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B-2016-1287�_ •CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10338 COLD HARBORAVE CUPERTINO, CA 95014-3328 (369 09 029) CONTRACTOR: S J K GROUP INC PERMIT NO: B-2016-1287 SANTA CLARA, CA 95050 OWNER'S NAME: Mr & Mrs WILLIAM KWAN HO AND YAN YUEK LEE TRUSTE DATE ISSUED: 09/23/2016 Woo OWNER'S PHONE: 408=605-8855 PHONE NO: (408) 781-3109 LICENSED CONTRACTOR'S DECLARATION ATION BUILDING PERNUT INFO: License Class B Lia #1001845 Contractor S J K GROUP INC Date 03/31/2019 X BLDG _ELECT -PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing X 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: Rear addition (248 St..); Side Addition (185 SX..); Remodel Bathrooms (430 S.f.); Kitchen Remodel (662 S.£); Convert garage to laundry/mud room i. I have and will maintain a certificate of consent to self -insure for Worker's (138 SX.); Other Remodel (277 S.£)• Install 3 (N) skylights; (I) water Compensation, as provided for by Section 3700 of the Labor Code, for the heater, (I) HVAC system rperformance of the work for which this permit is issued. REV # 1 - REDUCE SCOPE OF WORK - KITCHEN REMODEL (557.2 z. I have and will maintain Worker's Compensation Insurance, as provided for by SF); CONVERT GARAGE TO (N) LAUNDRY/MUD ROOM (138 S.F); Section 3700 of the Labor Code, for the performance of the work for which this SIDE ADDITION (87.7 S.F.); (N) COVER PORCH (93 S.F.); REMODEL permit is issued: ENTRY/DINING (378.6 S.F); INSTALL 1 (N) SKYLIGHT; (I) WATER APPLICANT CERTIFICATION HEATER; (1) FURNACE - ISSUED 9/23/16 1 certify that I have read this application and state that the above REV#2 - REPLACE A/C UNIT; REPLACE 8 (E) WINDOWS AND 3 (E) information is correct. I agree to comply with all city and county ordinances SLIDING DOORS- LIKE FOR LIKE; REPLACE SIDING WITH and state laws relating to building construction, and hereby authorize STUCCO - ISSUED 9/26/16 representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the Sq. Ft Floor Area: 433 Valuation: $150000.00 City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point APN Number: Occupancy Type: source regulations per the Cupertino Municipal Code, Section 9.18. 369 09 029 Deferred Submittal (R -3),R-3 (Custom),R-3 (Custom),Deferred Submittal (R-3),Deferred Submittal r r f (R-3),Deferred Submittal (R-3),Defened Submittal (R- Signatur % Date 17 3),Deferred Submittal (R-3),Deferred Submittal (R- 3),Deferred Submittal (R-3),Deferred Submittal (R - OWNER -BUILDER DECLARATION 3),Deferred Submittal (R-3) I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: PERMIT EXPIRES IF WORK IS NOT STARTED i. 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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR sale (Sec.7044, Business & Professions Code) 180 DAYS FROM LAST CALLED INSPECTION. 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). Issued by: ABBY AYENDE I hereby affirm under penalty of perjury one of the following three declarations: Date: 09/23/2016 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 RE -ROOFS: performance of the work for which this permit is issued. All roofs shall be inspected prior to any roofing material being installed. If a roof is 2. I have and will maintain Worker's Compensation Insurance, as provided for by installed without first obtaining an inspection, I agree to remove all new materials for Section 3700 of the Labor Code, for the performance of the work for which this inspection. permit is issued. s. I certify that in the performance of the work for which this permit is issued, I �- Signature of Applicant: shall not employ any person in any manner so as to become subject to the � Date: 4/20/2017 Worker's Compensation laws of California. If, after making this certificate of— exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER be deemed revoked. HAZARDOUS MATERIALS DISCLOSURE APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I have read the hazardous materials requirements under Chapter 6.95 of the correct. I agree to comply with all city and county ordinances and state laws California Health & Safety Code, Sections 25505, 25533, and 25534.. