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B-2017-0630CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0630 19370 CALLE DE BARCELONA CUPERTINO, CA 95014-3456 (375 05 010) OWNER BUILDER OWNER'S NAME: IP CHUNG-WAH NORRIS AND TIFFANY TRINH OWNER'S PHONE, 510-610-7463 LICENSED CONTRACTOR'S DECLARATION License Class Lie. # Contractor OWNER B I D R Date 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. 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. 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 4/25/2017 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, asowner of the property, am exclusively contracting with licensed - contractors to construct the project (Sec.7044, Business & Professions Code). Ihere y affirm under penalty of perjury one of the following three declarations: t. 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. 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. DATE ISSUED: 04/25/2017 PHONE NO: BUILDING PERMIT INFO: X BLDG —ELECT —PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: 1 ST FLOOR BATHROOM REMODEL (42 S.F.) Sq. Ft Floor Area: Valuation: $10000.00 APN Number: Occupancy Type: 375 05 010 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. by: Abby ende RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new material's for inspection. Signature of Applicant: Date: 4125/2017 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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, 25533, and 25534. Owner or authorized agent: _ Date: 4/25/2017 CONSTRUCTI 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. Signature ' Date 4/25/2017 Licensed Professional CUPERTINO CONSTRUCTION PERMIT APPLICATION. Dcoso COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildino(oDcupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION F I ALTERATION / Ti ❑ RF.VTST(1N / T)F.FFRRFTT nPTC>TMAT PrPRAaTT E PROJECT ADDRESS (y (� 'CA �j rJ t 1, APN # OWNERNAME ((�� ,1�qq(l q� tj1 i't U �E✓'t, OA I : of,% i - kTL ONX : PHON50- eCK I piD 6A 6) S 0 �){ �i FAX CONTACT NAME .. -� � ,� ! PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP + i OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building aAcupertino.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS 6 CA l APN 0�s ® f D BP# OWNER NAME SAY ff yy I\J.. f `OWNER ADDRESS �y a "'o ��.' DESCRIPTION OF WORK: qcldGU G We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. 1, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. (Q ) 2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. <V3. 1 understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the otal value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. 6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and "feral government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. �7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is p rformed under contract with a licensed general building Contractor. 8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010. doe revised 04/14/10 �. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. 0-10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. e11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide allll applicable laws and requirements that govern Owner -Builders as well as employers. �12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwnerBzrilderForm 2010. doe revised 04/14/10 \rik Building Department rtk4 City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/SUBCONTRACTOR LIST JOB ADDRESS VIN7C, Cd z 4.12, 'f, , ... - PERMIT#V611'-'06; 6 OWNER'S NAME-7, eL :‘ i, ktro,i. ';‘i,„,- IreAL, PHONE#4.tatr 64&, '/2/ P GENERAL CONTRACTOR. Me.- 6 efrc-i-eA BUSINESS LICENSE# ADDRESS 475-11), 5fers9 pe- '' , ' \ Ci."-- CITY/ZIPCODE qs-03-li *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. - . ... /Z-sli/17 I am not using any subcontractor : / 40 SignatureI Date Please check applicable subcontractors and complete the following information: / SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass/Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile _,------ ,--- / 54YI/17 411111111111 —•caner/Contractor Signature Date SMOKE I CARBON MONOXIDE ALARMS ..x,..,,,• -• OWNER CERTIFICATE OF COMPLIANCE �' Y �� Q-��Il7 W - COMMUNITY DEVELOPMENT DEPARTMENT C • BUILDING 3255 G DIVISION �,, ��19f 10300 TORRE AVENUE• CUPER cupertmo o� 777 3228•FAX(408)777-3333•bwldmg� CUPERTIN (408) r ss� £" ziy , s r w *,T� CERTI C T� S EDEN � � aetP f",ir 'L CANNOT B ED ' ' $ xal 7# SIO ec iii � �� - a ��+ps� ��Sa r"�Yt�v'�u��,2 S?�3'""�u�;f� 'SY �� G .+.f�,� 1 ; �� 3�"`��P :vop�, a�E ,a,� t � :sh#5 "' �z IsTJ� �Ok` �'Ys x ��... .a'"^L.'� �' r..". 7;•::°.,FA.' w.:5'g^E' �it4Wx� ��.�� .�,;o� �, •�;� ,. �...qi,�..AINOWAstoF4RAti., Alarms for PURPOSE n for the installation of all required Smoke and Carbon Monoxide compliance ncis a self-certification. 