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B-2016-3251 CITY OF'CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3251 21486 HOLLY OAK DR CUPERTINO,CA 95014-4928(362 02 029) ATKINSON CLIMATROLLERS INC SAN JOSE,CA 95112 OWNER'S NAME;KINI NAGARAJA B AND GEETHA B TRUSTEE DATE ISSUED;12/09/2016 OWNER'S PHONE:408-366-1675 PHONE NO:(408)294-6290 LICENSED CONTRACTOR'S DECLARATION 1 BUILDING PERMIT INFO: License Class C-20 Lic.#258540 Contractor ATKINSON CLIMATROLLERS INC Date 12/31/20116 X BLDG _ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing X MECH X RESIDENTIAL_COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: REPLACE FURNACE(SAME LOCATION);INSTALL(N)AC UNIT I hereby affirm under penalty of perjury one of the following two declarations: (SIDE YARD) 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. irf!z I have and will maintain Worker's Compensation Insurance,as provided for by -o/ ,F Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 1 Sq.Ft Floor Area: Valuation:$8362.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above g building county ordinances APN Number: Occupancy Type: information is correct.I agree to comply with all city and pstate hereby authorize 362 02 029 representatives laws tion ref this oses. ci agree a to savencinonstruction, v and andntioned property for re resentatives of this city to enter upon the above me mayinspacCu a againstr Cityin consequence of keep which City of Cupertino against.liabilities,judgments,costs,and expenses which pEi RMIT'EXPIRES S II+'WORK.IS NOT STARTED q the comply with allothis WITHIN 180 DAYS OF PERMIT ISSUANCE OR g perCupertinoMunicipal ynon-point Additionally,the applicant understands and will tom I granting source regulations the } Munici al Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. L'� V (Date 12/ 9 9/2016 Issued by:AbbyAyende Si haEure /; Date:12/09/2016 !- 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 remode 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) i', 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:12/9/2016 I hereby affirm under penalty of perjury one of the following three declarations: 1. I have and will maintain a Certificate of Consent to self-insure for Worker's ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. i 1 s M I • z. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under hapter 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 permit is issued. maintain compliance with the Cupertino Municipal Code, ,hapter 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 •loch emit hazardous i air contaminants as defined by the Bay Area Air Quality M•nagement District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Co.e,Chapter 9.12 and exemptiCon, I must forthwith comply with such revisions provisions of the the Health&Safety Code,Sections 25505,25533, nd 25534. Labexem tion,I become subject to the Worker's Com ensatio p y p or this permit shall /7 be deemed revoked. Owner or authorized agent: L / d.r s APPLICANT CERTIFICATION i `'Date:12/9/2016 I certify that I have read this application and state that the above information is I N TR III LE di IN EN 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 DECLARATION Code,Section 9.18. I understand my plans shall be used as public records. Signature Date 12/9/2016 Licensed Professional -10 2S \° t.T,...v".,. GENERAL PERMIT APPLICATION MEP • COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ; 1-,s ,,' 10300 TORRE AVENUE?