B-2017-0316r
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
10181 STONYDALE DR CUPERTINO, CA 95014-1056 (326 37 020)
CONTRACTOR:
AFFORDABLE WATER
PERMIT NO: B-2017-0316
HEATERS AND
PLUMBING INC_
28358
CONSTELLATION RD
VALENCIA, CA 91355
OWNER'S NAME: PEREYRA VICTOR LAND PAGALLO GUILIA M TRUST
DATE ISSUED: 02/27/2017
OWNER'S PHONE: 408-234-4801
PHONE NO: (855) 345-9087
LICENSED CONTRACTOR'S DECLARATION ATION
BUILDING PERMIT INFO:
License Class QaE Lic. #627368
Contractor AFFORDABLE WATER HEATERS AND PLUMBING INCDate
X BLDG —ELECT X PLUMB
09/30/2018
_ 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
JOB DESCRIPTION:
license is in full force and effect.
REPLACE 40 GAL WATER HEATER (GARAGE)
I hereby affirm under penalty of perjury one of the following two declarations:
i. 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.
Sq. Ft Floor Area:
Valuation: $3165.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
"N Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
326 37 020
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
may accrue against said City in consequence of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, t p ' ant understands and will comply with all non-point
180 DAYS FRSPECTION.
source regula on p r the Cupertino Municipal Code, Section 9.18.
�� R
Issued by SANAMES
Signature' II Date 02/27/2017
Date: 02/27/2017
RE-ROOFS:
OWINE DECLARATION
I hereby affir that am exempt from the Contractor's License Law for one of the
All roofs shall be inspected prior to any roofing material being installed If a roof is
following two. easons:
installed without first obtaining an inspection, I agree to remove all new materials for
1. I, a 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 ofApplicant:
2. I, as owner of the property, am exclusively contracting with licensed
Date: 02/27/2017
contractors to construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
ALL 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
HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued.
I have read the hazardous materials requirements under Chapter 6.95 of the
2. 1 have and will maintain Worker's Compensation Insurance, as provided for by
California Health & 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 compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
Health & Safety Code, Section 25532(a) 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 become 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 Cup' o Municipal Code, Chapter 9.12 and
the Health & Safety Code, ctio s 505, 25533, and 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
Owner or authorized agent'
be deemed revoked.
Date: 02/27/2017
INDINGAGENCY
APPLICANT CERTIFICATION
CONSTRU&AON
I certify that I have read this application and state that the above information is
I hereby affirm that there is a Aoostructin lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this perm• i 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
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.
•
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(@cupertino.org
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT CONTRACTOR ❑ CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
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CITY, STATE, ZIP
PHONE
USE OF PhD or DUPLEX ❑ MULTI -FAMILY
BUILDING: El COMMERCIAL
PROJECT IN WEALAND ❑ YES
URBAN INT =E AREA ❑ j O
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK � �'}� ^
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TOTAL VALUATION: J
6E;U E BY:
By my signature below, I c6tify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
agree to mply with all applicable local
ordinances and state laws relating to uil construction. I authorize representatives of Cupertino to enter the antified pr pjerty forinspection-purposes.
application and the information I have rovided is correct. I have read the Description of Work and verify it is acRX2
Signature ofApplicant/Agent: Date: , /
LEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
❑ OVER-THE-COUNTER�
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MEPMiscApp 2011.doc revised 06121/11
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CUPE TING
SMOKE / CA BON MONOXIDE ALARMS
O NER,CE TEFICATE OF COMPLIANCE
COMMUNITY DEVE OPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVE UE • CUPERTINO, CA 95014-3255
(408) 777-3228 - F (408) 777-3333 • building aa cupertino.org
PURPOSE
This affidavit is a self -certification for the ins allation 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 ivhere no interior access
for inspections are required.
GENERAL INFORMATION
Existing single-family and muliI family dwe
Monoxide alarms. When the valuation of ad
$1000.00, CRC Section 8314, R315, and CBC
Carbon Monoxide Alarms be installed.in the
shall be providedwith Smoke Alarms aild-Cay 5bn--- -
s, alterations, or repairs to existing dwelling units exceeds
ns 907.2.11.5 and 420.6 require that Smoke Alarms and/or
vin.- locations:
— AREA SMOKE ALARM CO ALARM
Outside of each separate sleeping area in the i. ediate vicinity of the X X
bedroom(s) - (Smoke alarms shall not be located. ithin 3 feet of bathroom door) _
On eve.ry level of a dwelling writ incllad�base entsadd habitable attics X — X
Within each sleeping room_- _ ! X
Carbon Monoxide alarms are not required M' ' dwellings which do not contain fuel -burning appliances anal that
do not have an attached garage. Carbon mo toxide` alarms combined with smoke aurins shall conlpiy with
CBC Section 420.6 and shall.be approved by he Office of the State Fire Marshal.