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the relating to building construction, and hereby authorize representatives of this city Health & Safety Code, Section 25532(a) should I store or handle hazardous to enter upon the above mentioned property for inspection purposes. (We) agree material. Additionally, should I use equipment or devices which emit hazardous to save indemnify and keep harmless the City of Cupertino against liabilities, air contaminants as defined by the Bay Area Air Quality Management District I judgments, costs, and expenses which may accrue against said City in will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and consequence of the granting of this permit. Additionally, the applicant understands the Health & Safety Code, Sections 25505, 25533, and 25534. and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18.. G Owner or authorized agent: Date: 4/20/2017 Signature bate 4/20/2017 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance 4e� CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1287 10338 COLD HARBOR AVE CUPERTINO, CA 95014-3328 (369 09 029) PETER CONSTRUCTION SUNNYVALE, CA 94089 OWNER'S NAME: Mr & Mrs WILLIAM KWAN HO AND YAN YUEK LEE TRUSTE DATE ISSUED: 09/23/2016 Woo OWNER'S PHONE: PHONE NO: (408) 529-2787 LENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class -GENERAL BUILDING CONTRACTOR Lic. #BZ48B7 Contractor ITER CONSTRUCTION Date 03/31/2018 X BLDG _ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing X 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: Rear addition (248 S.f.); Side Addition (185 S.f.); Remodel Bathrooms (430S..f); I hereby affirm under penalty of perjury one of the following two declarations: Kitchen Remodel (662 S.f.); Convert garage to laundry/mud room 1. I have and will maintain a certificate of consent to self -insure for Worker's (138 S.f.); Other Remodel (277 S.f.); Install 3 (1) skylights; (I) water Compensation, as provided for by Section 3700 of the Labor Code, for the heater; (N) HVAC system performance of the work for which this permit is issued. REV # 1 - REDUCE SCOPE OF WORK - KITCHEN REMODEL (557.2 I have and will maintain Worker's Compensation Insurance, as provided for by SF); CONVERT GARAGE TO (1) LAUNDRY/MUD ROOM (138 S.F); Section 3700 of the Labor Code, for the performance of the work for which this SIDE ADDITION (87.7 S.F.); (N) COVER PORCH (93 S.F.); REMODEL permit is issued. ENTRY/DINING (378.6 S.F); INSTALL 1 (N) SKYLIGHT; (N) WATER APPLICANT ANT ERTIFI ATION HEATER; (l) FURNACE - ISSUED 9/23/16 certify that I have read this application and state that the above REV#2 - REPLACE A/C UNIT; REPLACE 8 (E) WINDOWS AND 3 (E) information is correct. I agree to comply with all city and county ordinances SLIDING DOORS - LIKE FOR LIKE; REPLACE SIDING WITH and state laws relating to building construction, and hereby authorize STUCCO - ISSUED 9/26/16 representatives of this city to enter upon the above mentioned property for Sq. Ft Floor Area: 433 Valuation; $150000.00 inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. APN Number: - Occupancy Type: Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9,18. 369 09 029 Deferred Submittal (R -3),R-3 (Custom),R-3 (Custom),Deferred Submittal (R-3),Deferred Submittal eyZ-0i �, (R-3),Deferred Submittal (R-3),Deferred Submittal (R - Signature _ Date 1. �' 3),Deferred Submittal (R-3),Deferred Submittal (R- 3),Deferred Submittal (R-3),Deferred Submittal (R- BT MR DECLARATION 3),Deferred Submittal (R-3) I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: PERMIT EXPIRES IF WORK IS NOT STARTED 1. 1, as owner of the property, or my employees with wages as their sole WITHIN 180 DAYS OF PERMIT ISSUANCE OR compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 180 DAYS FROM LAST CALLED INSPECTION. 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). Issued by MELISSA NAMES I hereby affirm under penalty of perjury one of the following three declarations: Date: 09/23/2016 - - 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 BE -ROOFS: performance of the work for which this permit is issued. All roofs shall be inspected prior to any roofmg material being installed. If a roof is 2. 