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15060044CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10296 PLUM TREE IN CONTRACTOR: RAJA MOAZAM AND PERMIT NO: 15060044 JIANG YIMIN OWNER'S NAME: RAJA MOAZAM AND JIANG YIMIN 10296 PLUM TREE LN DATE ISSUED: 06/05/2015 OWNER'S PHONE: 4084310288 CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL REMODEL (4) BATHROOMS (299 SQ FT); KITCHEN License Class Lic. # REMODEL (228 SQ FT); REMODEL STAIRWAY AND GUARDRAIL. Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 1 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 Sq. Ft Floor Area: Valuation: $60000 performance of the work for which this permit is issued. 1 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 APN Number: 31633014.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, / costs, and expenses which may accrue against said City in consequence of the� '!® s" Date: granting of this permit. Additionally, the applicant understands and will comply Issued byr` /per C� GQ with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Signature Date All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should 1 use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the of the work for which thisg the Health & Safety Code, Se=s25505,25533., and 25534. performance Owner or authorized agent: Date: S permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I 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 and state laws relating to building construction, and hereby authorize 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, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -p . t source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. % � �� Signature Date 10 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 ���� D�, P� (408) 777-3228 • FAX (408) 777-3333 • building(a cupertino.org � ❑ NEW CONSTRUCTION ❑ ADDITION Im ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT n PROJECT ADDRESSAPN /02q6 {p(,14 W Te&F � 3 I J/ tP OWNERNAME ,� ^ ©� Z a n PHONE 1 ,OrLg g EMAIL � O�- / K STREET ADDSSI %oZ96 Pc.ovv\. -� ��NZ CITY, STAT ZI " FAX ctit►�c���co (-tot CONTACT NAME PHONE E-MAIL STF-1ZT ADDRESS CITY, STATE, ZIP FAX f2l-OWNER ❑ oWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CON'TRACTORAGENT ❑ ARC19TECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME D LICENSE NUMBER LICENSE TYPE BUS. LIC 4 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGLNEFR NAME LICENSE NUMBER I BUS. LIC 9 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK INT<Q-lag R6WOQ(-L . I((T -a"V CRkTth Qr-AADV&-.5 kpD Pk)N(-L 'SAF(- kAr 2NVFC.-14)4 Pir- O'1 (A I Q W 4,1 —f I2C79v ttil W jr4 0d l> W �A`1 V',r I A(p d W . b V� lL I Tc..t� yJ 9 u o R, E>3S SE CONS PROPO -'.'5_ E ST S USE TYPE OCC. SQ.FT. VALUATION (S) E)7STG NEWFLOOR• - DEMO TOTAL AREA AREA AREA NET AREA -" BATHROOM" REMODEL AREA KITCHEN.. REMODEL AREA OTHER_ REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LIDFTACH ❑ ATTACH DWELLING UNITS: IS A SECOND UNrr E) YES SECONDSTORY []YES BEING ADDED? ANO ADDITION? -,2IJO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN I-] YES C£IVFD Y '.. - TO VALUATION: PLAT�'1\TNG APPL,- �TO ' PL.ANNIING APPROVAL LETTER �YES EICHLER HOME? Y IBM By my signature below, I certify to each of the following: I am the property ovmer or authorized agent to act on the property.ovmer's behalf. I have read this application and the information 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 toling construction. I authorize representatives of Cupertino to enter the above-'dentled property for inspection purposes. Signature 6 %ss Applicant/Agent: of Date: SUPPLEMENTAL D\TFORMATION REQUIRED - S` OYEi2TH1rCOI77rTER BUIIDI2�GPLANREVIEW " New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of bulldmg� permit for new building. =C1� Ess.' OjPLANI�II��GYi4�NREVIEW Commercial Bldas: Provide a completed Hazardous Materials Disclosure AxD4[] b sr1nxg _ form if any Hazardous Materials are being used as part of this project.h RXi��F EI T —sem Copy ofPlanning Approval Letter or Meeting with Planning Prior to " f submittal ofBuilding Permit application. SC��rrrAoxsATrAsE�EiinisTRrcr BldgApp_2011.doc revised 0 612 1/11 CITE' OF CUPERTINO FM -,7 FEE ESTIMATOR — BUILDING DIVISION F r , ADDRESS: 10296 PLUM TREE LANE DATE: 06/05/2015 REVIEWED BY: SEAN rb9erh. Perxnii I cu: APN: BP#:15�62LOYY_ "VALUATION: 1$60,000 xPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: Plumb. bvyp. Fee: PENTAMATION 1 R3SFDREM PERMIT TYPE: WORK REMODEL 4 BATHROOMS 299 SQ FT); KITCHEN REMODEL 228 SQ FT); REMODEL SCOPE STAIRWAY AND GUARDRAIL. F r , (tech. Plan Check PhunbG Plan Chcck Elec, Flan (."heck rb9erh. Perxnii I cu: Plumh. Perini? Fee: hlec. Permit Fee: Other ilkch, Imp. F 0""Ier Phrmb Insp.ED 7-J other Eie:c�. Imp.1 -1 Meeh. Fee: Plumb. bvyp. Fee: hiee. Imp. /-' e: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These_fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution I1-053 Ef'. 7/1.113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 299 s.f. $645.00 Remodel, Bath (<=300 so IREMRESBAT Suppl. PC Fee: 0 Reg. () OT0.0 hrs $0.00 PME Plan Check: $0.00 2-2 87 s.