B-2017-0373CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0373
10580 MERRIMAN RD CUPERTINO, CA 95014-3922 (342 16 115)
OVERMILLER INC
CONCORD, CA 94520
/
OWNER'S NAME: BJELETICH JOHN G AND NANCY J TRUSTEE
DATE ISSUED: 03/07/2017
OWNER'S PHONE: 408-253-2139
PHONE NO: (925) 798-2122
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C36 Lic. #323839
Contractor OVERMILLER INC Date 07/31/2018
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 BUILDING & CLEAN-OUT
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.
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: $13000.00
APPLICANT CERTIFICATION
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
342 16 115
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 against said City in consequen a of the granting of this permit.
Additionally, the applicant understand will comply with all non -point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regu ations per the Cupertino 6nicipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Si ature Date 03-7-2017
Issued by: Kim Dunbar
�—
Date: 03/07/2017
E
I hereby affirmthat 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)
z. 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: 03-7-2017
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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.
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 Ma g v—W, t District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the Cupertino Municipal Cod Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety C ections 25505, 25533, 2__233!x;
Labor Code, I must forthwith comply with such provisions or this permit shall
�
C
be deemed revoked.`
Owner or authorize agent .
APPLICANT CERTIFICATION
Date: 03-7-2017
I certify that I have read this application and state that the above information is
CONSTRUC N LENDING AGENCY
I hereby affirm that there is a cdnstruction lending agency for the performance
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
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
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records.
Code, Section 9.18.
Licensed
Signature Date 03-7-2017
Si 9
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
cuPERTINO I (408) 777-3228 •FAX (408) 777-3333 • buildingCa?cupertino.org b-3,Ot
+— 0 3 4-33ElNEW CONSTRUCTION ElADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PF,RMIT #
PROJECT ADDRESS / Tj r� J ,�Ua n A c1-) D
V' \ 7_'PfHJO
APN7 cl � )
OWNER NAME
E-MAIL
STREET ADDRESSCr�Y,
STATE, ZIP
FAX
01L
CONTACT NAMEo5.�-MAH
STREET ADDRESS ]
CITY, ST TE, ZIP / �J
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❑ OWNER ❑ OWNER-B=ER ❑ OWNER AGENT 11 CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME ' , l� - _
LICENSE NUMBER;3m
LICENSE TYPE
BUS. LIC # L .-�-
COMPANY NAME T!/
fa ,
E-MAIL4
�eI �_ 1�_10 1Z <C,L-I-,
FAX
E)737
STREET ADDRESS
CITY, ST E, ZIP
PHO.
ARCHITECT/ENGINEER NAMF.
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK �12ZI aL�
Pl� Ali Q C T
(��U/
V `
EXISTING USE
PROPOSED USE CONSTR.
TYPE
I # STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA I
NET AREA
BATHROOM KITCHEN
OTHER
REMODEL AREA REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECKIPORCH AREA
GARAGE AREA: DETACH
[]ATTACH
# DWELLING UNITS:
ISA SECOND UNIT ❑YES
SECONDSTORY ❑YES
BEING ADDED? ❑NO
ADDITION? ❑NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
B
TOTAL VALUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO
By my signature below, I certify to each of the following: I roperty owner or au orized agent to act on the property owner's behalf, I hav read this
application and the information I ve provided is correct. I read the Description of Work and verify it is accurate. I agree to comply with all applicable local
,to-g con truction- ut o ' epresentatives of Cupertino to enter the above -identified property for inspection purposes.
ordinances and state laws rrt"
Signature ofApplicanUAgDate: ?I —
SUPPLEMEl M RM_ ATION REQUIRED
PLAN CHECKTITE
ROUTING SLIP
❑ OVER-THE-COUNTER
❑ BUILOINGPLAN REVIEW
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
❑ EXPRESS
❑ PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑ LARGE
❑ FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVHIONMENTAL HEALTH
BIdgApp_2011.doc revised 06121111
"L e «''�
CUPERTINO SANITARY DISTRICT
20863 Stevens Creek Blvd #100, Cupertino, CA 95014
Tel (408) 253-7071 - Fax (408) 253-5173
z`�fl SAN17,9$44ja'.
aw
�sAq�tasxea'��w CUPERTINO
SANITARY DISTRICT PERMIT LETTER
Cupertino Sanitary District has adopted Resolution No. 1263.
