B-2017-1216CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR. PERMIT NO: B-2017-1216
10887 NORTHRIDGE SQ CUPERTINO, CA 95014-0527 (316 36 028) PELLE HEATING &
AIR INC
SAN JOSE, CA 95111
OWNER'S NAME: YAMAMOTO ROBERT J
OWNER'S PHONE: 408-529-4965
LICENSED CONTRACTOR'S DECLARATION
License Class C-20 Lic. #809887
Contractor PELLE HEATING & AIR INC Date 10/31/2017
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.
I hereby affirm under penalty of perjury one of the following two declarations:
1. 1 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.
Date 7125/2017
I hereby affirm that I am exempt from :the Contractor's License Law for one of the
following two reasons:
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, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
DATE ISSUED: 07/25/2017
PHONE NO: (408) 978-7060
BUILDING PERMIT INFO•
X BLDG —ELECT _ PLUMB
X MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION
REPLACE FURNACE, INSTALL N A/C UNIT
Sq. Ft Floor Area: I Valuation: $6500.00
"N Number- Occupancy Type:
316 36 028
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
by Abby Ayende
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without fust obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant:
Date: 7/25/2017
I hereby affirm under penalty of perjury one of the following three declarations: I ALL ROOF COVERINGS TO BE CLASS "A"
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
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, C,
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 7/25/2017
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, ns 25505, 25533, and 25534.
Owner or authorized age
Date: 7/2 512 01 7
CONSTRUCTION LENDING AGENCY
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.
Licensed
Professional
GENERAL PERMIT APPLICATION
COMMUNITY DMEP
-
EVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building okupertino.om
PROJECT ADDRESS ( +� APN # 340
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OWNER NAME PHONE E-MAIL
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STREET ADDRESS i �—p g, + �e� CIT STATE, ZIP �^ ,> /
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CONTACT NAME { �p _ __ PHONE E-MAIL
Ca.
STREET ADDRESS 1P�Vldl® CITY, STATE, ZIP FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑.. CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
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LICENSE NUMBER
LICENSE TE
BUS. LIC
COMPANY NAME
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FAX
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_ STREET ADDRESS
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CITY, STATE, ZIP Cis
PHONE
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF SFD or DUPLEX
BUILDING: ❑ COMMERCIAL
❑ MULTI -FAMILY
PROJECT IN WILDLAND ❑ YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
ICAC`
PUY I VYY16i =q:�000 I
TOTAL VALUATION: 1\11Fi 4 ItECEED,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's behalf. 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 relatingt g construction. I author1 resentatives of Cupertino to enter the abov-identifi property for inspection purposes.
Signature of Applicant/Agena,;a �� --7 Date: S
MEPMiscApp_2011. doc revised 06/21/11
F __
\\,\46....\// SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE A 1' " C111
�
ytavr� COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
GUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildinc7(a.cupertino.orq
z2,7
PERMIT C. KNOT BE FINALED UNTIL THIS CERTIFICATE HAS BEEN . '
4& y COMPLETED,SIGNED AND;tETURNED TO THF,8• LDINU
VI IASSION ? ,
PURPOSE
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms
for compliance,with 2016 CRC Section R314,2016 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 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.
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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: Q D il ' "� R'l �t%� Permit NO.i390 �j6
Specify Number of Alarms: #Smoke Alarms: #Carbon Monoxide Detectors: I ? 1
I have read and ag m ly with the terms and conditions of this statement
Owner(or Owner Agent's)Name:
I p �� Signatur Date: q
Contractor Name: '� - �jU I�JS Q
Signature Lic.# �J .:� Date:
Smoke and CO form.doc revised 12/15/16
/f WATER-CONSERVING PLUMBING FIXTURES M :I ( rOWNER CERTIFICATE OF' COMPLIANCE
J
0c,, COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
GUPERT�NC? 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
-,(308)777-3228• (408)777-3333•buildinc a,cupertino.orq
Owner Name P O. f srlA O 1U Permit No. ,Po 4 13---Rib.
Address I V �� . p�Li Q �G2
gs c)•
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 isnot 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.
Eg 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.
cg 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 forrnl.;'
1
5. Please check ONE ofthefollowing:
TC My property is a single.family residential real property. See Civil Code Section 1101:4.
On and after'Januaryll; 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 i 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 Januaiy 1,2014,specified building alterations or improvements shall require non-compliant
plumbing fixturesto 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 propertyis a commercial real property. See Civil Code Section 1101.5.
On and afterJanuary,.l,'2014,specified building alterations or improvements shall require non-compliant
plumbing fixtures tollie 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',curie it'California Plumbing Code and California Green Building Standards Code,and manufacturer's
installation requirementsf and'that;the water-conserv',1_plumbing fixtures comply with the requirements as indicated in the
table on the following,page (
Owner or Owner Agent'signature. p Date: I1.i
Upon completing and signing this Certificate easer turn it to the Building Division in order to final your building permit.
' SB407 2015.doc revised 01/05/17
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Non-Compliant • Water-Conserving Plumbing Fixture
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Plumbing Fixture (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 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 '
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• (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
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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.
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SB4072015.doc revised 08/26/15