B-2016-3285CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMI
r NO: B-2016-3285
1019 SEPTEMBER DR CUPERTINO, CA 95014-4128 (362 15 019)
WATER HEATERS
ONLY INC
GRASS VALLEY, CA
95945
OWNER'S NAME: DEMPSEY KENNETH W TRUSTEE
DATE ISSUED:
12/16/2016
OWNER'S PHONE: 408-313-9804
PHONE
O: (800) 835-8345
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class Ofi Lic. #374573
Contractor WATER HEATERS ONLY INCDate 95/31/2017
X BLDG —ELECT X PL
MECH 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
license is in full force and effect.
JOB DESCRIPTION:
(N) 50 GAL WATER HEATER
3ARAGE
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-insurc 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.
42. 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.
APPLICANT CERTIFICATION
Sq. Ft Floor Area:
Valuati
n: $1500.00
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
362 15 019
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We) agre to save indemnify and keep harmless the
City of Cupertino against liabilit" , judgments, costs, and expenses which
PERMIT EXPIRES IF
WORK IS NOT STARTED
may accrue against said City '10 consequence of the granting of this permit.
Additionally, the applicant and r ptands and will comply with all non -point
WITHIN 180 DAYS
F PERMIT ISSUANCE OR
source regulations per the CUbArtino Municipal Code, Section 9.18.
180 DAYS FROM LAST
CALLED INSPECTION.
Signature Date 12/16/2016
Issued by: Kim Dunbar
Date: 12/16/2016
OWNER -BUILDER
I hereby affirm that I am exem ff in the Contractor's License Law for one of the
following two reasons:
All roofs shall be inspected prior to
any roofing material being installed. If a roof4s
1. I, as owner of the property, or my employees with wages as their sole
installed without first obtaining an i
rkspection, 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 ofApplicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 12/16/2016
I hereby affirm under penalty of perjury one of the following three declarations:
AT•i • ROOF COVERINtf5
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 I
AATERIALS DISCLOSURE
z. 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 Co
le, Sections 25505, 25533, and 25534. I will
permit is issued.
maintain compliance with the Cu
L3ertino 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
I 15532(a) should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the
Worker's Compensation laws of California. If, after making this certificate of
material. Additionally, should I use
air contaminants as defined by t
will maintain compliance with th
equi ent or devices which emit hazardous
Ie Bay a Air Quality Management District I
Cupe o Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Coe
a ons 25505, 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: 12/16/2016 �%Z
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 and state laws
I hereby affirm that there is a corjstruc
lending agency for the performance
relating to building construction, and hereby authorize representatives of this city
of work's for which this permit is
ssue ec. 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
ARC F1CT'SDECLARATION
Code, Section 9.18.
1 understand my plans shall be u
ed as public records.
Licensed
Signature Date 12/16/2016
Professional
+CUPERTINO
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 - building(5�cupertino.org
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11 OWNER ElOWNER-BUILDER❑ OWNER ArENT ❑ CONTRACTOR NTRACTORAGENT ElARCHITECT
0 ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME �j`j ✓ ' LICENSE NUMBER
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LICENSE TYPE
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BUS. LICIL
COM PANY i t� �v
!-ru r
E-MAIL
FAX
STREET ADDRESS
) J. Ate 1 ' �
CITY ST ZIP _
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GAS
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
—
BUS. LIC
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF FD or DUPLEX ❑ MULTI -FAMILY
BUILDING: -/El COMMERCIAL
PROJECT IN WILDLAND ❑YES
URBANINTERFACEAREA ❑ NO
PROTECT IN ❑ YE
FLOOD ZONE ❑ NO�
IS THE BLDG AN ❑ YES
EICHLERHOME? ❑ NO
DESCRIPTION OF WORK
TOTAL VALUATION:
RECEIV�BY:;�I
following: _ I the property owner or authorized agent to act on tyre property
By my signature below, I certify to each of the av
application and the information I have provided is corre e read the Description of RTork and verify it is accurate. I a
ordinances and state laws relating to building cons p authorize representatives of Cupertino to enter the above--identi
Signature of Applicant/Agent: Date:
owner's behalf. I have read this
ee to comply with all applicable local
d prop ty for inspection purposes.
ua
SUPPLEMENTAL RMATION REQUIRED
� OtFIcE use o1`rLY
-0 OVER-THE-COUNTER ,
O-- EXPRESS .
�.
STANDARD
a:
0' LARGE;
❑ A'LAIJOR -
MEP.AlliscApp_:2011.doc revised 06121/11
STATE OF CALIFORNIA
RESIDENTIAL ALTERATIONS — WATER HEATER
-CERTIFICATE OF COMPLIANCE
Prescriptive Residential �Alferations
Project Name: 0
A.GENERALINFORMATION
Fuel
F=7
� (,C> � ,5
CALIFORNIA ENERGY COMMISSION
d Floor Area
U. VVA I CK ncm I I IMU.2 I.F. �Iv—
01 02
1---
03
04
05
06
07
08
10
11
12
13
Back -Up
14
15
Water
Water Heating
of
Water
Heater
Rated
R� ted
Heating
Heating
Exterior
Solar
Dwelling UnitDHW
System
Water
Water
Heaters
Storage
Input
Input
Efficiency
Efficiency
d
Stan by
insul. R-
Savings
Central DHW System
System Distribution
Identification or
Heating
Heater
M4
volume
Fuel
Value
Value
Lass(}
Value
fraction
Distribution Type
Type
Name
SystemType
Type
system
(gal)
e
Type
Type
CA Building Energy Efficiency Standards - 2013 Residential Compliance
JuLY 2014
STATE OF CALIFORNIA
RESIDENTIAL ALTERATIONS -WATER HEATER CALIFORNIA ENERGY COMMISSION,
CF-IRALT-01-E
CE Page 2 o 2
Prescriptive Residential Alterationsate
)repararecl:
Project Narne;
Y_nn f
DOCUMENTATION AUTHOR'S DEC'
1, 1 certify that this Certificate of Compliance documentation Is accurate and complete.