Building Permit Request
(Over-the-Counte6
Single Family Project ❑ Multi -Family Project ❑ Commercial Project
Project Address: 106 ('�Q LA--P-rv't wLck
Permit Number: � r —
Scope of Work: �-2w ` PI L (-/o 10tH=t Kc< I 9 Q tAAt.0_Xt
Owner/Applicant Name: `P- >k --n Phone: - -7-2-7- R WD
Date: Prepared By:
City Authorized Representative
1, as property owner or authorized agent, acknowledge that all
will be met and all required fees will be aidC p ' to the a.CA�u
Dat �_, Signature:
owner/ Authorized Agent
Sanitary District requirements
ibWectron for proposed project.
CUPERTINO SANITARY DISTRICT OFFICE USE ONLY
❑ Pre -inspection Renrr—
Date:
'Final Inspection Required
Date Scheduled:
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.
Inspection Fee Paid Date Paid: 2, -7– 1-7
lnspp
-
Inspe tion Fees:
$250/unit - Single Family Residential already connected, but new cleanout is required
O $150/unit - Single Family Residential already connected with existing cleanout in working order
[� $350 Minimum – Commercial and Retail Actual Amount:
' $200/each –Disconnect and/or abandon lateral service
Connection Permit Fees:
O $350/unit - Single Family Residential connecting to existing lateral
O $650/unit – Single Family Residential connecting with new lateral
0 $100/unit – Multi, Hotel, Living Units, etc. Actual Amount:
D $500/connection - Commercial and Retail Actual Amount:
Connection Use Fees (See Attached Calculation Sheet):
D Area and Frontage Fees Amount:
Residential Excess Fees over 3.5 unit/acre Amount:
Commercial and Retail Connection Fees Amount:
I7 Commercial and Retail Change in Use Fees Amount:
Date: -7-1-7 Final Approval By:
Authorized(�ep esentative
Cupertino Sanitary District
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY,' DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • (408) 777-3333 • buildingQcupertino.org
PERMIT CANNOT BE HIS
COMPLETED, SLCj.NU. A
PURPOSE
This affidavit is a self -certification for the it
compliance with 2016 CRC Section R314, R
for inspections are required.
GENERAL. INFORMATION
Existing single-family and multi -family d
Monoxide alarms. When the valuation of
$1000.00, CRC Section R314, R315, and CI
Carbon .Monoxide Alarms be installed in 1
[LEI) UNTIL THIS CERTIFICATE HAS BEEN .
UTUIZUD TO THE BUILDING DIVISION
Latton of all required Smoke and Carbon Monoxide Alarms for
2016 CBC Sections 420.6 and 907.2.11.2 where no interior access
shall be provided with Smoke Alarms and Carbon
.s, alterations, or repairs to existing dwelling units exceeds
ns 907.2.11.5 and 420.6 require that Smoke Alarms and/or
vinR locations:
AREA
Signature....
SMOKE ALARM
CO ALARM
Outside of each separate sleeping area in the linInediate
bedroom(s) — (Smoke alarms shall not be located
vicinity of the
Within 3 feet of bathroom door)
X
X
On every level of a dwelling unit including basen
ients and habitable attics
X
X
Within each sleepingroom oom _ ;
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 he Office of the State Fire Marshal.
Power Supply: In dwelling units -with no ,cO imercial 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 I 'nishes or there is no access by means of attic, basement or crawl
space. Refer to CRC Section 8314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for
alarms which must be connected to the builcr
g wiring.
As owner of the above -referenced property;
installed in accordance with the manufactui
and California Residential Codes. The alarn
date signed below.
Address:
k "
Specify Number of Alarms:
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
# Sinoke Alarms:
Permit No. _? o f -7 _ o 3 7
# Carbon Monoxide Del
/ have read and aoreel to comely with the terms and conditions of this statement
Owner (or Owner Agent's) Name:.
� C
Signature....
+ /
! ................ ,............./................................................... DatellA.7l%...
Contractor Na e:
Signature.....................................................................
