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B-2017-0269CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2017-0269 10792 BROOKWELL DR CUPERTINO, CA 95014-4609 (369 21 034) MIKE COUNSIL PLUMBING INC SAN JOSE, CA 95131 OWNER'S NAME: DAVIS PAUL H AND BARBARA D TRUSTEE OWNER'S PHONE: 408-253-8015 LICENSED CONTRACTOR'S DECLARATION License Class C -N Lie. #679261 Contractor MIKE COUNSIL PLUMBING INC Date 04/30/2017 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 license is in full force and effect. 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. k 2. ///1 have and will maintain Worker's Compensation Insurance, as provided for by �V Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 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. Signat 02/15/2017 ISSUED: 02/15/2017 PHONE NO: (408) 272-4900 PERMIT INFO: BLDG _ ELECT X PLUMIi MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: REPLACE SEWER LINE WITH TRENCHLESS; INSTALL PROPERTY & FOUNDATION CLEANOUTS (SUNNYVALE SANITARY) Sq. Ft Floor Area: I Valuation: $35000.00 "N Number: Occupancy Type: 369 21 034 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 1 ED INSPECTION. Issued by: MELISS Date: 02/15/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the RF. -ROOF 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: 02/15/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" 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. 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. s. 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 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 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 02/15/2017 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, Sections 25505, 5533, and 25534. Owner or authorized agent Date: 02/15/2017 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildino()cupertino.org A PLUMIBING n 1,4ECHAMCAL (3,7-o/ --;� -026 f 7FLECTRICAT. I IMTC('T=TT ANT=nTIc PROJECT ADDRESS Z i kW CJk � l APN = / z ✓ OVTNERNTAME D OL ti PHONE J� E-MAIL STREET ADDRESS � �� J c, o �CITY, TATE, Z 6 t C( FAX CONTACT NAME D � P PHONE / 19 E-MAIL ( v STREET ADDRESS CITY, STATE, ZIPV FAX ❑ OWNER 0 OWNER -BUILDER ❑ OWNTERAGENT . ❑ CONTRACTOR ` ONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENTA\T CONTRACTOR NAME a 1 O a� LICENSE NUMBER ff Z t' ( LICENSE TYPE c36 W ( �g�%o BUS. LIC � d ^ t q ` COMPANY NAME At k4L E-1 9 Wj i '91e� FAX STREET ADDRESS 7 /jb 1 c' [ , (� (> l "1i CITY, ST TE, ZIP PHO s PE may) Z-72 -2106 ARCHITECTIENGINTEER. NAME LICENSE NUMBER BUS. LIC ft COMPANY NAME E-MAIL I FAX STREET ADDRESS CITY, STATE, ZIP I PHONE I USE OF XSFD .,DUPLEX ❑ MULTI -F -AM. LY PROJECT IN V,TILDLANTA ❑ YES I PROTECT IN - ❑ YES BUILDING: ❑ COMIkIERr_LAL URBAN INTERFACE ARZA ❑ NO FLOOD ZONE ❑ NO l IS THE BLDG AN ti'ES I EICHLER HOME? Cl NO DESCRIPTION OF WOP-Ik�� l qCd C( 6 — 1 ` Z4A �� lSC stn i V✓®\tom �i�� — -- TOTAL VP.L.UATIO.. 5— - By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on th roperty ow 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 accu to comply with all applicable local ordinances and state laws relating to building construction. T authorize representatives of Cupertino to enter the ovg-identified property for inspection purposes. Signature of Applicant/Agent: „ Date: SUPPLEMENTAL MTeRMATION REQUIRED o �E ,�Ec, } ER THE COUNTER ° EJ�RESS —: STANI)4RD. r A7EPA1flscApp_2011.doc revised 06/21111 SMOKE / CARBON MONOXIDE ALARMS OWNER.CERTIFICATE OF COMPLIANCEFILE �.a, COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION �r 3 P 4, CUPERT[t+F6 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228•FAX(408)777-3333•building( cupertino.orq PERMIT CANNOT BE A COMPL ETED,SIGNED ANI)RETUR.NE tD TO THC BUIL_DING DI SION PURPOSE 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 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 installed in the following locations: AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the X X —1 bedroom(s)—(Smoke alarms shall not be located within 3 feet of bathroom door) _ On every level of a dwelling unit including basements and habitable attics X X Within each sleeping room X _ J 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: Address: I O19 2 roc K.wvtl Dr (yr��® 66, I S a iLl Permit No. g-Zc fl 717Zr-� Specify Number of Alarms: #Smoke Alarms: I #Carbon Monoxide Detectors: I have read and agree to comply with the terms and conditions of this statement _ Owner(o ner Ag-n p Name: / sir "A. 1 a /Da e: Contractor Name: �l l� Lic.# ... .... Signature .� . N Datea/.2/ Smoke and COfor7n.doc revised 01/100/2017 ,tti WATER-CONSERVING PLUMBING FIXTURES r. E .....V OWNER CERTIFICATE OF COMPLIANCE F # .0.t COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION U" upERI NO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 c (408)777-3228•FAX(408)777-3333•buildinq(a cupertino.orq Owner Name _ �a I ei,5Permit No. Z-2 all-0Z-‘,9 Address 1®112 1,3>ra®Y.A. ,e.-l1 Pik.. ` l,//�uierkoin y C IS b1 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. 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. iNo 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. I /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. 'l Yes ' My real property is built andavailable 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 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 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). ❑ 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 ,.1„...."ater-c ingiplumbing fixtures comply with the requirements as indicated in the table on the following page. Owner or Owner Agent's Signature: Date: 1d3 J/9- 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 PE ZIT .,�r.�l:;bl,.,y�.r.,��.�s,fi�.:%,'N�,,t:�s,":Tr,a.�,F�.. Cl.�..r.a;�A.::urN�Ir'�cr:.�«?.s.f�O:�r.T,......:..Br:.•.,-E-::�E.-...I..l.r�IA2£E' —uex�%vq:<•:s?D C;-:-. LTED..:_ TauIzL .I IS tE �S:�EE � 7RNibTQ•� 3I0IL)II �3 •IS O.:2* ti9t-a : f t„, fi`% x3w.;•"; :x4 , x »z; a : yt� �'..�A ... .. Non-Compliant Water-Conserving Plumbing Fixture Plumbing Fixturel (Fixture Complying with Current Code Applicable to New Construction) Maximum Water Usage/Flow Rate Fixture Type 2013 CPC Ch.4 2013 CPC Ch. 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 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 shown,it is not required to be upgraded. SB4072015.doc revised 08/26/15 r