B-2016-3058CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
21317 GLEN PL APT 5 CUPERTINO, CA 95014-1473 (326 27 036)
OWNER'S NAME: AVERY GLENBROOK LP
OWNER'S PHONE: 650-961-8330
LICENSED CONTRACTOR'S DECLARATION
License Class C-4.10,20,36.38 Lic. #256057
Contractor THERMAL MECHANICAL Date 01/31/2018
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
E
ensation, as provided for by Section 3700 of the Labor Code, for the
mance of the work for which this permit is issued.
and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance ofthe work for which this
permit is issued.
APPLICANT CERTIFICATION
certify that 1 have read this application and state that the above
information is correct. l 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 C_t pertino Municipal Code, Section 9.18.
11/7/2016
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the stricture is not intended or offered for
sale (Sec.7044, Business & Professions Code)
z 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project(Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
t. 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.
z. 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.
s. 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. r—
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 11/7/2016
CONTRACTOR: PERMIT NO: B-2016-3058
THERMAL
MECHANICAL
SANTA CLARA, CA
ISSUED: 11/07/2016
PHONE NO: (408) 988-8744
BUILDING PERMIT INFO:
X BLDG X ELECT X PLUMB
X MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
BLDG 39/UNIT 5; ADD (N) A/C; REPLACE FURNACE, SAME
LOCATION; (N) WASHER AND DRYER HOOK UPS; (N) ELECTRICAL
SERVICE (70 AMP); (N) GAS LINE FOR STOVE; (N) 9 RECEPTACLE
OUTLETS; (I) I LIGHT; (I) BATHROOM EXHAUST FAN
Sq. Ft Floor Area: I Valuation: $20000.00
APN Number: Occupancy Type:
326 27 036
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
by: AbbyAende
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature ofApl
Date: 11/7/2016
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, 505, 25533,It
d 25534.
Owner or authorized agent:
Date: 11/7/2016
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
CONSTRUCTION PERMIT APPLICATION
CCOMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333
El NEW CONSTRUCTION El ADDITION X ALTERATION / TI El REVISION / DEFERRED ORIGINAL PERmrr #
PROJECT ADDRESS21317 Glen Place, BLDG 39, Unit #5'
APN 4 03(p
OWNERNAT%M .Avery Glenbrook LLC
PHONE
650-961-8330
E-MAIL avery@pacbell.net
STREET ADDRESS 130 East Dana Street
CITY, STATE, ZIP Mt. View, CA 94041
FAX 650-961-0571
CONTACT NA' 4E Rob Moyer
PHONE 408-593-4115
E-MAJI, rmoyer@thermaimech.com
STREET ADDRESS 425 Aldo ave.
CITY, STATE, ZIP Santa Clara, CA 95054
FAx 408-988-0233
OWNER ❑ owNER-BunDER 11 OWNER AGENT IX CONTRACTOR 000NTRACTOR AGENT 11 ARCHITECT 11 ENGINEER El DEVELOPER 11 TENANT
CONTRACTORNAME Thermal Mechanical
LICENSE NUMBER 256057
LICENSE TYPE
BUS. LIC # 299
C-4,10,20,36,38
"'A"Y" Thermal Mechanical
E-MAILrmoyer@thermalmech.com
FAX 408-988-0233
STREET "s' 425 Aldo ave.
CITY, STATE, ZIP Santa Clara, CA 95054
PHONE 408-988-8744
ARCHITECT/ENGINEERNAME
LICENSE NUMBER
BUS. LIC 9
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
Apartment renovation-
EMSTINGUSE
FROPOSEDUSE CONSM
TYPE
4 STORMS
USE
TYPE
Occ,
SQ.FT.
VALUATION
EX[STG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
I NETAREA
BATHROOM KITCHEN
OTHER
REMODELAREA REMODEL AREA
I
REMODELAREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: LJ DETACH
[]ATTACH
I
#DWELLINGUNITS:
IS A SECOND UNIT LIYES
SECOND STORY []YES
BEINGADDED? []NO
ADDITION? []NO
PRE -APPLICATION n YES IF YES, PROVIDE COPY OF
PLANNING APPROVAL LETTER
EICHLERHOME? NO
IS THE BLDG AN ❑ YESffic
D BY:
TIJ11 VALUATION:
,
I
PLANNINGAPPL9 f-INO
WtV4
o
to V0
0
By my signature below, I certify to each of the following: I am the property owner or authorized agen&o act ob the property owner's behalf I have read this
application and the information I have provided is correct. I have read the Descripti6n.of Work and verify it is accurate. 1 agree to comply with all applicable local
ordinances and state laws relating to buAng construction. alghoriz� representatives of Cupertino to enter the above-ident ed p perty for inspection purposes.
Date: AX
Signature of Applicant/Agent: ZA 7-,
SUPPLE M
,YXTAL INFORMATION REQ
PLAN CHECK TYPE
ROUTING SLIP
El OVER-THE-COUNTER
El nuuDIING PLAN REvrEw
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.
I El EXPRESS.
El PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
El STANDARD
El PuBLiewoRKs
Tor—m if any Hazardous Materials are being used as part of this project.
11 LARGE
mm DEPT.
I
Copy of Planning Approval Letter or Meeting with Planning prior to
0 MAJOR
El SANITARY SEWER DISTRICT
submittal of Building Permit application.
