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B-2016-2303 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2303 10189 VICEROY CT APT 3 CUPERTINO,CA 95014-0935(326 15 118) PACIFIC CONSTRUCTION& DESIGN CALABASAS,CA 91302 OWNER'S NAME: ITEM ROBERT W AND KIMBERLY A TRUSTEE DATE ISSUED:07/12/2016 OWNER'S PHONE; PHONE NO:(818)880-1466 LICENSED CONIRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lic.#1008104 Contractor PACIFIC CONSTRU TION&DESIGN Date 10/31/2017 X BLDG ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH X RESIDENTIAL T COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: UNIT 3-REMOVE FLOORING AND INSTALL WATERPROOFED I hereby affirm under penalty of perjury one of the following two declarations: FLOORING;REMOVE AND REPLACE DRY ROT;INSTALL NEW 1. I have and will maintain a certificate of consent to self-insure for Worker's COLUMN AT STAIR UPPER LANDING WITH FOOTING;RE ATTACH Compensation,as provided for by Section 3700 of the Labor Code,for the RAIL PER CODE performance of the work for which this permit is issued. 2./ I have and will maintain Worker's Compensation Insurance,as provided for by Xv!/ 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 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 32615 118 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 stathis permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR . Additionally,the applicant u nds and will comply with all non-point , source regulations pe upe ' unicipal de,Section 9.18, 180 DAYS FROM LAST CALLED INSPECTION. AS Date ° lZ / Issued by.Abbyyende Date:07/12/2016 Oq w OWNR-B 1n D R ARATION 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 1. I,as owner of the property,or my employees with wages as their sale 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(Scc.7044,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: ALL ROOF COVERINGS TO BE CLASS"A"OR 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 MATERIALS DISCLOSURE 2. 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 Section 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 permit is issued. maintain compliance with the Cupertino Municipal Code,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 store or handle hazardous 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 M ' ' al Code,Chapter 9,12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sectio 05,2 ;an3� d25;5 3;i. Labor Code,I must forthwith comply with such provisions or this permit shall � be deemed revoked. Owner or authorized agent: _ APPLICANT CERTIFICATION (--Date: "/2,i.6 ` 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 and will comply with all non-point source regulations per the Cupertino Municipal ARCHITEC S DECLARATION Code,Section 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINC (408)777-3228• FAX(408)777-3333•build inp(d)cupertino.org ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI R REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS / n r? P re � /�4� �3 APN# � (�e - IS )��1 PHONE OWNERNAME (/J j(J�(LI f MAIL STREET ADDRESS/d/ P J CITY,STATE,ZIP �`?� V � Ct��®�/e l G ✓yt, G CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP ��o/ e �i✓o'NC/f�',!�'t2 �� o C®9M/, FAX ❑OWNER ❑ OwNER-BUIIAER ❑ OWNERAGENT ❑ CONTRACTOR [:]CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME i ,SENSE NUMBER ®® A f�Gp LICENSE TYPE A BUS.LIC# J� �O COMPANY NAME /fJ Q 6 `/�•J /� R FAX [� l �✓ — /v Cr- T y E-MAIL i/�64 �t �3 G C� M�1s/`e STREET ADDRESS CITY TE ZIP PHONE 4 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# ®ail _X4 B 3 '. COMPANY NAMEg E-MAIL //� FAX tt O .er',d �>o..A/.6e STREET ADDRESSyP9 / CITY,STATE,ZIP/p��/ r�G a PHONE ADDRESS,.,/ e'/1/� y/y7� I vNe L/'a ® DESCRIPTION OF WORK r /^* tar-lb W EXISTING USE PROPOSED USE CONSTR TYPE #STORIES JV* Atria rpt—r• �e/I USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO ✓ TOTAL AREA. AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCHAREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: EI DETACH /,;,-o QATTACH #DWELLING UNITS: ISA SECOND UNIT ❑YES SECONDSTORY ❑YES BEING ADDED? ❑NO ADDITION? ❑NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES CENED$ T CAL PLANNINGAPPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? NO M�gg�r By my signature below,I certify to each of the follow' am weer or authorized agAnt to actlon the property owner's behalf. I have read this application and the information I have provided" act ave read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to build' ns on. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant7Agent: Date: / � l SUPPLEME AL INFORMA'T'ION REQUIRED � 'PLANGHECK�I'YPE ROtJ7INGSLIP - New SFD or Multifamily dwellings: Apply for demolition permit for ❑;;©VER THE COUATER ❑ BUILDING PLAN KEl'IEW existing building(s). Demolition permit is required prior to issuance of building permit for new building_ ❑_ xrREss�F�� ❑ PLANNING PLAN REVIEW Commercial Bldgs:s: Provide a completed Materials Disclosure II$LLG fl's NDARD ❑fl g mp `WDRES form if any Hazardous Materials are being used as part of this project. i ti LARGE TIRE DEPT l _Copy of Planning Approval Letter or Meeting with Planning prior to ❑;'11fiA�OR ° y,w., ❑ SANITARYSEWER DISTRICT., submittal of Building Permit application. L T_E 'IRONMENTAL,11;ALTRz, f BldgApp 2011.doc revised 06121/17 r ga , LIE 1008104 Tip all city and county offices,. T1 letter is a written author natio .for ose Fernandez to"subit plans,pull permits,and'obtain;a cite license as H ell as sign all:,docuine-ats far the hone improvement projects on behalf of MY company; If you have any.questions,ple sc do not hesitate tai call the office at the number listed above, Sine y, i pACIRC CONSTRt.JMO 868- I8-0ItS 38660 LEXINGTON ST*SUITE.572 REI IOTNT,CA 94536 5626 LA8 VIRG NES Iy.MSVITE 25'�CALABASAS,CA 1302 SMOKE I CARBON MONOXIDE'ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT•6UILDING DIVISION CUPERTU40 10.300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228-FAX(408)777-3333• building(akupertino.org Address 0 ;7it No. r��$� �� � � � - #of Alarms Smoke QJ Carbon Monoxide: I �j . �e T CANNOT Bk FIM, LEI)AND,COMP E EI?UNTIL 1,111S-CE, RTIFICATE ,y, HAS BEEI Si "lel +" � R Ei RI'�D fl,THE BL)� IN ISI IS ON 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 CSC 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 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 01 erated 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 comply with the terms and conditions of this statement Owner(or Owner Agent's)Name: /�/ ®d" d Si nature,;7.. 9,. . ......Date: .�1.".°-�A Contractor Name:JD v � �' l Phi nature......................... Lic.# .��.../;✓: .........Date: .. . Smoke and CO fonn.doc revised 03118114 WATER-CONSERVING PLUMBINFIL EG FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUP RTINO 10300 TORRE AVENUE• CUPERTINO,CA 95014-3255 r 10 08)777-3228•FAX(408)777-3333•building(cD_cupertino.org Owner Name j Permit No. -2 Address ld1 'V cfw 6 '43 m �a-'6 Z- � 1. Is your real property a registered historical site? Yes Civil Code Sections 1101.1 through 110 1.8 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? ❑ 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. )1 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. 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. X/ 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. 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 Civil Code Section 1101.5. l 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 1101.15. 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. Owner or Owner Agent's Signature: Date: l 1b Upon completing and signing this Certificate,please return it to the BuildingDivision in order to final your building permit. SB407 2015.doc revised 08126115 y � ,DING FEJ�'t OAl�TI�OT BE IN�LED AND COMPLETED UN TMS ICA � Lla1F ., A �0 N®naCrnpliant Water-Conserving Plumbing.-Fix "re., : - Plumbing Fixturel (Fixture Complying with Current Code Applicable to New Construction) MaXljrnq­,.et-Usa e/Fl6wRate z., _ Fixture Type 2013 CPC Ch 4 2013 CPC Ch.4 2013 CPC Ch. 4 Water Usage mattee 2013 CALGreen Div.4.3 2013 CALGreen Div. 4.3 2013 CALGreen Div. 5.3 /Flow Single-Family Multi-Family Commercial ResidentialResidentialWater 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 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 @ 00 psi psi Faucets May temporarily increase Mayltetnporarlly 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 @ defalult,to maximum 60 psi 1.8 allons per minute Where faucets meeting @ 6% psi the above are unavailable, Whore faucets meeting aerators or other means thebove 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.doe revised 08126115