Documentat!on Author Signature:
Documentation Author Name: n9
4e -!-e v\-- Signature Date;.
ComparW;"__ I "IT 5
CEA/ HERS certification1dentificatlon (if applicable):
Address- f
A
Phone:
aty/state/Zi C3 -z,-
RESPONSIBLE PERSOWS DECLARATION STATEMENT
Icertify the following under penalty of perjury, under the laws of the State of California;
1. The information provided on this Certificate of Compliance is true and correct.a
2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance(responsible
on this Certificate of
designer). devices for the building design or system design identified
3. That the energy features and performance specifications, materials, components, and;� manufactured
Compliance conform to the requirements of Title 24, Part 1 and Part 6'of the California Code of Regulations. provided on other applicable compliance documents,
4. The building design features or system design features Identified on this Certificate of Compliance are consistent with the information
worksheets, calculations, plans and specifications submitted to the enforcemen Itagenc for y approval with this building permit application.5. forthe building, and made available to the enforcement agency
I will ensure that a registered copy of this Certificate.of Compliance Shall be madd.avallable with the building permit(s) Issued
forall applicable inspections. I understand.that,a registered copy of this Certificate ofCompliance is required to be included with the documentation the builder provides to the building
owner at occupancy, Responsible DesignerSignature:
Responsible Designer Nams:_��
Date Signed,
Company,
Uctmse:
Address:
T7
0 V) k YX Phone:
0
For assistance or questions . regardfiligthe Energy Standards, contact the Energy Hotline at: 1-800-772-3300.
CA Building Energy Efficiency Standards - 2013 Residential Compliance
JuLY 2014
CU E ` 1NO
Owner
Address
WATER -CONSERVING PLUMBING FIXTURE I
OWNER CERTIFICATE OF COMPLIANCE i
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 77,77--3228 - FAX (408) 777-3333 • building(a Cupertino org
:!2xU 3285
1. Is your real property a registered historical site?
❑ Yes Civil Code Sections 110 1. 1 through 110 1. 8 do not apply. Skip the rest of the forin and'sign bottom of form.
No Go to Question 2.
2. Does your real property have a licensed plumber certifying that, due to the age or configuration ofthe property or its
plumbing; installation of water -conserving plumbing fixtures is not technically feasible? !
❑ Yes Civil Code Sections 110 1. 1 through 1101.8 do not apply. j
❑ The licensed plumber's certification has been provided to the Building, Division. I
Skip the rest of the form and..sign bottom of fon:m_ _
XNo 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.
>!a,No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994? j
❑ 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.
16 Yes My real property is built and available for use or occupancy on or before January 1, 19 4. -_
Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following s! aternents and sign
bottom of form..
5. 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 irnprovemerrts).
❑ 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 irnprovernents).
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 Cgde, and manufacturer's
installation requirements, and that the water -conserving plumbing fixtures comply with -the requirements as indicated in the
table on the following nage. _
I Owner or Owner Agent's Signature: gL";& Date:2 2 2,D_['Z
Upon completing and signing this Certificate, please return it to the Building Division in order to final your building pem-ii t.
2015.doc revised 08/26/15
1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shoal, it is not required to be upgraded.
SB4072015.doe revised 08/26/15
Non-Compliant
Water-Conserving Plumbing Fixture
PlumbingFixture
(Fixture Complying with Current Code Applicableto New Construction)
Fixture Type
Maximum Water Usage/Flow Rate
2013 CPC Ch. 4
2013 CALGreen Div. 4.3
2013 CPC Ch. 4
2013 CALGreen Div. 4.3
1 2013 CPC Ch. 4
' 2013 CALGreen Div. 5.3
Water Usage
/Flow Rate
Single -Family
Multi-Family
j 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 land one full flush
Urinals
Exceed 1.0
Gallons/flush
0.5 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
j
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 shoal, it is not required to be upgraded.
SB4072015.doe revised 08/26/15
.J.,e ,
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENTDEPARTMENT , BUILDING DIVISION
10300 TORRE AVENUE , CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.org
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
Existisingle.-family_anddn ti family_ 4Wgil ngs shall ]Ze pi6vided withSmoke Alarihs 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 dwelling unit including basements
X
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.
i
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.
7 _
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. ] ,p Q
Address: 1011P,U-T e.1m.�Q l llnb , A el t�1�/ Permit No. "2�1� -�C�
Specify Number of Alarms:
# Smoke Alarms: 1 7 I #
I have read and aoree to comply with the terms and conditions of this statement
Owner Cor Owner Agent's) Name:
`
Dav�� ¢. •!%Q ►"► g
Signature -•7• .. e;
.............................. .................
Contractor Name: If
Signature.................................................................. L,ic.#...................................... Date:
Smoke and CO form.doc revised 09/27/16