B-2016-3061CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-3061
10260 PARKWOOD DR APT 3 CUPERTINO, CA 95014-1521 (326 27 037)
THERMAL
MECHANICAL
SANTA CLARA, CA
95054
OWNER'S NAME: AVERY GLENBROOK LP
DATE ISSUED: 11/08/2016
OWNER'S PHONE: 650-961-8330
PHONENO: (408) 988-8744
LI :N D CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C-4,10,20.36.38 Lic. #256057
Contractor THERMAL MECHANICAL Date 01/31/2018
X BLDG X ELECT X 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:
BLDG 3/UNIT 3; ADD (N) A/C; REPLACE FURNACE, SAME
I hereby affirm under penalty of perjury one of the following two declarations;
LOCATION; (I) WASHER AND DRYER HOOK UPS; (I) ELECTRICAL
1. I have and will maintain a certificate of consent to self-insure for Worker's
SERVICE (70 AMP); (I) GAS LINE FOR STOVE; (I) 9 RECEPTACLE .
Compensation, as provided for by Section 3700 of the Labor Code, for the
OUTLETS; (1) 1 LIGHT; (N) BATHROOM EXHAUST FAN
performance of the work for which this permit is issued.
G
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: $20000.00
APPLICANT CERTIFICATION
1 certify that I 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 ordinances
and state laws relating to building construction, and hereby authorize
326 27 037
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.
Additionally, the applicant understands and will comply with all non-point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per the CC rtino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
'Signature Date 11 /8/2016
Issued by: Abby Avende
OWNER-BUILDER DECLARATION
Date: 11 /08/2016
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. 1, 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 forins
ection.
sale (Sec.7044, Business & Professions Code)
m �.
2. I, as owner of the property, am exclusively contracting with licensed ).S
gnature ofApplicant:
contractors to construct the project (Sec.7044, Business & Professions Code)
Date: 11/8/2016
I hereby affirm under penalty of perjury one of the following three declarations;
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
s. 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. I will
permit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
a. 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
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 CodSSsatiVs 25505, 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: 11/8/2016 -
I certify that I have read this application and state that the above information is
I hereby affirm that there is a c6nstruction lending agency for the performance
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
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.
I understand my plans shall be used as public records.
Licensed
Signature Date 11/8/2016
Professional
IPER 3 Il' O
❑ NEW CONSTRUCTION ❑ ADDITION ❑X ALTERATION / Ti ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS - ..
10260 Parkwood DR, BLDG 3, Unit #3
APN# -
6x l —6.d'
OWNER NAME - -
Avery Glenbrook LLC
PHONE - ..
650-961-8330
E-MAIL
avery@pacbell.net
STREET ADDRESS 130 East Dana Street
CITY, STATE, Mt. View, CA 94041
FAX
650-961-0571
CONTACT NAME Rob Moyer
PHONE 408-593-8115 -T-
E -71L rmoyer@thermalmech.com
STREET ADDRESS
425 Aldo ave.
CITY, STATE, ZIP
Santa Clara, CA 95054
FAX
408-988-0233
11 OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT lK CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHI'T'ECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME Thermal Mechanical
LICENSE NUMBER 256057
T-7810ENSE TYPE
BUS.LIC# 299
cobtPANYNAME Thermal Mechanical
E -M` ILrmoyer@thermalmech.com
FAX 408-988-0233
STREET ADDRESS 425 Aldo ave.
CITY, STATE; 7P Santa Clara, CA 95054
PHONE 408-988-8744
ARI CHTTECT/ENGINEER NAME
7 LICENSE NUMBER
BUS. LIC #
COMPANYNAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK '
Apartment -renovation -
EXISTINGUSE - -
PROPOSED USE - CONSTR
TYPE
# STORIES
USE
TYPE
OCC.
