B-2017-1536 CITY OF CUPERTINO BUILDING PERMIT
•
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1536
11505 SUNSET SPRING CT CUPERTINO,CA 95014-5134(366 52 018) WILLOW GLEN
ELECTRIC INC
SAN JOSE,CA 95155
OWNER'S NAME: LOTIA SAMARABBAS AND FARAH HASSAN TRUSTEE DATE ISSUED:09/11/2017
OWNER'S PHONE:612-812-9435 PHONE NO:(408)289-9725
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-10 Lic.#591918
Contractor WILLOW GLEN ELECTRIC INC Date 04/30/2018 X9/11/2017 BLDG _ELECT _PLUMB
MECH X RESIDENTIAL_COMMERCIAL
Lhereby 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:
(N)EV CHARGING STATION(40 AMPS)-GARAGE
I 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
a performance of the work for which this permit is issued.
V 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:$2340.00
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 366 52 018
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 re•ulations pert Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Q vi nr e Vi /L/� Date Issued by:Abby Ayende
Date:09/11/2017
OWNER-BUILDER DECLARATION
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
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,amexclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:
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 Munici.al Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 2550 25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall �r
be deemed revoked. 'r
O,,s; 0 authorized agent`
APPLICANT CERTIFICATION 7'
I certify that I have read this application and state that the above information is CONSTRUCTION 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(Sec.3097,Civ C.)
to enter upon the abovementioned 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. I understand my plans shall be used as public records.
• Licensed
Signature Date Professional
I 1---071A-
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
•l
est,/.0N 10300 TORRE AVENUE•CUPERTINO,CA 95014.3255
CUP O (408)777-3228• FAX(408)777-3333•build' ou A u c,,a° ' i-
PROJECT ADDRESS 41601.- G S 5-pI`4
perAPN# (00 ^ 5 2- -0+
OWNER NAME �V .I4� .',JX0)--t PHONEm,..-aEIA
YR + UIa ° fv• IL j01-•?LZ Cia
JLOo C virL
STREET ADDRESS CITY,STATE,ZIP
FAX
rlso5S1wkiseT sPai&DC, ex C.44002-i111ly, CA 6150/14
CONTACT NAMEPHONE 408 289-9725 E-MAIL
Mark Londre ( office@willowglenelectric.com
STREET ADDRESS
P. O° Box 8430 CITY,STATE,ZIP San Jose, CA 95155 FAX(408)289-9725
❑OWNER 0 f OWNER-BUILDER ❑ OWNER AGENT 1A CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER .0 TENANT
CONTRACTOR NAME Mark Londre LICENSE NUMBER 591918 LICENSE TYPE ^-10 BUS.LIC# 15897
COMPANY NAME Willow Glen Electric, Inc. E-MAIL office@willowglenelectric.com FAX (408)289-9725
STREET ADDRESS P. O Box 8430 CITY,STATE,ZIP San Jose, CA 9515.5 PHONE (408)289-9725
ARCHITECT/ENGINEER NAME N/A LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF lirSFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes 0 No FLOOD ZONE ❑ Yes ❑ No
0 SOLAR PANELS V ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER:
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: KILOWATTS(COMMERCIAL ONLY): TOTAL VALUATION3,{0 -
1 ^f
DESCRIPTION OF WORK ,a '
F A
1 Electric Vehicle Charging.Circuit: ,I2- 1114- Jp•j- -vi. (( 4?FUIo
40 >4P4 p. l i C1-1-4-17-6 e12CLi;c" 10I 1--1(...1.4 WA— .- c0 xi ec;O f
/A sr.A- G/111-4-67 L-----7 tC) c. -� --6 g LLA s. a... .i)..i,i
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R•ECEIVED BY;�/�1 (/
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 relating to building c c ze r ��gntatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: 01 / nDate: Cr'Sl' 14.! , f. ' ''
SUPPLEMENTAL INFORMATION REQUIRED i OFSt "; FCEUEONLY
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PVApp_2011.doc revised 03/16/11 ;'
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D.icuSign Envelope ID:2187507D-0655-45DE-823D-674BEDA28993 -
SMOKE/CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777=3228•FAX(408)777-3333•building a cupertino.orq
Permit No.B-2017-1536
Address 11505 Sun S e t Spring CO u r t #of Alarms Smoke: 6 Carbon Monoxide: 2
PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE
HAS BEEN SIGNED AND RETURNED TO THE BUILDING DIVISION
.�_...._..M_�..._--.._ ._ ._._:�.-.�-.�.�� _�f___._.___ _ _r._ ____ _.,...._____.._mow_.__�� ��
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 the X X
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 of1wall 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 have been tested and are operational,as of the date signed
below.
I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name: ,—Docusoyne/Id by:
e�_ �(�
Samar t_oti a Signature...S'Avga�!�..1, tit Date/15/2017
Contractor Name: 'o6a2E3258A2A476..
Signature Lic.# Date:
Smoke and CO forn:.doc revised 03/18/14
DocuSign Envelope ID:2187507D-0655-45DE-823D-674BEDA28993 r
iitVWATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
/4,,5-,.1,,>, COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildinoAcupertino.orq
Owner Name Samar Lot a Permit No. B-2017-1536
Address 11505 Sunset Spring Court, Cupertino, CA 95014
PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE
HAS BEEN Man AND RETURNED TO THE BUILDING DIVISION
Please refer tothe 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.
DocuSigned by: 9/15/2017
Owner'Signature: L Date:
lat No Go to Question 2. StutAar Witt
06A2E3258A2A476...
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?
D 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.
DocuSigned by:
9/15/2017
Owner'Signature: S ,,,' (Alia Date:
L2 No Go to Question 3.
06A2E3258A2A476...
3. Is water service permanently disconnected for your building?
O Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form.
Owner' Signature: DocuSigne4by: . Date: 9/15/2017
El No Go to Question 4. S6vAtAr WI .
05A2E3258A2A476...
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
O 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.
DocuSigned by:
Owner'Signature: SomtO" Lb Date:9/15/2017
N Yes My real property i talk-1E064=4611e for use or occupancy on or before January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 apply. Refer to the attached.
a 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).
0 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).
0 My property is a commercial real property. Sec 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 2015.doc revised 02104115
D'ocuSign Envelope ID:2187507D-0655-45DE-823D-674BEDA28993
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 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-conservintprambing fixtures comply with the requirements as indicated in the table below.
Owner's(or Owner Agent's)Signature: Stukkal'' (,bfia Date:9/15/2017
�-06A2 E3258A2A476....
Upon completing and signing this Certificate,please return 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 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 beidesigned 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 2015doc revised 02/04/15