B-2017-0229 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0229
22100 WALLACE DR CUPERTINO,CA 95014-0125(326 03 037) ONE DAY COMPLETE
REPIPE
SAN JOSE,CA 95112
OWNER'S NAME: LEE CHUEN E AND GENE H DATE ISSUED:02/08/2017
OWNER'S PHONE:650-279-6202 PHONE NO:(408)603-0554
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-36 Lic.#885692
Contractor ONE DAY COMPLETE REPIPE Date 10/31/2018 X BLDG _ELECT X PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH 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:
REPLACE SEWER MAIN;CLEANOUT
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.
cf,2P-1 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:$7000.00
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 326 03 037
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 againstsaidCity in conseqandce the hg othis 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.
Signature Date 2/8/2017 Issued by:AbbyAyende
� '� v Date:02/08/2017
OWNER` JILDER 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
1. 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:2/8/2017
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 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 agent: /..,,, .1
• APPLICANT CERTIFICATION Date:2/8/2017
I certify that I have read this application and state that the above information is CONSTRU TION 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 ARCIIITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Licensed
Signature Date 2/8/2017
Professional
- o\ O22
.. . .
GENERAL PERMIT APPLICATION
NIE p,
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
• '..„.',.,:,`'!ll.
, .„1,---i...(4,:--• 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 .
MISC
CUPERTINO
(408)777-3228- FAX(408)777-3333•buildinacupertino.orq
a PLUMBING 0 MECHANICAL 0 ELECTRICAL 0MISCELLANEOUS
' PRO .D,T AD a. , /..,./;„ ••• doo, . i i
' 7 AIN'' 32,(0 06 0139s .
• OWNER NAME/
— - ' # P iN Aip Air E5&9Ai. 30 .
STREET. e 0. .-
9 401 /.a(d ..— crry, STATE,ZIP ,
1 - r• .4t ." .A......110
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CONTACT NAME 5Ck\mt 0.5 cuitiruciti- PHONE E-MAIL
STREET ADDRESS
• 0 owNER. 0 OWER-BUDER 0 OWNER AGENTON•lith. CTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
. ..
CONTRACTOR NA.1‘1 • ->-\--. . .: 11 4
) L-/ 11 AC9t17 .
LICENSE TYPE BUS.
LICENSE NUMBERgag#, LIC C 3 2i 32?. ..,
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COMYI." E-mAIL FAx
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STREETzADDRESS4,,,' , .„ , ., QTY,STATE ...• PHONE .";4`iilf , ,,, ,
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ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS,LIC C
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COMPANY NAME E-MAIL FAX
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STREET ADDRESS CITY,STATE,ZIP PHONE
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• . USE OF t SFD orDUPLEX 0 MULTI-FAMH,Y 1 PROJECT Eivell_DLANa) 0 YES PROTECT LN i_t YES IS THE BLDG AN 0 YES
BUILDING: 0 COMMERCIAL . i 1 URBAN INTERFACE AREA 0. NO FLOOD ZONE . El NO . EICHLER HOME? 0 NO
.. , . _ . . _ ... ..
DESCRIPTION OF WORK 04 f, , // .....
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TOTAL VALUATION: 's" ,. (20, :RECEIVED BY;a:',.'f:.,,if'eri!i-P:'!, W':,",:g:::.; ,-':,,,.?'3-j::fin,',-;i•--!;:qosi3-..:,ig,,:::,)f,,,.•,:::,J..,;,..,,!--,-, -
- -
• By my signature b-ow,I certify to ea h of e .}I•• I L. I. i the pro.e owner or authorized agent to act on the property owne'a behal,..I have read this
application and the information I have provided is correct. I have read the Description on of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state lawsrelatina • •tulding constru_ •. I a •e e r .. z.• .tives of Cupertino to enter the above-identified property for ins ection purposes.
Signature of ApplicantiAgen
Date: ',Iaft _ IF
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, . . . SUPPLEMENTAL INFORMATION REQUIRED ,.1t,::h;;2ff.,:W:.-;,, .g,.. . ,, .,,I!,:,
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MEP.11(dscApp_2011.doe revised 06/21/11
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CUPERTINO SANITARY DISTRICT
ION
20863 Stevens Creek Blvd#100, Cupertino, CA 95014
Tel(408)253-7071 • Fax(408)253-51734/1/1,:i40:1'.-4'
t, i40:1>4CUPERTINO
SANITARY DISTRICT PERMIT LETTER
Cupertino Sanitary District has adopted Resolution No. 1263.
Building Permit Request
(Over-the-Counter)
Single Family Project I I Multi-Family Project 7 Commercial Project
Project Address: /a /�fv I
Permit Number: 10- 1 -- bug
Scope of Work-.'(,- l� r � r # s IV _ Li
Owner/Applicant Name) /. .j //—Phone: t / A- Qs.�Address:fi? �% 7C
Date: -113112" Prepared By: ( c t
iCity Authorized Representative
I, as property owner or authorized agent, acknowledge that all Cupertino Sanitary District requirements
will be met and all required fees will be paid prior to the approval of final inspection for proposed project.
Date: 41/72-- Signature:
�' �� � ner/Authorized Agent
CUPERTINO SANITARY DISTRICT OFFICE USE ONLY
(i Pre-inspection Requ_ir4 Final Inspection Required
Date Scheduled: Ni
Date: -7 Conditional Approval By:
Authorized Representative
Cupertino Sanitary District
District will notify owner of the required fee within 5 days after Pre-Inspection has been,completed and cc
City of Cupertino.
