B-2017-0223CITY OF CUPERTINO BUILDING P�RMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0223
11902 SHASTA SPRING CT CUPERTINO, CA 95014-5107 (366 55 025)
A R S AMERICAN
RESIDENTIAL j.
SERVICES OF i
CALIFORNIA INC
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:i
MEMPHIS, TN 381'2
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OWNER'S NAME: HALLER IRMGARD E ET ALi
DATE ISSUED: 02/07/2017
OWNER'S PHONE: 408-253-2383
PHONE NO: (408) 286-8931
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERTli
T INFO:
License Class ELECTRICAL Lic. #742039
Contractor R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC
X BLDG _ ELECT
X_ MECH X RES
_ PLUMB
ENTL4L _ COMMERCIAL
Date 10/31 /2017
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
JOB DESCRIPTION:
license is in full force and effect.
REPLACE FURN
I�
E (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
f
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 Compensation Insurance,
2 and will maintain Worker's as provided for byG
Sq. Ft Floor Area:
i
Valuation: $8828.00
Section 3700 of the Labor Code, for the performance of the work for'which this
permit is issued.
APPLICANT CERTIFICATION
r
I certify that I have read this application and state that the above
APN Number:
j
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
366 55 025
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
PERMIT EXPIRES
IF WORK IS NOT STARTED
City of Cupertino against liabilities, judgments, costs, and expenses which
WITHIN �p
DAYS OF PERMIT ISSUANCE OR
may
may accrue against said City in consequence of the granting of this permit.
N
Additionally, the applicant understands and will comply with all non-point
180 DAYS FROM
LAST CALLED INSPECTION.
source regulations per the Cupertin Municipal Code, Section 9.18.
Issued by: A
n
Signature /( e Date 2/7/2017
i?
Date: 02/07/2017
,
i
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
All roofs shall be in
installed without firs
RE-ROOFS:
pected prior to any roofing material being installed. If a roof is
Obtaining an inspection, I agree to remove all new materials for
following two reasons:
1. I, as owner of the property or my employees with wages as their sole
inspection.
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business & Professions Code)
Signature ofApplic
t:
2. I, as owner of the property, am exclusively contracting with licensed
Date: 2/7/2017
contractors to construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROC
COVERINGS TO BE CLASS "Al- 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
US MATERIALS DISCLOSURE
performance of the work for which this permit is issued.
I have read the hi
zardous materials requirements under Chapter 6.95 of the
2. I have and will maintain Worker's Compensation Insurance, as provided for by
California Healti
x,& Safety Code, Sections 25505, 25533, and 25534. I will
Section 3700 of the Labor Code, for the performance of the work for which this
maintain complian
a with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
Health & Safety
I
ode, Section 25532(a) should I store or handle hazardous
'
3. I certify that in the performance of the work for which this permit is issued, I
material. Addition
lly, should I use equipment or devices which emit hazardous
by the Bay Area Air Management District I
shall not employ any person in any manner so as to become subject to the
air contaminants a
will maintain comp
defined Quality
"ance with the Cupertino Municipal Code, Chapter 9.12 and
Worker's Compensation laws of California. If, after making this certificate of
the Health
& Safety Codp. Sections 25505,25533, 'nd 25534.
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
'ner or authorized
Qw7
d agent:
be deemed revoked. G
Date: 2/7/2017
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
I hereby affirm that
ONSTRUCTION LENDING AGENCY
there is a construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which
his permit is issued (Sec. 3097, Civ C.)
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
T' D r, RATION
consequence of the granting of this permit. Additionally, the applicant understands
I understand my pl
ARCHIT .
ns shall be used as public records.
and will comply with all non-point source regulations per the Cupertino Municipal
Code, Section 9.18.
Licensed
.-_
GENERAL PERMIT APPLICATIONMEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING
(VISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building cupertino.g
C tt P E RTt N C} ,
❑ PLUAQBfiTG ❑ MECHANICAL ❑ ELECTRICAL
❑MISCELLANEOUS
PROJECT ADDRESS J \: I APATr
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CONTACT NAME
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❑ OWNER 13 OWR-BUILDER ❑ O)XNERAGENTT. 11 CONTRACTOR ZFC5011RACTORAGEM1T ❑
I',ARCHITECT ❑ ENGA'EER ❑ DEVELOPER ❑ TENTAN'T
CONTRACTOR NAME 1 Age LF
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COMPANY NAME
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ARCHITECT(ENGINTEER.Nkl+IE
LICENSENTUMBER
BUS. LIC
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COMPANTYNAME
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF aFD or DLTLEX ❑ MULTI -F -A -MI .Y PROJECT IN WILDL.AND EI YES PROJEC $
Pq El YES
IS THE BLDG .AN El YEs
BUILDING: ❑ COMMERCLkI. I URBAN INTERFACE ARFA 0 N I FLOOD
i NTE ❑ NO .,
I EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
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TOTAL VALUATION: 1tECEI
$3
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By my signature below, I certify to each of the following: I an the property owner or authorized agent to a
;on the property o-Aer's b alfa I have read this
is
application and the information I have provided is correct. I have read the Description of Work and verify i
accurate. I agree to comply with all applicable local
ordinances and state laws relating to buil 5 construction. I autho ' e representatives of Cupertino to enter
'e above-identi! • er-ty f r tion purposes.
Signature ofApplicant/Agent: Date:i.'
i i
SUPPLEMENTAL INFORMATION REQUIRED
i,TSE,ON L1.. .
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' fl fl) F;I2 _THE-COLd7�TER '
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,.. ._LARGE .:
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AfEPAIRsc,App_2011.doc revised 06121111
.-_
CUPIERTIi`` O
r--
Owner Naive � YI
Address
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) i 77+-3228 • FAX (408) 777-3333 • building(a)cupertino.org
Ct.
'5".-20.1 7 -0 z2-3
m- D (-R- 16 0
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.
JY 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_.
Skip the rest of the form and sign bottom of form.
o 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.
,VY es 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..
FPl ase 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, 2017, all non-
compliant plumbing fixtures shall be replaced with water-conseiving 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).
❑ 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`plurnbing fixtures comply with the requirements as indicated in the
table on the followinE4 page. P • y/t _ i ,
I Owner or Owner Agent's Signature: , .,( 7ZIZ4 G%ct-Df Eyi pz Date: % I
Upon completing and signing this Certificate, pleaWe return it to the Building Division in order to final your building permit.
SB4072015.doc revised 08/26/15
1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shoani, it is not requirea to ee upgraaea.
SB407 2015.doc revised 08126/15
Non -Compliant
Water -Conserving Plumbing Fixture
Plumbing Fixturel
(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/flow rate is equal to or lower than the figure shoani, it is not requirea to ee upgraaea.
SB407 2015.doc revised 08126/15