B-2017-0886CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0886
1110 HUNTERSTON PL CUPERTINO, CA 95014-5069 (362 22 03 1)
D W C PLUMBING INC
SAN JOSE, CA 95120
OWNER'S NAME: JACQUES KEVIN R AND KATHY L
DATE ISSUED: 06/02/2017
OWNER'S PHONE: 408-996-8100
PHONE NO: (408) 315-6967
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C-36 Lic. #1Q0$Q
Contractor D W C PLUMBING INC Date 07/31/2017
X BLDG —ELECT X PLUMB
—
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
license is in full force and effect.
JOB DESCRIPTION:
INSTALL (1) SEWER CLEAN OUT
I hereby affirm under penalty of perjury one of the following two 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
Sq. Ft Floor Area:
Valuation: $2600.00
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
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
362 22 031
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 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
source regulations per the Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 6/2/2017
Issued by: Abby Ayende
OWNER -BUILDER DECLARATION
Date: 06/02/2017
I hereby affirm that 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 roofmg material being installed. If a roof is
t. 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:26/ /2017
1 hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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.
HAZARDOUS MATERIALS DISCLOSURE
z. 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
s. 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 Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sections 25505,:26533;;And 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.y'�..
Owner or authorized agent: �-----�
APPLICANT CERTIFICATION
Date: 6/2/2017
1 certify that I have read this application and state that the above information is
CONSTRUCTION LENDINGAGENCY
correct. I agree to comply with all city and county ordinances and state laws
I hereby affirm that there is a construction lending agency for the performance
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
Code, Section 9.18.
1 understand my plans shall be used as public records.
Licensed
Signature Date 6/2/2017
Professional
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 M I
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CUPERTINO
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2PLUMBING nMECHANICAL nELECTRICAL nMISCFl.I,ANF0I1S
(408) 777-3228 •FAX (408) 777-3333 •building@cuaertino.or
PROJECT ADDRESS
APN # ' ,) 2 - 'i 2 -03 I
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OWNER NAME
PHONE
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E-MAIL
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STREET ADDRESS .
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CITY, STATE, ZIP
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FAX
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CONTACT NAME
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PHONE
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E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT
CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
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LICENSE NUMBER
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LICENSE TYPE
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COMPANY NAME
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ARCHITECTIENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY. STATE, ZIP
PHONE
USE OF SFD o DUPLEX ULTI-FAMILY
PROJECT IN WILDLAND ❑ YES
PROJECT IN YES
IS THE BLDG AN ❑ YE
BUILDING: ❑ COMMERCIAL
URBAN INTERFACE AREA 91P0
�❑
FLOOD ZONE B4 NO
EICHLER HOME?
DESCRIPTION OF WORK
TOTAL VALUATION: '1 �U
RECEIVED BY,
By my signature below, I certify to each of the following:
I am the property owner or authorized agent to act on the property owner' behalf. have read this
application and the information I have provided is correc
I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building cons
I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent:
Date:
SUPPLEMENTAL INF TION REQUIRED
OFFICE USX ONLY
❑ OVER-TWCOUNTER
W
❑ EXPRESS
❑ STANDARD
❑ LARGE
a
❑ MAJOR
MEPMiscApp_2011.doc revised 06/21/11
CUPERTINO SANITARY DISTRICT
20863 Stevens Creek Blvd #100, Cupertino, CA 95014
Tel (408) 253-7071 • Fax (408) 253-5173
v
"'460sect'%� CUPERTINO
SANITARY DISTRICT PERMIT LETTER
Cupertino Sanitary District has adopted Resolution No. 1263.
Building Permit Request
(Over -the -Counter]
////''"ingle Family Project ❑ Multi -Family Project ❑ Commercial Project
Project Address:
Permit Number: 17) -WI -1---
Scope of Work:
Owner/Applicant Name:
Address:
Date: (0—,2 -! 7
Phone:
orized 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 t9_the�p royal of final inspection for proposed project.
Date: , 6 / 7 Signature:
Owner / Authorized Agent
CUPERTINO SANITARY DISTRICT OFFICE USE ONLY
❑ Pre -inspection Required Final Inspection Required
Date Scheduled:
Date: %/I (kl_ �_� �'_ _!
Z,/ 1 % Conditional Approval B
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 Cupe ino.
Inspection Fee Paid Date Paid:,//Q —2 �%
Insp,er,tio Fees:
$250/unit - Single Family Residential already connected, but new cleanout is required
D $150/unit - Single Family Residential already connected with existing cleanout in working order
$350 Minimum — Commercial and Retail Actual Amount:
D $200/each — Disconnect and/or abandon lateral service
Connection Permit Fees:
O $350/unit - Single Family Residential connecting to existing lateral
$650/unit — Single Family Residential connecting with new lateral
$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:
D Commercial and Retail Connection Fees Amount:
D Commercial and Retail Change in Use Fees Amount:
Date: �Q-2 "/ 0�/ 0 Final Approval By:
Authoriz d Representative
Cupertino Sanitary District
L.
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(n)cupertino.org
I'ERIVAIT CANNOT BE`FINALED UNTIL TffiSCERTIFICATE FIAS BEEN !.
COMPLETED, SIGNEID AN�D Ig ruRNEI9 TO THE BUILDING IDIVISI®N ;'
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
bedroom(s) — (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
a
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:
Permit No. V�
Specify Number of Alarms: # Smoke Alarms: # Carbon Monoxide Detectors:
I have read and agree to comply with the terms and conditions of this statement
Owner (or Owner Agent's) Na,,,m�e:RR
Vv,
/
Signature..... ............................................. Date: G�??.....
Contractor Na e:
Signature...................................................................... Lic.#........................................ Date:...................
Smoke and COform.doc revised 0111012017
E �I F4ill
Owner Name
Address
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 ^ FAX (408) 777-3333 • building(d_)cupertino.org
-P-6a-0
PEIRMiT CANNOT BE EINALED AND -COMPLETED lUNTIL THIS CERTIFICATE
ACAS BEEN SIGNEI9 AND RETURNED TO THE BUIL
DING`DIVISION
Please refer to the attached California Civil Code Sections 1101.1 —1101.8 which are part of this Certification form.
1. Is your real property a registered historical site?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form.
Owner' Signature:
XNo Go to Question 2.
Date:
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.
Sign below and skip the rest of the form.
Owner' Signature:
XNO Go to Question 3.
Date:
3. Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form.
Owner' Signature:
XNo Go to Question 4.
Date:
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. Sign below and skip the rest of the form.
Yes
Owner' Signature:
Date:
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. Refer to the attached.
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.
SB407 2014.doc revised 03/18/14
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/We, the owner(s) of this property, certify under penalty of peijury that non-compliant plumbing fixtures have been replaced
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_ _4h the reAe ements as indicated in the table below. ,
Upon completing and signing this Certificate, please return iVto the Building Division in order to final your permit.
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.
SR407 2014.doc revised 03/18/14
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,
average flush volume of two reduced flushes and one full flush
Urinals
Exceed 1.0
0.5 gallons/flush
Gallonstflush
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.
SR407 2014.doc revised 03/18/14