B-2017-0026 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0026 '
11003 NORTHSKY SQ CUPERTINO,CA 95014-0540(316 40 002) GRADE A PLUMBING
SERVICES INC
CAMPBELL,CA 95008
OWNER'S NAME: KEMISETTIANIL PAND LAKSHMI DATE ISSUED:01/04/2017
OWNER'S PHONE:508-330-9988 PHONE NO:(408)569-8284
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-36 Lic.#962210 ,
Contractor GRADE A PLUMBING SERVICES INC Date 06/30/2017 X BLDG _ELECT X PLUMB
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: .
NEW 3/4 jeta, 1, t° j
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 ([ O k---
Compensation,as provided for by Section 3700 of the Labor Code,for the
ciperformance 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:$1800.00
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 316 40 002
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 180 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.
SignatursaA Date 01/04/2017 Issued by:Kim Dunbar
Date:01/04/2017
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
i. 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:01/04/2017
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
s. 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 which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance 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 authorized agen
APPLICANT CERTIFICATION Date:01/04/2017
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 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.
Licensed
Signature Date 01/04/2017 Professional
1\ /„„,,p.:\ GENERAL PERMIT APPLICATION MEP
( COMMoNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
toy c,Igs:.' 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•buildinq(a)cupertino.orq MISC
'PLUMBING Q MECHANICAL DELECTRICAL 0 MISCELLANEOUS
PROJECT ADDRESS APN#
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- .ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STRESS CITY,STATE,ZIP PHONE
USE OF ,. SFD or DUPLEX 0 MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN 0 YES IS THE BLDG AN 0 YES
BUILDING:' 0 COMMERCIAL URBAN INTERFACE AREA 0 NO FLOOD ZONE 0 NO EICHLER HOME? 0 NO
DESCRIPTIONp{ OF WORK q} Rig Q +j
1 d_:d.FdC 5 ',L¢°i a o 3 ..A y -'E - ,1.-.e- ^w' CO 34m. 175,
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TOTAL VALUATION: RECEIVED,
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By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the 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 accurate. I agree to comply with all applicable local
ordinances and state laws relatin_to building construction. I authorize representatives of Cupertino to enter the abov -identi ed property for inspection purposes.
Signature of Applicant/Agent: i. Date: t q _O 1, -1
..-
SUPPLEMENTAL
SUPPLEMENTAL INFORMATION REQUIRED Orr10E USE ONLY
w 0 OVER-11 E-COUNTER
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MEPMiscApp 2011.doc revised 06/21/11
pi
, , SMOKE / CARBON MONOXIDE ALARMS O iii/13-
[ OWNER,CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333• building( cupertino.orq
PERMIT CANNOT BE FINALED UNTIL THIS CERTIFICATE HAS BEEN
COMPLETED,,SIGNED,AND:j2ETURNED 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 4.20.6 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: (( 0 0 3 No S lc [LA..? CA- ci. p 1-1 Permit No. 3-2 o S 1 —002.-(a
Specify Number of Alarms: #Smoke Alarms: I_ I #Carbon Monoxide Detectors: 13 I
I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name: /
Signature 7� "p --K-0‘^^-1-14 - Date 01 (oi'1
Contractor Name:
Signature Lic.# Date:
Smoke and CO form.doc revised 09/27/16
•
FIL
t WATER-CONSERVING PLUMBING FIX URES
OWNER CERTIFICATE OF COMPLIAN E 11141—
COMMUNITY COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DI ISION
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildingna,cupertino.orq
Owner Name A N I L— K E rt iS F Tr1 Perm t No. 43—2011 — ca0L-1
Address (I 0 03 N a v 1 S 1i/ S ; Cup L,,j C - 9 SD 1
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 thform 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 confit ation of the property or its
plumbing,installation of water-conserving plumbing fixtures is not technically feasible'
El Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
❑ The licensed plumber's certification has been provided to the Building D vision.
Skip the rest of the form and sign bottom of form.
E 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.
® No Go to Question 4. —
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
El 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 110 .4.
On and after January 1, 2014,building alterations or improvements shall require al non-compliant plumbing fixtures
to be replaced with water-conserving plumbing fixtures throughout the building.On•r before January 1,2017,all non-
compliant plumbing fixtures shall be replaced with water-conserving plumbin. fixtures (regardless of whether
property undergoes alterations or improvements).
❑ My property is a multifamily residential real property. See Civil Code Section 1101. .
On and after January 1, 2014,specified building alterations or improvements shall red uire 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 ith water-
conserving plumbing fixtures throughout the building(regardless of whether prope 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 re.uire 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 no' -compliant plumbing fixtures will be
replaced prior to date specified above with water-conserving plumbing fixtures in accorl ance with Civil Code Sections 1101.1
through 1101.8,the current California Plumbing Code and California Green Building St. dards Code,and manufacturer's
installation requirements, and that the water-conserving plumbing fixtures comply with e requirements as indicated in the
table on the following page.
Owner or Owner Agent's Signature: tic •A• P- Date: r,r ncriz6l7
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 pERNIIT CANNOT BE FINALED.AND COMPL TED UNTIL TABS
CERTIFICATE HAS BEEN SIGNED.AND RETURNED TO THE UILDING DIVISION
,
Non-Compliant Water-Conserving Plumbing Fixture
Plumbing Fixture (Fixture Complying with Current Code Asplicable to New Construction)
Maximum Water Usage/Flow Rate
Fixture Type 2013 CPC Ch. 4 2013 CPC C . 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 Residents.I
Water Closets Exceed 1.6 Single flush toilets: 1.2: gallons/flush
(Toilets) Gallons/flush Dual flush toilets: 1.28 gallons/flush effec ive flush volume (the composite,
average flush volume of two reduces flushes and 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 certifies to the performance criteria of
gallons per minute U.S. EPA WaterSense Specification for Show:rheads
(A hand-held shower is considered a showerh-ad.)
For multiple showerheads serving one shower the combined flow rate of all
showerheads and/or other shower outlets con rolled by a single valve shall not
exceed 2.0 gallons per minute @ 80 psi, or th shower shall be designed to
allow only one shower outlet to be in operatio 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 gal ons
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 inute 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,
minute @ 60 psi, and must gallons per minu e @
default to maximum 60 psi, and must
1.8 gallons per minute @ default to maxim m
60 psi 1.8 gallons per Minute
Where faucets meeting @ 60 psi
the above are unavailable, Where faucets eeting
aerators or other means the above are
may be used to achieve unavailable, aer-tors or
reduction. other means maV 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