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B-2016-3166 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3166 20990 VALLEY GREEN DR APT 640 CUPERTINO,CA 95014-1836(326 09 053) HOMEOWNER BUILDER OWNER'S NAME: KORET VC I LP DATE ISSUED:i 11/23/2016 OWNER'S PHONE:408-253-0200 PRONE NO: LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic.# Contractor HOMEOWNER BUILDER Date X BLDG _ELECT _PLUMB provisionsX MECH X RESIDENTIAL_COMMERCIAL I herebyaffirm that I am licensed under the 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: UNIT 64-INSTALL WASHER AND DRYER HOOK UPS 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 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:$500.00 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 Type: and state laws relating to building construction,and hereby authorize 326 09 053 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 11/23/2016 Issued by:AbbyAyende Date: 11/23/2016 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. Vsale(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:11/23/2016 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 - 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 California Health&SafetyCode,Sections 25505 25533 and 25534. I will Section 3700 of the Labor Code,for the performance of the work for which this > > 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 Cupertino Municipal Code, hapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the - the Health&Safety Cod Sections 25505,25533,a 25534. be deemed revoked. provisionspermit Labor Code,I must forthwith complywith such or this shall Owner or authorized agent: �1 L! y APPLICANT CERTIFICATION Date:'11/23/2016 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 sour e regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code,.Section 8. I understand my plans shall be used as public records. , Licensed Signatur ( j// Date 11/23/2016 Professional ( g-tpot ..:-.51(e GENERAL PERMIT APPLICATION . . _ ...., , ;.. - . . . COMMUNIlY DEVELOPIAENT DEPARTMENT•BUILDING DIVISION •-.' 10300 TORRP AVENUES CUPERTINO,CA 95014-3285 MISc - (408)777-3228.FAX(408)777-3333.______buildinatacupertino aro CUP fl-ATI NO OPLUMEING [211-4t.C8112\11C.A.L- 017-....LEcTRIC.Al. DizscELAT .171.--ous PROLSCI ADDIMS , I .1..2NA - r , , - , < 1 ,,1 O9 0 53 - OWN-'a XAla i.,- „ 1 I T ) Y . 10 11) Ip . STP.F.....4"1.4.DDRit''''• 1 ' ' r 12 e,,,- 4.0 (i 9 J-ii 1r CONTACT R.L.ivIE riONS E-MAIL c 0,4! k 1-.1 e -5 - , k-• -I.i ' , Sre4.--.-ti ADDRESS , tit - .,, le _ _ al 4 jS.TA.tz, , t/ wein ‘-', 4i 4J-1/4/ jEx ilowl.........---. 0awk....,..,..-siszrz...... 0 DVA,...7.zsz 0 Colzi.m.,,,c103. 0coya.ker.,-.)RAm„-T 0 AR=-----....-..,.. 0.2.-=..1.,..... 0 CONTRACTOR WIT:. LIM- I‘IssmMx..z.-. ..... . .. LI -tarr•=• as4.1...3c e,--. a , ,---. in -7 e 5 , ,9 AIL i Lt.- Zer,t4DANY N.1-1.cr. i ,, ) c) 'hi of _) , - It V .-4 1 4- I A stktrz. ADDr.iss i FHONS / ` 1 ,i'-' 1 p ..,/ e>' 19- q / 4" 4°/D — r . Aacirr,..c.r,z4Gr. .34,...2.c..-, COWERYNAW.,2 SIXT..T.TADDRFSS _ .1.1=ASENUMBEM . I Calr,STAri,Z2 B US.LIC 0 "---- F.4-X F7.7.01v.- 733:4. I 0? 0&re orDUPLST. Ci /401.71-.F.L-1M.Y -PRO-I-it-A'RZ WL 0 l'n FROM-TN 0)....z s n YES Bi..727.2-440: a con,makt Imam DEMFACE.1-?Jil. 0 NO FLOOD ZONE El IsTO maxt ,R.Ectle,,E7 0 No D1.-.:SD.Rrilati OF WORE. ibt--sA--e-- A f r 0 ot-si- -e 1- igi i -- To-LQ..v.L_Luxnai: By ray simatere below I certifY to each of the.followiaa: I mth mope*Owzier Ca-ratb0:5:Zad r-E,-nt to aei ou the Fom-ty mom's behak: I have read this • apolkatio,and the:nib:.-lcation I have rovided is corre.ct. live read the Descriptiom of Work d verify it is accurate. I aes to comply with all apolible local orrs,,,,,ces sod state laves relaza.‘g to".•...,:ling coast-a. ta-i. I zuthor---e=presentatves oa Ceztaao to ez:er the.above-ide-,,trmee paper4,ior-.m.o.ecdon pr47,0ses. /-- .j.---- • ..,.4., .4 A Si.v..zare of Aoplicaati.A.seat: 1..., Ad /GAF ..41,41ffilk Date: // 23—/ ... .........., SUP.PLIM47.NTAI-LNKFORNIAT.ION -fit TRED ffr---4------':_. t. A.c-7:-*4*-1K-'41---=--- •- 4---T------. .............-...-- -.2.-,-----_----------- --.-.--- ------.._._,,,_,_.- -;--- --,'.--,--------7-;-- ': --------=---------*----,-----.---1,--._:.---___:----- -aa-• Ls-Eir-7'"7t-L4-z-'3"*"-- --' - - f------"..!*;7-------- _ .----..7i-z,..--- ---.__,..- ---- .-,-- -- " -:;.„_,__-- v___,----:.., .„ - -_•,- -11.---,-------------fa.-- . M.---',,,,--,,,_-_-'%-z7:-.,._.,-T--7--t-a:--------_ --------W------------,--..,,,,--:• - AC-P-allisc4Dp 201!do e revized 06121/L1 r UNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION CUPERTINO ak ' ` • Dear Property An application for a building permit has been submitted in your name listing yourself as the builder of the property ` ^'• - improvements specified at SITE - ' ik —= -��, � . - ' ,~^~"=p yourresponsibilitiesonerification Form to make yousawiadre of possible risk you may incur by having this permit issued in your name as the Own will not issue a building permit until you have read,initialed your understanding of eaCh rovisio.n,si.gqed,and returned this form to us at our official address indicated. An agent of the owner cannot P ute this notice unless you,the property owner, obtain the a ex . -,-val=f" =pe,nunng authority. -- OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INF RMATION 5,ve7r---ms, -lease re--- ,acd initial each statei-------- ifyyou un. derstand or verny" this informarion.) 