1 have and will maintain Worker's Compensation Insurance, as provided for by installed without first obtaining an inspection, I agree to remove all new materials for Section 3700 of the Labor Code, for the performance of the work for which this inspection, permit is issued. 3. l certify that in the performance of the work for which this permit is issued, I Signature of Applicant: shall not employ any person in any manner so as to become subject to the Date: Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will correct. I agree to comply with all city and county ordinances and state laws maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the relating to building construction, and hereby authorize representatives of this city Health & Safety Code, Section 25532(a) should I store or handle hazardous to enter upon the above mentioned property for inspection purposes, (We) agree material. Additionally, should I use equipment or devices which emit hazardous to save indemnify and keep harmless the City of Cupertino against liabilities, air contaminants as defined by the Bay Area Air Quality Management District I judgments, costs, and expenses which may accrue against said City in will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and consequence of the granting of this permit. Additionally, the applicant understands the Health & Safety Code, Sections 255 33, and 25534. and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Owner or authorized agent. -, Date: Signature Date � — 20/1 EMMUAON LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARMON I understand my plans shall be used as public records. Licensed Professional CUPERTINO 1 n NFW r'nT.TCTR T T(-TTnM CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT •`BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 rr (408) 777-3228 • FAX (408) 777.3333 • building(@cupertino.oro i ( 4.T)TlTTTnT:T 1 I AT TT_D A-rTn-KT lTT�I nc( Tc T"T/r -rrrn n rim ORIGINAL PERMIT 4 >-724a[6-12C--? BIdg,4pp_201I.doC revised 06/21/11 9 -!6 NM1 PROJECT ADD RESS i o 90- Avu- f PN OWNERNAhIE jL, (/j / f°9Y ) PHONE �('�S E-1ZAIL / %J J `14 VV VAN woo l0 l/ ��1 STREET.ADDRESS _(1 A F1 � n I�d p CITY; STATE, ZIPil� FAX LG `YJ� rTft fC-� I'`- CONTACT N.AlIE q) PHO\T / }� E-NLAIL STREET ADDRESS CITY, SA,Z_ RO1TER13 OV�TER-BUILDER O'WNERAGEvTEl CONTRACTOR 11 CON'TTORAGENT❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANTT CONTRACTOR NAME LICENSE hLMBER LICENSE TYPE BUS. LIC n COMPANY NAME E-MAIL FAX STREETADDRESS CITY, STATE; ZIP PHONE ARCHITECT/ENGINEER NAA4E LICENSE NUMBER C _ GL f / 0 i (j BUS. LIC COMPANY NAME � C E-kLAIL FAX STREET ADDRESS F CITY, STATE, ZIP I PHONE. DESCRIPTION OF WORK UY� 4r N'4 -5cop-L'�l xr' w V , `."" ii' (G� a"etyV l/� E ISTA'G tiSE PROPOSED USE - CONSTR TYPE =STORIES --� I _ -- USE TYPE OCC. I SQ.FT. VALUATION (S) FLOOR DEMO TOTAL AREANEW AREA AREA I AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA P0RCH AREA DECK DECKPORCH AREA GARAGE AREA: ❑ DETACH IAREATOTAL ❑ ATTACH Yi DELLLNG UNITS: ISASECONDUNIT ❑ ITS SECOND STORY E] YES BEL'�GADDED? ANO ADDITION? E] NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES -RECENED BY r 1 TOTAL VA %7S ION: .A PLNAZNG ADPL=. ❑ NO PLANNING APPROVAL: LETTER EICHLER HOME? ❑ NO ✓ w ul 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 information I have ded 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 tq dSu' in- cook, struct' n. I authorize representatives of Cupertino to enter the above -identified operty for inspection purposes. V Signature of Applicant/Agent: / ,� �(_ —� Date: SUPPLEMENTAL Q OR-MATION iT UIRED ' PL nCHECKTIPi ?, ? i20UTII�G.'SLIP„.,, „ New SFD or Multifamily dwellings:. Apply for demolition permit for � J Ot ER THE COU ITER ❑ BL'iLDL\G PLA\ REi�ES� existing building(S). Demolition permit is required prior to issuance of building ” r perfor neer building. E�PREss � � PLA �\II�GPLA\ REY IE16 Commercial Bldgs: Provide a completed Hazardous Materials Disclosure C1 STANDARD{ PCBLIey�; oRl.s form if any Hazardous Materials are being used as part of this project. : L 4RGE x � FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to - ' a � T) 4- R SA\ITARI SERERDISTRICT submittal of Building Permit application. x `�` � ,� EI�'Y'IROI�TiEi\T:4L HEALTI3. > . _ •- BIdg,4pp_201I.doC revised 06/21/11 9 -!6 NM1 