£ $645.00 Remodel, Kitchen (<=300 so IREMRESKIT Permit Fee: Hourly Only? ()Yes Q No $0.00 Suppl. Insp. Fee:I) Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 1 a.r. Admiaistra0vc T'cc: 0 E) Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: $0.00 hours $143.00 Inspections ISTINsp Inspection, Hourly Q �� Travel Docuinentraiiorl tees: Strong Motion Fee: IBSEISMICR $7.80 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $3.00 �`SUBTOTAL S: $10.80 $1,433.00 TOTAL FEE;'' $1,443.80 Revised: 05/07/2015 CUPERTINO P&P-�,A l- I D Lpe-R- JS DVWV ft- Z�ww. 4A-2�A — ynS-g3l- O2L9 8 CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 1-911�'I Ic' Owner / Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork vl ei E Cement Finishing Electrical -T *k 1< Excavation Fencing Flooring / Carpeting OW IVC- P - Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing -f� -r 1" Septic Tank Sheet Metal Sheet Rock Tile 1-911�'I Ic' Owner / Contractor Signature Date CUPERTINO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder o�the property improvements specified at: SITE ADDRESS .. ..y .. _.-_:...- ..APIC: ' : BP# OWNER NAM - . fLrf-�✓k :.......; __...._ QWNERADDRESS- - .. �_.-.o2-9G Puts. I`P��� ��-►�� . DESCRIPTION OF WORK: I�✓T� iLl UfL R�yvtd'��Z We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIREy1OS: Please read and initial each statement below to signify you understand or verify this information.) understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insura ce coverage for injuries to workers on my property. 2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. ✓3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. V4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be counde nsi Bred an "employer" r state and federal law. 6. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to/serious financial risk. 7. I understand under California Contractors' State License Law, an Owner- Builder who builds single- family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work isp �rmed under contract with a licensed general building Contractor. 8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04/14/10 `, 9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors. 10. 1 am.aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. _Z1 1. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. "12. I agree to notify the issuer of this formimmediately of any additions, deletions, or changes to any of the information 1,have- provided on this form. Licensed contractors are regulated bylaws designed to protect.the-public. If . you contract with:sorneone who does not have a license, the.Contractors' State License Board may be unable to assist you with any financial loss you may.sustain as a. result of a complaint.. -Your only remedy against unlicensed Contractors maybe irr civil.court. It is also important for. you -to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If " you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verif the property owners si nature. Property Owner's Signature: — Date: S --------------------------------------------------------------------------------------------------------------------------------------------- (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owners drivers license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owners signature. Property Owner's Signature: Date: OwnerBuilderForm 2010.doc revised 04/14/10 ADDITIONAL CODE REQUIRMENTS Energy code mandatory lighting measures: 1. All permanently installed high efficacy luminaires shall be switched separately from low efficacy_ luminaires. (150(k)(7)) 2. Permanently installed lighting in Kitchens shall be high efficacy luminaires. Up to 50% of the wattage of permanently installed lighting in kitchens may be in lights that are not high efficacy. (I 50(k)(8)) 3. Permanently installed luminaires in bathrooms, garages, laundry rooms and utility rooms shall be high efficacy luminaires OR are controlled by an occupant sensor(s) certified to comply with Section 119 that does not turn on automatically or have an always on option. (150(k)(10)) Plumbing plan notes: 4. Water closets shall have an average water consumption of not more than 1.28 gallons per flush. (CPC 403.2) S. Shower heads shall have a water flow not to exceed 2.0 gallons per minute @ 80 psi. (CPC 408.2) 6. Faucets in kitchens, wet bars, lavatories, laundry sinks, etc shall have a water flow not to exceed 1.8 gallons per minute @ 60 psi. (CPC 403.6) 7. Shower, stalls shall have a clear interior finish area of 7.1 sq. ft. and be able to accommodate a minimum 30 inch circle at the threshold level. These clearances shall be maintained up to a height of 70 inches above shower drain. (CPC 408.6) 8. Shower compartments and walls above bathtubs with installed shower heads shall be finished with a smooth, nonabsorbent surface to a height not less than 72 inches (6 ft). (CRC 8307.2) 9. The maximum hot water temperature discharging from the bathtub, shower and whirlpool bathtub filler shall be limited to 120 degrees Fahrenheit. The water heater thermostat shall not be considered a control for meeting this provision. (CPC 409.4 & 408.3) 10. A 30 -inch clear width for water closet compartment and 24 inch clearance in front of water closet. (CPC 402.5) Electrical Plan Notes: 11. The installation of smoke alarms in all of the following areas shall be provided: (CRC R314.3) a. On the ceiling or wall outside of each separate sleeping area in the immediate vicinity of bedrooms. b. In each room used for sleeping purposes. 