B-2016-2736 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR: PERMIT NO:B-2016-2736
20410 VIA PALAMOS CUPERTINO CA 95014-.6330(316 01 188) JEMICO LLC
HAYWARD,CA 94544
1
OWNER'S NAME; ( DATE ISSUED:09/15/2016
OWNER'S PHONE:408-252-5401 PHONE NO:(866)420-4109
LICENSED:D ONT A TOR' D R ATjON BUILDING PERMIT INTO:
License Class B.C17 Lic.#97270
Contractor JEM ICO LLC Date ,1 X BLDG _ELECT _PLUMB j
_
I hereby affirm that I am licensed under a provisions of Chapter 9(commencing MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Bu iness&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
1 ST FLOOR REPLACE PATIO DOOR
I hereby affirm under penalty of perjury one of the following two declarations:
i. I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided'.for b Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
[� z. 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:$5730.00
APPLICANT CERTIFICATION
I certify that I have read this application nd state that the above
information is correct.I agree to comply ith all city and county ordinances APN Number: Occupancy Type:
and state-laws relating to building constr ction,and hereby authorize 316 01 188
representatives of this city to enter Upon the above mentioned property for
inspection purposes. (We)agree to say..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 grantingall
this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands a d will comply with all non-point
source regulations per the Cupertino Muiielpal Code;Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
gnature @// Date 09/15/2016 Issued by:Kim Dunbar
I
Date:09/15/2016
OWNEWB UDER DEC L RATION
-
I hereby affirm that I am exempt from thi Contractor's License Law for one of the RE-ROOFS:
following two reasonsI All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I a
i. I,as owner of the property,or my I employees with wages as their sole p gree to remove all new materials for
compensation,will do the work,,nd the structure is-not intended or offered for inspection.
sale(Sec.7044,Business&Profe;sions Code)
z. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the proje4(Sec.7044,Business&Professions Code). Date:09/15/2016
E
I herebyaIirmunder p in perjury one of the followingthree declarations:
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
ihave and will maintain a Cerhfiigate
of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the p- 1
performance of the work fo;whish this permit is issued �— HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by ''7 have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Gode,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
a. 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 lavas of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subjegt to the Worker's Compensation provisions of the the Health&Safety Cod ,Se tions 25505,25533,and 25534.
Labor Code,I must forthwil conal ply with such provisions or this permit shall f
be deemed revoked. Owner or authorized agent: 6
APPLICANT�ERTIFIC
ATION Date:09/15/2016
certify that I have read this applicajtion and state that the above information is CON TRUCTIONLENDING AGENCY
correct.I agree to comply with all city an county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and her by authorize representatives of thiscityof work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned j prop wty 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 play accrue against said City in Lender's Address
consequence of the granting of this;perrr}it. Additionally,the applicant understands
and will comply with
Code,Section with all non-point so urce regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
I
I understand my plans shall be used as public records.
i
Licensed
Signature Date 09/15/2016
Professional
CONSTRUCTION PERMIT APPLICATION
i
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (40,8)777-3228 FAX(408)777-3333•building(cDcupertino.or
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESAPN#
S
C) �2VIS,
rIE[p
OWNER NAME. �Aa d�✓ I;�fs _... PHONE(Iti 0r5'Z.. J'L1 E-MAIL_.. ,..
