B-2016-3228CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:,
CONTRACTOR:
PERMIT NO: B-2016-3228
10175 PARKWOOD DR APT 6 CUPERTINO, CA 95014-1460 (326 27 037)
THERMAL
MECHANICAL
SANTA CLARA, CA
95054
OWNER'S NAME: AVERY GLENBROOK LP
DATE ISSUED: 12/09/2016
OWNER'S PHONE: 650-961-8330
-
PHONE NO: (408) 988-8744
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT
INFO:
License Class C-4,10,20,36.38 Lic. #256057
Contractor THERMAL MECHANICAL Date 01/31/2018
X BLDG X ELECT
X 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:
BLDG 33/UNIT 6;
ADD N A/C; REPLACE FURNACE, SAME
I hereby affirm under penalty of perjury one of the following two declarations:
LOCATION; (N) WASHER
AND DRYER HOOKUPS; (N) ELECTRICAL
1. I have and will maintain a certificate of consent to self -insure for Worker's
SERVICE (70 AMR)
M
-'
); (N) GAS LINE FOR STOVE; (I) 9 RECEPTACLE
Compensation, as provided for by Section 3700 of the Labor Code, for the
OUTLETS; (N) 1 LIGHT;
(I) BATHROOM EXHAUST FAN
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
P4
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Sq. Ft Floor Area:
Valuation: $20000.00
APPLICANT CERTIFICATION
1 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
ATN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
326 27 037
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 E
IRES IF FORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
WITHIN 1
0 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 / 1 1 1
Issued by: Abby A
ende
Date: 12/09/2016
OW NER-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 in
pected prior to any roofing material being installed. If a roof is
r. 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 Applican
:
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;
ALL ROO
COVERINGS TO BE CLASS "A" OR BETTER
r. 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
z. I have and will maintain Worker's Compensation Insurance, as provided for by
I have read the ha
ardous 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
permit is issued.
maintain compliant
B 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
ode, 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,
air contaminants as
should I' use equipment or devices which emit hazardous
defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compl
ante 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 25505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authoriz
d agent:. /
APPLICANT CERTIFICATION
Date: 12/9/2016
e111
I certify that I have read this application and state that the above information is
NSTRUCffION LENDING
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 t
iis 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.
1 understand my pla
is shall be used as public records.
Licensed
Si
Signature Date 12/9/2016
9
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE CUPERTINO, CA 95014-3255
CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • buildin cu ertino.or � _ � t 6. � •� 'i
NEW CONSTRUCTION ❑ ADDITION 0 ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS. 10175 Parkwood DR, BLDG 33, Unit #6 APN# — 2 — 0 3
OWNERNAME Avery Glenbrook LLC PHONE 650-961-8330 E MAIL avery@pacbell..net.
STREET ADDRESS 130 East Dana Street. CITY, .STATE, ZIP Mt. View; CA 4041 FAX
650-961-0571
CONTACT NAME Rob Moyer PHONE 408-593-8115 E-MAIL rmoyer@thermalmech.com
STREET ADDRESS 425 Aldo. ave. CITY, STATE, ZIP FAX .408-988-0233
Santa Clara, A 95054
❑ OWNER ❑ OWNER -BUILDER ❑OWNERAGENT IK CONTRACTOR ❑ CONTRACTORAGENT ❑ A CHITECT ❑ ENGINEER ❑ DEVELOPER '❑ TENANT
CONTRACTORNAME Thermal Mechanical. LICENSE NUMBER 256057 LICENSE TYPE BUS. LIC# 299.
C-4,10,20,36,38
COMPANYNAME Thermal Mechanical E-MAIL rmoyer@thermalmec .com FAX 408-988-_0233
STREET ADDRESS 425 Aldo ave.. CITY, STATE, ZIP Santa. Clara, C A 95054 PHONE
408-988-8744
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.. LIC
COMPANY NAME I E-MAIL
STREET ADDRESS I CITY, STATE, ZIP
DESCRIPTION OEWORK-
"- add new AC, replace furnace in same location, (N) was
(N) gas line for stove, (N) electrical outlets, (N) light, (N)
USE
AARRIEG I �AFLOOR DEMO TOT
I: AREA I NETAAREA I I'
REMODELAREA .I REMODELAREA I REMODELAREA
FAX
PHONE
hook ups, (N) electrical panel (70 AMP
rl exhaust fan
TYPE I OCC. SQXT. VALUATION ($)
# DWELLING UNITS IS A SECOND UNIT ❑ YES SECOND STORY DYES
BEING ADDED? []NO ADDITION? []NO
PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES CE ;� TOTAL VALUATION:
PLANNING APPL# NO PLANNING APPROVAL LETTER EICHLER HOME? NO
V
By my signature below, I certify to each of the following: I am the property owner or authorized agent toa e property owner's 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 ccurate.. I agree to comply with all applicable local
ordinances and state laws relating to bu' s tion. �I authorize representatives of Cupertino to enter the above -identified pro erty for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION RE,(�UIRED
_ New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
form if any Hazardous Materials are being used as part of this project.
—Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
BldgApp_2011.doc revised 06/21/11
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - building almoertino.ora
i URPO"!)r,
`Flais 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 suZgle-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
the bedroom(s)
X
X
_
On every level of a d.-cvelling unit includin- basements
X
i X
Within eac
X
i
Carbon Monoxide alarms are not required in dwellings which donot 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 pour=er supply, alarm(s) may be solely battery. operated..
Tia 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:lei
al-leuv o V a ¢ 4 `- 4� Permit No. 8-2M (6-,-
Specify Number of Alarms: it Smoke Alanzzs: I # Carbon Monoxide Detectors:
I have read and agree to comply with the_teL=_-,and conditions of this statement
Owner (or Owner Agent's) Name:
_ --
�4 r
�rGZr>
Signature ....... �, at
................................... Date:
Contractor Name: 9�,30-11
( ee"4'nq,ev
frl ,'�L B -L
Signature...... Lic.#..��'......�......5..�.......Date: �`l�
CUPERTINO
Owner N.
Address
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
Is your real property a registered historical site?
❑ Yes Civil Code Sections 1101.1 through 110118 do not apply. Skip the rest of the form and sign bottom of form.
P(No Go to Question 2.
1
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?
AT -Yes Civil Code Sections 1101.1 through 11011:8 do not apply.
,fnZ The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign'bottoin of form.
❑ 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.
'1 No Go to Question 4.
4. Is your real property built and available fo'r 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..
Please 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=conseiving 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 tluoughout the building (regardless of whether property undergoes alterations. or improvements).
I, as the owner or owe ier'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 age.
Owner or Owner Agent's Signature:�rs. Date:
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
1. If the existing plumbing fixture water usage/tlov rate is equal to or lower than the ngure snoNAni, it is not requirea to oe upgraaea.
SB40 7 2015.doe revised 08/26/15
Non -Compliant
Water -Conserving Plumbing Fixture
Plumbing Fixture/
(Fixture Complying with Current Code Applicable to New Construction)
Maximum Water Usage/Flow Rate
Fixture Type
Water Usage
2013 CPC Ch. 4
2013 CPC Ch. 4
2013 CPC Ch. 4
/Flow Rate
2013 CALGreen Div. 4.3
2013 CALGreen Div. 4.3
2013 CALGreen Div. 5.3
- 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/tlov rate is equal to or lower than the ngure snoNAni, it is not requirea to oe upgraaea.
SB40 7 2015.doe revised 08/26/15