12. The installation of carbon monoxide alarms in the following areas shall be provided: (CRC R315.1) a. Approved carbon monoxide alarms shall be installed outside of each separate sleeping area in the immediate vicinity of the bedrooms and on every level including basements in dwelling units that have fuel -fired appliances or attached garages. 13. A minimum of two 20 amp small appliance branch circuits shall be provided for all receptacle outlets in the kitchen, dining room, pantry, or other similar areas. (CEC 210.11(C)(1)) 14. At least one 20 amp branch circuit shall be provided to supply bathroom receptacle outlets. Such circuits shall have no other outlets. (CEC 210.11(C)(3)) 15. In every dwelling unit, fixed appliances such as food waste grinders, dishwashers, washing machines, dryers, laundry tray locations, built-in refrigerators or freezers, furnaces, AC units, built-in heaters or any other fixed appliance with a motor of/4 h.p. or larger shall be on a separate 20 amp. branch circuit. 16. All receptacles in bathrooms, garages, accessory buildings, outdoors, crawl spaces, unfinished basements, kitchens (where receptacles serve counter top surfaces), laundry, utility, wet bar sinks (within 6 feet of the edge of the sink), shall have ground -fault circuit interrupter (GFCI) protection. (CEC 210.8(A)) 17. In all areas specified in 210.52, all non-locking type 125 -volt, 15- and 20- ampere receptacles shall be listed tamper-resistant receptacles. (CEC 406.12) ResKitBathPo1iey_2014.doe revised 01/15/14 CUPERTINO RESIDENTIAL KITCHEN/BATH REMODEL POLICY COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingCcDcugertino.org GENERAL INFORMATION A building permit is required for all kitchen and/or bath remodels except when the scope of work ONLY involves the installation of cabinets and/or the replacement of countertops [CRC Section 105.2 ex 6] without altering any electrical, plumbing or mechanical systems or altering any existing walls. PLAN REQUIREMENTS 1. Provide a completed `Addition/Remodel' building permit application. 2. Provide three sets of completely dimensioned floor plans (both existing and proposed) showing the area of alteration(s). Floor plans shall indicate the following: a. Location of existing and new walls showing existing and new windows. b. Location and sizes of all doors. c. Location of all upper and lower cabinets. d. Location and use of all adjacent rooms. e. Location of smoke alarms and carbon monoxide detectors. Smoke Detectors and carbon monoxide detectors are required to be installed in accordance with Section R314 and R315 of the California Residential Code. 3. Ceiling Plan. Provide ceiling plan (three sets) to show ceiling heights, as well as, existing and proposed electrical and/or mechanical work at the ceiling level. 4. Structural Framing Plan. Provide three sets of the structural framing plan if any walls are being removed or relocated. Plan shall show all walls existing, removed and added and verify how new framing members are supported as a result of the removal of any bearing walls. 5. Plumbing, Mechanical and Electrical Plans. Provide three sets of plans showing electrical receptacles, electrical fixtures and switching, and ventilation. 6. Energy documentation. Two sets including the. CF IR -ALT Residential Compliance Form. 7. Owner -Builder Disclosure Form (for property owners applying for their own building permit) 8. Details and Notes: Provide all details and notes required to explain the proposed scope of work. NOTE: All drawings must be signed by the person preparing them. All work shall comply with the 2013 California Building Code (based on the 2012 IBC Code), 2013 California Residential Code (based on the 2012 IRC Code), 2013 California Plumbing Code (based on the 2012' UPC Code, 2013 California Mechanical Code (based on the 2012 UMC Code, 2013 California Electrical Code (based on the 2011 NEC Code), 2010 California Energy Code (based on the 2008 Building Energy Efficiency Standards) *. * Effective 7/1/14, drawings shall comply with 2013 California Energy Code (based on the 2013 Building Energy Efficiency Standards) ResKitBathPolicy_2014,doc revised 01/15/14 I WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE FILE COMMUNITY DEVELOPMENT DEPARTMENT -BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 CURERT1140 (408) 777-3228 - FAX (408) 777-3333 - buildingCcDcupertino.o Owner Name WO A 7,- AM 4 PerinitNo. - Address Please refer to the attached California Civil Code Sections 1101.1-1101.8 which are part of this Certification form. 1. Is your real property a registered historical site? 0 Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest/of the form. Owner' Signature: Date: �l/i6 t"o 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? 