B-2016-2805 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2805
22321 KENDLE ST CUPERTINO,CA 95014-1024(326 13 106) WILLOW GLEN
ELECTRIC INC
SAN JOSE,CA 95155
OWNER'S NAME: MOK OSA C S AND FARRAH FEN YU TRUSTEE, DATE ISSUED:10/05/2016
OWNER'S PHONE:408-838-8769 PHONE NO:(408)289-9725
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-10 Lic.#59191a
Contractor WILLOW GLEN ELECTRIC INC Date 04/30/2018 X BLDG —ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —M ECH 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:
(1)EV CHARGING STATION(40 AMP)-GARAGE
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.
�y - 'I have and will maintain Worker's Compensation Insurance,as provided for by
V Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation $1990.00
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 326 13 106
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save indemnify and keep harmless the
City of Cupertino against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE 4R
Additionally,the applicant understands and will comply with all non-point
source regula' s pe he Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
/ i � -Signature". � Date 10/0512016 Issu
Date: l
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RF:ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. .I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:10/05/2016
I hereby affirm under penalty of perjury one of the following three declarations ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. I have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. 1 will
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued.
Health&Safety Code,Section 25532(a)should I store or handle hazardous
3. I certify that in the performance of the work for which this permit is issued I material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code ctions 2$505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:.'
APPLICANT CERTIFICATION Date:10/05/2016
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws 1 hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address
judgments,costs,and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally,the applicant understands ARCHITECT'S DECLARATION
and will comply with all non-point source regulations per the Cupertino Municipal
I understand my plans shall be used as public records.
Code,Section 9.18.
Licensed
Signature Date 10105/2016 Professional
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERT1 @O (408)777-3228+FAX(408)777-3333•buiidin cu eq!no.or
PROJECT ADDRESS '$ / rD APN# Ila
OWNERNAMEPHONE E-MAILS 0 to 4 fes , 0,S a tA 61 C1 &2, 0
STREET ADDRESSCI Y, STATE,ZIP FAX
CONTACT NAME Mark Londre PHONE (408)289-9725 E-MAIL
office @wilIowa lenelectric.com
STREETADDREssRO. Box 8430 CITY,STATE,ZIP San Jose, CA 95155 1
FAX(408)289-9725
13OWNER 11OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR.NAME Mark Londre LICENSE NUMBER 591918 1
LICENSE TYPE; ^-1 O. BUS.LIC# 15897
COMPANY NAME Willow Glen Electric, Inc. E-MAIL office@willowgienelectric.com FAX (408)289-9725
STREET ADDRESS R O. BOX 8430 CITY,STATE,ZIP San Jose, CA 95155 PHONE (408)289-9725
ARCHITECT/ENGINEER NAME N/A LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD Or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE: ❑ COMnlerClal URBAN INTERFACE AREA ❑ Yes ❑ NO FLOOD ZONE ❑ Yes ❑ No
------
❑SOLAR PANELS ELECTRIC VEHICLE CHARGING STATION T SOLAR WATER HEATING ❑ OTHER:
FOR SOLAR PANELS. NUMBER OF PANELS/UNITS: KILOWATTS(COMMERCIAL ONLY): TOTAL.VALUATI N6
DESCRIPTION OF WORK <'
Electric Vehicle Charging Circuit: Ltf iS l�
A) '17' F PRO f0 RIC71-ler CORS F —46 C 26
RECEIVED BY:
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I hake 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 to building cononn. au horizeeje�prresentatwes of Cupertino to enter the above-ide tified property for inspection purposes.
>�/ ! jGtr,V�'
Signature of Applicant/Agent: Date:{—
SUPPLEMENTAL INFORMATION REQUIRED OFSCCE'ISE ONLY
w 0 OVER-THE-COUI#rTER
❑' EXPRESS
:E
CI ,STANDAR'D
❑ LARGE
a
❑ MAJOR
PVApp_2011.doc revised 03116111
WATER 'CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE-OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
, -
(408)777-3228•FAX(408)777-3333 `building(D_cupekino.oig
Owner Name: Osa Mok
Permit No 13 ad
.Address 22321 Kendie Street,"Cupertino, CA 95014
r ;
PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE
HAS BEEN SIGNED AND RETURNED TO THE BUILDING DIVISION '
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?
❑ 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 6 —//.-
EIR 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..,
Sign below and skip the`rest of the form: _
Owner' Signature: Date: 10
iX 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. Sign:below and skip the rest'of the form.
Owner' Signature: Date:
19 No Go to Question 4. r
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.
Owner' Signature: Date:
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.,Refer to the attached.
® 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 futures 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 alterationsor 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 berep laced with water-
conserving plumbing fixtdres throughout the building(regardless of whether property undergoes alterations or
improvements).
My property is a commercial real property. :S.ee 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.
SB407 2015,doc revised 02104115
I3UILD�1G p C OT FII6TAI,ED AND CO _-L ETED TJNTIL THIS
CET1FCrTE BBE I NSD HETLTRNED TtO THE BUII;DING pIVISOly
;on-Compliant Water-Conserving Plumbing Fixture
Plumbing Future' (Fixture Complying with Current Code Applicable to New Construction)
Fixture Type Maximum Water Usage/Flow
a/Flow Rate
Water Usage 2013 CPC Ch.4 2013 CPC Ch.4 2013 CPC Ch. 4
/Flow Rate 2013 CALGreen Civ.4.3 2013 CALGreen Div.4.3 2013 CALGreen Div. 5.3—
Single-Family Multi-Family Commercial
i Residential Residential
Water Closets Exceed 1.a Single flush toilets: 1.28 gallons/flush
(Toilets) Gallons/flush I` 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
Gallons/flush 0.5 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. FPA 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 r May temporarily increase May temporarily
up to 2.2 gallons per increase up to 2.2
minute @ 60 psi, and must gallons per minute @
default to maximum 60 psi, and must
1..8 gallons per minute @ default to maximum
60 psi 1.8 gallons per minute
Where faucets meeting @ 60 psi
the above are unavailable, Where faucets meeting
aerators or other means l the above are
may be used to achieve unavailable, aerators or
reduction. other means may be
used to achieve
reduction.
1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shown,it is not required to be upgraded.
SB407 2015.doc revised 08/26115
SMOKE/CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333•building a)-cupertino.org
l 9 5C)14 Permit No.6-c,20 1 o-c2 60 J
Addresses ( I'c c�V Ic�I p �- z�/pp y ,`a e� #of Alarms Smoke to Carbon Monoxide
' r r
PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE
HAS BEEN SIGNED AND RETURNED TO THE BUILDING DIVISION E
I
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 SMOKE ALARM CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the X X
bedroom(s)
On every level of a dwelling unit including basements X X
Within each sleeping room X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel-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.
1 have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name: rN
OSaMok Si nature......._.. ............................,...................:..............:............Date:
Contractor Name:
Signature.............:....:................................................Lic.#......................................Date: ...................
Smoke and CO form.doc revised 03118114