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B-2016-2872
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: JPERMIT NO: B-2016-2872 20596 KIRWIN LN CUPERTINO, CA 95014-4317 (359 23 039) OWNER/BUILDER OWNER'S NAME: BLACK SUSAN J TRUSTEE OWNER'S PHONE: 201-616-8098 LICENSED CONTRACTOR'S DECLARATION License Class Lic. # Contractor OWNER/BUILDER Date I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 1. I have and will maintain a certificate of consent to self -insure for Worker's DATE ISSUED: 10/06/2016 PHONE NO: BU]ILDING PERMIT INFO: X BLDG —ELECT —PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: KITCHEN REMODEL - M,E,P (206. S.F.) REV #1 - WALL DEMO; RECONFIGURE SINK - ISSUED 2/28/2017 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 providedTor by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $5000.00 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 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. Signature Date 2/28/2017 hereby affirm that I am exempt from the Contractor's License Law for one of the APN Number: Occupancy Type: 359 23 039 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by)p��k xn,_ Date: 10/06/2016 two reasons: All roots shall be inspected prior to any roofing material being installed. If a roof is 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) I, as owner of the property, am exclusively contracting with licensed Signature ofApplicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 2/28/2017 I hereby affirm under penalty of perjury one of the following three 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. 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. 3. 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. 1 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 2/28/2017 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: Date: 2/28/2017 CONSTRUCTION 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 DECLARATION I understand my plans shall be used as public records. Licensed Professional CUNS f RUCTION PERMIT APPLICATION COM MUNJ-TKbEVELOPI\4ENT DEPARTMENT • BUILDING DIVISION 10300 TORRE HVENUE ° CUPERTINO, CA 95014-3255 CUPERi fNU (408) 777-3228 . FAX (408') 777-3333 ° buildino�cuaertino.or i l ❑ NTTE-W CONSTRUCTION ❑ 6.DDITION ❑ .ALTER.ATIOhT / TI 'ISION DEFERRED '64aQ. 2Zq-2 ORIGLNAL PERMIT PROJECTADDRESS t� ' - Pet I iA v O','WTP.NAA E�t "� I �✓ /X I�ggi_PaH_OA� n �� V c(oV STREET.ADDRESS 2-05 �p � a R -W itj LA CITY; STATE, ZIP �1 F Ly CONTACT N. h E j✓ A �/�A �,n� i )I �C PHONE F1 __a , / 1 ,�� I E-IVJL - 44 alt STREET ADDRESS 21/ � 1 kC � �-G1i lr� 4 t / CITY, STATE, ZIP (5;; ib f% jjy * FAX OH'?\ ❑ OR'\-rR.Bi."L� DER ❑ OV,•T'ER! RAGE. ❑ CO1\7 gCTOR ❑ CO?.'TRSCTOR AGENT ❑ ARCHITECT ❑ ENGLMEER ❑ DE\ `ELOPE"R ❑ TEI`A\T CONTP.4LCTORNAA4E I I n,LICE SE L?v BER LICENSETYPE BUS. LIC;: CON3AI,Y NAMIE E-AiA.IL FAX STREETADDP.ESS CITY, STATE; ZIP I PHONS ARCIi1TECT/ENGNEEPI N�AMM e LICENSE NTUMMER I BU'S. LIC'- COMTANYN.Ahffi E-?;iAIL FAX —� STREET ADDRESS `I ! CITY, STATE, ZIP � PHONE V _ a• I r 0 t I Cv CV- 1 ^. f V � 01�7� P 10 �_- 0�7 t eq 10 A7 tJO Lf�li tt)tJ EXISTING USE PROPOSED USE CONSTR iYPE _ STORIES USE TYPE OCC. j SQ.FT. VALUATION (S) FXISTG NERC FLOOR DEMO TOTAL AP,EA AREA AREA NET AREA BATHROO1,1 KITCHEN - OTHER REA40DELAREA REE1,40DEL.AP-EA RE1,10DELAREA PORCH:.REA DECK AREA TOTAL DFCKIPORCHSREA GARAGE AREA: ❑ DETACH ❑ .ATTACH I DZiELLL^'G L:`ITS: IS A SECOND LK IT ❑ YES SECOND STORY ❑YES BELNG.ADDED? ❑NO ADDITION? ED NO - i PRE :+.°PLIC.ATION' FS LF YES, PROVIDE COPY OF ❑ IS THE BLDG A'\ YES ❑ :FECEIVPDbY:= TOTALVALUATION: PLAARL�G APPL = ❑ KO PLi'.'�-LtiG APPROV.k,T LETTER EICHLER HOME? ❑ -NO 1 By lily signature below, I certify to each of the follow-ine: I am the property owner or authorized agent to act one property owner's behalf. I have read this application and the info mation I have provided is correct. I have read the Description of oik and verify it is accurate. I agree to eompl), \,•ith all applicable local ordinances and state laws relatinyg to build' _ constructioa. I authorize representatives of Cupertino to enter the above -identified property for inspection proposes. SiMatureofApplicantAgent: % Date: 0Z SUPPLEMENTAL L INFOR\ZATION REQUIRED PLs:\_C..3E.C. ,Kr TY._PE, � .. L.'. iI, `:G...SSLIP.. New S D o Muluramll d-wellings: Apply far -demolition pe 11t for O:._ -::._K:2.: -.T,_ H:•:E:e_:::C, V existing building(s). Demolition p prior __- ernllt is required nor to Issuance of buildir.Q eII it for new bLildln�. --�. '. .%'EXPRESS[' ,=-'%`. z'i1::-i:°;:''<=-:. �: PlA'd'iL\GPL3NRE�'IE\i':i!`:; 's= �Commercial Bld_a s Provide a.eem completed Hazardous:\4afena]r Disclosure ,- P r �•'ST"��DARD - , . I]:_PLBLIGii'ORi:S - turn ]f any I-iaza,dous ?\�<<e�Ial� arebeing used as psi < or Lhls pro ..,.t. � .�....:.-:..:•:.,, :.....::...::::.-...:..,_.:.... _� :.:.::.. I�::: L_�RGE<.::.:;.;:.:. ,-:, :::.: _:.::::•..;.:;... r.. _ ;-..,.:., ..,..:;::�_::: - �: FIRE DEP =?;' :t.`.'