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B-2017-0500CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0500 678 MILLER AVE CUPERTINO, CA 95014-4640 (375 42 012) HOMEOWNER BUILDER OWNER'S NAME: JEN KO-TAAND CHRISTINAN DATE ISSUED: 03/28/2017 OWNER'S PHONE: 408-910-6832 PHONE NO: LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic. # XBLDG ELECT X PLUMB Contractor HOMEOWNER BUILDER Date _ _ 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 SEWER MAIN; CLEAN OUT I hereby affirm under penalty of perjury one of the following two declarations: m. 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. Sq. Ft Floor Area: Valuation: $900.00 APPLICANT CERTIFICA� TION_ I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances 375 42 012 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 Cupertino against liabilities, judgments, costs, and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED of may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the applicant understands and will comply with all non -point 180 DAYS FROM LAST CALLED INSPECTION. source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date / 8/ 017 Issued by: Abby A e) ndg Date: 03/28/2017 nxxnv�R BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RF -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: I, the or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for inspection. m. as owner of property, compensation, will do the work,, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, the am exclusively contracting with licensed Signature of APp licant: 2. as owner of property, contractors to construct the project (Sec.7044, Business & Professions Code). Date: 3/28 20 17 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER m. 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 HA?ARDOUS 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 I have and will maintain Worker's Compensation Insurance, as provided for by l Health & Safety Code, Sections 25505, 25533, and 25534. I will Lail. Section 3700 of the Labor Code, for the performance of the work for which this California maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the permit is issued. s. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(x) should I store or handle hazardous 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 the Cupertino Municipal Code, Chapter 9.12 and Worker's Compensation laws of California. If, after making this certificate of I become to the Worker's Compensation provisions of the will maintain compliance with the Health & Safety Code, Sections 25505, 25533, and 25534. exemption, subject Labor Code, I must forthwith comply with such provisions or this permit shall � T �a be deemed revoked. / Owner or authorized agent: (/ Date: _7 AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is CONSTRUCTION LENDING that there is a construction lendingagency for the performance I hereby affirm correct. I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued (Sec. 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 Additionally, the applicant understands DECLARATION consequence of the granting of this permit. and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S I understand my plans shall be used as public records. Code, Section 9.18. Signature s �� - Date �$[2 177 Licensed Professional GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildina(@cupertino.org misc CUPERTINO E -71 -Tr---' 7I7,,rnruArnrAT nRTRrTRICAT. nMISCELLANEOUS Ix I PROJECT ADDRESS T �� APN # ✓� Z ' D Z OWNER NAME Ta EMAIL kd3��l a ��(IROt CE PHONE �T �3®®�i�s" I FAX STREET ADDRESS ' p ] Ave i t zpg CITY, STATE, ZIP gN -`jd CONTACT NAME �.J t a Yl PHONE . - /� EMAIL a6�Z ®qq KJ Q C- ( STREET ADDRESS CITY, STATE, ZIP FAX OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME B Q �a n N BER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME SENUMBER BUS. LIC # COMPANY NAME E-MAIL FAX o STREET ADDRESS CITY, STATE, ZIP PHONE USE OF SFD w DUPLEX ElMULTI-FAMILYPROJECT IN WnALAND ❑ YES AREA NO PROJECT IN ❑YES FLOOD ZONE ❑ NO IS THE BLDG AN' EI YES EICHLER HOME? ❑ NO BUILDING: ❑ COMMERCIAL URBAN INTERFACE ❑ DESCRIPTION OF WORK --------------- A c ease� TOTAL VALUATION: RECEIVED BY agent to act on the property owner's behatf. I have read this By my signature below, I certify to each of the following: I am the property owner or authorized application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local forinssppecti�,g ordinances and state laws relating to building °cons Property purposes. 