B-2017-1121CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1121
898 HYDE AVE CUPERTINO, CA 95014-4639 (375 39 008)
M G CONSTRUCTORS
& ENGINEERS INC
MORGAN HILL, CA
95037
OWNER'S NAME: ARNOLD PETER M AND CLAIRE K
DATE ISSUED: 07/12/2017
OWNER'S PHONE: 408-307-0643
PHONE NO: (408) 842-5599
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class ALB Lic. #642058
Contractor M G CONSTRUCTORS & ENGINEERS INC Date 07/31/2019
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:
REPLACE SEWER LINE UNDER HOUSE; REPLACE SUMP PUMP -
I hereby affirm under penalty of perjury one of the following two declarations:
LIKE FOR LIKE
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.
`` 2. I have and will maintain Worker's Compensation Insurance, as provided for by
t i Section 3700 of the Labor Code, for the performance of the work for which this
Sq. Ft Floor Area:
Valuation: $12000.00
permit is issued.
✓✓
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
375 39 008
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 Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 7/12/2017
Issued by: ABBY AYENDE
OWNER-BUIWER DECLARATION
Date: 07/12/2017
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 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)
2. I, as owner of the property, am exclusively contracting with licensed
Signature ofApplicam:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 7/12/2017
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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.
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 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, See ns 25505, 25533, and 25534.
/D
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 7/12/2017 j
I certify that I have read this application and state that the above information is
CON STRUCA ON LENDING AGENCY
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 (See. 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 7/12/2017
Professional
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(akuoertino.org �(r'j I
❑ NEW CONSTRUCTION ❑ ADDITION L'3 ALTERAUON / TI ❑ REVISION / DEFERRED ORIGINAL PERNIIT #
PROJECT ADDRESS $ H Y D F AVC"N
# 3 7-5-- _. 0 ® .
OWNERNAMEp E T LK A R N o LD
PHONE (( 06) 30'� p� (, 3
E-MAILarIc1 f e �O '6e
it
STREET ADDRESS! g �'
CITY' STATE' ZIP C U PERT 1 NO (-A 1 5 0 1 Li
FAX
CONTACT NAME II ATT H E W t -j A in (_. N 1 i
PHONE C 51 O, I a 1 0 [l cl
EMAIL rv\ A t t k` r"W t0 r\ S L iN uG o r+5 • n c r
tl
STREET ADDRESS 1565 0 V IMEyARD gLYP A a32
CrrY,STATE, ZIP MOR&IAN 1•A1LL n CA 15 0 3 11
FAX
❑ OWNER ❑ OWNER-BURDER ❑ OWNER AGENT &ICONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGIIdffii ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME M A R k 61A R R 1 S o NII
LICENSE NUMBER �, y a o y 8
LICENSE TYPE
BUS. LIC #
COMPANYNAME Mf1 COIJ�TRUciOt:S 4 Fni61111[E RS
E-MAIL 1"WAL►L0 wJtcr%-401u(EClh6•'ne-L
FAXtyaas) $ya_ 5e55
STREETADDRESSl5b50 VnNEyd�
AK9 gLV9 A3,STAT=MORf�A1s
�� HILL- CA `15037
PHONEtyO$) Eqa L5511
ARCHITECT/ENGINEER NAME M A.- N E I,J H A G1 C R 7 i
LICENSE NUMBER C -7;L 4 g B
BUS. LIC #
COMPANY NAME Mr^ LCNSFI�LICTORS d. C-
`
E-MAIL
EMAIL MettbI-0 dt-Aurtor6- e L
FAX j09') t-ya- `j 5`l °l
5l 6 50 V I WE yA IL D 13 LVD A d 3�
STREET ADDRESS 1
CITY, STATE, ZIP M O KeiA N H 1 LL I C -A, q 5 031
PHONE �ti 0$� s 1{ a- S 5 `� 1
DESCRIPTION OF WORK
INSTALL Clv PLL! M ING l-i/SFS FOR (<(TCIi - Swf< AND[ v To
kxtS'iINC LVr'1 LiNC TNS L CN SUMP PUMP
EXISTINGUSE
PROPOSED USE CONSTR.
TYPE
#STORIES
USE
TYPE
OCC
SQ.FT.
VALUATION (S)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NECAREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
I
❑ ATTACH
# DWELLING UNITS:
IS A SECOND UNrr ❑ YES
SECOND STORY ❑ YES
BEINGADDED! ❑NO
ADDITION! []NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
TOVL VALUATION:
PLANNING APDL# 0 N PLANNING APPROVAL LETTER
EICHLERHOME! ❑ NO
- -
12-000
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's behatiV I have read this
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
ordinances and state laws relating to buildingZI ves of Cupertino to enter the above -identified property for inspection purposes.
Signature of Appli—t/Agent: G Date: Z�M-0r112
ro-111
SUPPLEMENTAL INF TION REQUHMY,
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER-THE-COUNTER
❑ BUH,DING PLAN 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
11PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑ LARGE
❑ FmE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ SANtTARY SEWER DISTRICT
submittal of Building Permit application
❑ ENVIRONMENTAL HEALTH
BldgApp_201 Ldoc revised 06/21/11
1 SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
,'S COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
C'U.PERTlNO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777.3333• buildino cupertino.orq
' PERMIT CANNOT BEFINALED UNTIL THIS CERTIFICATE HAS BEEN ;
COMPLETED,SIGNED,AND RETURN6-T6-THE BUILDING DIVISION
PURPOSE
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314,2013 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 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 X X
the bedroom(s)
On every level of a dwelling unit including basements 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
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: 999. //VA /-'tJ-_ Permit No.#S-)017'If
Specify Number of Alarms: #Smoke Alarms: IF_ #Carbon Monoxide Detectors: I Z- I
I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name:
Signatures ? - /I.7.Date:
Contractor Name:
Signature Lic.# Date:
Smoke and CO form.doc revised 09/27/16
.£; WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
BUILDING DEVELOPMENT DEPARTMENT•
DIV ISION
CUPERTINO10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildinq a(�cuoertino.orq >>
Owner Name C.>�-'f w' E �! 1? •* kP X Permit.No. f 0 1-1 .--1121
Address
1 /)U2 , Capp ono C4 i4
� .s,s�k�s� �"� � �' �w rx .�a�
RM C LOT B� b LED f`ID GO rl T 'I�TflL ' IJ 3wIFIC T
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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?
El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form.
Owner' Signature: Date:
12 INlo 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?
ElYes 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: Date:
' 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. Sign below and skip the rest of the form.
/ Owner' Signature: Date:
® 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. Sign below and skip the rest of the form.
Owner' Signature: Date:
❑ 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. Refer to the attached.
f My property is a single-family residential real pperty. See Civil Code Section 1101.4.
On and after January 1, 2014, buildirong 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.
SB4072014.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 perjury 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 fixture . .•1y with ere•4 ements as indicated in the table below. /
Owner's (or Owner Agent's) Signature: �— -% Date:`1// ( l 1
Upon completing and signing this Certificate,please re it to the Building Division in order to final your permit.
Non-Compliant Water-Conserving Plumbing Fixture
Plumbing Fixture1 (Fixture Complying with Current Code Applicable to New Construction)
Maximum Water Usage/Flow Rate
Fixture Type 2013 CPC Ch.4 2013 CPC Ch.4 2013,CPC Ch. 4
Water Usage 2013 CALGreen Div.4.3 2013 CALGreen Div. 4.3 2013 CALGreen Div. 5.3
/Flow Rate
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
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-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.
SB407 2014.doc revised 03/18/14