52_1, 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an'Owner building personally.I,as an Owner-Builder,may be held liable and subject to serious financial risk for any injudes sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my Insurance coverage for injuries to workers on my property. 5 c 2.I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. 3.1 understand as an"Owner-Builder"I am the responsible party of record on the permit.I understand that I may 5 iii protect myself from potential financial risk by hiring a licensed Contractor and name instead of my 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license 5 fit numbers on permits and contracts. (5.12..5. I understand if I employ or otherwise engage any persons,other than California licensed total value of my construction is at least five ed dollars($500) labor and materials, I may be considered an°employer"under state and federal law. '-- -'` -~ ~ 5 tol 6.1 understand if I am considered_'"employee federal government.withhold payroll taxes, provide workers'compensation disability insurance,and contdbute to unemployment compensation for each n�eoz�ecmua�ooUcUa}dm� stand my failue to abide by 5 V 7. I understand under California Contractors'State License Law,an Owner-Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless allwork is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. '5 Li 8.1 understand as an Owner-Builder if I sell the property for which this permit is issued,1 may be held liable for any financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. avnerBuilderForm 201 adoe revised 04/I4/10 '~ ~ ^ } 9.I understand I may obtain more information regarding my obligations as an°emplo er"from the InternalRevenue Service,the United States Small Business Administration,the California Department of Benefit Pa m YState License Board(CSLB)at 1_800-321-CSLB(2752)or www,csib.ca.gov for more information about licensed y ants, and the California Division of Industrial Accidents. I also understand 1 may contact the California Contractors' contractors. tensed 1/10, 1 am aware of and consent to an Owner-Builder building permit applied am the party legally and financially responsible for proposed construction activity at the site address listed aboveunde that I . 11. I agree that,as the party legally and financially responsible for this proposed cons by all applicable laws and requirements that govern Owner-Builders as well as employers,auction activity,I will aisle • - 12 I agree to notify the issuer of this form immediately of any additions, deletions,or information 1-have-provided on this form.Licensed contractors are regulated bylaws designed to protect--the. Ychanges-toany of the you contract with someone who does-not have a license,the Contractors'State License Board may be unable to public. If. _assist you with art financial loss you may sustain as a result of a complaint-Your only remedy against unlicensed Contractors may-be in civil court.If is also important for you-to understand that if an unlicensed Contractor or employee of that individual or firm is injured while workingon Your property, you mays be held liable for damages. If -- yrtiulobtain a permit-as Owner-Builder and wish to hire Contractors,you will be responsible for verifying whether or not- those Contractors are properly licensed and the status of their workers'compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS:Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued,this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note:A copy of then form notarization, or other verification acceptable to the city maybe required to be property d when the permits issued to verify the property owner's sit nature Property Owner's Signature: t. 'd --7 7 Date: (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for construction permit for the Owner-Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner,the execution of which I understand Is m authorize the following person(s)to act as my agent(s)to apply for,sign,and file the documents rltherebyian Owner-Builder Permit for my project. Scope of Construction Project(or Description of Work): - Project Location or Address: Name of Authorized Agent Tel No Address of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy.Note:A copy of the property owner's driver's license,form notarization, or other • verification acceptable to the city maybe required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OumerBuiIdes-Farm 2010 dee revised 04/14/10 • ,f--:q .11 :, ' r. : SMOKE I CARBON MONOXIDE ALARMS w �` OEft(N€R CERTIFICATE CO I[PLIANCE =, ��.a,� , COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION /�� 10300 TORRE AVENUE• CUPERTINO;CA 95014-3255 (408)777-3228 FAX(408)777-3333 buildinq(a,cupertino.orq x s ,`r R s t v _ ti n PERMIT CANT OTBE EINALED UNTII' THIS CERTIFICATE h AS BEEN g , �L_ E' 'EI)�SIGNED . 