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15020002P CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10240 PHAR LAP DR CONTRACTOR: MIDEX CONSTRUCTION PERMIT NO: 15020002 OWNER'S NAME: RAMI RUBIN 2031 STAATS WAY DATE ISSUED: 02/03/2015 OWNER'S PHONE: 4082522438 SANTA CLARA, CA 95050 PHONE NO: (408) 221-4363 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ REMODEL (2) BATHROOMS 128 SQ FT TO INCLUDE License Class rry� Lic. #_9�G�f M,E,P'S f Contractor /y/ 1, SC Date 0 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: 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. Sq. Ft Floor Area: Valuation: $30000 Uave and will maintain Worker's Compensation Insurance, as provided for by APN Number: 32639026.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 80 DAYS FRO LED INSPEC IO . indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the `y Ygranting of this ermit. Additionally, the applicant understands and will ply y' with all non-po t source regulations per the Cupertino Municipal Cc , Se 9.18. Signature Date � 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 materials for inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with th Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by for the Health & Safety Code, Secti s 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work which this Owner or authorized agent: Date permit is issued. 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 CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CONSTRUCTION PERMIT APPLICAT'I®N���MaRk COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION n 02 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 y CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building a-cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION M ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESSm APN # � 2rj /,2a(�' w, pr® V OWNER NAME PHONE ��-,6 . E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX &%'2_qV CONTACT NAME PHPNE Z e E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME MI I�G LICENSE NUMBER X559- LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS zv,3 CITY, STATE, ZIP � ✓r- PHONE c• zz l -433 ARCHITECTIENGINEER NAME LICENSE NUMBER BUS. LIC # 2 COMPANY NAME E-MAIL FAX ,4. ©wnr ukr? ah�.�m STREET ADDRESS CITY, STATE, _ ZIP PHONE =5 ® Y�p I DESCRIPTION OF WORK DESCRIPTION l7r W2 elgop=tom? 14TX" I EXISTING USE PROPOSED USE CONSTR. TYPE #STORIES USE TYPE OCC. SQ.Fr. VALUATION ($) EXIST NEW FLOOR DEMO TOTAL AREA 12$ ll>6 7� AREA ® AREA NET AREA Iv BATHROOM KITCHEN OTHER REMODEL AREAI�F REMODELAREA d REMODELAREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: []DETACH OtRAT7ACH # DWELLING UNITS: IS A SECOND UNIT E] YES SECOND STORY []YES I BEING ADDED? JRNO ADDITION? fiJNO PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES :RECEIVE BY: TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? X NO 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 6ave read this application and the information I h ro ' ed read the Description of Work and verify it is accurate. I agree to comply with all applicable local �co�ave ordinances and state laws rela ' g to bu' Ing authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: 2 2 SUPPLEMENtAL INFORMATtON REQUIREDJi PLAN`CHECTCTYPE t%ouTmcsLtP -, El IOVEWTHF.COUNTER' ❑ BUILDING 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 a Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD. ❑PU13LIC wol is form if any Hazardous Materials are being used as part of this project. ❑ -- LARGE ❑ FORE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ C'MAJOR ❑, SANITARY SEWER DISTROCT submittal of Building Permit application. _ . ❑ ENVIRONMENTAL HEALTH B1dgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION imlADDRESS: 10240 phar lap dr DATE: 02/02/2015 REVIEWED BY: Mendez Plan Check Fee: APN: BP#: *VALUATION: $30,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY USE: SFD or Duplex PME Plan Check: PENTAMATION PERMIT TYPE: 1 R3SFDRE i WORK remodel 2 bathroom 128 sq ft SCOPE Suppl. Insp. Fee:Q Reg. Q OT0,0 rilecli. llerfnii Fee: (.BtiiG e rt�lrze�1?., 1r.rn. 1!.°kech, i qp3 Fee: 11'rcmb, P'laia C7:e'r Phan!, Permit 01,17erl;Wrlb Inst. ET IBr7?mbl , rsp, Fee: flee. IBhm i.zfeC?