B-2016-2862C.
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-2862
11063 WILKINSON AVE CUPERTINO, CA 95014-4795 (356 17 034)
C - BROOK
CONSTRUCTION
LOS ALTOS, CA 94024
OWNER'S NAME: CONDAMOOR RAVI AND SHANTHA
DATE ISSUED: 10/05/2016
OWNER'S PHONE: 650-2244445
PHONE NO: (650) 224-4445
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class a Lie. #480262
Contractor C - BROOK CONSTRUCTION Date 06/30/2017
X BLDG _ELECT _ PLUMB
MECH 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:
ADD NEW FRONT ENTRY
I hereby affirm under penalty of perjury one of the following two declarations:
i. 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
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
Sq. Ft Floor Area:
Valuation: $20000.00
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
"N Number:.
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
35617 034
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
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant and stands and will comply with all non -point
source regulati s per the Cu ertino Munic al Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
/ i
Signature f Date 10/5/2016
Issued by: AbbyAygnde
Date: 10/05/2016
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
i. 1, as owner of the properly, 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 (Sce.7044, Business & Professions Code)
2. I, as owner of the property am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sce.7044, Business & Professions Code).
Date: 10/5/2016
1 hereby affirm .under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
i. 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
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code, for the performance of the work for which this
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued,
Health & Safety Code, Section 25532(x) should I store or handle hazardous
a. i certify that in the performance of the work for which this permit is issued, I
material. Additionally, should I use en 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 Quality Management District I
ay Are
Worker's Compensation laws of California. If, after making this certificate of
�,� maintain compliance with the Cupertino unicipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety e, Sections 5505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
owner or authorized ag nt: t
APPLICANT CERTIFICATION
Date: 10/5/2016 j
I certify that I have read this application and state that the above information is
Y
e o lending ency for the performance
1 hereby affirm that theris constructi
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issu ( Sec. 3097, Civ C.)
,
relating to building construction, and hereby authorize representatives of this city
Lender's Name
to enter upon the above mentioned property for inspection purposes. (We) agree
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
ARC'HITECT'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 10/5/2016
Professional
CONSTRUCTION PERMIT APPLICATION
s COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 . build ino(�cuperdno.org
C U P E RT I lel e� t—
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PROJECT ADDRESS
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ARCHITECT/ENGINEER NAME ,r( LICENSE NT UMBER
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BUS. LIC;!
COMPANY NAME .
E-MAIL
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STREET ADDRESS
CITY, STATE, ZIP
I PHONE
DESCRIPTION OF WORKA�Zr�
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EXISTING USE - PROPOSED USE - CONSTR TY E = STORIES
i
USE
TYPE
OCC.
SQ.FT.
VALUATIO\' (S)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER. --
REA4oDELAREA
RE-\40DELAR.EA
REMODELAREA
PORCHAREA
DECK AREA
TOTALDECKRORCHAREA
GARAGEAREA: ❑DETACH
- --
❑ATTACH
DWELLLNG UNITS:
IS A SECOND U -N ❑ -I-ES
SECOND STORY El YES
BELNGADDED? ONO
ADDITION? ElNO
PRE -APPLICATION ❑ PES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
CENED B `
- -.
TOJ- kVALUATION:
PLA \WLNG ADPL= ❑ NO PLANNING APPROVAL LEITER
E LER HODIE? NO
By my signature below, I certify to each of the following: ain the property owner or authorized agentto act the property owner's behalf. I have read this
application and the information I have ra lided is co ect,. have read the scnption of lWork and verify it is accurate. I 'gree to Imply with all applicable local
ordinances and state law relating to l ldina cons ction. I authorize rep sentatives of Cupertino to enter the abog id�ified perry for inspection purposes.
Signature of Applicant/Agent: Date:
D Q
SUPPLEMENT TFOP-mA7y"
7\iet' SFD OI Multlfalmily d�VellingS: ppl deri]0 ilOn pe111]lt for
0\ ER THE LOU ITER
BL'iLDIRG PLaI� RE1ESijy
existing building s). Demolition permit is required prior to issuance of building_}
permit for new building.
� EIPRESS
a' yy
"
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
sTAND�RD
❑ PI BLtc ti� oRl.s
foram if any Hazardous Materials are being used as part of this project.
❑
x
�
LARGE �: r
FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
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Ci s��ITAiti sE�i ERDISTRICI �
submittal of Building Permit application.
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B1dg1pp_2011.doc revised 06/21111
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CUPERTINO
PURPO0FL
SMOKE l CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildinaacunertinn nrn
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 INFORMA'T'ION
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 bedroom(s)
X
X
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 specified below have been tested and are operational; as of the
date signed below.
Address: 0 i12 i'3 P Permit No.
Specify Number of Alarms: # Smoke Alarms: � # Carbon Monoxide Detectors: =
1 have read and agree to comply with the terms and conditions of this statement
Ow r (or Owner Agent's) Name;
[��.n�
Signature .......... ...... }..<............................................ Date:
Contractor Name:
Signature.................................................................. Lic.# ......................................Date:
Smoke cnad COfornz.doc revised 09/27/16
CUPERTINO
Owner Name j a
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 -FAX (408)777-3333 o building(a)cupertino.org
pp '�-D ' f�/d� f``1 �"'�n Permit N
Address
- /<
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.
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.
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.
'J!�,,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.
Yes My real property is built and available for use. or occupancy on or before January 1, 1994.
Civil Code Sections 110 1. 1 through 1101.8 apply. Check one of the three following statements and sign
bottom of form..
5. Please check ONE of the following:
My property is a single familyresidential 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 aanultifamily residential real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alteration 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 sliall be replaced with water -
conserving plumbing fixtures.throughout the building (regardless of whether property undergoes alterations or
improvements).
❑ My property is a commercial real property. See Civil Code Section 1101.5.
On and -after January 1, 2014, specified building alterations or improvements shall require non- compliant
plumbing fixtures to be replaced with water -conserving plumbing fixtures.
On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving
plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements).
I; as the owner. or owner's agent of this property, certify under penalty of perjury that non-compliant plumbing fixtures will be
replaced prior to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 110 1. 1
through 11.01.8, 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 followine paee. A—) 1
IOwner or Owner Agent's Signature: /�-�.: C-- c-ol'' Date: i / / I
Upon completing and signing this Certificate, please return it to the Building Division in order to final your building permit.
SB4072015.doc revised 08/26/15
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 08126/15
Non -Compliant
Water -Conserving Plumbing Fixture
Plumbing Fixture
(Fixture Complying with Current Code Applicable to New Construction)
Fixture Type
Maximum Water Usage/Flow Rate
2013 CPC Ch. 4
1 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
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. 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, and must
1.8 gallons per minute @
default to maximum
60 psi
1.8 gallons per minute
Where faucets meeting
@ 60 psi
the above are unavailable,
Where faucets meeting
aerators or other means
the above are
may be used to achieve
unavailable, aerators or
reduction.
other means may be
used to achieve
reduction.
1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shown, it is not required to be upgraded.
SB407 2015.doc revised 08126/15