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10338 COLD HARBORAVE CUPERTINO, CA 95014-3328 (369 09 029) OWNER'S NAME: Mr & Mrs WILLIAM KWAN HO AND TAN YUEK LEE TRUSTE Woo CONTRACTOR: PETER CONSTRUCTION SUNNYVALE, CA 94089 PERMIT NO: B-2016-1287 DATE ISSUED: 09/23/2016 OWNER'S PHONE: 408-605-8855 PHONE NO: (408) 529-2787' LICENCED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lic.7#8 4887 Contractor PETER CONSTRUCTION Date 03/31/2018 X BLDG _ELECT —PLUMB X MECII X RESIDENTIAL _COMMERCIAL 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. JOB DESCRIPTION: Rear addition (248 S.f.); Side Addition (185 S.f.); Remodel Bathrooms (430 I hereby affirm under penalty of perjury one of the following two declarations: S.f.); Kitchen Remodel (662 S.f.); Convert garage to laundry/mud room 1. I have and will maintain a certificate of consent to self -insure for Worker's (138 S.f); Other Remodel (277 S.f); Install 3 (1) skylights; (N) water Compensation, as provided for by Section 3700 of the Labor Code, for the heater; (N) HVAC system performance of the work for which this permit is issued. REV # 1 -REDUCE SCOPE OF WORK - KITCHEN REMODEL (557.2 2. I have and will maintain Worker's Compensation Insurance, as provided for by SF); CONVERT GARAGE TO (N) LAUNDRY/MUD ROOM (138 S.F); Section 3700 of the Labor Code, for the performance of the work for which this SIDE ADDITION (87.7 S.F.); (N) COVER PORCH (93 S.F.); REMODEL permit is issued. ENTRY/DINING (378.6 S.F); - ISSUED 9/23/16 APPLICANT CERTIFICATION Sq. Ft Floor Area: 433 Valuation: $150000.00 1 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 APN Number: Occupancy Type: representatives of this city to enter upon the above mentioned property for 369 09 029 Deferred Submittal (R3),R-3 (Custom),R-3 inspection purposes. (We) agree to save indemnify and keep harmless the (Custom),Deferred Submittal (R-3),Deferred Submittal City of Cupertino against liabilities, judgments, costs, and expenses which (R-3),Deferred Submittal (R-3),Deferred Submittal (R- Rmay mayaccrue against said City in consequence of the granting of this permit. 3),DeferredSubmittal (R-3),Deferred Submittal (R - Additionally, the applicant understands and will comply with all non -point 3),Deferred Submittal (R-3),Deferred Submittal (R - source regulation r upertino Municipal Code, Section 9.18. 3),Defeaed Submittal (R-3) Signature Date 09/23/2016 PERMITEXPIRES' IF WORK IS NOT STARTED OWNER JI D .R DECLARATION WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. I, as owner of the property, or my employees with wages as their sole Issued by: M LISSA compensation, will do the work, and the structure is not intended or offered for Date' 09/23/2016 sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). RF ROOFSi All roofs shall be inspected prior to any roofing material being installed. If a roof is I hereby affirm under penalty of perjury one of the following three declarations: installed without first obtaining an inspection, I agree to remove all new materials for 1. I have and will maintain a Certificate of Consent to self -insure for Worker's inspection. Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Signature of Applicant: 2. I have and will maintain Worker's Compensation Insurance, as provided for by Date: 09/23/2016 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. s. I certify that in the performance of the work for which this permit is issued, I ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE exemption, I become subject to the Worker's Compensation provisions of the I have read the hazardous materials requirements under Chapter 6.95 of the California Health &Safety Code, Sections 25533, and I will Labor Code, I must forthwith comply with such provisions or this permit shall Municipal ter 9.1 maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the be deemed revoked. Health & Safety Code, Section 25532(a) should I store or handle hazardous APPLICANT CERTIFICATION material. Additionally, should I use equipment or devices which emit hazardous I certify that I have read this application and state that the above information is air contaminants as defined by the Bay Area Air Quality Management District I correct. I