B-2016-2387 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2387
22684 LIBERTY OAK IN CUPERTINO,CA 95014-5612(342 32 042) MOOMAU PLUMBING
SAN JOSE,CA 95118
OWNER'S NAME: GREENE JULIANE R TRUSTEE&ET AL DATE ISSUED:07/26/2016
OWNER'S PHONE:408489-4141 PHONE NO:(408)396-3837
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class PLUMBING Lic.4792821
Contractor MOOMAU PLUMBING Date 08/31/2016 X BLDG —ELECT X 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:
REPLACE 40 GAL WATER HEATER
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
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$1917.00
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 342 32 042
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
sourceregulaf Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signat a Date 07/26/2016 Issued by:MELISSA
Date:07/26/2016
OWNER-BUILDER DECLARATION
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 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. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7644,Business&Professions Code). Date:07/26/2016
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. 1 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
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 Area Air Quality.Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Cod,S 255 3,and 255
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent.l f
APPLICANT CERTIFICATION Date:07/26/2016
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 ARCHITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Licensed
Signature Date 07/26/2016 Professional
CONSTRUCTION PERMIT-APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO3 1 (408)777-3228• FAX(408)777-3333-buildingecupertino.org
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS M �` nA a 1 APN# S LfZ __ 3 C'�7
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OWNER NAME j( PHONE RNA W A r,�11 E-MAIL
STREET ADDRESS CL
�\ LhfCITY, ol STATE,ZIIP FAX
CA
CONTACT NAME - PHONE - E-MAIL -
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑. DEVELOPER. ❑TENANT
CONTRACTOR NAME ��j� LICENSE NUMBER %f�� LICENSE TYPE BUS.LIC#
COMPANY NAME A A�j�`o1n n iy , t V ` E-MAIL l n ala/ y _ FAX
STREET ADDRESS CIITY,STATE,ZIP /I PHONEI r r
d uC0 a 15,00
ARCHITECT/ENGINEER NAME r ` LICENSE NUMBER.. �(, BUS.LIC L# W
COMPANY NAME E-MAIL FAX
-
STREET ADDRESS CITY,STATE,ZIP i PHONE
II /nom' Thy,
J��-./ �t y./pl/DESCRIPTION OF WORK, _i _ t/�l/ttl // h �/�-1''".Y
EXISTING USE PROPOSED USE CONSTR.TYPE. #STORIES .
USE TYPE OCC, SQ:FTVALUATION($}
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA - AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCHAREA DECK AREA [75TATDECK/PORCH AREA GARAGE AREA: DETACH
ATTACH
#DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY ❑.YES - " -
BEING ADDED? []NO ADDITION?
PRE-APPLICATION []YES IF YES,PROVIDE COPY OF IS THE BLDG S
PLANNING APDL.# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? r]No
By my signature below,I certify to each of the following: I am the property owner or authorized agent he property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and vers it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to ding construction. I authorize representatives of Cupertino to enter the abo end ti I d property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATIO RE UIRED ;
Q PLAlY:CHECKTItP� ;ROI3T'ING`SLIP
_New SFD or Multifamily dwellings: Apply for demolition permit for ❑ ovER rim courlTER ❑ HUMANo 1? AN R w
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. D'E PRE, S ❑ PT ANNING°PLAN RE(iEw
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑',STA NliAitD ❑:PtISLZCvvoRxs
form if any Hazardous Materials are being used as part of this project.
Q,LARG�:�i ❑,:>i`ix>ln>;rT:
_Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR;'. ❑ 5�NITARY SEWERbIszRlcT .
submittal of building Permit application. _
❑�F IYIRONMENTAI HEALTfY
BldgApp 2011.doc revised 06121111
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BON MONOXIDE ALARMS
YO
COMPLIANCE
COMMUNITY DEVELOPMENT?DEPARTMENT BUILDING DIVISION
,t.Tfl 'C 10300TORREAVENUE. CUPERTINO,GA95014-3255
(408)777-3228* FAX'(408)777-3333• buildingncupertino wg
t e
—
I1JIZPOS
This affidavit is a self-certification for the
in 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
iizspections are required.
G-M A]L INTPORMA'l['i{ON
EXisting single-family and multi-family dwellings shall be provided with Smoke Alarms and Carbon
Tvlonoxide 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 SlViI KE AILAR CO ALARlVi€
Oufside of each separate sleeping area in the imrnediate vicinity of the X
bedroom(s)
On every leveIof a dwelling unit iticludirig basements
GV'iflin each X slee in morin
i
Carbon Monoxide alarms are not required in dwellings which,do not contain fuel boating appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms slla
1T col i�ply with.
C `C Section 420.6 and shall be approved by the Office of the State Fire Marshal,
Power Supply:'In-dwelling-tints with no commercial power supply,alarm(s)may be solelylsattzery operateelk.
In existing dwe'll'ing iunits, aIarrns are permitted to besoler battery operated where repairs or, alteratiorls,do,
not result in,the,removal of wall and ceiling fin sites or there is ino access by means of attic,basernertt or crawl
space Refer tef.CRC Section 8314 and CBC Sections 90!1.2.11.4 and 420:.62.An electrical perimt is required for
alarms which must be comilected to the building wiring.
As owner of the above-referenced property,f hereby certify that the alarm(s)referenced above has/have been
installed in accordance with the manufactnirer s instructions and in compliance with the California:Ruiildnatg
and California Residential,Codes. The alarrnshave been tested aizd are operational, as of the date signed
below.
I
—. I have read and a:ree to c01'M-
2,2 with" termas anal conditions,of this statement
si haferr�_:, J//
r .. .. F
.... .......... .......Date:........... ...I
WATER-CONSERVING PLUMBING FIXTURES N ' A
OWNER CERTIFICATE OF COMPLIANCE ,
COMMUNITY DEVELOPMENT DEPARTMENT.BUILDING DIVISION
CUPERTII'+O 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)7g-3228•FAX(408)777-3333 building(Wcupertino.ora ii 2
Owner Named / fAli1 7 Permit No)
Address �Ll� i b�rty On i�: Lane., w!ft n o t CA q5
1. Is your real property a registered historical site?
Q Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
0 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.
El 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. 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.
FIN�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 ease check ONE of the following:
! I ' My property is a single-family residential real property. See Civil Code'S'ection 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 1,201-9,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 followm* page.
Owner or Owner Agent's Signature:
t.-
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit.
SB4072015.doe revised 08126115
BUILDIl�TG PERMITCANNOT BE EINALED AND COMPLETED$TNTIL'THIS
CERT ITICATE HAS BEEN I ED AND�ETIIRNED TO THE BUILDING DTYISION
Non-Compliant Water-Conserving Plumbing Fixture
Plumbing Fixturel (Fixture Complying with Current Code Applicable to New Construction)
Maximum Water 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.4.3 2013 CALGreen Div. 5.3
/Flow Rate Single-Family Multi-Family Commercial
Residential Residential
Water Closets Exceed 1.6 Single flush toilets: 1.28 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: O.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 2015.doe revised 08126115