B-2017-0156CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0156
10175 PARKWOOD DRAPT 4 CUPERTINO, CA 95014-1459 (326 27 037) THERMAL
MECHANICAL
SANTA CLARA, CA
95054
OWNER'S NAME: AVERY GLENBROOK LP
OWNER'S PHONE: 650-961-8330
LICENSED CONTRACTOR'S' DEC .ARATION
License Class C10. C20, C36.038 Lie. #?`�(L51
Contractor THERMAL MECHANICAL Date 01/31/2018
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.
hereby affirm under penalty of perjury one of the fallowing 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
/C
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 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
I certify that 1 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 relating to building construction, and hereby authorize
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
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 Code, Section 9.18,
Date' 01/31%2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business & Professions Code)
1 I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (See.7044, Business & Professions Code).
hereby affirm under penalty of perjury one of the following three 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 of the Labor Code, for the performance of the work for which this
permit is issued.
I certify that in the performance of the work for which this permit is issued, I
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
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
APPLICANT CERTI>+ICATION
I certify that 1 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
relating to building construction, and hereby authorize 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 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
Code, Section 9.18.
Signature Date 01/31/2017
DATE ISSUED: 01/31/2017
PRONE NO: (408) 988-8744
BUILDING PERMIT INFO:
BLDG X ELECT X PLUMB
MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
BLDG 33/UNIT 4; ADD (1) A/C; REPLACE FURNACE, SAME
LOCATION; (N) WASHER AND DRYER HOOK UPS; (N) ELECTRICAL
SERVICE (70 AMP); (N) GAS LINE FOR STOVE; (N) RECEPTACLE
OUTLETS; (N) LIGHT; (I) BATHROOM EXHAUST FAN
Sq. Ft Floor Area: 4 Valuation: $20000.00
"N Number: Occupancy Type:
326 27 037
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
by: MELISSA NAMES
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant:
Date: 01/31/2017
TO BE CLASS "A"
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Section25505, 25533, and 25534.
Owner or authorized agent,
Date: 01/31/2017
I hereby affirm that there is aconstruction lending agency for the performance
of work's for which this permit is issued (Sec. 3057, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional
N
CONSTRUCTION PERMIT APPLICATION
-COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - building �j
P-cupertino.orc
CUPERTINO I R, 2-01 0)
F� NEW CONSTRUCTION FIADDITION RX ALTERATION/T1 n REVISION 1DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS 10175 Parkwood DR, BLDG 33, Unit #4
APN 9
OWNER NAME Avery Glenbrook LLC
PHONE 650-961-8330
r -MAIL avery@pacbell.net
STREETADDRESS 130 East Dana Street
CITY, STATE, ZIP Mt. View, CA 94041
1 FAX 650-961-0571
CONTACT NAME Rob Moyer
I PHONE 408-593-8115
1 Y. -MAIL rmoyer@thermaimech.com
STREET ADDRESS 425 Aldo ave.
CrrY,STATP, ZIP Santa Clara, CA 95054
1 FAX 408-988-0233
0 OWNER El OWNER --BUILDER 0 OWNERAGENT IX CONTRACTOR n CONTRACTOR AGENT 13 ARCHITECT IJ ENGINEER 0 DEVELOPER 0 TENANT
CONTRACTOR NAME Thermal Mechanical
LICENSE NUMBER 256057
G-4 10 20 36�38 PE
BUS. LIC # 299
COMPANYNAmE Thermal Mechanical
E-MAILrmoyer@. thermaimech.com
FAX 408-988-0233
STREET ADDRESS 425 Aldo ave.
c'Ty,sTAEz" Santa Clara, CA 95054
PHONE 408-988-8744
ARCHITECT/BNGINEFRNAME
LICENSE NUMBER
SUS. LIC 9
COMPANY NAME
R -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
f
DESCRIMION OFWORK add new AC, replace furnace in same location, (N) washer/dryer hook ups, (N) electrical panel (70 AMP};
(N)gas line for stove, (N) electrical outlets, (N) light, (N) bathroom exhaust fan
-EXISTING USE
I
PROPOSED USE CONST.R.TYPB
Y1 STORIES
USE
TYPE
OCC,
SQFT.
VALUATION ($)
BXISTG
NaWrFLOOR
OEM -T-
E
TOTAL
AREA
ARBA
AREA
NET AREA
_FA'_T_11_R06M_
KITCHEN
ER
REMODELAREA
RMODELARBA
ELAREA
R1MO—D
PORCHARFA
DECK AREA
I
—GTH
TOTALDECY&ORCHAREA
ARAGEAREA: HDVrACH
[ATTACH
#DWRLUNGUNITS:
15 A SECOND UNIT UYES
SECOND STORY nYHS
BRINCADDED?