� istr c'. flemli Fee: Ohhe r Eire. Iia, ti. Elec, bisq. Fee: NOTE: This estimate does not include fees due to other Deparhnents (Le. Planning, Public Works, Fire, Sanitary Sewer District, School Dish•ict, etc.). These fees are based on the prelfminmy information available and are only an estimate. Contact the Dept.ror addn 7 taro. FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 128 s.f. Remodel, Bath (<=300 sf) $645.00 IREMRESBAT Suppl. PC Fee: Q) Reg. 0 OTT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax. A({li inistrauive T°'ee: 0 E) Work Without Permit? 0 Yes Q) No $0.00 Advanced Planning Fee. $0.00 Select a Non -Residential E) Building or Structure 0 ?;ave/ I)oc:unjentaaion Fees: Strong Motion Fee: IBSEISMICR $3.90 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC 1 $2.00 71 SUBTOTALS:`:' $5.90 $645.00 TOTAL FEET $650.90 Revised: 01/06/2015 CUPERTINO Owner Name WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 10 P (408) 777-3228 • FAX (408) 777-3333 • building(a upertino.ora ct a / ?A-141 RA, 9j Permit No, I5'0 ? 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: ❑ ' No 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: ❑ No 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: ❑ No 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. Owner' Signatur . \, Date: U rL�`�� Yes My real property i built an available for use or occupancy on or before January 1794! 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. Orr and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing Kf tur`es -be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1, 2017, all. aon-compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless whe" property undergoes alterations or improvements). ❑ yproperty 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 properly. See Civil Code Section 1101.5. On and after Januaiy 1, 2014, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. SB40 7 2014. doc revised 03118/14 S On or before January 1, 2019, all non-compliant plumbing fixtures shall b .,replaced with water conserving plumbing _fixtures throughout the building (regardless of whether property.. undergoes alte'ration's 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 fixtures co y Xithjth4,r4quirernents as indicated- in the table below. Owner's (or Owner Agent's) Signature: F Date: Upon completing and signing this Certiticate, please return it to the Building Division in order to final your permit. - ' Non -Compliant) - WatermConserving Plumbing -Fixture PlumbingFixture".',l (Fixture Complying with Current Code Applicable to New Construction) Fixture Type,;;, Maximum Water Usage/Flow Rate "`'• l 'Water Usage - 2013 CPC Ch. 4 ° CALGreen Div. 4.3 2013 CPC Ch. 4 2013 CALGreen Div. 4.3 2013 CPC Ch. 4 - 2013 CALGreen Div. Rate X12013 5.3 I Single -Family Multi -Family Commercial ./Flow Residential Residential Water Closets, IExceed 1.6 ngle 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 j 0.5 gallons/flush Gallons/flush Showerheads Exceed 2.5 X2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of gallons per minute aU.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 howerheads 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 .jallow only one ower outlet to be in operation at a time. Faucets — Exceed 2.2 gallons ^ Maximum 1. 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; !120 psi minimum 0.8 gallons per minute @ 20 psi ' In common and public use areas: 0.5 gallons per minute @ 60 psi I 1.8 gallons per minute I 60 psi Faucets — ;fExceed 2.2 gallons ¢ =1.8 gallons per minute @ 1.8 gallons per minute. 1.8 gallons per minute @ 60 Kitchen per minute 1-!60 psi @ 60 psi psi Faucets, :.May temporarily increase May temporarily 1p to 2.2 gallons per increase up to 2.2 vinute @ 60 psi, and must gallons per minute @ .14 ,?default to maximum 60 psi, and must" 1.8 gallons per minute @ . default to maximum . '60 psi 1.8 gallons per minute ' f Where faucets meeting . @ 60 psi +N the above are unavailable, Where faucets meeting fq +'jaerators.or other means the above are Imay be used -to achieve unavailable, aerators or reduction other means may 6' ,. ' used to achieve reduction 1. If the existsg plumbing fixture water usage/flow rate is equal to or lower than the fi ure shown i isfo4req wi�d,o _pgadlo SB4072014.doe revised 03/18/14