3-/j n. I authorize representatives of Cupertino to enter the above -identified T`e►ri Signature of Applicant/Agent: f Date: SUPPLEMENTAL INFORMATION REQUIRED 6114cl usE ONLY— ❑ OVER THE -COUNTER?: -- ❑ EXPRESS - F _ �_ .❑ -STANDARD Z e - ` El ;LARGE ❑, ,?KAJOR AIEF'MiscApp 201 Ldoe revised 06121111 MI CUPERTINO SANITARY DISTRICT 20863 Stevens Creek Blvd #100, Cupertino, CA 95014 Tel (408) 253-7071 • Fax (408) 253-5173 �syget�sxEo �9s6 CUPERTINO SANUARY DIS 1 i I r 1 PEiRN 1 LET= Cupertino Sanitary District has adopted Resolution No. 9263. Building Permit Request (Over -the -Counter) 10 Single Family Project ❑ Multi -Family Project ❑ Commercial Project Project Address: 1 Permit Number: s-uo Scope of Work: U L.4 b Owner/Applicant Name: D��R JPhone: e4l' Date: Prepared By: ifrku { yquu_ City Authorized Representative 1, 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: 3/24/27o 17 Signature: ��— Owner / Authorized Agent CUPERTINO SANITARY DISTRICT OFFICE USE ONLY ❑ Pre -inspection Required Date Scheduled: Final Inspection Required Date: DU Conditional Approval By: /' Cath Authorized liepresentative 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. a inspection Fee Paid Date Paid: — t Connection Permit Fees: ❑ $350/unit - Single Family Residential connecting to existing lateral (CCN & inspection included) ❑ $650/unit - Single Family Residential connecting with new lateral (CCN & inspection included) ❑ $100/unit up to 4 units & $65 above 5 - Housing (Multiple, hotel, condo, living units, etc.) $500/connection - Commercial & Retail (Permit only. CCN and inspection not included) ❑ $200/each — Disconnect Permit Inspection Fees: ❑ $250/unit - Single Family Residential already connected, but new cleanout required (CCN & inspection included) ❑ $150/unit - Single Residential already connected w cleanout (CCN & inspection included) Date: P Final Approval By: Authorize- Representative Cupertino anitary District CUPERTINO 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 CSC 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 bedrooms) — (Smoke alarms shall not be located within 3 feet of bathroom door) X X On every level of a dwelling unit including basements and habitable attics X X Within each sleeping room 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 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 alanns 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. f i Address: 679 Mi 41&t > Ce.(,Z�..,q,.Z'�_PermitNo.�-�D 7-5-ao Specify Number of Alarms: # Smoke Alarms: # Carbon Monoxide Detectors: 1 have read and agree to comply with the terms and conditions of this statement Owner (or Owner Agent's) Name: r—o T & ` C Signature....e�1 ..7...... .................. Date: .................................................................... ....... Contractor Name: Signature...... ............................................... ................ Lic.#........................................ Date:................... Smoke and COform.doc revised 0111012017 CUPERTINO Owner Name o �. Address WATER -CONSERVING PLUMBING FIXTURE_ S OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • .CUPERTINO, CA 95014-3255 (40,§11777-32281- FAX (408) 777-3333 • building(a)-cupertino.org 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. 'C 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. No 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. Yes 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.. 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 the water -conserving plumbing fixtures comply with the requirements as indicated in the table on the followin4 page. f e , , 9 j _ IOwner or Owner Agent's Signature: to, JDate: 1011 / I Upon completing and signing this Certificate, please return it to the Building Division in order to final your building permit. SB4072015.doc revised 01/05/17 1. If the existing plumbing fixture water usage/flotu rate is equal to or lower than the tigure shown, it is not required to be upgraded. SB407 2015.doc revised 08/26/15 Non -Compliant Water -Conserving Plumbing Fixture Plumbing Fixture (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, f 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/flotu rate is equal to or lower than the tigure shown, it is not required to be upgraded. SB407 2015.doc revised 08/26/15