016 CRC Sado ^14.8315,2016 CBC Sections 420.6 and 907.2.11.2 where no interior access with 2016 CRC Section R� , for inspections are required. GENERAL INFORMATION dwelling is exceeds u single-familyansa and multi-family dwellings shall be provided with Smoke Alarms Carbon Existingalterations,or repairs to existing Monoxide alarms. When the valuation of additions, MCBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or $1000.00, CRC Section R314,R315, and Carbon Monoxide Alarms be installed in the following locations: • SMOKE ALARM CO,ALARM AREA of the I Outside of each X X separate sleeping area in the immediate vicinity bedroom(s)—(Smoke alarms shall not be located within 3 feet of bathroom ttlcs Xm door) On every level of a dwelling unit including basements and habitable Within each slee.m room and that ntain dor noMonoxide alarms are not required in dwellings which do not o h Inoke aurning applianceshall comply with do nott have an attached garage. Carbon monoxide alarms coin and shall be approved by the office of the State Fire Marshal. CBC Section 420.6 alarm(s)may be solely battery operated. units with no commercial power supply, Power Supply:In dwelling operated where repairs or alterations do existing dwelling units, alarms are permitted to be solely battery electrical ernvt is required for In fllushes or there is no access by m ans o a c,basement or crawl space.t result Refer in the CRC S removal of wall andceiling to Section R314 and CBC Sections 907.2.11.4 and 420.6.2• alarms which must be connected to the building wiring• arms referenced above has/have been the above-referenced property,I hereby certify that the al ( ) As owner of manufacturer's instructions and in complianCe j'`'1�the California Building installed in accordance with the manL s specified below have been tested and are operational, as of the ins io l 6_�j and California Residential Codes.The alarm p permit No!�� date signed below. ca' ' Address: CarbonMoiioxideDetectors: �� krY t'` #Smoke Alarms: . Specify Number of Alarms: _ I have read and agree•to comply with the terms and conditions of this statement , / .....Date"...1.1 ....l..' Owner Agent's)Name: ............................ . or • Owner Ag•a Si.nature....................., 0 Contractor Name: 9kii9 . Signs t �� Smoke and CO form.doc revised 01/10/201; 3 }F WATER-CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE 1�� 3�2 COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE• CUPERTINO,CA 95014-3255 (408)771-3.228,•F (408)777-3333• buildinq(a)cupertino.orq Owner Name.eS ' U� W.c^'1 NVMf Gp'O e it No. 2'V Address \ .1*#n"0 � 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. 0 The licensed plumber's certification has been provided to the Building Division. Skip the rest of the form and sign bottom of form. i44.110 Go to Question 3. 3. Is water service permanently disconnected for your building? 0 Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and,sign bottom of fon.-n. o 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. es' 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.. 5. Please check ONE of the following: property is a single-family residential real property. See Civil Code Section 1101.4. / .0n 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). ❑ Myproperty 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 plurrrbing 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 ofperjury that non-compliant plumbing fixtures will be replaced prior to date specified abovewith 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 following page. Owner]or Owner Agent's Signature: " Date:4)1.41 f —' Upon completing and signing this Certificate,please return it to the Buildin,, ivi . `fn'order to final your building permit. SB407 2015.doc revised 01/05/17 'x» l T , - a s s § - 4 t, ,4,, n7'z. F+.i v ' � 'W , ,fiO L TiD _ JLTHIIS'l DINrLMrC P O B�FLDA D ETD 1( � � �CA �S BE�S1L -D : 3 eS' Rr n-Compliant Water Conserving Plumbing Fixture lumbing Fixture • (Fixtur'e'Com plying with Current:Code'Applicable to New Construction) - ._ - „.. - ----Max`imumnater Usage/Flow Rate'- Fixture Type 2016 CPC Ch. 4 2016 CPC Ch. 4 2016 CPCCh.4 Water Usage 016 CALGreen Div. 4.3 2016 CALGreenrDiv:-4.3' ,• 2016 CALGreen Div. 5.3' /Flow:Rate Single-Family`�• : Multi Family Commercial Residential Residential Water Closet Exceed 1.6 Single flush toilets: 1.28 gallons/flush (Toilets) Gallons"/,flush' Dual flush,toilets: -1.28 gallons/flusheffective-flush volume (the composite, average'flush volume-of two':reduced flushes and one full flush) Urinals Exceed 1.0 • Gallons/flush 0.5gallons/flush. Showerhead Exceed 2.5 .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 commonand public use-areas: 0.5 gallons • per minute @ 60 psi 1.8 gallons per minute. @:60,prix Faucets— • Exceed 2.2 gallons .8 gallons per:minute.@ �.. ' 1�:8 gallons per minute 1.8 gallons per minute• @ 60 Kitchen per minute 0 psi. .. . @60,psi..: psi Faucets .ay 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 maxim um 604psi, and must: . . .8-gallons per minute_@ default to±maximum • 0 psi 1 8'gallons per minute `. - Where faucets meeting @,60,psi the`above are unavailble; Where faucets'meeting aerators or other means the above ?,17.9.,,,..,,,,,., ust `5 areamaybe sedto achieve unav,aabe, era.tors o r . ,e t !�i • ;...Vutirie Os -. £othmeanfn esy rcvx '} t ` usedto achiee''' x - t t i ES Y ? iZ 4 YreductionF pLF , s tbugade d,'-'-'''''i..--:-'..--- 6 e/flowraeis equaltoorlonrthanthe fguresowntinoreudoer '1 Ifthe exstg pigfitrwaeag , 1 . s i L' E . r > t r 4 � e lc z rifr•oGr m4 F"2 ` ta _ r e t { . .F r :,ai 4{,+4-mr � 4� ✓i tit .a l ss3a ;f4 ?4� i i�` #..v.:, } } t L;1 z.y::.., '� C f' �. 'h f ` 3 t ' , s>J SB407 2015.doc z evzsed 01/05/17 Abby Ayende 04/25/17 04/25/17 B-2017-0630 Abby Ayende