•CUPERTINO,CA 95014-3255 MLS C . CUPERTINO (408)777-3228•FAX(408)777-3333•building aa..cupertino.orq El PLUMBING ,V(MECHAIICAL El ELECTRICAL El MISCELLANEOUS PROJECT ADDRESS Z ( 4? / ) o �} V— APN# �2 OWNER NAME K:e J ,�//r / /p lj c/ I vrl I f D V CA. (A °\,_) V) PHONE Q /'/'6 TJ J' E-MAIL STREET ADDRESS') I i V ` j CITY, STATE,ZVIP �j(y , - FAX p �,(�(`�'� , icy CONTACT NAME �p !,'rJ�! �jI ff pm V .Y ��1`k!V I� ail - PHONE ® i ✓J /1 E-MAIL STREET ADDRESS ( ;/1 j( I $4 ��II CITY,STATE,ZIP 5c.ion D xae, ,k!( A c7 5 j)z FAX ❑.OWNER 0 OWNER-BUILDER 0 OWNER AGENT! CONTRACTOR ❑CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPR 0 TENANT CONTRACTOR NAME i li /�J LICENSE NUMBER? 5 1. LICENSE TYPECZ0 BUS.LIC# l Li COMPANY NAME I� J (^,� ,+� �,�7 Jf,p �71.1 R.rlf , Y;e1 r) �.. _E- d�-i:CAWr i �J� 'i,ftAlli . Y7(t't l a syn.,.. STREET ADDRESS I CITY,STATE,ZIP PHONE 1,905,2.57116(270 ARCHITECT/ENGINEER NAME. LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX r STREET ADDRESS CITY,STATE,ZIP PHONE USE OF - >' TH SFD or DUPLEX 0 MULTI-FAMILY PROJECT IN WILDLAND 0 YES PROJECT IN 0 YES IS E BLDG AN ❑YES BUILDING: ✓✓✓❑COMMERCIAL URBAN INTERFACE AREA. 0 NO FLOOD ZONE 0 NO EICHLER HOME? ❑NO DESCRIPTION OF WORK �//� '} /� / p� ) 7 �9 / {1� v� 4 3 2..,0 Y TOTAL VALUATION: � RECETVEI?BY � = '�^ By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owne's behal. I have real 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 co struction. I authorize representatives of Cupertino to enter the above-identified pro erty for inspection purposes. i ) Signature of Applicant/Agent: ,/ Date: I /70 /( . , SUPPLEMENTAL INFORMATION REQUIRED u �u k€IARFJr � . .,-k ,''4,iii.Yr, tIA DOOR•` z m r MEPMiscApp_2011.doc revised 06/21/11 • SMOKE / CARBON MONOXIDE ALARMS . OWNER CERTIFICATE OF COMPLIANCE Tamat INO COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION UPERT 10300 TORRE AVENUE• CUPERTINO,CA 95014-3255 C (408)777-3228• FAX(408)777-3333• buildinq(a cupertino.orq PERI�TIT C SO' BE FINALED UNTIL THIS CERTIFICATE HAS BEEN. 4 3 CI}l!'IPI�Ts+T II,SIGNED,A14 3 R T NED TO TFIB+ $II I I G I SLON 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 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 420.6.2. 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 (C I 7410/ or 12 Permit No.13- 20l - 2 f Specify Number of Alarms: # Smoke Alanns�-,�, p �- 6 #Carbon Monoxide Detectors _ I have read and agree to coy with the terms and conditions of this statement Owner(or Owner Agent's)Name: Signature ,�' Date:WW2 Contractor Name: f . � Lica 5-9 5i-1Q Date:t2-11-4/ ky —k Signature Smoke and COfo»n.doe revised 09/27/I6 \ /' WATER-CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE . .€.p� COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION . CUPERTINO10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228•FAX(408)777-3333•buildincAcupertino.orct Owner Name Permit No.q3 —2 6 6 - 2 5"/ Address 1 y C'K' IA 6 V. h ,V,_ ( 1\i— a 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. `WIN° 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. _ I6 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. gr'iNo 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. WYes 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: rif 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: '97,1,v.„4-7/6"--- Date: CiP/C)- / Upon completing and signing 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 FINALED AND COMPLETED UNTIL THIS CERTIFICATE$AS BEEN SIGNED AND RETURNED T L3 T BUILDIN GDIVISI©1' . ..-.«s•.- -,s -;a-fk".=••,•xu�:s;.•r-•r^•r•»x.c--.sr>.•�.«rr.•-s<.-x.•uar c•.,-,c•z z•caw•.<•rx•;-�e-rrc-rrr.. ..---.,c:•r•-w.-••w-tt-r--...m-• ..sz- -•sr-sr s - • ..... Non-Compliant Water-Conserving Plumbing Fixture Plumbing Fixture (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) Utinals 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