B-2017-0195CITY OF CUPERTINO BUILDING PERMIT
BUII.DINGADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0195
18948 TILSON AVE CUPERTINO, CA 95014-3655 (375 09 014)
ATKINSON
CLIMATROLLERS INC
SAN JOSE, CA 95112
OWNER'S NAME: SPRINGER WERNER WAND CECILIE TRUSTEE & ET
DATE ISSUEED: 01/31/2017
OWNER'S PHONE: 408-371-$922
PHONE NO: (408) 294-6290
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C-20 Lie. #258540
Contractor ATKINSON CLIMATROLL RS INC Date 12/31/2018
X $LDG _ELECT _PLUMB
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 WALL HEATER (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.
:---I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 the Labor Code, for the of the work far which this
of performance
permit is issued.
Sq. Ft Floor Area:
Valuation: $1960.00
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
375 09 014
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 Code, Section 9.18,
180 DAYS FROM LAST CALLED INSPECTION.
�}Municipal
UMZj2"r C� (l'�""'''
-Signature Date 1/3112017
Issued by: Abby Ayende
OWNER-BIi MB,DEfI:ARATION
Date: Q1131/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RF ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a of is
following two reasons:
1. 1, 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. 1, as owner of the property, am exclusively contracting with licensed
Signature ofApplicant:
contractors to construct the project (Sce.7044, Business & Professions Code).
Date: 1/31/2017
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1. 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.
Z I have and will maintain Worker's Compensation Insurance, as provided for by
HAZARDOUS MATERIALS DISCLOSURE
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. 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
Health & Safety Code, Section 25532(x) should I store or handle hazardous
s. I certify that in the performance of the work for which this permit is issued, I
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to became subject to the
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 2555505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:i
['Date:
1/31/2017
APPLICANT CERTIFICATION
LENDINGagntAGENCY
I certify that I have read this application and state that the above information is
CONSTRUCTION
i hereby affirm there is a construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of works far which this permit is issued {Sec. 3097, Civ C.)
whihatch
relating to building construction, and hereby authorize representatives of this city,
Lender's Name
to enter upon the above mentioned property for inspection purposes. (We) agree
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
ARCHITECT'S DECLARATION
and will comply with all non -point source regulations per the Cupertino Municipal
I understand my plans shall be used as public records.
Code, Section 9.18.
Licensed
Signature Date 1/31/2017
Professional
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - buildingQcupertino orgmisc
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PROJECT ADDRESS
1219
IxI� AI I MISCELLANEOUS
:5,on Ave,
APN #
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPERqTENANT
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NAME LICENSE NUMBER
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STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF SFD or DUPLEX ❑ MULTI -FAMILY
BUB.DING. ❑COMMERCIAL
PROJECT IN WILDLAND ❑ YES7PR.0JECT
URBAN INTERFACE AREA ❑ NOOD
IN ❑ YES
ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
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TOTAL VALUATION: 1 V0,
RECEIVED BY: S"
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 beh If. 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. 1 agree to comply with all applicable local
ordinances and state laws relating to building authorize representatives of Cupertino to enter the Bove -identified property for inspection purposes.
Signature of Applicant/Agent: {irk—
Date: / 1
SUPPLEMENTAL INFORMATION REQUIRED
oIcl USE ONLY
❑ OVER=rffl�-COUnTEa
'
❑- -EXPRESS-
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a STANDAVW1 -
❑ LACI
El MAJOR
MEPMiscApp_2011.doc revised 06/21/11
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SMOKE i CARBON MONOXIDE ALARMS
OWNER, OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 m building(alcupertino.org
.........:.. _
CANN®T 3E F WA ED UNTH., THIS CERTIFICATE HAS BEEN
;E AN32ETITDNEii I+D TH I3iTI�I3INIIC33�_ "ry
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with. 2016 CRC Section R314, R315, 2016 CBC Sections 420.6 and 907.2.11.2 where no interior access
for inspections are required.
GENERAL INFORMATION
Fisting single family -and multi -f amuly4wellirrgs-sha-Rbe -Carbon-- — - - -- -_
Monoxide -alarms.- UAIizen tine-A,-aluation of additions,_alterations,:or repairs to .existingd«Tellung_viui.s exceeds
$1000.00, CRC Section 8314, R315, and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or
Carbon Monoxide Alarms be installed.in the following locations:
F AREA
SMOKE,ALARM
CO ALARM—{
Outside of each separate sleeping area in the immediate vicinity of the
X
X
bedroom(s) - (Smoke alarms shall not be located within 3 feet of bathroom door)
I
On every level of a dwelling unit including basements and habitable attics
X
�_
_ X
_
Within each sleeping room +,
X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply: In dwelling units with -no commercial power supply, alarm(s) may be solely battery operated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling firdshes or there is no access by means of attic, basement or crawl
space. Refer to CRC Section 8314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for
_- warms Carhichar-rust be�coru-tected-to tine uildhT, wirinqb-----
As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms specified below have been tested and are operational, as of the
date signed below. f�,r�
Address: ®�Z T/1 -SO ,4'0 f f/R `?'6(j/ Permit No. 6-2017-6(75-
Specify
^20176(75-
Specify Number of Alarms: # Smoke Alarms: # Carbon Monoxide Detectors:
I have rParl and anrPP to rmmnly with the terms and conditions of this statement -
Owner (or Owner Agent's) Name:
IV<7C1%(� .$�
WA
Signature ........ .... .................Date: 2.4.-1...
Cont actor Name:
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.. :..... Lia#�"j Date/ ......
Smoke and COfonn.doc remised 01/1012017
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WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE e CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408 77-3333 • buildingCcDcupertino.org
Owner Name -15-* ,,, Permit No.
Address cog` �7TL 'CJ Fd� , G^G�f� �a�®Cd TROA/
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 the form and sign bottom of form.
RP 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.
0 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 forin 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.
0 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 theothree following statements and sign
bottom of form..
5. Please check ONE of the following:
R 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-hexeplaced-with:watermconserving-plumbiirgfixtures,---_
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-conservingplumbing 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. n
Owner or Owner Agent's Signature:6 cic/r Date:
Upon completing anci signing tors uenincate, please return it to the xsunamg i ivision in oruer Lo imai yvur ouiii.uug trc1nnL.
SB40 7 2015.doc revised 08/26/15
BUII.DiNG PERl4�
CERTIFICATE -HAS:]
ice: '•5� �i-_ � w ... _ ='.
;E FINALE'D AND COMPTiETED UNTIL THiS
1. If the existing plumbing fixture water usage/tlow rate is equal to or lower than the tigure shown, it is not required to be upgraded.
SB4072015.doc rerised 08/26115
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/tlow rate is equal to or lower than the tigure shown, it is not required to be upgraded.
SB4072015.doc rerised 08/26115