B-2016-3090 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR PERMIT NO;B-2016-3090
19946 PORTAL PLZ CUPERTINO,CA 95014-3366(369 45 025) RESIDENTIAL
HEATING AND AIR
CONDITIONING INC
CAMPBELL,CA 95008
OWNER'S NAME: PINTOYARON DATE ISSUED:11/10/2016
OWNER'S PHONE:408-915-8416 PHONE NO:(408)377-4073
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B.C-20 Lic.#705554
Contractor RESIDENTIAL HEATING AND AIR CONDITIONING INC Date X BLDG _ELECT _PLUMB
04/30/2017 X 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 JOB DESCRIPTION:
license is in full force and effect. (N)HEAT PUMP CONDENSER-COURT YARD
I hereby affirm under penalty of perjury one of the following two declarations:
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
hperformance of the work for which this permit is issued.
ave 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:$15500.00
APPLICANT CERTIFICATION
I 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 369 45 025
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 PERMIT EXPIRES IF WORK IS NOT STARTED
City of Cupertino against liabilities,judgments,costs,and expenses which
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 180 DAYS FROM LAST CALLED INSPECTION.
source regulations per the Cupertino Municipal Co e,Section 9.18.
Signaturei 1,"1„/
/ " / Date 11/10/2016 Issued by:AbbyAyende
Date: 11/10/2016
OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed.If a roof is
following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1. I,as owner of the property,or my employees with wages as their sole inspection.
compensation,will do the work,and the stricture is not intended or offered for
sale(Sec.7044,Business&Professions Code) Signature of Applicant:
2. I,as owner of the property,am exclusively contracting with licensed Date:11/10/2016
contractors to construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
2. I have andivill maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will
Section 3700 of the Labor Code,for the performance of the work for which this maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous
s. I certify that in the performance of the work for which this permit is issued I material. Additionally,should I use equipment 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 Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code,Sections 25505,25533,and 25534 ,
exemption,I become subject to the Worker's Compensation provisions of the C( A.L
n} p
Labor Code,I must forthwith comply with such provisions or this permit shall
Olin;;or authorized agent 4 I I orlon on�
be deemed revoked. {Date:11/10/2016 y
'' _t 1 CONSTRUCTION NDINGAGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance
correct.I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued(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 ARCHITECT'S DECL TION
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
Professional
Signature Date 11/10/2016
- . ..
1GENE///-
RAL PERMIT APPLICATION
COMMUNI0OTY DEAVM E P
VELOPMENT DEPARTMENT•BUILD.
wart apses 0 TRRENUE CUPERTINO,CA 95014-3255ING DIVISION
CUPERTINQ (410308)777-3228E FAX.(408)777-3333•buildinq(a)cupertino.orq '
0 PLUMBING ❑MECHANICAL 0 ELECTRICAL ❑M
_ ISCELLANEOUS
PROJECT ADDRESS ,1 Cp.]
I(0 p V Y i_1,+) p'a 2 c7 . - 6114 /
OWNER NAME
1 coron PI n 1 V PHONE 408_
Qi j b t 1/0 E-MAIL
E-MAIL
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zoyalio)>Corr1
STREET ADDRESS CI
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CONTACT NAME ke 1.\,� A/ f � PHONE �v, 6 E-MAIL
I v Co I UB`,377-� kellyeresilvatcoln
STREET ADDRESS se -rti ch Lane CITY,STATE,ZIP l/i r CSIrn
1) 1 I,C� qS�O FAX
11W IIx Lim 1
o OWNER 0 OWNER-BUILDER 0 OWNER AGENT 0 CONTRACTOR 2CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER ❑ DEVELOPER 0 TENANT
CONTRACTOR NAME C ci-tby Haire LICENSE NUMBER 7 05559 LICENSE TYPE D C2 i t io
l BUS.LIC#
COMPANY NAME p ((� / (�/Q}7 /
Q 1 d ice, ti Q i i-1 lA 1 1(I E-MAIL
�dc ke l lye rQ.silleaf. covn, FAX gob-317-c1801
STREET ADDRESS ( ' �y`!!SI ch Lone CITY,STATE,ZIP Co i_ r� l �1Q 41-1-1_,
1-1 (1„...-,,,
lV/ V 174 i 1, t-fl I ll�u PRONE 1 UO '5 I�� I /-5
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD or DUPLEX 0 MULTI-FAMILY PROJECT IN WILDLAND 0 YES PROJECT IN 0 YES IS THE BLDG AN 0 YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE 0 NO EICHLER HOME? 0 NO
DESCRIPTION OF WORK A mooing,
a a i n g heat Fur)))
r))) c p ensu
TOTAL VALUATION: 15,L500, ED BY:
tr)
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 beh f. 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 buil "ng construction. I authorize rept sen awes of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: r r l cip I Date: A 0 16
SUPPLE I TAL INFORMATION REQUIRED
OBFT E DSE.ONLY .
EI O R T'—CtitINTER
CI EXPRESS
❑ STANDARD.
0 L:A ,
0 MAJOR
MEPMiscApp 2011.doc revised 06/21/11
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE FELE
ax.,att COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
ILL—16l
(408)777-3228•FAX(408)777-3333•buildinq(c�cupertino.orq
a PERMI pivA11NOT l.E FIN L i TTNT ?°THIS CERTI JGAT 1TA BEEN
0MPp1ITIJ SIGNED. J D RETURNED TOr HF BiI0 1 D SIGN
a_
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 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 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 X X
the bedroom(s)
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 420.62.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 o the``
date signed below. \�
Address: 19 � a � tz � �.; t A//76 , C 9 col y- Permit o. 6._.2,O! O'1 O
Specify Number of Alarms: # Smoke Alarms: ( #Carbon Monoxid Detectors: ( 1
^f
I have read and agree to comply with the ter ryrs d conditions of this statement
Owner(or Owner Age Ys)Name:
Signature //..., Date: )2-MC
Contractor Name:
Signature Lic.# Date:
Smoke and.CO fonn.doe revised 09/27/16
WATER-CONSERVING PLUMBING FIXTURES F a. E
OWNER CERTIFICATE OF COMPLIANCE
y .as, COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTllNit 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•building(a,cupertino.org
Owner Name \/o• `0 °a �f 0 Permit No. -2A 4-7)0 0
Address I9144 P ir4 P �-c r% �r ` C 14 (co
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.
No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
LI 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..
5. Please check ONE of the following:
M 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 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.
Owner or Owner Agent's Signature: .'"". , R Date:
Upon completing and signing this Certificate,p ~.se re . it to the Building Division in order to final your building permit.
SB407 2015.doe revised 08/26/15
BUILDING PERI4IIT CAN OTiBE1INALED Alm CO° PLETED UNTIL THIS *
-
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E A.S BEE SICi E`H AICD TURINED Ti T 1 BITHI
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Non-Compliant Water-Conserving Plumbing Fixture
Plumbing Fixturel (Fixture Complying with Current Code Applicable to New Construction)
Maximum Water Usage/Flow Rate .
Fixture Type 2013 CPC Ch.4 2013 CPC Ch. 4 2013 CPC Ch.4
Water Usage 2013 CALGreen Div. 4.3 2013 CALGreen Div.4.3 2013 CALGreen Div. 5.3
/Flow Rate 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
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.
SB4072015.doc revised 08/26/15