B-2016-3201 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3201
22436 RANCHO DEEP CLIFF DR CUPERTINO,CA 95014-3962(356 02 053) AFFORDABLE WATER
BEATERS AND
PLUMBING INC
28358
CONSTELLATION RD
VALENCIA,CA 91355
OWNER'S NAME: FINN RITAATRUSTEE DATE ISSUED:12/02/2016
OWNER'S PHONE:408-257-3396 PHONE NO:(855)345-9087
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C36 tic.#627368 '
Contractor AFFORDABLE WATER HEATERS AND PLUMBING INC Date X BLDG _ELECT X PLUMB •
09/30/2018 _MECFI 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. REPLACE 50,GAL WATER HEATER,SAME LOCATION
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
4erformance of the work for which this permit is issued.
K <-(7 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
Sq.Ft Floor Area: Valuation:$22810.00
permit is issued.
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 356 02 053
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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR
may accrue agains said City in consequence of the granting of this permit.
Additionally,the a' licant understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION.
source regulation-/per the Cupertino Municipal Code,Section 9.18.
it Issued by:MELISSA NAMES
Signature I Date 12/02/2016'
Date:.12/02/2016.
(.hl_t-: Ii t_' It ._.:: 1 RE-ROOFS:
I hereby affir hat 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 asons 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 structure 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:12/02/2016
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 permitis issued. I have read the hazardous materials requirements under Chapter 6.95 of the
z. I have and will 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
3, 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 :,y Area Air Quality Management District I
will maintain compliance with the C pertino Munici.al Code,Chapter 9.12 and
Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Cod•' tions 2551- ' 533,and 25534.
exemption,I become subject to the Worker's Compensation provisions of the ii
Pi
Labor Code,I must forthwith comply with such provisions or this permit shall �/`
Date:12/02/2016 r i
APPLICANT CERTIFICATION s s It a _`.i I
I certify that I have read this application and state that the above_information is I hereby affirm that there is a cgntruction 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 i : sued(Sec.3097,Civ C.)
relating to building construction,and hereby authorize representatives of this city Lenders 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 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.
\erg/ GENERAL PERMIT APPLICATION •
mE p
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING G DIVISION
4,,,,s. TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228 FAX(408)777-3333 buildinq(a�cupertino.orqWI ISC
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L.4aLUMBING ❑MECHANICAL El ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS /
224 0 .av? ,ip �t t APN# -3..5-e.
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OWNER NAME E.�t A ��/� PHO /d 0f <?51 39, Ai MA_
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STREET ADDRESS
CONTACT NAME '-6,-
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STREET ADDRESS L! Vi 1 CITY STATE,ZIP 1 .
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OA FAX A4A-
O OWNER 0 OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR CI CONTRACTOR AGENT El ARCHITECT '❑ENGLNEER ❑ DEVELOPER` 0 TENANT
CONTRACTOR NAME40, ,_ LICEN NUMBER LICENSE TYPE BUS.LIC#2.6 Q�/�'7
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ARCIIITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
- COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ®SED or DUPLEX 0 MULTI-FAMILY .PROJECT IN WILDLAND.... _... -_.. _ C - .
0 YES PROJECT IN 0YES IS THE BLDG AN 0 YES
BUILDING: ❑.COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE 0 NO EICHLER HOME? 0 NO
DESCRIPTION OF WORK
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TOTAL VALUATION: 4, Is.
EIVEDBY• :'
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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'
r' .ehalf ave read.this
application and the information I have rovided is correct. I have read the Description of Work and verify it is accurate. I:gree c.i , with all applicable local
Signature oa and state
laws relating: /® construction. I authorize representatives of Cupertino to enter the above-ides:r te e rty for inspection purposes.
ordinances state laws to/Mk
il.,,
Date: -/2"
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S i',•LEMENTAL INFORMATION REQUIRED OFF cE USE aiX
F'E,R 'FlE-COUNTER .. .
0 EXPRESS
0 STANDARD
a 0,LARGE:
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Q MAJOR
ME PMiscApp_2011.doc revised 06/21/11
- SMOKE 1 CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
.COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
CUPERTINO
(408)777-3228• FAX(408)777-3333• buildinq(a cupertino.orq
PER " [I1 CANNOT BE"FINALEI)UNTIL THIS CERTIFICATE:HAS BEEN s
fJl'IPLETD,gIGNEI), i ITIINEI3 TO T13�IILIILIINGI ?ISIDN'f
'�
7 c ,....
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
_-� 'xistingssinal -farad; ana m Iti.-farfidly dwell ngs,shaltbe provided_with-Smoke_Alarm.s_.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 arenot required in.dwellings which do not contain fuel-burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarmsshallcomply 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 whererepairsor 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: -2674-5 4 ca4--s1(C (- a (,) �1O C-1 T i 1 u f6( i Ivo Permit No.20f` 2O/
Specify Number of Alarms: #Smoke Alarms: I I 4 Carbon Monoxide Detectors: IMMI
/have read and a ree to co pl with the terms and conditions of this statement
Owner(or Owner Agent's)Name: '
Signature aL"'U c ' l7 Date:
Contractor Name:
Signature Lic.# Date:
Smoke and CO form.doc revised 09/27/16
\is/ WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
.e.04 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
•
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildinq(a�cupertino,orq p r,.
Owner Name T l�— A f=--f Al!�C Permit No.20/6®'-)201
Address A.2 4/. ?4 kt r. c 6-")0 ( eq r--4&-47"/
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.
mi 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.
LI The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the fonn and sign bottom of fo rm.
XL 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.
• g 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.
Eic 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: - •
My property is a singlefamily residential real property. See Civil Code Section 1101.4.
On and after January T-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; !db- C/, Date: % /7
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit.
SB407 2015.doc revised 08/26/15
BUILDING PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS
CERTIFICATE'HAS BEEN SIGNED ANI RETURNED TL)THF BUILDING_ IVI ION
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