El ENviRoNmENTAL HEALTH
BldgApp_201 Ldoe revised 06121111
SMOKE I CARBON MONOXIDE ALARMS
3 0 -
OWNER CERTIFICATE OF COMPLIANCE
like COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
CWFERTINO 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - building(6cupertino.or
M1
PURPOSE 1 .1
'11iis-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 907.2.11.21 where no interior access for
irispections are required.
GENERAL INFORMATION
F,xisting single -fan -Lily and multi -family dwellings shall be provided with Smol
Monoxide alarms. When the valuation of additions, alterations, or repairs to e,.
$1000,00, CRC Section 8314 and CBC Sections 907.2.11.5 and 420.6 require that
Monoxide Alarms be installed in the following locations:
Alarms and Carbon
L I rting dwelling units exceeds
Smoke Alarms and/or Carbon
AREA SMOKEIALARM CO ALARM
Outside of each separate sleeping area in the immediate vicinity of
the bedroom(s)
a -t every level of a dwelling unit including basements X
Within each sleeping room X"
Carbon Monoxide alarms are not required in dwellings which donot contain fu6l-burridng appliances and that
do not have an attached garage. Carbon monoxide alarms combined with.s o e alarms shall comply with
C --'BC 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) ir
11-t existing dwelling units, alarms are permitted to be solely battery operated w
not result in the removal of wall and ceiling g ffi-dshes or there is no accessby me
space. Refer to CRC Section R314 . and . CBC Sections. 907.2.11.4 and 420.6.2. All E
alarms which must be connected to the building wiring.
As owner of the above -referenced property, I hereby certify that the alai-m(s) re
instal -led in accordance with the manufacturer's instructions and in compliance
and California Residential Codes, The alarms specified below have been tested
date signed below. U.—
G,��4 04'1.75
Specify Number of Alarms:
Smoke
be solely battery operated.
e repairs or alterations do,
; of attic, basement or crawl
trical permit is required for
enced above has/have been
-th the California Building
d are operational, as, of the
Permit No.13 --Zd (.,-,30
I r� 4 —4 -- fn r nrrinhl With fhP fprm.q and rnndiffons of this statement
Detectors:
I I favu
Owner (or Owner Agents) Name:
P
-
1 Date
i .
,7-4MOf W /P�,Zz- a
Signature ..... . ..... .................... .............. .....
....................... ........ .......................... .........
......... I ..........................
j ...... .............
Contractor Name:
r/
me
211
Signature .... .... .... .. ... . ......... Lic�# .
.............................. ......... . ..... I ...........
1 ...... Date*
CUPERTINO
Owner Name
Address
WATER -CONSERVING PLUMBING FIXTU
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVI
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - building (o_Dcu0ertiho.o r_q
enT.
all W
N
1. Is your real property a registered historical site? 'I
F1 Yes Civil Code Sections 1101.1 through 1101,8 do not apply. Skip the rest of the form and sign bottom of form.
UK No Go to Question 2.
e I -
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?
MYes Civil Code Sections 110 1. 1 through 110 1. 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.
7 No Go to Question 3.
3. Is water service permanently disconnected for your building?
F] Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the foamandsign 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?
0 No My real property is built and available for use or occupancy after January 1, 1994.
. y
Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form ld sign bottom of form.
XYes My real property is built and available for use or occupancy on or before January 1,994.
Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three followilg statements and sign
bottom of form.. F
Please check ONE of the following:
[I 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 -c
to be replaced with water -conserving plumbing fixtures throughout the building. On or bef(
compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtu
1Kproperty undergoes alterations or improvements).
My property is a multi; residential real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or improvements shall require i
plumbing fixtures to be replaced with water -conserving plumbing fixtures.
On or before Januat y 1, 2019, all non-compliant plumbing fixtures shall be replaced with -A
conserving plumbing fixtures throughout the building (regardless of whether property unde
improvements).
0 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 i
plumbing fixtures to be replaced with water -conserving plumbing fixtures.
On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced
plumbing fixtures throughout the building (regardless of whether property undergoes altera.
1pliant plumbing fixtures
January 1, 2017, all non -
(regardless of whether
compliant
alterations or
compliant
water- conserving
or improvements).
1, as the owner or owner's agent of this property, certify under penalty of perjury that non-cornpliant plumbing fixtures will be
J
replaced prior to date specified above with water -conserving plumbing fixtures in accordancp wi�tfi 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 requi I Fements as indicated in the
table on the following oaae. I I le
Owner or Owner Agent's Signature: 73- rC; 1 Date: '4r1W
Upon completing and signing this Certificate, please return it to the Building Division in order to final your
SB40 7 2015. doc revised 08126115 -
i. lr the existing piumbtng fixture water usage/tiow 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 Fixturel
(Fixture Complying with Current Code Applicable
Ifo New Construction)
Fixture Type
Maximum Water Usage/Flow
Rate
2013 CPC Ch. 4
2013 CPC Ch. 4
2013 CPC Ch. 4
12013
Water Usage
/Flow Rate
2013 CALGreen Div. 4.3
2013 CALGreen Div. 4.3
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 com
fined 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.
i. lr the existing piumbtng fixture water usage/tiow rate is equal to or lower than the figure shown, it is not required to be upgraded.
SB407 2015. doc revised 08/26/15