B-2016-2890CITY OF CUPERTINO BUILDING PERMIT
BU -DING ADDRESS:
10315 STERN AVE CUPERTINO, CA 95014-3643 10 049)
CONTRACTOR:
PERMIT NO: B-2016-2890
(375
GAGNE BROTHERS
ENTERPRISES INC
NOVATO, CA 94949
OWNER'S NAME: ZERANG TAHMINAH TRUSTEE
DATE ISSUED: 10/10/2016
OWNER'S PHONE: 408-8586719
PHONE NO: (415) 506-0400
LICENSED CONTRACTOR'S DECLARATION ARATION
BUILDING PERMIT INFO:
License Class AC -36 Lic. #857357
Contractor QAGNE BROTHERS ENTERPRISES INCDate 04/30/2017
X BLDG _ ELECT X PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
— MECH X RESIDENTIAL _ COMMERCIAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
I hereby affirm under penalty of perjury one of the following two declarations:
REPLACE CLEAN OUT AT BUILDING & PROPERTY LINE
1. I have and will maintain a certificate of consent to "self -insure for Worker's
-
ompensation, 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
C/ Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT
Sq. Ft Floor Area:
Valuation: $9000.00
CERTMCATION
certify that I have read this application and state that the above
APN Number:
Occupancy Type:
information i rre . I agree to comply with all city and county ordinances
and state ws relati g to building construction, and hereby authorize
375 10 049
repres tatives of t is city to enter upon the above mentioned property for
Cirsption purpos . (We) agree to save indemnify and keep harmless the
Cof Cupertino gainst liabilities, judgments, costs, and expenses which
PERMIT EXPIRES IF WORK IS NOT STARTED
TJ y accrue ag nst said City in consequence of the granting of this permit.
ditionaliy, a licant understands and will comp) with all non -point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
ource reg ation the Cupertino Municipal Co , Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
tur Date 10/10/2016
Issued by Kim Dunbar
OWNER -B lILD R DECRATION
Date: 10/10/2016
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RF�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)
z. 1, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 10/10/2016
I hereby affirm under penalty of perjury one of the following three declarations
1. I have and will maintain a Certificate of Consent to self -insure for Worker's
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
_
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 ofthe work for which this
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
permit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
3. 1 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
Worker's Compensation laws of California. If, after making this certificate of
air contaminants as defined b ht B Area Quality Management District I
will maintain complia ith the Cupertfn unicipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health Safety Code, S ns 2550 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit sha
be deemed revoked.
or authorized agen .
APPLICANT CERTIFICATION
Date: 10/10/2016
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 build: ons r tion, and hereby authorize representatives of this city
of work's for which this permit is issued (Sec. 3097, Civ C.)
to enter upo a above mentioned property for inspection purposes. (We) agree
Lender's Name
to save i emnify and kee harmless the City of Cupertino against liabilities,.
judgm ts, costs, and' ex enses which may accrue against said City in
Lender's Address
cons quence of the gr ting of this permit. Additionally, the applicant understands
and ill comply with non -point source regulations per the Cupertino Municipal
ARCHITECT'S DECLARATION
Cod , Section 9.1K,
I understand my plans shall be used as public records.
-
Signature -- "_ Date 10/10/2016
Licensed
Professional
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • build ing(a-)cupertino.org
MEP
MISC
PROJECT ADDRESS I O� / � A � � APN
OWNERN`
`Tt 1rt g �. E MAII
STREET ADDRESS ® t s CITY, STATE, ZIP FAX
®
65Q
CONTACT NAME PHONE
1 ppb
LA ( S.-1 `E' -,ISO
+t Ov EMAIL. _
STREET ADpRES�t�� CITY, STATE, ZIP FA}
®'� V1,—Tb
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME LICENSE NUMBER LIC�EE TYPE BUS. LIC #
FAX
1"ll"9Jv"" Ep@'�iCY1�L��t��1t �46'lKllll lllb'lDlPt °C
STREET ADDRESS ^ /�
T 0l4 �' i L DtLJA{—
CITY, STATE ZIP
Q`
PHONE
14M 1141 —?$®
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E -MATT.
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF FD or DUPLEX ❑ MULTI -FAMILY
PROJECT IN WIL,DLAND ❑ YES
PROJECT IN ❑.. YES
IS THE BLDG AN ❑ YES
BUILDING: ❑.COMMERCIAL
I URBAN INTERFACE AREA ❑ NO
FLOOD ZONE ❑ NO
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
LL/Ll
TOTAL VALUATION: 9000 , �� RECEIVEDBY':
By my signature below, I cerci tkg#o property owner or authorized agent to act on t1le pr erty owner's behalf. I have read this
application and thein
nation I have provided" corre t. I have re d the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state I ws relating to build' n Ion. -a Ze reds entatives of Cupertino to enter the above- denrifi d property for inspection purposes.
Signature ofApplicant/Age Date: (� is®�� (�
MEPMiscApp_2011.d6c`revised 06/21/11
+CUPERTINO
Owner Name
Address t ^ f. 1 t
1.
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE CUPERTINO, CA 95014-3255
Is your: real property a registered historical site?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
0 No Go to Question 2.
Skip the rest of the form and sign bottom of form.
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?
El 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.
❑ No Go to Question 3.
3. Is water service permanently disconnected for your building?
El 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 4.
j
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
11 No My real property is built and available for use or occupancy after January 1, 1994.
Civil Code Sections 1101.1 through 1.101.8 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 form..
5. Please check ONE of the following:
❑ 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 plumbingfixtures 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.
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 current California Plumbing Code and California Green Building Standards Code, and manufacturer's
installation requirements, and that the water -conserving. plumbing fixtures comply with the requirements as indicated in the
table on the following page. r
Owner or Owner Agent's Signature: f c- Iy / { J f,Yate e'' J C? - I
ITnon comnleting and signing this Certificate_ nlease return it to the Building Division in order to final vour building hermit.
SB407 2015.doe revised 08126115
i. it 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 2015. doc revised 08126115
Non-Compliant
ing Plumbing Fixture
Plumbing Fixturel
(Fixture Complying with Current CodelApplicab eto New Construction
Fixture Type
Maximum Water Usage/Flow Rate
2013 CPC Ch. 4
2013 CPC Ch. 4
2013 CPC Ch. 4
Water Usage
/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
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 DSi
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 maybe
used to achieve
reduction.
i. it 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 2015. doc revised 08126115
ruAr at
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 • bdldinO�cupertino:orq
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 eve 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.
Irt existingdwelling 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:
Specify Number of Alarms:
# Smoke Al
No.
# Carbon Monoxide 1
I have read and agree to comply with the terms and conditions of this statement
Owner (or Owner Agent's) Name:
7Si.gnature'� `-y` 4ate� /
....... ............... ....... (J...._.... ��.....
Contractor Name:
Signature.................................................................. Lic.# ...................................Date:
Snake and COfornz.doe revised 09/27/16