ADDITION? JJNO
PRE -APPLICATION []YBS IF YES, PROVIDE COPY OF
IS'PHFBLDGAN 1]YPS
D
TOTAL VALUKIAGN;
PLANNINGAPPLO []140 PLANNTNG APPROVAL LUITER
EICHLER HIE R? []NO
By my signature below, I certify to each of the following: I am the property owner omfut—horized agl5nt to act peproperty owner's behalf, I have, read this
application and the information I have provided is correct [ have read the Description of Work and verify itls4ccurate, I agree to comply with all applicable local
ordinances and state laws relating to buildi:gpgl ion. I authorize represerpitives OfCupertiao to enter the above-identi iq pro erty /r inspection purposes.
f Date: 7
Signature ofApplicant/Agent:
SUPPLEMENTAL INFORMATION REQ TJMED`ROUT
-.7
. .. .... a
I . -GSLIP
New SFD or Multifamily dwellings: Apply for demolition pen -nit for
existing building(s). Demolition permit is required prior to issuance of building
permit for ncw building.
[11' EXPRESS,.--PLANNINGPLAN-REVI
w,
Commercial Bldgs: Provide a completed Hazardous h1atorials Disclosure
�d: STANIIV f
LIC VDRK&
TuBL
Tor - in if any Hazardous Materials are being used as part of this Project.
Copy ol'Planning Approval Letter or Meeting with Planning prior to
-MAJIO�
R,
submittal of Building Permit application.
.:.D'F.&VjkG L HEALTH
BldgApp '101 Ldoe revised 0612 1/11
_4
PUAr or,
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
�ul,f l 10300 TORRE AVENUE • CUPERTINO140 ; CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buiidinq(8.cuoertino.oro
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 folloiAdhg locations:
AREA _
SMOKE ALARM
CO ALARN/1 .
Outside of each separate sleeping area in the immediate vicinity of
the bedroom(s)
X
X
On evrery le�� el of a d -i velling unit including basements +
Within each sleepier room
X
X
+ _ 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.
.Pgvver Supply: In dwea-ig units with no commercial. power supply, alarm(s) maybe solely battery. operated.
Til 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
i-istalled in accordance with..the manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms specified belol%7 have beentested and are operational, as of the
date signed below.
Address: �l J d' +/,t�j t� tit ��` 7 Permit No..92-017-015
Specify Number of Alarms: # Smoke Alarnns; 4 Carbon Monoxide Detectors:
I have read and agree to comply with the and conditions of this statement
Owner (or Owner Agents) Name:
!i4 5 1.- Axzzo
Signature.......-^.............................................................................. ........... Date
........................................... 3
Contractor Name:
�3p Mee1�a r�
.....I..................
Signature.....r. '' .............. .... �. ,,...,.. Lic .....�.... ..��... .......Da#e:-Tli��fl i
CUPERT(NO
Owner Name
Address
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
777-3.228 • FAX (408) 777-3333 • buildina cupertino.oro
PennitNo._ p2-01
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.
No Go to Question 2.
Does your real property have a licensed plumber certifying that, due to the age or configuration of the property or its
lui ing, 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 forn.
❑ 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.
`9 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 forin..
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, 2'017, all non-
compliant plumbing Mures 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-conseiving 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).
❑ Myproperty is a conunercial 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 (regardlessof whether property undergoes alterations. or improvements).
I, as the owner or mti ner's agent of this property, certify under penalty of perjury that non-compliant plumbing fixtures will be
replaced prior to date specified above with grater -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 Daae.
Owner or Owner Agent's Signature: Date:
TJnon comnletina and sianina this Certificate, tvlease return it to the Building Division in order to final your building permit.
04072015.doc revised 08/26/15
1. If the existing plumbing fixture water usage/flotiv rate is equal to or lower than the figure shown, it is not required to be upgraded.
SB407 2015.doc revised 08126/15
Non -Compliant
Water -Conserving Plumbing Fixture
Plumbin Fixturel
(Fixture Complying with Current Code Applicable to New Construction)
Fixture Type
Maximum Water Usage/Flow Rate
2013 CPC Ch. 4
2013 CPC 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
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
ppsi
60
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/flotiv rate is equal to or lower than the figure shown, it is not required to be upgraded.
SB407 2015.doc revised 08126/15