agree to comply with all city and county ordinances and state laws will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and relating to building construction, and hereby authorize representatives of this city the Health & Safety Code, Sections 25505, 25533, and 25534. to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, Owner or authorized agent: judgments, costs, and expenses which may accrue against said City in Date: 09/23/2016 consequence of the granting of this permit. Additionally, the applicant understands CONSTR TION,• IN AGENCY and will comply with all non -point source regulations per the Cupertino Municipal I hereby affirm that there is a consWction lending agency for the performance Code, Section 9.18. of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Signature Date 09/23/2016 Lender's Address CONSTRUCTION PERN41T APPLICATION Is COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 V#W (408) 777-3228 • FAX (408) 777-33 ' • building(@cupertino,org CUPERTIN4 � �J� _ " ❑ NEW CONSTRUCTION 9 ADDITION ❑ AL•TERP.. ,, i / TI ❑ REVISION /DEFERRED ORIGINj�yAL PERMIT # V PROJECT ADDRESS Q ' AONE 4'0 / .,rOg SSS E-MAIL�/i/_ W���li%Q, t�l- OWNERNAME:l� /,f, Woo STREET ADDRESSfC n /?� !� ��j, C� �cJlC C' / /tai CITY, STATE, ZIP/? L � 64 FAX �r CONTACT NAME evict e PHONE406�6 �/S 7�'� E-MAIL STREET ADDRESS 63-:7c 3 � 7Omy �aee /P CITY, STATE, ZIP /��{ �A FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR M CONTRACTTO,RAGENT ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS, LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEERNAME 91(s'1'V ne, LICENSENUMSER �� _ AL^�' BUS. LIC# COMPANY NAME C�/� �a`•L, n �� / /, • 7C - C� E-MAIL FAX ——J-/a4Lj,V STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK r7Ca �O� �d � �fr� Jc Ok4 OF RIVR& , R culknvel- 0-1Te1f,c,41 , 5101AII&,,v eallA eel- CE} To <w> 44a1r-A&V(9X . tD7��Ti»/r . ;b�9r� i �'Ny :er��l�v ��. �� �,er c�. �®�� �l3� • ` .6 S� EXISTING USE PROPOSED USE CONSTIL TYPE II STORIES USE TYPE DCC, SQ.FT. VALUAT]ODI($) EXISTO - AREA NEW FLOOR AREA DEMO AREA TOTAL NETAREA A EXT- 00M KITCHEN - OTHER REMODELAREA REMODBLAREA REMODELAREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA: DETACH ❑ ATTACH DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEINGADDED? NO ADDITION? [:]NO PRE -APPLICATION OYES 1FYES, PROVIDE COPY OF PLANNING APPL# NO PLANNING APPROVAL LETTER 15 THEaLpGAN []YES EICHLER HOME. ❑NO !REC _ _-'��'`is�'a-;;-'•;y_�• _ - - _ _`"�'S�`=";�'C'—`•��--•��':�� TOTALS UATIO By my Signature below, l certify to each of the following: I am the property owner or authori tit. to n the property owner's behalf. I have read this application and the information I have provided 's-co�t� I have read the Description of Work andit is accurate. I agree to comply with all applicable local for inspection ordinances and state laws relating to building. I file' n. I authorize representatives of Cupertino to enter the above -identified property purposes, Date: Signature of Applicant/Agent: SUPPLEMENTAL INFORMATION REQUIRED Q iii-,�,^,�:�„a._.�:a.-.:,. ::.. ...e..1..... .. __•_:e: PLAN New SFD or Multifamily dwellinegs: Apply for demolition permit for , existing building(s). Demolition . ennit is required prior to issuance of building :�-�--J-'-~- " " ' ••" ,` .. .:.:: ...: ....`-.,,'., :.: permit for new building, :.: ... _...c:•s: _•tee>:'�;�:i=s:,: i'(ti_!;S:>.:c;� = - ::.. _.'.... i1 ..-.,..,:c-.::,-•cam•::—a_.rn-. , r-:,:�:.�.. r,r'a' ...: c.:: ercial Bldgs: Provide a completed Hazardous Materials Disclosure Commercial 0`;STANDARD: '..s'c' >'_=i;T =: = ;:: _I�_,PLfBLIC.tVO$KSs -:- :;;v •;;t, '.;-. -- form if any Hazardous Materials are being used as part of this project. - Copy of Planning Approval Letter of Meeting ��r Ith Planning prior to fz�=:_:y:-::_:..__:?•.;'<.��eE'_:a':"_i:��::':i';' ::^:-•:��'::`;C:F'•7<.:r;-�;rs,,–.,.: ::''!'-:•.�:.:<t%i.. z submittal of Building- Permit application. �->,::-::.-.::.:::::--,--�-- _ ._..... - 2- .: ;::,........_•...