STREET ADDRESS K i� $I���I (� ®� CITY,STATE,ZIP FAX
CONTACT NAME �si 'gt
j l� PHONE E_
t o — Z-6 3 0 31 7C � -� d eaa ,J
STREET ADDRESS CITY, ATE',ZIP !tLri FAX
30-too Seh �/v 5
O.OWNER ❑ OWNER-BUILDER �'�❑ OWNERAGENT -CONTRACTOR El CONTRACTOR AGENT El ARCHITECT ElENGINEER El DEVELOPER El TENANT
CONTRACTOR Ni�AME }gam r LICENSE ER LICENS TYPE -7 BUSIM
COMPANY NAME 1 _
E;41AIL
F"nv cP re6 I�eas co FAX
STREET ADDRESS �Q $ ,�8 CITY,STATE, IP e a �,Cf PHONE -
30 v CA °I Ll J 510- :3s76
ARCHITECTIENGINEER NAME I LICENSE NUMBER BUS.LIC#
COMPANY NAME
E-MAIL FAX
i
STREET ADDRESS {
CITY,STATE;ZIP PHONE
DESCRIPTION OF WORK
EXISTING USE. - -PROPOSEDiUSE I CONSTR TYPE -4/STORIES
USE TYPE OCC. SQ.FT. VALUATION($)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA. AREA NET AREA
BATHROOM KITCHEN OTHER - -
REMODEL AREA REMODEL AREA REMODEL.AREA.
PORCH AREA DECKAREA TOTAL DECK/PORCHAREA GARAGE-AREA:. DETACH - - -
[]ATTACH
#DWELLING UNITS: - IS A SECOND UNIT .DYES: SECOND STORYEIYEs -
BEINGADDED?, []NO ADDITION? E]NO - o
i
PRE-APPLICATION ❑YES .IF YES,PROVIDE Copy OF IS THE.BLDG AN ❑YES REC B ;. ,TOT VALUATION:
OVAL LETTER EICHLERHOME? E]NO :� �o
PLANNINGAPPL# ANO PLANNING,APPR
By sin and the lowinf,matron hae each ofthe following: I am the property owner or authorized agent to act on the property owner's behalf. I Dave read this
B m signature below,I ce to ea
e rovided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to ding construction. I authorize representatives of Cupertino to enter the ab(o�ve ideen✓tifi d property for inspection purposes.
Signature of Applicant/Agent: Date: ��
SUPPLEMENTAt INFORMATION REQUIRED rLANe>1cx TYPE ouTINc sL>P
_New SFD or Multifamily dwellings: Apply for demolition permit for h
❑ OVER-THE;COUNTER _LI BUILDINGPLANREVIE.
ermitg b new building. permit is required prior to issuance of building
existing building(s).s . Demolition
lI ❑ EXPRESS. :LI PLANNING PLAN REVIEW.
Commercial Bldgs: Provide la completed Hazardous Materials Disclosure Q' STANDARD ❑ PUBLICwORBS
form if any Hazardous Materials are being used as part of this project. ❑ LARGE FIRE DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to El
submittal of Building Permit application. MAJOR ❑ SANITARY SEINER DISTRICT
0 ;ENVIRONMENTALHEALTH
BldgApp 2011.doe Devised 06/21/11
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUP RTIfNO 10300 TORRE AVENUE• CUPERTINO,CA 950143255
(408)777-3228•FAX(408)777-3333•buildingP_cupertino.org
t � Cgpl / _Permit Noo
Address °`' #of Alarms Smoke: Carbon Monoxide: 2—
'E CANNOT INAEED AND. O1V,IPL,ETEI)LIN�a,THIS CERFICTE
........ s
"S"M EN�� r +r +'l RT+1 i�N 3 .fl Ti�IE B 1I� lll OY F ,
PURPOSE
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
inspections are required.
GENERAL INFORMATION
Existing single-family and multi-family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions,alterations, or repairs to existing dwelling units exceeds
$1000,00, CRC Section 8314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon
Monoxide Alarms be installed in the following locations:
AREA SMOKE ALARM CO ALARM_
Outside of each separate sleeping area in the immediate vicinity of the X X
bedroom(s)
On ever level of a dwellin unit including basements X X
Within each sleeping room
Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal:
Power Supply:In dwelling units with no commercial power supply,alarm(s)may be solely battery operated.
In existing dwelling units,alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic,basement or crawl
space.Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2.An electrical permit is required for
alarms which must be connected to the building wiring.
As owner,of the above-referenced property,I hereby certify that the alarm(s)referenced.above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes..The alarms have been tested and are operational, as of the date signed
below.
