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B-2016-3122 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3122 20237 NORTHBROOK SQ CUPERTINO,CA 95014-0501(316 39 035) PAYLESS WATER HEATERS& PLUMBING INC VALENCIA,CA 91355 OWNER'S NAME: WU GRACE-ANN TRUSTEE DATE ISSUED:11/15/2016 OWNER'S PHONE:408-368-8653 PRONE NO:(661)775-2979 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C36 Lic.#836216 Contractor PAYLESS WATER HEATERS&PLUMBING INC Date 08/31/2018 X BLDG _ELECT X PLUMB —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 license is in full force and effect. JOB DESCRIPTION: (N)40 GAL WATER HEATER-GARAGE 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 Compensation,as provided for by Section 3700 of the Labor Code,for the r performance of the work for which this permit is issued. 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:$1200.00 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 316 39 035 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 liabil''-s,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said Ci in onsequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant Lir der-tangs and will comply with all non-point source regulations per the u.- bib Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Sitilla ignature _ Date 11/15/2016 Issued by:Kim Dunbar .- . Date: 11/15/2016 I ilkI. I-: L I . I MIN I I hereby affirm that I am ex...pt 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 i. 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 inspection. compensation,will do the work,and the structure is not intended or offered for 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:11/15/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. 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 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 a. I certify that in the performance of the work for which this permit is issued,I material. Additionally,should I use equipm•1 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 Are• •' Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cuper i,o unicipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Co.- • ':•,s -i 5,25533,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:11/15/2016 I► I III lMIL I certify that I have read this application and state that the above information is I hereby affirm that there is a construe IA ing agency for the performance correct.I agree to comply with all city and county ordinances and state laws of works' for which this p ermit is issued ec.3097,Civ C.) relating to building construction,and hereby authorize representatives of this city 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, 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 DECLARATION 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 Signature Date 11/15/2016 Professional / GENERAL PERMIT APPLICATION E P v . COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION T,�,< 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO sc (408)777-3228• FAX(408)777-3333•buildinq( cupertino.orq ' `i+LUNIBING El MECHANICAL ����� -3/ ��� . ❑ELECTRICAL El MISCELLANEOUS PROJECT ADDRESS" y�i �1 1 �»fit _ Q /yam !®V 2�� �v 0 eTt Mate--5 APN# 3�(j' ® 3 9 ®0,3 OWNER NAME 6"(24]c (/`A "'® l T).36 d Yo E-MAIL STREET ADDRES:20Q -/ l 1 0+ I ITY,S 1 i VC...1 A 14 FAX § CONTACT NAMEA', l✓ I 1 1 V re, (40,G;)`J73 7� J aY 'l-itt) a �i l4., + �'1Q✓ �se 1 :. STREET ADDRESISI014 sob+ i c�TY,STATE,ZIP FAX tail, C4-P 1 iC C_� k CA 1(o)(o' 5.2_ ❑OWNER 0 OWNER-BUILDER 0 OWNER AGENT 0 CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT CONTACTOR N P Rt._� LICENSE 76 LIC nSE TYPEtto BUS L "'St.,. -f COMP A"VNAMR E-MAIL FAX . STREET ADDRESS C TY,STATE, P 7I ('e s'1t t`t'1Z#-[�-(Z. TY, % ZIP, rIA, c....14_, ' 13 cS r tptONE( )P7 `..act 7,at d ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF '!1.FD or DUPLEX 0 MULTI-FAMILY PROJECT IN WILDLAND 0 YES PROJECT IN 0 YES IS THE BLDG AN 0 YES BUILDING: 0 COMMERCIAL URBAN INTERFACE AREA 0 NO FLOOD ZONE 0 NO EICHLER HOME? 0 NO DESCRIPTION F WNOA o , D (2 L,A' CIG — 00 S/ (..)2), TOTAL VALUATION: t-2....00 --� ,,, . ,', 44700,)",„ By my signature below,I certify to each of the foil '�g: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided i co ect. 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 co s. ction. I authorize representatives of Cupertino to enter the above-id tified operty for inspection purposes. Signature of Applicant/Agent: `� Date: ' ( S SUPPLE i j7 AL INFORMATION REQUIRED OFFICE[ISE ONLY OVER TRE COULTER 4 k {^ `D. EXPRESS © STAi\'Dtai 1RD k PLARGE D. MAJOR MEPMiscApp_2011.doc-revised 06/21/11 ` SMOKE / CARBON MONOXIDE ALARMS I ' F OWNER CERTIFICATE OF COMPLIANCE A • tai ik COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION u i w TINO 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 (408)777-3228^FAX(408)777-3333•buildinq a(�cupertino.orq liagag.g=4 PszI.EjRMI-TA'susiOT BExaFa NAED UTILx THIS CERs Tr4 I�, ICTrJ HAS'B.' EEf uy l -644z, E A D ON 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 SSmoke 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 bedrooms) On every level of a dwelling unit including basements X X Within each sleeping room ?� 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 420.6.2.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: 2°837 ,t E'r~ �ft5t 1.c. , c O , Permit No. 6-2o/6~3f2 2 Specify Number of Alarms: #Smoke Alarms: I ,, I #Carbon Monoxide Detectors: I I have read and agree to comply with the terms and ccnditions of this statement Owner(o Owner Agent's)Name: r' Z f'i`t GZ u , Signature �� Date: �/ Contractor Name: Signature Lic.# Date: Smoke and COform.doc revised 09/27/16 Fi . A WATER.CONSERVING PLUMBING FIXTURESfita05 ;rp .11 OWNER CERTIFICATE OF COMPLIANCE c.Ep� COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION [�1 Ft`I t 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333• building(a cuoertino.orq Owner Name 0/2 1C1-- i eflit 7 id"a'g Permit No. 13 20t6 -312-2— Address 12-2Address 2.c2 X37 dof-77f, i&z K C iab) 774/o , Got o1 --o6 o/ 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 faun 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 fornrand-sigirbottonr-ofform. ANO 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. 2/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.. 5. P19-ase check ONE of the following: Ig 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). El 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 ompliantplumbing 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: ' Date: 2//0//6 Upon completing andsigning this Certificate,please return it to the Building Division in order to final your building permit. SB4072015.doc revised 08/26/15 BUILDING PERMIT CANNOT BE FIIVVALED AND COMPLETED UNTIL=THIS , s Lf:R CASE HA1�BEEN IGNED AND RETUORNED CHE I3IJII DING3)I sION� �'. 6 ' Non-Compliant Water-Conserving Plumbing Fixture Plumbing Fixture1 (Fixture Complying with Current Cc de 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) Ulna's 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 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 ope-ation 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 tempo-arily 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/flow rate is equal to or lower than the figure shown,it is not required to be upgraded. SB407 201.5.doc revised 08/26/15