Lic.#........................................ Date:...................
Smoke and CO form.doc remised 01/1012017
CUPERTINO
Owner Name,^
Address
i
i
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERT FiCATE OF COMPLIANCE
COMMUNITY DEVELO MENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUO • CUPERTINO, CA 95014-3255
����('l0— 77-7-328_ 1 (4� 77/7-3333 • buildinaCacupertinPer –ai e) 3 7
-` a Permit No � �•Yennit No � �•`
I
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.
Eff'No Go to Question 2.
2. Does your real property have a licensed plumber ertifying that, due to the age or configuration of the property or its
plumbing, installation of water -conserving plumb' g fixtures is not technically feasible?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
❑ The licensed plumber's certificati�oj i has been provided to the Building Division.
WNo Skip the rest of the form and sign bottc in of form.
Go to Question 3.
3. Is water service permanently disconnected for ybiw building?
XNo
es Civil Code Sections 1101.1 through ,1101.8 do not apply. Skip the rest of the form and sign bottom of form.
Go to Question 4.
4. Is your real property built and available for use 10 occupancy on or before January 1, 1994?
❑ No My real property is built and available
Civil Code Sections 110 1. 1 through l l
VYes My real property is built and. available
Civil Code Sections 110 1. 1 through 11
bottom of form..
Please check ONE of the following: ,
Myproperty is a single-family residential real
On and after January 1, 20L4,. -building alterat
to be replaced with water -conserving plurmbinl
compliant plumbing fixtures shall be repla(
property undergoes alterations or improvemet
❑ My property is a multifamily residential real pi
On and after January 1, 2014, specified buildir
plumbing fixtures to be replaced with water -cc
On or before January 1, 2019, all non-compli,�
conserving plumbing fixtures throughout,the b
improvements).
❑ My property is a colnmercial real property. Se
On and after January 1, 2014, specified buildir
plumbing fixtures to be replaced with water -cc
On or before January 1, 2019, all non-com
plumbing fixtures throughout the building (reg
use or occupancy after January 1, 1994.
.8 do not apply. Skip the rest of the form and sign bottom of fonn.
use or occupancy on or before January 1, 1994.
.8 apply. Check one of the three following statements and sign
roperty. See Civil Code Section 1101.4.
ms or improvements shall require all non-compliant pl unbing fixtures
fixtures throughout the building. On or before January 1, 2017, all non -
;d with water -conserving plumbing fixtures (regardless of whether
)erty. See Civil Code Section 1101.5.
alterations or improvements shall require non- compliant
>eiving plumbing fixtures.
plumbing fixtures shall be replaced with water -
[ding (regardless of whether property undergoes alterations or
Civil Code Section 1101.5.
alterations or improvements shall require non- compliant
Serving plumbing fixtures.
iant plumbing fixtures shall be replaced with water- conserving
dless of whether property undergoes alterations or improvements).
I, as the owner or owner's agent of this property; c
ertify under penalty of'perjury that non-compliant plumbing fixtures will be
replaced prior to date specified above with water-
onselving plumbing fixtures in accordance with Civil Code Sections 1101.1
through 1101.8, the current California Plurmbingj Gode
and California Green Building Standards Code, and manufacturer's
installation requirements, and that the water -cons
ing plumbing fixtures comply with the requirements as indicated in the
table on the following page.
n.=
Owner or Owner Agent's Signature: 711`
Date:
Upon completing and signing this Ceitilicateop e 3se return it to the Building Division in order to final your building permit.
SB4072015.doc revised 08126/15
1. If the existing plumbing fixture water usage/flotu
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
Plumbing Fixture1
(Fixture
Complying with Current Code Applicable to New Construction)
Fixture Type
Maximum Water Usage/Flow Rate
201
CPC Ch. 4
2013 CPC Ch. 4
2013 CPC Ch. 4
Water Usage
/Flow Rafe
2013 CALGreen
Div. 4.3
2013 CALGreen Div. 4.3
2013 CALGreen Div. 5.3
- Sin
le-Fami[y
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-
eld 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 ar
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/flotu
is equal to or lower than the figure shown, it is not required to be upgraded.
SB407 2015.doc revised 08126/15