71 Inspection Fee Paid Date Paid: g-I ?-
Inspec ion Fees:
$250/unit-Single Family Residential already connected, but new cleanout is required
$150/unit-Single Family Residential already connected with existing cleanout in working order
n $350 Minimum—Commercial and Retail Actual Amount:
$200/each—Disconnect and/or abandon lateral service
Connection Permit Fees:
$350/unit-Single Family Residential connecting to existing lateral
$650/unit—Single Family Residential connecting with new lateral
$100/unit—Multi, Hotel, Living Units, etc. Actual Amount:
$500/connection -Commercial and Retail Actual Amount:
Connection Use Fees(See Attached Calculation Sheet):
fl Area and Frontage Fees Amount:
0 Residential Excess Fees over 3.5 unit/acre Amount:
n Commercial and Retail Connection Fees Amount:
Ti Commercial and Retail Change in Use Fees Amount:
Date: 9 - - (7 Final Approval By: 4,
Authorized ep esentative
Cupertino ary District
�r V
CUPERTtNO
SMOKE / CARBON MO -NOXI -DE ALARMS
OWNER. CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildingacugertino.orq
PURPOSE
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with -2016 CRC Section 8314, R315, 2016 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, R315, and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or
Carbon Monoxide Alarms be installedin the following locations:
AREA
I SMOKE ALARii2
CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the
bedroom(s) — (Smoke alarms shall not be located within 3 feet of bathroom door)
XX
On every level of a dwelling unit including basements and habitable attics
X
:—�—�
Within each sleeping room _
X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel-bunuzg 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) maybe solely battery operated.
La 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 ox,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 sign
Address:
zed below.
119
Permit No.
9 -20)�:M
Specify Number ofAlarms: # Smoke Alarms:_ # Carbon Monoxide Detectors:
/ have read and agree to cpmp/X with the terms and conditions of this statement
O% (or Owner Agent's) Name:
4f V1
Sinat................................................................... .......................Date:..................
ontractor Name:
r
&9naA........................................................ Lic.# . �(G..... .. at ....
v - v
S
Smoke mrd CO fonrr. doe revised 0111012017
CUPERTINO
Owner. Name
Address
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMET DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CPPERTINO, CA 95014-3255
-3228 • FAX (408) �77-3333 • building(a�cupertino.org
No. 0/N
e
1. Is your real'property a registered historical site?
❑ Yes Civil Code Sections 1101.1 through 1101: do not apply. Skip the rest of the form and sign bottom of form.
-'LJ�o 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 plunbimg
5ixtures is not technically feasible?
Yes Civil Code Sections 1.101.1 through 110 i.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.
❑ No Go to Question 3.
Date: `
3. Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 110 1. 1 through 110 L.
No Go to Question 4.
do not apply. Skip the rest of the form and sign bottom of form.
4. Is your real property built and available for use or o6cl panty on or before January 1, 1994?
❑ No My real property is built and available for se or occupancy after January 1, 1994.
Civil Code Sections 1101.1 through 1101. do not apply. Skip the rest of the form and sign bottom of form.
S My real property is built and available fob i ise or occupancy on or before January 1, 1994.
Civil Code Sections 1101.1 through 1101.E 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 pr (ol
On and after January 1, 2014, building alteration,,
to be replaced with water -conserving plumbing fix
compliant plumbing fixtures shall be replaced
property undergoes alterations or improvements).
❑ My property is a multifamily residential real prope
On and after January 1, 2014, specified building a
plumbing fixtures to be replaced with water-consae
On or before January 1, 2019, all non-compliant p:
conserving plumbing fixtures throughout -the build
improvements).
❑ My property is a commercial real property. See C
On and after January 1, 2014, specified building a
plumbing fixtures to be replaced with water -cone
On or before January 1, 2019, all non-cornplia
plumbing fixtures throughout the building (regard)
-rty. See Civil Code Section 1101.4.
or improvements shall require all non-compliant plumbing fixtures
ures throughout the building. On or before January 1, 2017, all non-
;vith water -conserving plumbing fixtures (regardless of whether
See Civil Code Section 1101.5.
.tions or improvements shall require non- compliant
g plumbing fixtures.
Bing fixtures shall be replaced with water -
(regardless of whether property undergoes alterations or
L Code Section 1101.5.
•ations or improvements shall require non- compliant
ng plumbing fixtures.
plumbing fixtures shall be replaced with water- conserving
of whether property undergoes alterations or improvements).
I, as the owner or owner's agent of this property, cert
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 Plumb' d
and California Green Building Standards Code, and manufacturer's
#irig'pluinbing
installation requirements, and that the water cfixtures
comply with the requirements as indicated in the
table on the following age.
Owner or Owner Agent's Signature:
Date: `
Upon completing and signing this Certificate, please returri it to the Building Division in order to final your building permit.
SB407 2015.doc revised 08126/15
1. If the existing plumbing fixture water usage/floe rate is equal to or lower than the figure shown, it is not required to be upgraded.
SB407 201 S. doc revised 08126115
Non-Compliant
Water-Conserving Plumbing Fixture
PlumbingFixture
(Fixture 'Com plying with Current Code Applicable to New Construction)
Maximum Water Usage/Flow Rate
Fixture Type
Water Usage
2013 CP!C 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 peI 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/floe rate is equal to or lower than the figure shown, it is not required to be upgraded.
SB407 201 S. doc revised 08126115