_; ['`; <:?: ;t;� i;'_'';; CoDy of Planning z royal Letter or k eetma withPlanning prior to p. .. PP o �P ::;._:. _,_: _ ll lllttal Uld Q llllltapplication. s b 1 of B 1 m Pe, ....:.. _...._ :_,. _ S vITORY.SE�S ER DISTRICT = _? ;=. EN TALEtEALT$ Bid App_2011.doc rel ised 06/21/11 CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2016-2872 20596 KiRWIN IN CUPERTINO, CA 95014-4317 (359 23 039) HOMEOWNER/BUILD ER OWNER'S NAME: BLACK SUSAN J TRUSTEE DATE .ISSUED: 10/06/2016 OWNER'S PHONE: 201-616-8098 PHONE NO: LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic. # Contractor HOMEOWNER/BUILDER Date X BLDG _ELECT _ PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing — 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: KITCHEN REMODEL - M,E,P (206 S.F.) I hereby affirm under penalty of perjury one of the following two declarations; is 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. Sq. Ft Floor Area: Valuation: $5000.00 APPLICANT CERTMCATION I certify that l have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinan es and state laws relating to building construction, and hereby authorize 359 23 039 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 wh ch PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City inconsequence of the granting of this per it. Additionally, the applicant understands and will comply with all non -poi t WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 10/6/2016 Issued by: Abby Ayende Date: 10/06/2016 OWNER -BUILDER DER D T RATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -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 properly, or my employees with wages as their sc le 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 at offered for inspection. / sale (Sec.70441 Business & Professions Code) Las owner of the property, am exclusively contracting with license I Signature of Applicant: �f contractors to construct the project(Sec.7044, Business & Professi ns Code). Date: 10/6/2016 I hereby affirm under penalty of perjury one of the following three declar tions; ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. I have and will maintain a Certificate of Consent to self -insure for I Vorker's I 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 `z. I have and will maintain Worker's Compensation Insurance, as pro) rided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 ofthe Labor Code, 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 3. 1 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 shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous Worker's Compensation laws of California. If, after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I 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, Sections 25`505,, and 25534. Labor Code, I must forthwith comply with such provisions or this p ermit shall _W33, C be deemed revoked. V" Owner or authorized agent: APPLICANT CERTIFICATION Date: 10/6/2016 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 I 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, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Signature n� Date 10/6/2016 Licensed Professional CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building cupertino.orq LJ NEW CONSTRUCTION ❑ ADDITION Q ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS APN # 20596 Kirwin Lane Cupertino 1 35923039 OWNER NAME Ashutosh & Pallavi Kulshreshtha PHONE 201.616.8098 E-MAIL pallavi.kulshreshthaCgmail.com STREET ADDRESS CITY, STATE, ZIP FAX 20596 Kirwin Lane Cupertino CA, 95014 CONTACT NAME. Pailavi Kulshreshtha PHONE 201.616.8098 E-MAIL pallavi.kulshreshthaCgmaii.com STREET ADDRESS CITY, STATE; ZIP FAX 20596 Kirwin Lane Cupertino CA 95014 0 OWNER ❑ OWNER -BUILDER ❑ OWNER. AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER I LICENSE TYPE I BUS. LIC # ' COMPANY NAME I E-MAIL I FAX 1 STREET ADDRESS I CITY, STATE, ZIP I PHONE I ARCI-ETECT/ENGINEER NAME I LICENSE NUMBER I BUS. LIC # ICOMPANYNAME I E-MAIL FAX I STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK Remodel of first floor e�h to EXISTING USE PROPOSED USE CONSTR. TYPE # 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 DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA DETACH 11 ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY []YES BEING ADDED? [ONO ADDITION? ONO PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES CEIVED B _ ' T9 AL VALUATION: PLANNING APPL # E] NO PLANNING APPROVAL LETTER EICHLERHOME? NO By my signature below, I certify to each of the following: I am the property owner or authorized age to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: . • Date: to t ®� SUPPLEMENTAL INFORMATION REQUIRED New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. _ Commercial. Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. BldgApp_201 1. doe revised 06/.21/11 OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 building(a)cupertino.ora Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS APN BP# 16^-*L(9'T�Q^.► - OWNER NAME ti'rOsH OWNERADDRESS WIN "fJ DESCRIPTION OF WORK: IDF— e40 t Aq)D We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. Please read and initial each statement below to signify you understand or verify this information.) C1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. 1, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. . �2. I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. '3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that 1 may j protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. r II U _5.1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the i total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be - 1 considered an "employer" under state and federal law. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee. I also understand my failure to abide by these laws may subject Mme to serious financial risk. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent to offer therrtlor sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. �8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwnerBuildeYFonn 2010. doe revised 04114110 ML"9. I understand I may, obtain more information regarding my obligations as an 'employer' from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed con tractors. �( __ 10. 1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. X11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. 6 2. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by Taws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assisfyou with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may held liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION. LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the: permit is issued to verify the -property owner's signature. Property Owner's Signature: r Date O O 6 `0" ------------------------------- -----------------------------------------------------------------------=-------------------------- -- (NOTE. The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwnerBuildeYFonn 2010.doe revised 04/14/10 CUPERTINO SMOKE / 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 • building alcupertino.ong PURPOSE This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2016 CRC Section R314, R315, 2016 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, R315, 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) - (Smoke alarms shall not be located within 3 feet of bathroom door) X X _ On every level of a dwelling unit including basements and habitable attics 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 4.20.6 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 S_9 b W I Aj L N C U P Cf,7rrVQ C.,6- qSD I� Permit No. 9-416-2 9 1 L ! --Ul6-2f? -73 Specify Number of Alarms: # Smoke Alarms: # Carbon Monoxide Detectors: l have read and agree to comply with the terrns and conditions of this statement Owner (or Owner Agent's) Name: �AS4U%OS/� J k(11-ShInA' Si nature ....... ........ ................f-.............................................. ....................... Date ..`....(...... Contractor Name: Signature.................................................................. Lic.# ......................................Date:.................. 017 Smoke and COfoam.doc revised 01/1012017 [•ITI74a 1'1*J WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 17 r ro (408) 777-3228 •FAX (408) 777-3333 • building (a)cupertino.org Owner Name _ S H U T ©S H Permit No. v� Address 20 k ! P_ W I IV C.n/ 9 C- U PFw_?'i,V 0 C,+ 015-0 IV 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. G^o Go to Question 2. 2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the property or its plumbing, installation of water -conserving plumbing fixtures is not technically feasible? ❑ 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. f 4o 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.. Please check ONE of the following: Myproperty 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-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. n & ../� . , 1. _ Owner or Owner Agent's Signature: Date:' / ' a (w ' t Upon completing and signing this Certificate, please return it to the Building Division in order to final your building permit. SB4072015.doe revised 08126/15 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 08/26/15 Non -Compliant Water -Conserving Plumbing Fixture Plumbing Fixture (Fixture Complying with Current Code Applicable to New Construction) Maximum Water Usage/Flow Rate Fixture Type Water Usage 2013 CPC Ch. 4 2013 CPC Ch. 4 2013 CPC Ch. 4 /Flow Rate 2013 CALGreen Div. 4.3 2013 CALGreen Div. 4.3 2013 CALGreen Div. 5.3 Single -Family Multi -Family Commercial Residential Residential Water Closets Exceed 1.6 Single flush toilets: 1.28 gallons/flush (Toilets) Gallons/flush Dual flush toilets: 1.28 gallons/flush effective flush volume (the composite, average flush volume of two reduced flushes and one full flush Urinals Exceed 1.0 0.5 gallons/flush Gallons/flush Showerheads Exceed 2.5 2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of gallons per minute U.S. EPA WaterSense Specification for Showerheads (A hand-held shower is considered a showerhead.) For multiple showerheads serving one shower, the combined flow rate of all showerheads and/or other shower outlets controlled by a single valve shall not exceed 2.0 gallons per minute @ 80 psi, or the shower shall be designed to allow only one shower outlet to be in operation at a time. Faucets — Exceed 2.2 gallons Maximum 1.5 gallons per Within units: 0.5 gallons per minute @ 60 Lavatory per minute minute @ 60 psi; minimum Maximum 1.5 gallons psi Faucets 0.8 gallons per minute @ per minute @ 60 psi; i 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. 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