-a.,;;;,,,�,,-- �:, _ BldgApp_2011.doc revised 06121/11 po7 aye, CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: CONTRACTOR: P RRMIT NO: B-2016-1287 10338 COLD HARBORAVE CUPERTINO, CA 95014-3328 (369 09 029) PETER CONSTRUCTION SUNNYVALE, CA 94089 OWNER'S NAME: Mr & Mrs WILLIAM KWAN HO AND YAN YUEK LEE TRUSTE ATE ISSUED: 08/29/2016 OWNER'S PHONE: 408-605-8855 I1 PBONE NO: (408) 529-2787 1 License Class B Lie. # 74 7 Contractor PETER CONSTRUCTION Date 03131/2018 hereby affirm that I am licensed under the provisions of Chapter 9 (commencing ith Section 7000) of Division 3 of the Business & Professions Code and that my cense is in full force and effect. 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. - 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. APPLICANT CERTIFICATION I certify that 1 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date 9/2/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: r. 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) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: r. 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. 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. a. f 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. PERMIT X BLDG —ELECT LUMB X MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION; Rear addition (248 S.f.); SideAddition (185 SX..); Remodel Bathrooms (430 St); Kitchen Remodel ( 62 SX); Convert garage to laundry/mud room (138 SX.); Other Remodel (277 S.f); Install 3 "skylights; (N) water heater; (1) HVAC syste Sq. Ft Floor Area: 433 IYaluation: $150000.00 APN Number: ccupancy Type: 369 09 029 eferred Submittal (R -3),R-3 (Custom),R-3 stom),Deferred Submittal (R-3),Deferred Submittal -3),Deferred Submittal (R-3),Deferred Submittal (R- ),Deferred Submittal (R-3),Deferred Submittal (R- ),Deferred Submittal (R-3),Deferred Submittal (R - ),Deferred Submittal (R-3) APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree( to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date 9/2/2915 PERMIT EXP IES IF WORK IS NOT STARTED WITHIN 180 XYS OF PERMIT ISSUANCE OR 180 DAYS FR9,M LAST CALLED INSPECTION. Issued by: RE -ROOFS: All roofs shall be inspect prior to any roofing material being installed. If a roof is installed without first ob ' ' g an inspection, I agrees to remove all new materials for inspection. Signature of Al Date: 9/2/2016 ALL ROOF CdVERINGS TO BE CLASS "A" OR I have read the hazard nis materials requirements under Chapter 6.95 of the California Health & afety Code, Sections 25505, 25533, and 25534. I will maintain compliance wi h the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code Section 25532(a) should I store or handle hazardous material. Additionally, s hould I use equipment or devices which emit hazardous air contaminants as de ted by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & S afety Code, Sections 2550$ 33, and 25534. Owner or authorized agent: Date: 91212415 STRUCOONI IN I hereby affirm that ther ' is a c nstruction lending agency for the performance of work's for which this ermit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address 0014STRUC ION PERMIT APPI_ICA T I( COMMUNI I f DEVELOP'IViEN i DE?AR i MEN7 : BUiLDIN-G D I M0 70RRE AVENUE CUPER. T MID, CA S'501/4-3255 f C[3RE'RTit�IG' (408) 777-3228 - FAX (408) 777-3333 bu'1ldtrio Q.ruoerino.ori n vmw C ClT RT�C%,C;N V: =711 MW . n TI n RZE,19I0N I D1- 0YUGI? d.L PB21J,I7 t ?Ru;rcr}nn?ass035 Lf)�� I Rnn `oaq (��1 �� —1/1/ GtjG>�C��y i ST?,.Sct ADMESS ` CaAY, SV r_, Z: —� G :EX t/ ! COMACT r VS r ��! E-1JASJ ' t` 0"O 7 I 14 _qc S:P=ir }� 3T.:SS Z% Cam U C?Y, Vii: i?, ZF? 04c-'es � t CA F—/,x u 13 OVttcR Q OK`dr-BGu3>;:t. 0 oV,NrZRhCT'i' 1 CO',rM .CPOR �Coi ??CTO' };G1.i 3.CIusaCT ❑ �r1C? n^R D:1sLOP^� ❑ _�-Aj'r CO1vii1 Ci OR 1�/.f r L IC✓1 Sc?�U1,'3rP I Ll NQS? i) to nUS, LiC r, jl 5 i'i Ft`f Ae7p3t_-gS CITY, STA—m-, ZIP P iOh� _, FRC�i CrrG7v iR1fJ�C' ( L1C rSr°Lh�^ /3^,(� �+ { 5L'S,LiCR t/'A (— (3 ] 4 /-- CO1,�.P.11' ? �.k z Z41 AM, FAX sr, aeT f onR ss _ �JM�yy/� y� atA/3 A � x 4Q �C_ s� a G U FROPO.,EID Us -a COIa:S i R 1l?B ST011M 111sE I ire occ. I sQ.rT. I VALUATION (S) 7G 'aw FI.GOR Dc1,49 TOT f T - �� IF 339.x- I I I BhTu.7i0 1J .. y°'1�'Clbw. .I I,aTG'r'. 0P_Lf.F)z z A :? 1f6 SLf� P�7.4._.=.' CI ?DY,06 Ak:A DECK i VE!. i0l F1 D_C1:/PO C_i f i:_h Gl*L11EE A.,'.?,.5: DD-m"CH 9� WATTACFi RAHcLLtJ.'G'�:,i,5: 15kSECONDLJN []?'.