall not employ any person in any manner so as to become subject to the air contaminants as def-coed by the ay Area uali a ement District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the upertin ni ' ode,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Cod�Se 553.3,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall r� be deemed revoked. owner or authorized agent: APPLICANT CERTIFICATION {Date:7/13/2016 I certify that I have read this application and state that the above information is N N LENDING A E -Y I hereby affirm that there i a ns ruction lending agency for the performance correct.I agree to comply with all city and county ordinances and state laws i relating to building construction,and hereby authorize representatives of this city of work's for which this p r it is is 3ued(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 AR HITS T' DE LARATI Code,Section 9.18. 1 understand my plans shall be us d as public records. Licensed Signature Date 7/13/2016 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 �B (408)777-3228•FAX(408)777-3333•building((Dcugertino.org DNEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS �(��`� �� `/� r APN# OWNERNANIE J�PHONEAL EVMAIL.... .. STREET ADDRESS CITY, STATE,ZIP FAX CONTACT NAME(/ - 4^I� I PHON)s� _. o� E-MAIL V-50 CoN STREET ADDRESS a xCITYSTATE, `� p q / FAX , CIR El OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR /CONTRACTOR AGENT ElARCHITECT ElGINEER 11DEVELOPER 11TENANT CONTRACTOR NAME?L D i ^ q� ICENSE NUMBq �� LICENSE TYPI, BUS.LIC# COMPANY NAME ! !� E-MAIL`� FAX STREET ADDRESS i p l�(� W g CITY,STATE,ZIPS �40r, q L.j I PH r �' a ARCHITECT/ENGINEERNAME �-V LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR-TYPE 1 #STORIES �. USE TYPE OC 13. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN - OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECKAREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ATTACH #DWELLING UNITS IS A SECOND UNIT ❑YES SECOND STORY []YES BEINGADDED? ❑NO ADDITION? [:]NO PRE-APPLICATION E]YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES -DOLED$Y' y✓s" TO VAL ATI N: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO .� - �'" By my signature below,I certify to each of the followm the erty owner or authorized agent to act on e property o er's behalf. I have re d flus application and the information I have provided is co ct. read the Description of Work and verify it is accurate. I afire to comply with all app icable local ordinances and state laws relating to building co c authorize representatives of Cupertino to enter the above-identifie property for inspectioi L purposes. Signature of Applicant/Agent: w Date: SUPPLEMENT ATION REQUIRED PiANGIIEi7IPE IiouTii+i 'silt" � r _New SFD or Multifamil Wellings: Apply for demolition permit for D`OvER THE COUNTER D BU[I✓AINGPLAN YiEw existing building(s). Demolition permit is required prior to issuance of building permit for new building. L7 xrRE s ' © PLANNING PL itcEw 13 If Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STAND RD ❑ �IiHLlcwotrKs ,. form if any Hazardous Materials are being used as part of this project. "r LARGE'';'. FIS DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ©,-1VIAJOR, " ❑ ShNITARYSEW RDISTI2ICT submittal of Building Permit application. a ❑' I;ISTVHtONMENT'I,HEALTH 1dgApp_2011.doc re ised 06121111 FIL7 SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT•BUILDIN`G DIVISION CUP RTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 I (408)777-3228 FAX(408)777-3333®building(a)-cupertino.org 7-307 �Adalress=26q-z� Smoke: S ,—CarbariMorioxide- PURPOSE This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R31.4,2013 CBG 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 8314 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 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 ih 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 907:2.12:4 and-42�6:2:An el�ctrical-Term t-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 comply with the terms and conditions of this statement Owner,(or Owner Ageennt's)N me: t -Signature .............. .. .. . ........ ......... ...........1..Date: ........ .......... Contractor Name: Signature...................................................................Lic.#......................................Date: ................... Smoke and CO form.doc revised 03/18114 WATER-CONSERVING PLUMBING FIXTURES Lj FIL OWNER CERTIFICATE OF COMPLIANCE g 16116 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION tJ 'E1 -I�1TC 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 ( 7 322$ AX 40$ 7 7-3 wild' cu ertino.or Owner Name & rA ( C,� /` Wermit No.15 701(P Z 3 ' Address� �� V 1 G( ��a i �S G�''s�1 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. VNo 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? ED 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. Isater service permanently disconnected for your building? V6 es 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 4. 4. Is your real property built and available for use or occupancy on or before January 1, 1994? 5 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. El 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 propertyis a single-family resid6ntial 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). ❑ My property is a multifamily residential real property. See Civif Code Section 1101.5. On and after January 1,2014,specified building alterations or improvements shall require non-compliant plumbing fixtures-to be.replaced ver-ith_water-conseruino plumbing.,fi tures.-——_ - — r ---�,-,_ 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 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 Signature: Date: Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit. SB407 2015.doc revised 08126115 BUILDIJVG PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS �CEt2IFZCA°fiES SEN AND `T1RN "SV,LT�I3ING DIVI SON mp Non-Compliant Water=Conserving Plumbing°Fixture Plurnhing Fixturel . , (Fixture`Complying.with Current Code Applicable to New Construction) Maximum Water Usage/Flow a/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 Exceed1.6 Single flush toilets: 1.28 gallons/flush (Toilets) Gallons/flush Dual flush toilets: 1.28 gallons/flush effective flush volume (the composite, Urinals Exceed1.0 average flush volume of two reduced flushes and one full flush ' Gallons/flush 0.5 gallons/flush i Showerheads Exceed 2.5 " 2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of — gallons per mii-iu `-.S--E-PA 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 - ---- -50 psi--- .__ __ ---- .-'1:i3"gaiions-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 2015.doc revised 08/26115