B-2016-2376 CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: CONTRACTOR: PERMIT NO:B-2016-2376
6701 JOHN DR CUPERTINO,CA 95014-4564(369 27 056) PRECISION POWER
ELECTRIC
SAN JOSE,CA 95128
OWNER'S NAME: GRAVENHORST HENRYAND MONAE TRUSTEE DATE ISSUED:07/25/2016
OWNER'S PHONE:408-255-9928 PHONE NO:(650)245-6402
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class(x-10 Lic.#928095
Contractor MECISION POWER ELECTRIC Date 01/31/2017 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:
I hereby affirm under penalty of perjury one of the following two declarations: UPGRADE PANEL(200 AMP);SAME LOCATION
i. 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
erformance 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:$2000.00
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 369 27 056
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 liabilif s,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said QW! co sequence of the granting this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applic u ands and will comply with all ll non-point
source regulations p th erti unicipa 7 ode,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 7/25!2016 Issued by:AbbyAey nde
Date:07/25/2016
I hereby afSr that I am exempt from the Contractor's License Law for one of theFR
following tw reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. I, s 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)
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: 25/2016
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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. 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(x)should I store or handle hazardous
material. Additionally,should I use equipment or devices 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 Are uality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupe n �cipal Code,C apter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code, c'F 505,25533,a d 2.5534.
Labor Code,I must forthwith comply with such provisions or this permit shall ;
be deemed revoked. `
Owner or authorized agent:
APPLICANT CERTIFICATION <Date:7/25/2016
certify that I have read this application and state that the above information is NSENDIN A EN Y
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there' o truction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this per,it 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'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Signature Date 7/25/2016 Licensed
Professional
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE/VENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•building(a)cupertino.orgCUPERTINO MISC
❑PLUMBING ❑MECHANICAL EIELECTRICAL [:]MISCELLANEOUS
PROJECT ADDRESS APN# tel�.F j
L, (X ( p
OWNER NAME J,e *o,B PHONE ,A,�� �" E-MAIL
yvmv � lud
STREET ADDRESS { � j CITY, STATE,ZIP FAX
CONTACT NAME PHONE E-MAIL
STREET ADDRESS
CITY,STATE,ZJP 3WV FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME �� LICENSE NUMBEICENSE TYPE _� BUS.LIC#
COMPANY NAME yy} E-MAIL �� FAX
STREET ADDRESS CITY,STATE,ZIP J' �jf C/�;, /��/- PHO
ARCHITECT/ENGINEERNAME �l -7 LICENSE NUMBER (� jJ BUS.LIC# (}
COMPANY NAME E-MAIL - FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ko
DESCRIPTION OF WORK
TOTAL VALUATION:
By my signature below,I certify toe of thf I am e property owner or authorized agent to a t on the property owner's behalf. I have read this
application and the information I h e pr v d' o ect. I ve read the Description of Work and verify it is accurate.y�I agree t comply with all applicable local
ordinances and state laws relatin to bui�' ctio authorize representatives of Cupertino to enter he abov -itlentifie property for inspection purposes.
Signature of Applicant/Agent: Date: '
SU AL INFORMATION REQUIRED o� zC us> ONLY
uT
D',OYER 1'HE-COUI?T'ER
; U
❑�-,STANA�R7f
a ❑ LARGE:
❑: MAJOR
MEPMiscApp_2011.doc revised 03116/11
i
FI LE71
SMOKE / CARBON MONOXIDE ALARMS R CERTIFICATE OF COMPLIANCE
P"-cb
OWNER J
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CLJPERTIIN.0 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•building(a)cupertino.org
p Permit No. 6 ra
'
Address 5TO 1 0.111-14 #of Alarms Smoke: Carbon Monoxide:
PERH r CA1 NC)T BE FINALED AND CONIPL TED UNTIE THIS CERTIFICATE
FS BE]ENg AICD iIFTiTRNI+T ]C{ THH' ITLDN llI' SIOT`'�
71
F
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.
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)
i
On every level of a dwelling,unit including basements X X
Within each sleeping room X _ J
: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 CSC 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
I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name: I
g�C 114 l - � l3 , . - Si nature. h..y 'L 'f/J G° C !� ......................................Date: . ... .'
Contractor Name: F
Signature....................................................................Lic.#......................................Date: ...................
Smoke and CO fonn.doc revised 03/18/14
I
. .WATER-CONSERVING PLUMBING FIXTURES TF1
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
11F'IEFt7[I IU 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
( 8 7 -3228• ( } 77-333 •
building( cu ertino.or
Owner Name 'Ay v ' Permit No. 1 6
Address &101
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.
5d 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.
El The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom offonm.
i?rNo 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.
Dir-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.
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- y
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 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: J-1. Date: &6L6
Upon completing and signing this Certificate,pleaseieturn it to the Building Division in order to final your building permit.
SB407 2015.doc revised 08126115
tTILI11 PItTI111�DT�E FIl�ALD SNC!C®1LETD ITIL�T<IEIS
� ST
Non-Com
pliant Water-Conserving Plumbing Fixture
PlumbingFixture' (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 bate 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,
Urinals Exceed 1,0 average flush volume of two reduced flushes and one full flush
Gallons/flush 0.5 gallons/flush
Showerheads Exceed 2.8 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, y
Faucets— Exceed 2.2 gallons Maximum 1.5 gallons per Within units: 0.5 gallons per minute @ 60
Lavatory per minute minute cx 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
__d
Kitchen per minute 60 psi60
@ psi
psi
Faucets May temporarily increase May temporarily i
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 2015.doe revised 08126115