Power Supply: 171 dwelling units with no cc . ercial power supply, alarm(s) may be solely battery operated.
In existing dwelling units, alarms are permitied to be solely battery operated where repairs or alterations do
not result in the removal of wall and:ceilirng f i Zishes or there is no access by means of attic, basement or crav,71
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 build' Zg wiring.
As of^;ler of the above -referenced property,
installed in accordance with the manufactu7
and California Residential Codes. The alarn
date signed below. S4�!r
Address: t ° /
Specify Number of Alarms:
1
r
hereby certify that the alarm(s) referenced above has/have been
s instructions and in compliance with the California Building
specified below have been tested and are operational, as of the
/0/yermitNo. 1j- or7-'O3) G
Alarms: 4 Carbon ?ylonoxide Detectors:
l have read and agree Itn rmmniv with tha farms and rnndifinns of fhiP .etafamant
Owner (or Owner Agent's) Name:
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..................�...................................................... Date4:`l.
Contractor Name:
Signature.. ...
I ............................................................ Lic.# ......................................Date:............,.....
Smoke and CO foi77r.doc Yevised 01/_7012017
61 Owner Name C'i
Address 1 s 1 S
WATER -CONS RUING PLUMBING FIXTURES
OWNER CERT FICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENU • CUPERTINO, CA 95014-3255
408) n7-3228 - AX�,(108) 777-3333 • buildinala cupertino.om
�4/ Q4�' a C1 Perinit No.
l�
- 0 3 /4
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.
1, No Go to Question 2.
2. Does your real property have a licensed plumber yertifying that, due to the age or configuration of the property or its
plumbing, installation of water -conserving plumb hg fixtures is not technically feasible?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
_____❑__The licensed_ luinbe_r's certification has been provided to the Building Division.
Skip the rest of the form and sign bottc in of form.
❑ No Go to Question 3.
3. Is water service permanently disconnected for yot r building?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
X 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 or use or occupancy after January 1, 1994.
Civil Code Sections 1101.1 through 11 H.8 do not apply. Skip the rest of the form and sign bottom of form.
J Yes My real property is built and. available For use or occupancy on or before January 1, 1994.
Civil Code Sections 1101.1 through 11)1.8 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 improvement ). -
❑ My property is a multifanily residential real pr perry. See Civil Code Section 1101.5.
On and after January 1, 2014, specified buildin alterations or improvements shall require non- compliant
plumbing fixtures to be replaced with water -co serving plumbing fixtures.
On or before January 1, 2019, all non-compliar t plumbing fixtures shall be replaced with water -
conserving plumbing fixtures throughout.the b ilding (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-cor liant 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, c
rtify under penalty of perjury that non-compliant plumbing fixtures will be
replaced prior to date specified above with water -c
onserving 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-7nse.
g plumbing fixtures comply with the requirements as indicated in the
table on the following age.
Owner or Owner Agent's Signature: V
Date:
Upon completing and signing this Certificate, ple ise retunl{ it to the Building Division in order to final your building permit.
SB407 201 S. doc revised 08126115
1. If the existing plumbing fixture water usage/flov�
is equal to or lower than the figure shown, it is not required to be upgraded.
SE4072015.doc revised 08/26/15
Non -Compliant
Water -Conserving Plumbing Fixture
Plumbing Fixture!
(Fixt
ure Complying with Current Code Applicable to New Construction)
Fixture Type
Maximum Water Usage/Flow Rate
201
CPC Ch. 4 I
2013 CPC Ch. 4
2013 CPC Ch. 4
Water Usage
!Flow Rafe
2013 C
LGreen Div. 4.3
2013 CALGreen Div. 4.3
2013 CALGreen Div. 5.3
Sin
le-Farnily
Multi -Family
Commercial
Residential
I Residential
Water Closets
Exceed 1.6
Single flush toilets: 1.28 gallons/flush
(Toilets)
Gallons/flush
Dual
lush 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 galtonslflush
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
showerh
ads 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 fat
icets 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/flov�
is equal to or lower than the figure shown, it is not required to be upgraded.
SE4072015.doc revised 08/26/15