B-2016-3059CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-3055
10250 PARKWOOD DR APT 1 CUPERTINO,. CA 95014-1522 (326 27 037)
THERMAL
MECHANICAL
SANTA CLARA, CA
95054
OWNER'S NAME: AVERY GLENBROOK LP
DATE ISSUED: 11/07/2016
OWNER'S PHONE: 650-961-8330
PHONE NO: (408) 988-8744
LICENSED 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 -7.000) of Division 3 of the Business & Professions Code and that my
license is;in full force' and effect.
JOB DESCRIPTION.
BLDG 1/UNIT 1; ADD (N) A/C; REPLACE FURNACE, SAME
I hereby affirm under penalty of perjury one of the following two declarations:
LOCATION; (N) WASHER AND DRYER HOOK UPS; (I) ELECTRICAL
L I have and will maintain a certificate of consent to self -insure for Worker's
SERVICE (70 AMP); (N) GAS LINE FOR STOVE; (1) 9 RECEPTACLE
Compensation, as provided for by Section 3700 of the Labor Code, for the
OUTLETS; (N) 1 LIGHT; (I) BATHROOM EXHAUST FAN
performance of the work for which this permit is issued.
i. 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
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
32627 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.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understands and will comply with all non -point
source regulations per he Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature ate 11/8/2016
Issued by: AbbyAyendg
Date: 11107/2016
OWNER -BUILDER DECLARATION.
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 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: 11/8/2016
}
I hereby affirm under penalty of perjury one of the following three declarations:
s
ALL ROOF COVERINGS TO BE CLASS „ A„ OR BETTER
z. 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.
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
3. 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
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 Cu� er�o �� Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Corje, s 2 505,255 , and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTMCATION
Date: 11/8/2016
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
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.
Licensed
Signature Date 11/8/2016
Professional
COMMUNITY DEVELOPMEN T DEPARTMENT TENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTI O, CA 95014-3255
(403) 777-3228 - FAX (403) 777-3333
NEW CONSTRUCTION ❑ ADDITION QX ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS 10250 Parkwood' DR, BLDG 1, Unit ##1
APN#,Q�.`°��,
OWNERNAME Avery Glenbrook LLC
PHONE 650-961-8330
E-MAIL avery@pacbell.net
STREET ADDRESS
130 East Dana Street
, CITYSTATE, ZIP
Mt. View,. CA 94041
FAX
650-961-0571
CONTACT NAME Rob Moyer
PHONE 408-593-8115
EMAIL nlaoyer@thermalmech_com
STREET ADDRESS 425 Aldo ave.
CITY, STATE, ZIP
Santa Clara, CA 95054
FAX 408-988-0233
❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT IX CONTRACTOR ❑:CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
Thermal Mechanical
LICENSE NUMBER 256057
LICENSE TYPE
BUS. LIC-# 299,
C-4,10,20,36.38
coMPANYNAME Thermal Mechanical
E-MAILrmoyer@thermalmech.com
FAX 408-988-0233
STREET ADDRESS 425 Aldo ave.
CITY, STATE, ZIP Santa Clara, CA 95054
PHONE 408.988-8744
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
Apartment renovation
EX[STING USE ` - -
PROPOSED USE CONSTR.
TYPE
# STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EMSTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
.. KITCHEN.
OTHER
REMODEL AREA.
REMODELAREA
REMODELAREA
PORCH AREA
DECK AREA.
_ TOTAL DECK/PORCH AREA
GARAGE AREA: ODETACH
❑ATTACH
#DWELLINGUNITS:
ISA SECOND UNIT ❑YES
SECOND STORY OYES
BEINGADDED? ❑ NO
ADDITION? ❑ NO
T-
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
PLANNINGAPPL# ONO PLANNINGAPPROVALLETTER.
IS THE BLDG AN ❑ YES
EICHLERHOME? ❑.NO
RECEIVED BY:
TO VALUATION:
4 1
7 8
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 have read this
application and the information T 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 build' o Mon. I authorize representatives of Cupertino to enter the above-ided perty for inspection purposes.
/en
�(
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER -THF -COUNTER
❑ BUILDING PLAN REviEw
New SFD or Multifamily dwellings: Apply for demolition permit for
existing buildings). 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
❑ PUBLIC WORKS
_
form if any Hazardous Materials are being used as part of this project.
p 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.d6c revised 06121111
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AJENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • AX (408) 777-3333 • build! no(a cupertino.ora
PURPOSE
`nais affidavit is a self -certification for the • zstallation 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 i10 interior access for
inspections are required.
GENERAL INFORMATION
Existing single-family and multi -family d ellings 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 folio u-tz locations:
AREA
_ SMOKE ALARM
CO ALARM
Outside of each separate sleeping area ii
the bedroom(s)
i the immediate vicinity of
X
X
_
On every level of a dwelling unit includ
no- basements
Within each sleepily room
X
i
Carbon Monoxide alarms are not required in dwellings wl-dch do.not contain fuel -bunting appliances and tl:lat
do not have an attached garage. Carboni ionoxide alarms combined with. smoke alarms shall comply with
CBC Section 420.6 and shall be approved I y the Office of the State Fire Marshal.
Power Supply: Tn dwelling units with no c mmercial. 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 ceili -i finishes or there is no access .by means of attic, basement or cralAT1
space. Refer to CRC Section R314'andCBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for
alarms which must be connected to the bu ding wiring.