SQ.FT_
VALUATION ($)
EX[STG
NEW FLOOR
DEMO
TOTAL
-
AREA
AREA
AREA
NETAREA
-.--
BATHROOM
KITCHEN
OTHER
-
REMODELAREA
REMODELAREA
REMODEL:AREA
PORCHAREA
-
DECKAREA
T TOTAL.DECKIPORCHAREA
GARAGEAREA: DETACH
-
-
❑ ATTACH
#DWELLINGUNITS
IS A SECOND UNIT []YES
SECONDSTORY []YES
BEING ADDED? []NO
ADDITION? ❑ NO
PRE -APPLICATION [I YES IF YES, PROVIDE COPY OF
ISTBEBLDGAN ❑YES
RECEI BY:
TIAL VALUATION:
PLANNINGAPPL# []NO PLANNING APPROVAL LETTER
EICHLER HOME? E] NO
h
By my signature below, I certify to each of the following: I am the property owner or authorized agent to acl on the pTloperty 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 b g constructi n. I authorize representatives of Cupertino to enter the above!-"d/en ified p perty for inspection purposes.
,
Signature of Applicant/Agent: ®e Date: �r
SUPPLE ME TAI. INFORMATIO n QUIRED
PLAN CHECK. TYPE.
ROUTING SLIP
❑ OVER-THE-COUNTER
❑ BUILDING PLAN REVIEW
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.
❑ EXPRESS
❑. PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
El STANDARD
ElPuBLic woRl,-s
To—nn 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
❑ MAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
B1dgApp_2011.doc revised 06121/11
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(d)cupertino.ora
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 ito 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 ALAR
_ _
Outside of each separate sleeping area in the immediate vicinity of
X
_ I
the bedroom(s)
On every level of a dwelling unit including basements
Within each sleepier room
X
X ��
( X_ u
Carbon Monoxide alarms are not required in dwellings which do.not contain fuel -burning appliances sand that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with .
CIBC 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,
Iin existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result it 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 Nvith .the manufacturer's instructions and in compliance with the California Building
a.1 -d California Residential Codes. The alarms specified below have been tested and are operational, as of the
date signed bQlow.
Address: 0 �C_f Y' -')o 0
Permit No.g zo1(v °-s' ` /
Specify Number of Alarms: # Smoke Alarms: -4 Carbon Monoxide Detectors:
I have read and agree to comply with theterms-.and conditions of this statement
Owner (or Owner Agent's) Name:
MZ e
Signature....... `..... ............Date:
......................................................................................... ....
Contractor Name:: q
e t'e� ee,4.4,,1,
1 signature.,. !A'�--� .,� �� �-� Lica ..�'.'�. �`. °�.,��.......Date:7%��
. ......... /
V--7.- _-7 /-,n r_ .___ .7_- _. __ .. _ _ � r-1111—
CUPERTINO
Owner Name
Address
WATER -CONSERVING PLUMBING FIXTURES -
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
777-3228 - FAX (408) 777-3333 - building(cDcupertho.ora
1. Is your real property a registered historical site?
❑ Yes Civil Code Sections 1101.1 through 110.1.8 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
luinbing, 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.
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.,
Please 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
ioncompliant 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 corm-ercial 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- conselving
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 grater -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 «rater -conserving plumbing fixtures comply with the requirements as indicated in the
table on the followinz page.-~'-"'+
Okvner or Owner Agent's Signature; � (?j( le'r'lze, Date -3/;S
S
Upon completing and signing trus certincate, please rerun it to the rsuueing 1rivr5ivn in uiuci w uuui yvui uuiiw118 P�iuu
SB4072015.doc revised 08/26/15
1. If the existing plumbing fixture water usage/floe rate is equal to or lower than the figure shown, it is not required to be upgraaeo.
SB407 2015.doc revised 08126/15
Non -Compliant
Water -Conserving Plumbing Fixture
Plumbing Fixturel
(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;
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/floe rate is equal to or lower than the figure shown, it is not required to be upgraaeo.
SB407 2015.doc revised 08126/15