B-2017-0003EA
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: 13=2017 331
19863 PORTAL PLZ CUPERTINO, CA 95014-3370 (369 46 025)
HOME WORKS
CONSTRUCTION INC
SAN JOSE, CA 95129
OWNER'S NAME: NAM PAUL V AND VOCI-NAM CHRISTINE
DATE ISSUED: 01/03/2017
OWNER'S PHONE: 408-398-8519
PHONE NO: (408) 850-6477
LICENSED CON T TOR' D L R ATION
BUILDING PERMIT INFO:
License Class D Lie. #949588
Contractor HOME WORKS CONSTRUCTION INC Date 08/31/2018
X BLDG —ELECT _ PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
M ECH 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:
KITCHEN REMODEL -M.E.P. (90 SF)
I hereby affirm under penalty of perjury one of the following two declarations:
r. 1 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: $20000.00
APPLICANT CERTIFICATION
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
369 46 025
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 IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
WITHIN 184 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant un erstands and will comply with all non-point
source regulations/per the grupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 01/03/2017,
Issued by: Kim Dunbar
Date: 01/03/2017
I hereby affirm that I. am exempt from the Contractor's License Law for one of the
RE-ROOFS:
following two reasons:
All roofs shallbe inspected 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)
z. 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: 01/03/2017
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 MATERIALS DISCLOSURE
2. 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 Code, Sections 25505, 25533, and 25534. I will
permit is issued.
maintain compliance 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 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 or devic hick emit hazardous
air contaminants as defined by Qu anagement District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with Cup unic' Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety 0 2 3 and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
4oMun1c*
be deemed revoked �f/
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 01103/2.017
certify that I have read this application and state that the above information is
correct. l agree to comply with all city and county ordinances and state laws
CTI
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,
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
and will comply with all non-point source regulations per the Cupertino Municipal'
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Code, Section 9.18.
Licensed
Signature Date 01103/20177
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
40300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.ora
CUPERTINO
❑ NEW CONSTRUCTION ❑ ADDITION VALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS3 V AL Py APN # 6/ �j lL
OWNER NAME a 5—nt4 I (.S PHONE q p�
STREET ADDRESS CITY, STATE QIP FAX
CONTACT NAME ,,'gPHONE E-MAIL
STREET ADDRESS00. � S / l INS CITY, STATE, ZIP �l (� FAX
OWNER OWNERS-BUILDER !❑' OWNERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑. ENGINEER ❑ DEVELOPERS ❑ TENANT
CONTRAC OR NA LICENSE I-Z LICENSE E BUS.
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COMP NAI FAX
ST,4EEJ,A,DLLCITY, STAT , ZIP PHO ,
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9 L71- 7-14
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC tt
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY, STATE, ZIP PHONE
DESCRIPTION OP WORK
' y Z,)-5
EXISTING USE - - PROPOSED USE - CONSTR. TYPE #STORIES - - _ -
USE TYPE OCC, SQ.FT. VALUATION ($)
EXISTG NEW FLOOR - - DEMO TOTAL - - - AREA AREA AREA NET AREA
BATHROOM - KITCHEN-OTHER
REMODEL AREA REMODEL AREA® REMODELAREA
PORCH AREA DECK AREATOTAL DECK/PORCH AREA GARAGE AREA: DETACH -
ATTACH
#DWELLING UNM: IS A SECOND UNIT _]YES SECOND STORY ❑YES
BEINGADDED? E] NO ADDITION? []NO -
PRE APPLICATION ❑ YES IF YES, PROVIDE COPY OF Is THE BLDG AN Fl YES r BY n K �. '� Y TOTAL VALUATION:
PLANNING APPL # Q NO PLANNING APPROVAL LETTER EICHLER HOME? E]NO
x,.
By my signature below, I certify to each of e following: I aIn property owner or authorize agent to act on the property owner's behalf. I h ve read this
application and the information I have pro Ided is c rrect. I hav read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to h con orize representatives of Cupertino to enter the above enti ed property for inspection purposes.
Signature of Applicant/Agent' Date:
SUPPLEMENTAL INFORMA ON REQUIRED
PLAN CHECK TYPE..
,... �- _�... ._ROHT'INGSLIP^ ...,,�r•sk ._
New SFD or Multifamily dwellings: Apply for demolition permit for 1=j ovEx rlconnTEx� BUII DING PLANREi IERt' "
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. EGRESS ❑ PLAAIvI1aGPLANREUIER
Q.
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑> sTANDAxD ❑ PiIBLrCwoxxs E
form if any Hazardous Materials are being used as part of this project. �� = "
D: LARGE,1 FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
�[ IUTAJOR V SITARY$EZuERDISTRICT
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$ pp
ba;ET�'VIRONiiiENT:4LHEALTH
BldgApp_Ml.doc revised 06121/11
1:----- F i L
\\ Ir' SMOKE / CARBON MONOXIDE ALARMS Pactio.53 `4-
,...&9 OWNER CERTIFICATE OF COMPLIANCE
+(.)p4 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333• buildingAcupertino.orq
F
PERMIT CANNOT BE FINALE'):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: /9' ,' " �. f Permit No. ;17--
I
Specify Number of Alarms: #Smoke Alarms: #Carbon Monoxide Detectors: I �`I
I
I have read and agree to comply with the tpns andconditions of this statement
Owner(or Owner Agent's)Name: ,,::: � � �
Signature �' Date. 1 Si,
Contractor Name:
Signature Lic.# Date:
Smoke and CO fonn.doc revised 09/27/16
I
1 i
\\k WATER-CONSERVING PLUMBING FIXTURES 1 Fl Lr
r.' ,
OWNER CERTIFICATE OF COMPLIANCE u .33 H--
., ,,,, COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
� ( 08 777-3228•F (408)777-3333•buildinq(a,cupertino.ord
Owner Name ( ^ 4) lAX e,.1 �--p ` _ Permit No. 0(7 Ckp 0
Address /ql 6 7414,-.L._ ',L / ) <..��../ 7
1. Is your real property a registered historicalfsite?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form 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 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.
1 Skip the rest of the form and sign bottom of form.
ICNo 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.
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.
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 single-family residential real property. See Civil Code Section 1101.4.
On and after January 1, 2014,building alterations ori improvements shall require all non-compliant plumbing fixtures
to be replaced with water-conserving plumbing fixturs 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).
II
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: /�k �' L Date: 5f -5/2r 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
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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 CPQ Ch. 4 2013 CPC Ch.4
Water Usage
/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
1 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/floti r rate is equal to or lower than the figure shown,it is not required to be upgraded.
r,
SB407 2015.doc revised 08/26/15