As owner of the above -referenced pro
installed in accordance with the manu
and California Residential Codes. The
date signed below. /� J
Address: `5Z0 Pats r�O
Specify Number of Alarms:
I hereby certify that the alarm(s) referenced above has/have been
rer's instructions and in compliance with the California Building
ns specified below have been tested and are operational, as of the
Smoke
Permit No. 2
_# Carbon Monoxide Detectors:
I haves rAarf anri am -a fn r^mmnly wifh fha farms nnrf nnnrfifinno of thio of�fa r,o f
Owner (or Owner Agent's) Name:
J_4MOf 0 Gr ZZO
Signature
........................................................................................... Date
Contractor Name:
/ p , �°"°�C" 't�iL I`Z ®® A�a,��
Signature......
f/
.. .. .... ......... Lica..��".�.!�Q..,�....�.......Date:� j
Owner Name
Address
WATER -CON ERVING PLUMBING FIXTURES
OWNER CER IFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVEN E • CUPERTINO, CA 95014-3255
(408) 777-322p/8 • FAX 408) 777-3333 • building cDcupertino.org
1�I Cc i;94y,�,9 _ / C Ppnnit Nn s
Z0«o-30
1. Is your real property a registered historical site?
❑ Yes Civil Code Sections 1101.1 through 101.8 do not apply. Skip the rest of the form and sign bottom of form.
L<No Go to Question 2.
2. Does' your real property have a licensed phunbe certifying that, due to the age or configuration of the property or its
plumbing, installation of water -conserving pluir bing fixtures is not technically feasible?
jYes Civil Code Sections 1101.1 through 1101.8 do not apply.
(� The licensed plumber's certificate n has been provided to the Building Division.
Skip the rest of the form and sign bo om of form.
❑ No Go to Question 3.
3. Is water service permanently disconnected for y ur building?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
`0 No Go to Question 4.
4. Is your real property built and available f6'r use
❑ No My real propert=y is built and availab
Civil Code Sections 110 1. 1 through
Yes My real property is built and availab
Civil Code Sections 110 1. 1 through
bottom of form..
Please. check ONE of the following:
❑ My property is a single fannily residential rec
On and after January 1, 2014, building alter
to be replaced with water -conserving pluimbi
compliant plumbing fixtures shall be rep]
property undergoes alterations or irnproverne
My property is a multifanidy residential real
On and after January 1, 2014, specified build
plumbing fixtures to be replaced with water -i
On or before January 1, 2019, all non-cormpli
conserving plumbing fixtures throughout the
improvements).
❑ My property is a connnercial real property.
On and after January 1, 2014, specified build
plumbing fixtures to be replaced with water-(
On or before January 1, 2019, all non-coi
plumbing fixtures throughout the building (re
occupancy on or before January 1, 1994?
for use or occupancy after January 1, 1994.
01.8 do not apply. Skip the rest of the form and sign bottom of form.
for use or occupancy on or before January 1, 1994.
01.8 apply. Check one of the three following statements and sign
property. See Civil Code Section 1101.4.
:ions or improvements shall require all non-compliant plumbing fixtures
fixtures throughout the building. On or before January 1, 2017, all non-
-ed with water -conserving plumbing fixtures (regardless of whether
aerty. See Civil Code Section 1101.5.
alterations or improvements shall require non- compliant
aeiving plumbing fixtures.
plumbing fixtures shall be replaced with water-
lding (regardless of whether property undergoes alterations or
Civil Code Section 1101.5.
alterations or improvements shall require non- compliant
seiveng plumbing fixtures.
iant plumbing fixtures shall be replaced with. water- conserving
dless of whether property undergoes alterations. or improvements).
I, as the owner or owner's agent of this propel ty,
celtify 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 -cons
wing plumbing fixtures comply with the requirements as indicated in the
table on the following page,
Owner or Owner Agent's Signature,
s7r /rm—e?" Date:
Upon completing and signing this Certificate, please return it to the Building Division in order to final your building permit.
SB4072015.doe revised 08/26/15
1. If the existing plumbing fixture water usagelflov�
is equal to or lower than the ngure snown, it is not requirea to oe upgraaea.
SB407 201.5.doc revised 08/26/15
Non -Compliant
Water -Conserving Plumbing Fixture
PlumbingFixture
(Fix
ure Complying with Current Code Applicable to New Construction)
Maximum Water Usage/Flow Rate
Fixture Type
Wafer Usage
201
CPC Ch. 4
2013 CPC Ch. 4
2013 CPC Ch. 4
!Flaw 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 ilush
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 -h
Bid shower is considered a showerhead.)
For multiple
showerheads serving one shower, the combined flow rate of all
showerhe
ds 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 gallon
3 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 gallon
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 gallon
per minute @
default to maximum
60 psi
1.8 gallons per minute
Where fat
icets meeting
@ 60 psi
the above
are unavailable,
Where faucets meeting
aerators c
r other means
the above are
maybe u
ed to achieve
unavailable, aerators or
reduction
other means may be
used to achieve
reduction.
1. If the existing plumbing fixture water usagelflov�
is equal to or lower than the ngure snown, it is not requirea to oe upgraaea.
SB407 201.5.doc revised 08/26/15