I have read'and agree to co2L&with the terms and conditions of this statement
Owner(or Owner Agent's)Name:
V ...........Date:
Signature............ . ,........ ......... ................... �
Contractor Name:
Sinature...................................................................Lic.#.......................,..............Date: ...................
Smoke and CO form.doe revised 03118114
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO
(408)777-3228•FAX(408)777-3333•buildinaCaD_cupertino.org
Owner Name ' �{- Permit No. `2-��� 2 � J6/
Address 2,64yo IV; P4 Cid
y
1. Is"your real property a registered historical site?
0/Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
Q 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
p^l Bing,installation of water-conserving plumbing fixtures is not technically feasible?
C 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.
E4 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.
2 No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1,1994?
El 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.
dyes 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. —PI/ase check ONE of the following:
L 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).
❑ My property is a multifamily residential real property. See Civil Code Section 1101.5.
On and after January 1,2014,specified building alterations or improvements shall require non-compliant
plumbing fixtures to be replaced with water-conserving plumbing fixtures.
On or before January 1,2019,all non-compliant plumbing fixtures shall be replaced with water-
conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or
improvements).
❑ My property is a commercial real property. See Civil Code Section 1101,5:
On and after January 1,2014,specified building alterations or improvements shall require non-compliant
plumbing fixtures to be replaced with water-conserving plumbing fixtures.
On or before January 1, 2019, all non-coin pliant 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 following page.
Owner or Owner Agent's Signature: Date:
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit.
SB40 7 2015.doc revised 08126115
"WOUN
-M-.,.�.., ...�,. .a'.1 ...,:..s..r.Fa...1..�.',..�w�n"c'°......—, �+,+t�"aaS,a���.cN,'�1.�'�.stir�.Sta��"rsYw.Lfi�mc,•;f �
Nori--Co rnplla 5� �1latermConservingPlutnbingFlxture
Pie s b€n ixtfi re (Fixtg�£re Cor plying with Current Code Applicable to New Construction)
Fixture Type # Maximum Nater t4a a/F#rsRate
Water Usage 2013 CPC Ch.4 2093 CPC Ch.4 2013 CPC Ch.4
/Flogs;Rate2013 CALGreen Div. 4.3 2013 CALGreen Div.4.3 2013 CALGreen Div. 5.3
Single-Family Multi-Family Commercial
Water Closets Exceed 16 Residential Residential
(Toilets s, Single flush toilets: 1.28 gallons/flush
) Gallons/,iush Dual flush toilets: 928 gallons/flush effective flush volume(the composite,
Urinals - - avera e flush volume of two reduced flushes and one full flush)
Exceed 1.0
Gallons/flush 0.5,gallons/€lush
Showerheads Exceed 2,5 2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of
talions per rrrslnuLe U.S. EPA 1katerSense Specification for Showerheads
(A hand-held shower is considered a showerhead.)
For multiple showerheads serving one shower,the combined flow rate of all
sl overheads and/or other shower outlets controlled by a single valve shall not
j exceed 2.0 gallons per minute @ 80 psi,or the shower shall be designed to
f allow only one shower outlet to be in operation at a time;
j l aucets- Exceed 2.2'ca;lons A-axis num 1.5 gallons per Within units: 0.5 gallons per minute @ 60
Lavatory per minute minute c@z 60p i;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
l in common and public
use areas: 0,5 gallons
per minute @ 60 psi
1 1.8 gallons per minute
60 psi
Faucets- Exceed 2,2 gallons 1 1,8 gallons per minute @ 9.8 gallons per minute 1.8 gallons per minute @ 60
Kitchen per minute i 50 psi @ 60 psi psi
s Faucets I May ternporarily increase May temporarily
1 i up to 2.2 gallons per increase up to 2.2
(
minute @ 60 psi,alio must gallons per minute @
default to maximum 60 psi,and must
? 1.8 gallons per minute @ default to maximum
60 psl 1.8 gallons per minute
Wnere 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 usageffl ow rate is equal to or lower than the figure shown,it is not required to be upgraded.
SB407 2015.doc revised 08126/15