=S SDCOtiDSTdAY ?S BFING ADDED2 h0 I ADDrr10h?j'}:0 spr• eau ,Cl T10:� 1'S =YDS, ?ROiS�° COPY Or IS , J£ BLDG ' N D YES t om} = �" - = 70T.`�L \ r` t UA IMIN: �^ LA-IMMjf??L9 ,.[]340. PLA1\+T�GE.PP?OVALL_ETI-L � ':IC1:L=RR01."L! NO � � �'C G'. 000' _ By,my sr lia-wrcblow, I seft1y to tach of ilia following: ;: I er1 thcB r opery o. ',u or authoriLed -i ,o a t on the prope, y ov ;,er's'ceh lf. I have d this amlicaimi _rd the 1,ior ,.a ;un I ha-ve prop>ided :s co„ --"t: I h�v d t'ie escnptioD of T o -k zrei w, �=y ; 1s �ecL s.a, I z� ee to co nilly wish Gil _opl,cz:oie local weira,ces znd state laws re)2_+gig to b+ 'icira co7smctio- _ or, •e repr sen -tires of Cuperiia� to en#er `e abe.+e-idcr,:in`.ed propery :or ins action ptoses. S1 4i re of Apphc �tlrge, / � 5UPP?-EA?T�J Ti 0RR4 1011 R> ut D z�= lz iev; SF7 or M.ill fa 1 dv. 11inzs, , Dnly for c unlit on p-,it'or lctir ✓�+110rr:�(S). JCY OlttiO_Y 1..,i :l1t 1 p ler i0 :_51. p-.-?Ct Or-ui)d'ara I `Q TOI `ki;1}' 1J1 „__9le_,>. '`-`� I"+,..._.Llt ��ti-F? . B1d2s: Provide a eo-ple, d r_`'azs cimus Maa rials Diselosl�re T� ,�4 = o _ d ce t Oi ii: s T) Oject, __,y .Hazy CO -+s b/ uerl, ala Lae bthm,gg i1,. t'5 '2. A�D:oV `l_er Mlar;t;rtg i it, Piu`i•+ g t0 - Copy OMc tea] Q cl y or prior CTR - s— cii` wYr a�T TR_rCT subu i'LLFl of BulldL'?g Pum -It EDP]3Mt;011, . Rlaa;, ijp 3011.docrevise0612YJ1 . CITY OF CUPERTINO T, VV FRTTMATnR --.- RITIT,nING DIVIS ON OCCUPANCY TYPE: 10338 Cold Harbor Ave DATE: 02/01/2016 REVIEWED BY: PAUL LAADDRESS: APN: 369 09 029 13P#; #VALUATION: $150,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SPD or Duplex 2nd Unit? - 'Yes W No 0 Yes � No PENTAMATION 1R3SFDADD PERMIT TYPE: USE: OTC? ,d$r'(;323.00 WORK Rear addition 248 S. • Side Addition 185 S,f. • Bathrooms Remod 430 S.f. ; Kitchen Remodel 662 f. SCOPE S.Q; Convert garage to laundry/mud room (138 S.f.); Other Remodel (277 S.f.); install 3 (N) skylights; OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA (s.i FEES PC, EE ID BP FEES BP FEE ID ' R-3 (Custom) If 8,111-B,IV,V-i3 433 f31,626.00 olhel 'Irma Ira.ct.. M PLCK ,d$r'(;323.00 IADDINSP $1,.323.00 Suppl. Insp. Feer Reg. C) OT 1. T•. v--:4— -.Q- District hrs $0.00 939 s.f . R model, Other I $647,00 IRI:MR ri OTH PME Unit Fee: $0,00 PME Permit Fee: $48.00 I # Sl; ylight ; $1;293.00 'MKYL< Ccitlstr t ctfot t{ a1.21rnlrrl,slrf't11 'c /Tee 1 # M chanical 0 $143,00 7tYIFR= l�� furnace, Forced -Air Work Without Permit? Yes No „ Advanced Plannigg Fee: IPLLONCa $0,00 $60.62 TOTALS: 433 $1,626.00 Stronglotion Fee: IBSEISMICR $1,323.00 Select an Administrative Item � NiECI, HOURLY Yeses Q No .5'Cltool PLTJMI3, HOIIRLi' �. rtes No LE4UBIfY des Nn Mech, Plan Cheek 0.0 hrs $0.00 11lufni3, P1ara i.hook t"t;. War., c `h al. Mech. Permit Fee: MPERMIT I'I;e3r3h. 1'ctiPPERMiT 0.0 O#her Mech. Insp. 0.0 hrs $48.00 olhel 'Irma Ira.ct.. PME Plan Check: I'c..a P1'•dimb. IrlSj3_. l' -C:. Ins'. $1,.323.00 Suppl. Insp. Feer Reg. C) OT 1. T•. v--:4— -.Q- District NOTE: This estimate noes not include fees clue to other Depai lents (i.e. Planning, Public Wo AS, tre, t ry eF .1 _ .. _._u..__.__.... ;...r .., .,s;.,... --]"Ala marl mw nNhF fill n. thnate. Contact the Dent. for addn'l info. District, eta e t hesej ees erre Uasets ow tsu if,—i.... — 1E EITEMS (lTee liesolution 11-053 t'f. 7/11.131 UUGI...... WE - E•c rFEE FEE QTY/FEE MISC ITEMS Plan Check Fee: $1,626.00 300 s.f. Re nodel, Bath (<=300 sf) $645.00 II M BST Suppl, PC Fee: Q Reg. OT 0.0 hrs $0.00 PME Plan Check: $0.00 1 NU s,f. R model, Kitchen (<=300 s f) $645.00 IRE :KIT Permit Fee: $1,.323.00 Suppl. Insp. Feer Reg. C) OT 0,0 hrs $0.00 939 s.f . R model, Other I $647,00 IRI:MR ri OTH PME Unit Fee: $0,00 PME Permit Fee: $48.00 I # Sl; ylight ; $1;293.00 'MKYL< Ccitlstr t ctfot t{ a1.21rnlrrl,slrf't11 'c /Tee 1 # M chanical 0 $143,00 7tYIFR= l�� furnace, Forced -Air Work Without Permit? Yes No „ Advanced Plannigg Fee: IPLLONCa $0,00 $60.62 .