0 Yes Civil Code Sections 1101.1 through 1101.8 do not apply. D The licensed plumber's certification has been, provided to the Building Division. Sign below and skip the rest of the ,form Owner' Signature: Date:- J/V/1� .No Go to Question 3, 4 3. Is water service permanently disconnected for your building? ❑ yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form. Owner' Signature: Date:1/lf� J4' , 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. Sign below and skip the rest of the form. lq� OwnerSignature. Date: 16 11 Yes Myr6al property is built and available for use or occupancy on or before January 1, 1994. ,Civil Code Sections 1101.1 through 1101.8 apply. Refer to the attached. X41 My property is a single-family residential 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-colupliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless of whether property undergoes alterationsor improvements). 0 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). 0, Myproperty 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. SB40 7 2 015. doc revised 02104115 On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving pluinbiig fixtures throughout the building (regardless of whether property undergoes alterations or __ ..:H..,i;,qjpr.ov inents). UWe, the owner(s) 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 Mures 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 fixture mply with the requirements as indicated in the table below. Owner's (or Owner Agent's) Signature: - Date: 4L& Upon completing and signing this Certificate, please return it to the Building Division in order to final your pen -nit. 1. if the existing plumbing fixture water usage/clow rate is equal io or lower inan,Luc UgLUU JllUWJJ, a 1J IWL 1G1iU11C.0 uJJSI . u. SB40 7 2015. doc revised 02/04/15 Non -Compliant Water -Conserving Plumbing Fixture Plumbing Fixturel (Fixture Complying with Current Code Applicable to New Construction) Fixture Type Maximum Water Usage/Flow Rate 2013 CPC Ch. 4 " 2013 CPC Ch. 4 2013 CPC Ch. 4 Water Usage /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 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: _ 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,, andmmust 1.8 gallons per minute @ . default to.aximum 60 psi" 18. gallons per minute Where faucets meeting ;@ 60 psi the above are unavailable," V1/here faucets meeting aerators or other means the above are-'. " , maybe lased to achieve Unavailable, aerators or reduction. other means maybe used to achieve reduction.: 1. if the existing plumbing fixture water usage/clow rate is equal io or lower inan,Luc UgLUU JllUWJJ, a 1J IWL 1G1iU11C.0 uJJSI . u. 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Is your real property a registered historical site? 0 Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest/of the form. Owner' Signature: Date: �l/i6 t"o 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? 0 Yes Civil Code Sections 1101.1 through 1101.8 do not apply. D The licensed plumber's certification has been, provided to the Building Division. Sign below and skip the rest of the ,form Owner' Signature: Date:- J/V/1� .No Go to Question 3, 4 3. Is water service permanently disconnected for your building? ❑ yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form. Owner' Signature: Date:1/lf� J4' , 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. Sign below and skip the rest of the form. lq� OwnerSignature. Date: 16 11 Yes Myr6al property is built and available for use or occupancy on or before January 1, 1994. ,Civil Code Sections 1101.1 through 1101.8 apply. Refer to the attached. X41 My property is a single-family residential 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-colupliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless of whether property undergoes alterationsor improvements). 0 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). 0, Myproperty 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. SB40 7 2 015. doc revised 02104115 On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving pluinbiig fixtures throughout the building (regardless of whether property undergoes alterations or __ ..:H..,i;,qjpr.ov inents). UWe, the owner(s) 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 Mures 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 fixture mply with the requirements as indicated in the table below. Owner's (or Owner Agent's) Signature: - Date: 4L& Upon completing and signing this Certificate, please return it to the Building Division in order to final your pen -nit. 1. if the existing plumbing fixture water usage/clow rate is equal io or lower inan,Luc UgLUU JllUWJJ, a 1J IWL 1G1iU11C.0 uJJSI . u. SB40 7 2015. doc revised 02/04/15 Non -Compliant Water -Conserving Plumbing Fixture Plumbing Fixturel (Fixture Complying with Current Code Applicable to New Construction) Fixture Type Maximum Water Usage/Flow Rate 2013 CPC Ch. 4 " 2013 CPC Ch. 4 2013 CPC Ch. 4 Water Usage /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 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: _ 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,, andmmust 1.8 gallons per minute @ . default to.aximum 60 psi" 18. gallons per minute Where faucets meeting ;@ 60 psi the above are unavailable," V1/here faucets meeting aerators or other means the above are-'. " , maybe lased to achieve Unavailable, aerators or reduction. other means maybe used to achieve reduction.: 1. if the existing plumbing fixture water usage/clow rate is equal io or lower inan,Luc UgLUU JllUWJJ, a 1J IWL 1G1iU11C.0 uJJSI . u. SB40 7 2015. doc revised 02/04/15