B-2016-3282 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: , PERIM NO:B-2016-3282
21560 EDWARD WAY CUPERTINO,CA 950144765(356 18 019) AMERICAN HVAC&-
PLUMBING INC
CAMPBELL,CA 95008
OWNER'S NAME: SUNDARESH SUBRAMANIAN AND SUDHA TRUSTEE DATE ISUED:12/16/2016
OWNER'S PHONE:408-257-3722 PHONE 110:(408)440-0304
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C20 Lic.#946540
Contractor AMERICAN HVAC&PLUMBING INC Date 04/30/2018 X BLDG _ELECT _PL
X 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:
REPLACE FURNACE AND AC UNIT(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
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:$15000.00
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 356 18 019
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 I[F WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS �F PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations ne e Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 12/16/2016 Issued by:Kim Dunbar
r L __ Date:12/16/2016
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 tol 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.
sale(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:12/16/2016
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 ATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous mate 'als 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 e,Sections 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section f25532(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 u e equipment or devices which emit hazardous
air contaminants as defined by th Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with th Cupertin . 'cipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Co e,Sec ', s 2550.,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 L/ Date:12/16/2016
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 ssued(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.
Licensed
Signature Date 12/16/2016 Professional
•r
r GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
,Ig 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
ts
(408)777-3228•FAX(408)777-3333•buildinq(a?.cupertino.orq:' 0 1 32gfill I S C
CUPERTINO
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0 PLUMBING ®MECHANICAL 0 ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS 2.1 s/"_c e t(e Nab
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OWNER NAME. 54,)
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STREET ADDRESS - /• CITY,STATE,ZIP FAX
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❑OWNER 0 OWNER-BUILDER 0 OWNER AGENT 0 CONTRACTOR EKONTRACTOR AGENT 0 ARCHITECT ❑1NGINEER 0 DEVELOPER 0 TENANT n
CONTRACTOR NAMELICENSE NUMBER LICENSE TYPE BU . C#
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USE OF SFD or DUPLEX 0 MULTI-FAMILY PROJECT IN WILDLAND 03Es PROJECT IN ❑Y S IS THE BLDG AN 0 YES
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BUILDING: 0 COMMERCIAL URBAN INTERFACE AREA • O FLOOD ZONE 0"NO EICHLER HOME? 0K0
DESCRIPTION OF WORK
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TOTAL VALUATION: 4t 1" 50 RECEIVE i ,
By my signature below,I cgrt�fy to each of the following: I am the property owner or authorized agent to act on the operty owner's behalf. I have read this
application and the information I have provide.' .-•et. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relati•v . it it onstruct..n. I authorize representatives of Cupertino to enter the above-idenf e property for inspection purposes.
Signature of Applicant/Agent: -"mo i Date: ) l Li
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SUPP - I NTAL INFORMATION REQUIRED I OFFICE USE ONLY
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MEPMiscApp_2011.doc revised 06/21/11
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SMOKE / CARBON MONOXIDE ALARMS
Tov,
OWNER CERTIFICATE OF COMPLIANCE
yY.Ip�r COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildinq(a cupertino.orq
PERMIT CANNOT BE FINALED UNTIL THIS CERTIFICATE HAS.BEEN
COMPLETED,SIGNED%AND RETURNED TO THE BUILDING DIVISION
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 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: 2-1 Pz�7®`-1? -81(01 y Permit No.
Specify Number of Alarms: #Smoke Alaiius: I 6 I #Carbon Monoxide Detectors: ( 2--
I have read and agree to comply with the terms and conditions of is statement
Owner(or Owner Agent's)Name:
Sih/D '!,d Signature... - Date:/y2�/c
<-a
Contractor Name:
.t �� ei°�Air;.-; Signature ✓ Lic.# Date:
�
Smoke and CO form.doc revised 09/27/16
\\ WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
-r.,, - COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO IN 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333• buildinq(a cupertino.brq
Owner Name 01,✓ SeimM-e-&c H Permit No.
Address 2-i S- L t41,1-t 1,1 6--4-1 c n---e 7>,0D Se-D 1 ti
1. Is your real property a registered historical site?
El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
gNo 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.
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.
7KNo 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.
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:
'l.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).
El 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: ` -C' Date: / /2-2176
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 FINAI.ED.AND COMPLETED UNTIL THIS
(.i RTIFICA TE HAS BEEN_:SIGNED AND RETURNED TO T. BUILDING DIVISION
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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 inute @ 1.8 gallons per minute 1.8 gallons per minute @ 60
Kitchen per minute 60 psi @ 60 psi psi
Faucets May temporaril increase May temporarily
up to 2.2 gallon; per increase up to 2.2
minute @ 60 ps, and must gallons per minute @
default to maxi urn 60 psi, and must
1.8 gallons per inute @ default to maximum
60 psi 1.8 gallons per minute
Where faucets eeting @ 60 psi
the above are u available, Where faucets meeting
aerators or othe 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