� elect a Non -Residential Building or Structure r Travel Documentation Fee: ITRAVDOC $48.00 Stronglotion Fee: IBSEISMICR $19.50 Select an Administrative Item � Bldg Stds Commission Fee: IBCBSC $6.00 - UIT©Y TOTAL VV r . . _ c Revised: 01101/2016 Ili i SIT 274 E. Hamilton Avenue, Suite C Campbell, California :95008-0240 Voic �: 408-871-7273 Fax: 408-871-7274 Web: wwwSMSEinc.com r Email: SMSEincnQ- aol.com l V V December Re: eld i pectin fo`'r epoxy anchors "l r Residential Ad itio;& Remodel 10338 Cold H rbor Ave. Cupertino, CA SMS job. : 7098hI'',16 visite ecember 1, 2 16, the aforementioned site at project contractor's request to provide structural observal'ion for the installation of threaded rod holdown anchors for new retrofitted shear -walls,) Listed below are my findings: I . All holdowns were ro I�`erl p p y� located as per engineering document. Drawings preparedl'�by SC Design Group with Project 1D: 1548, Dated: 06.26.116. 2. SET -XP" epoxy (ICC -ES ESR -2508), by Simpson Strong Tie, was used as required. 3. I was informed that the, dulled holes where wire brushed prior to my arrival. 4. The anchor depths were measured in my presence. 5. The anchor depths were n general conformance with the design documents. Any holes that were not ac'Ceptable were drilled deeper: • 15" minimum for 5/$" diameter threaded rod holdown anchors. 6. Sample holes where re-1Iblown in my presence and found clean. Any holes that were not acceptable were rb-bru-Med and re -blown in my presence. 7. The epoxy was well mixed coming out of the nozzle when applied. 8. The holdown anchors ere properly inserted info the pre -epoxied holes in conformance with ma�ufac­urer's installation instructions. Sezen & Moon Structural E il' gineering, Inc, (SMSE) did not engineer this project and] we do not accept any responsibil ty for the following items: design documents, as -built conditions, safe job site c8'idifions, adequate holdown anchor sizes, embedment and locations. Our responsibilitlyI' only extends to: proper epoxy anchor installation, threaded rod size and location per d�sign]documents by others. s Please call our office at comments. Sincerely, John H. Park, Project Engin 1 17273 ext. 3# if you have any further questions or, L ZZ 1 of 2 Holes 2 of 2 SMOKE 1 CARBON MONOXIDE ALARMS , ` '4 OWNER CERTIFICATE OF COMPLIANCE - COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO,CA 95014-3255 .� �C CUPERTtC3 (408)777-3228®FAX(408)777-3333•buildinq(�cupertino.org 15 � � �e�µY£ Permit No. -2' , { e Address '�-` yitA724-0 Ar. -- _ of Alarms Smoke: Carbon Monoxide: _ e PERI IT CANNOT it I+INALED-A\TlD CONIPLE'TED 1<7NTLL T S CERTw1 GATE HAS BEEN StGI\ I3 Al I3 ZETURNEI TO Till;BUILDING OW:IRON 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 I SMOKE ALARM CO ALARM____ Outside of each separate sleeping area in the immediate vicinity of the bedrooms) - _ k � On every level of a dwelling unit including basements X ' Within each g- p� �slee inroom X — --- — I 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 CRS Section R314 CBC Sections 907.2:11-4 d420`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 m 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 nth the terms nd conditions of this statement x:._ Owner(or Owner Agent's) ameLx): ,�°r Signature ... . . .. .,l f. Date 1 —0 Contractor Name: / ' ( � Lic.# Date: .. Signature ) -t Smoke and CO fornzdoc revised 03/18/14 WATER-CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE x.p COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO I � `I 7 .` (1'.<. ( 08)777-3228••FAX(408)777-3333••building cupertino.orq "t 1 Owner Name yA-7-3Permit No. S I f:_ "-- 2-.r =- Address / 0 4 4,, , 46tTeR vi 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. Vf/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. la 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. ,Et 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. `Plane check ONE of the following: 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- compliant plumbing fixtures shall be replaced with water-conserving plumbing fixtures (regardless of whether property undergoes alterations or improvements). El 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. or-before-.January.i,-201_9,-all_non-compliant plumbing-fixtures-shall be replaced with water- c 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 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: c. Date: Upon completing and signing this Certi`ii te, ea urn it to t - outtditig=Division in order to final your b ldmg p-rmit: SB4072015.doc revised 08/26/15