B-2016-3130 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:Il-2016-3130 •
10276 VIRGINIA SWAN PL CUPERTINO,CA 95014-2025(316 46 003) TRENCIIFREE INC
SAN JOSE,CA 95151
OWNER'S NAME: MIYAMOTO JUDITH A TRUSTEE - DATE ISSUED 11/16/2016
OWNER'S PHONE:408-966-7003 PHONE NO:(40817'26-7926
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C12 C36 Lc.#971016
Contractor TRENCHFREE INC Date 03/31/2018 X BLDG _ELECT X PLUMB
—MECH X RESIDENTIAL_CO RCIAL
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:
REPLACE 30'+/_OF MAIN WATER LINE FROM METER TO HOUSE
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
U Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
2,, '''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:$5000.00
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 APN Number: Occupancy Typ I;
and state laws relating to building construction,and hereby authorize 316 46 003
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 the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature/ `,Date 11/16/2016 Issued by:MELI _rii-0014: 1 _
Date: 11/16/2016
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:11/16/2016
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
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,Secttions 25505,25533,and 25534. I will
permit is issued maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
s. 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 equipf4,_,ent or devices which emit hazardous
air contaminants as defined by the Bay Aea 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 Code,Sections 55 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:11/16/2016f
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
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 Dr_CLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Licensed
Signature Date 11/16/2016 Professional
.
•
GENERAL PERMIT APPLICATION M E P
4#.>, COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
.1s 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
cUF�ER`E~INQ C
(408)777-3228• FAX(408)777-3333•buildinq(a cuperfino.orq 4' M
I S
e7` Z°l6 - 3130
•LUMBING 0 MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS di ✓ c. ® c et
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APN# Jr 7/6.6 7 4e".
C o U
OWNER NAME ! Li-7
L' _ t ( - $J PH 1 ► 0 I m E-MAIL
STREET ADDRESS 02*-y A t� a s I t.I t�STA`E r. d 0 H
CONTACT NAMtre •- 'HOA E. e
STREET ADDRES 6 V tet
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FAQ
❑OWNER 0 OWNER-BUILDER 0 R
OWNE'` lAGENT CONTRACTOR 0.CONTRACTOR AGENT E
NT 0 ARCHITECT 0 ENG1NEER 0 DEVELOPER 0 TENANT
CONTRACTOR NAT �` , .i LICENSE NUMBER. / /4 LICENSE YPE BUS.LIC 4�6 /
(L,' (�' r /� o
COMPANY NAaFtrie 1.t.cti E-M _rp�� a FAX.
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STREET ADDRESS ,STATE,ZIP r
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF 0 SED or DUPLEX El MULTI-FAMILY PROJECT IN WILDLAND 0 YES PROJECT IN 0 YES IS THE BLDG AN 0 YES
BUILDING: 0 COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑.NO EICHLER HOME? 0 NO
DESCRIPTION OF WORK
1 Rv e E tet
•
TOTAL VALUATION: ✓j 6 - Y
By my signature below,I certify to each of the following: I am the property owner or authorized age u'' n�perty owneris 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 building ction. I authorize representatives of Cupertino to enter the above-idem/fled pro,e for inspection purposes.
Signature of Applicant/Agent: Date: l
•
SUPPLEMENTAL INFORMATION REQUIRED _ Y o0IC USE.ON Y
ER TIIE COU\TER n,
ii.Vr EXPRESS yg€
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MEPMisc pp_2011.doc revised 06/21/11
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
�r.,,� COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
�CU ERTU4 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildinqacupertino.orq
PERMIT'CAl\IIVOT�E l WALED UNTIL THIS CERTIFICA'11'Z BIAS BEEN
CO*ArMPLETE TG1 ED1 As]t ��� U E B I ICQ
TH IlV � N
-
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 42.0.6 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
,
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
riot 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 9.07.2.11.4 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 7..."of the
date signed below. l
Address: �"- / O a t �� VL l eGice- ,; t
1 Permit-No.
Specify Number of Alarms: #Smoke Alarms: I I #Carbon Monoxide Detectors` I'
/have read and agree to comply with the terms and conditions of this statement
Owner Or Owner Agent's)Name:
Si nature / . r Date: 1+1 .1)
1-
&Aril k , ti q2,0a,� Dt
Contractor Name:
Signature Lic.# Date:
Smoke and COform.doc revised 09/27/16
WATER-CONSERVING PLUMBING FIXTURES
VI OWNER CERTIFICATE OF COMPLIANCE
01: COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO
(40V777-3228 777-3228•FAX(408)777-3333•buildinqacupertino.org
Owner Name KO B 1' I i CCM O Permit No. '"
Address
tO VCfa s eun 10160- C iL4os - 'r /Y
1. Is your real property a registered historical site?
El yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
111/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.
El The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
L No Go to Question 3.
3. Is water service permanently disconnected for your building?
es 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?
l 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.
Tgr 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. P1/ase 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 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: A a if vvv,rteviY lU Date: ,i 2 g
Upon completing and signing this''ertificate,please return iiito the Building Division in order to final your building permit.
SB4072015.doc revised 08/26/15
BUILDING PE1 MIT C TOT BE FJNALED AND COMPLETED UNTIL TIIIS
_ (iERTIFIfq E HAS BEE lit t ND L TO5TWE B ILDINO-:DWIMIUO
ka.3..:3.'i
Non-Compliant Water-Conserving Plumbing Fixture
Plumbing Fixture1 (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 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 2015.doc revised 08/26/15