1 RETURNED TO i 1+1ULLBIN DJ ISI.O1 �� t do's)as .� ��' �.�` a"�.�''�` oit x �S¢ .:�. � ��e fir � _"- , „ ...., .. ;'�: 5 ",,,,,,.w' , mmii "ir'.�x : 'ice.-w-l*.:a.. ;: ,;'� PURPOSE This affidavit's a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance wth 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections artrequired. GENERAL IFORMATION • Existing singl 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, CR(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 1 CO ALARM I Outside bf 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 earch sleeping room , X Carbon Mono id.e alarms are not required in dwellings which do:not Contain fuel-burning appliances and that do not have i.attached garage. Carbon monoxide alarms combinedwith smoke alarms shall comply with CBC Section20.6 and shall be approved by the Office of the State Fire Marshal. Power Suppl I: 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 tiie removal of wall and ceiling finishes or there is no access by means of attic,basement or crawl ' space. Refer tb 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 Califonnil Residential Codes. The alarms specified below have been tested and are operational, as of the date signed below. Address: L Permit No. �� o� - � f -Specify Number of Alarms: # Smoke Alarms: IIMIIII #Carbon Monoxide Detectors: I have read and agree to comply with the ter s and conditions of this statement Owner(or bwner Agents)Name: ', Signature. �� e Date://.8 /'d Contractor Name: Signature Lic.# Date: Smoke and CO form.doc revised 09/27/16 I �, ' , " � WATER-CO[�SERV[{�G PLUMBING,FIXTURES 1 � OWNER CERTIFICATE OF COMPLIANCE I .1%, COMMUNITY DEVELOPMENT DEPARTMENT / b . BUILDING DIVISION - !I ' i CUP Rl!' NO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255;,. (408)777-3228•FAX(408)777-3333•buildingcupertirto.orq . Owner Name /l0/� f 9e14,/i),4 10 'Permit No. ,8 a O/f —?/e z Address 0 9, gx„., f);y-/A L2 a°/ e,"/; (/ . 9527/'; 1. Is your real property a registered historical site? • Yes Ci V it Code Sections.110.1.1 through 1101.8 do not apply. Skip tl e estof the form and sign bottom of form. ik No G to Question 2. 2. Does your re 1 property have a licensed plumber certifying that,due to the age of 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. f .No Gd to Question 3. C5- 4.--'1 /(0,2,--(---,,,- , 3._. Is water service..permanently disconnected for your building? ❑ Yes Cil it Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. I No Go to Question 4. a";11:1 (1 " 4. Is your real p oper-ty built and available for use or occupancy on or before January 1, 1994? El No M real property is built and available for use or occupancy after January 1, 1994. Cilil 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�NE of the following:, ❑ My property is a single-family residential real property. See Civil Code Sectic5av-,--5 on'1101.4. On and of er January 1, 2014,building alterations or improvements shall require all non-compliant plumbing fixtures to be replced 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 pldrnbing fixtures (regardless of whether property u dergoes alterations or improvements). My property is a multifamily residential real property. See Civil Code Section 1101.5. On and aer January 1, 2014,specified building alterations or improvements shall require non-compliant plumbing tures to be replaced with water-conserving plumbing fixtures. 1 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 110_.5. On and afiler January 1, 2014,specified building alterations or improvements shall require non-compliant plumbing ffixtures 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 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 11018,the current California Plumbing Code and California Green Building Standards Code,'and manufacturer's installation r quirements,and that the water-conserving plumbing fixtures c oniply with the requirements as indicated in the g page.on the f llowm a g e. 1 Owner or Ownff Agent's Signature: c-----5;;X004; Date: f;'..30-</` Upon completing and signing this Certificate,please return it to the: ".ding Division in order to final your building permit. i SB4072015.doc revised 08/26/15 • BUILDING PERMIT CANNOT BE FINALE])AND CO�LETED UNTIL THIS S�'vs ,'snA.d. ERTIFICATE ILA&BEE STGNED AND 12ETURT ED TO THEBUiLD1N DYVISIO.N :nn:.r ...�-.sufi .. , „K .....wcre rru i.; , ... .:w ,. -;W ,.z,.m:.n:r _�.z-.s.*wnm,:rr ., mwa mss.,-* w=•. i Non-Compliant WaeConsinPlumbing Fixture Plumbing Fixture1 (Fixture Complyingtrertode 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'i 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. A so certified to the performance criteria of gallons per minute U.S. EPA WaterSense Specification for Showerheads (A hand-held shower is considered a shbwerhead.) 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, When faucets meeting aerators or other means the above ire 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