B-2016-2364 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2364
10618 NATHANSON AVE CUPERTINO,CA 95014-1331(326 43 013) STREET PLUMBING
AND ROOTER
SAN JOSE,CA 95128
OWNER'S NAME: DORTENZIO MARIO D AND ARLENE E DATE ISSUED:07/22/2016
OWNER'S PHONE:408-230-4119 PHONE NO:(408)496-1155
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-36 Lic.#582217
Contractor STREET PLUMBING AND ROOTER Date 12/31/2017 X BLDG _ELECT X PLUMB
I hereby affirm that I am licensed ander 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: REPLACE 50 GALLON WATER HEATER(SAME LOCATION)
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
4performance of the work for which this permit is issued.
7 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:$1200.00
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 326430,13
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 regulations pefRhe Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
i"
Signature t
Date 7/22/216 Issued by:AbbyAyende
Date:07/22/2016
Iherebaffirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
y All roofs shall be inspected nor to an roofing material being installed.If a roof is
following sons: p p� y g g
r. 1,as 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:7/22/216
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
s. 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 Cuper'no Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code, c ons 2550 5533,and 25534.
Labor.Code,I must forthwith comply with such provisions or this permit shall ,.
be deemed revoked. .O,wner or authorized agent:
APPLICANT CERTIFICATION (Date:7/22/216
I certify that I have read this application and state that the above information is CONSTRUCRON LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a c; struction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permits 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 5 DECLARATION
I understand my plans shall be used as public records.
Code,Section 9.18.
Licensed
Signature Date 7/22/216 Professional
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERT NO (408)777-3228•FAX(408)777-3333•building(c)-cupertino.org ZM M1 SIC
PLUMBING ❑MECHANICAL ❑ELECTRICAL p❑erM�ISCELLANEOUS
PROJECT ADDRESS ((A f 0L APN# '
ai
OWNERNAME d a��r�rw G�j fry PHO YiY6(�� ,�,t IL
STREET ADDRESS C®�/Fy `^V vCITY,STA CTE ZIP L® `/ r gS01� _ FAX _
CONTACT NAME ` (P PHONE C116y) f6
STREET ADDRESS �2q �A�j ►+,Q - r/iF/ CITY,STATE,ZIP r I� - EI
/I fs-/?y
F J
11 OWNER OwNER-BUILDER -f❑ OWNWNER� (AGENT ❑ CONTRACTOR 1:1 CONTRACTOR AGENT El ARCHITEC
T 11 ENGINEER ❑. DEVELOPER ❑.TENANT
CONTRACTOR NAME C tom ' LICENSE NUMBER I f LICENSE TYPE 2� BUS.LIC#
COMPANY NAME EMAIL rAX
_ y
STREET ADDRESS ( `� f p, ` / A �A CITY,STATE,ZIP ® qS 12-9
�n O_ 11 f r — I S
ARCHITECT/ENGINEERNAM'E J !/LICENSE NUMBER ` 7 / g� B S.LIC# C(y
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 ❑ No
DESCRIPTION OF WORK
TOTAL VALUATION: RECEIVED BY
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the infonnation I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buildingpo ction. 1,aa4HOze rep re . s of Cupertino to enter the above-identified pr erty for inspection purposes.
Signature ofApplicant/Agent Date: 2
SUP AL 114FORMATION REQUIRED
Q OFFICE T7SE ONLY
W OYFR.�.'IiE-COI7I�TTER ..
F" 0 'EXPRESS
STANDARD
U
LARGK
0.MAJOR'.
MEPMiscApp_2011.doc revised 03116111
SMOKE % CARBON MONOXIDE ALARMS
s-
OWNER CERTIFICATE OF COMPLIANCE:
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 7 a�
10300 TORRE AVENUE CUPERTINO,CA 95014-3255
CUPERTINO .1 (408)777-3228 FAX(408)777-3333-building a)-cupertino.org
ermit No. _ �� - Z 34 W
AddressL �4-9 6�
�7 '' " #of Alarms Smoke: Carbon Monoxide: ..
PERMIT CANNOT$E FINALED AND CoMkikET D UNTIL,THIS CERTIFICATE 1
HASZFE� f L {
AND T TT 97 RV TC)�HE BLTILDII G IVB ION 'gWN �
PURPOSE
This affidavit is a self-certification for the installation of all required Smoke and C on Monoxide Alarms for
compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 wriere no interior access for
inspections are required.
GENERAL INFORMATION
Existing single-family and multi-family dwellings shall be provided with Smoke A arms and Carbon
Monoxide alarms. When the valuation of additions, alterations,or repairs to existirig 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- urning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke idarms 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 e 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)refer ced above has/have been
installed in accordance with the manufacturer's instructions and in compliance witFi 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 OwnerAgent's)Name: _
0,4i 1i o 'D, Voie."T-.A1zi o 'Si nature !. ��1bI f
.......................................Date:`
Contractor Name:
Si natur ... .........Lic.#...... � .. ...!........Date:
Sm ke and COform.doc revised 03/18/14
WATER-CON'SERVINC PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
I�F
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISI N r.
LUPE TING 10300 TORRE AVENUE CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333•building(d,cupertino.org
Owner Name u&l` IFN i� AQLjC-VjL ,.1 Permit No.
jj
Address I ` � K? TT `A N 1�6 M �VULZ7- i CtP "b CA �b 1
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 I Go to Question 2.
-2 Does your real property have a licensed plumber certifying that, due to the age or configure ion of the property or its
plumbing,installation of water-conserving plumbing fixtures is not technically feasible?
Q Yes Civil Code Sections 110 1.1 through 1101.8 do not apply.
❑ The licensed plumber's certification has been provided to the Building Divisi n.
Skip the rest of the form and sign bottom of form.
No Go to Question 3.
c-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.
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..
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 orb fore January 1,2017, all non-
compliant plumbing fixtures shall be replaced with water-conserving plumbing f tures (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.
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 a1tc rations 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.
LOwner or Qwne.r,Agent's Signature: �� � �`G� 1 (Date:_.- g 6//Z-
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
BUILDING PERMIT CANNOT BE FINALED AND COMPLETE UNTIL THIS
CERT �ATES BSE i { p fATTi) tES1URI�T)LD TSD I"HE B DING DL' ISIDN
Non-Compliant Water-Conserving Plumbing Fixture
4 PlumbingFixturel (Fixture Complying with Current Code Applic 'Fixture
to New Construction)
Maximum Water Usage/Fl 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. .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 gal ons/flush
(Toilets) Gallons/flush Dual flush toilets: 1.28 gallons/flush effective f ush 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 .e performance criteria of
gallons per minute U.S. EPA WaterSense Specification for Showerhee ds
(A hand-held shower is considered a showerhead.)
For multiple showerheads serving one shower,the rombined 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 sho er 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 na,,. 60 j
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'publi
-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 ,
y 1:8 g'-116h `pd-r minute @ default to maximum
60 psi 1.8 gallons per minut
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 08126115