B-2017-0303CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0303
19987 TWILIGHT CT CUPERTINO, CA 95014-2304 (316 31037)
WILLOW GLEN
ELECTRIC INC
SAN JOSE, CA 95155
OWNER'S NAME: GOGINENI KAMALAKAR AND SUDHAMSA
DATE ISSUED: 02/23/2017
OWNER'S PHONE: 408-859-3906
PHONE NO: (408) 289-9725
TRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C-10 Lic. #591918
Contractor WILLOW GLEN ELECTRIC INC Date 04/30/2018
X BLDG —ELECT _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) EV CHARGING STATION (50 AMP) GARAGE
I hereby affirm under penalty of perjury one of the following two declarations:
r. 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.
�� 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
Sq. Ft Floor Area:
Valuation: $2090.00
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
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
316 31 037
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 02/23/2017
Issued by: Kim Dunbar
OWNER DECLARATION
Date: 02/23/2017
-BUILDER
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
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. I, as owner of the property, am exclusively contracting with licensed
Signature ofApplicairt:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 02/23/2017
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. 1 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
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
s. 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
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person any manner so as to become subject tthe
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, Sections 25505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:.tel f
APPLICANT CERTIFICATION
Date: 02/23/2017
I certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
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,
Lender's Address
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
ARCHITECT'S DECLARATION
and will comply with all non -point source regulations per the Cupertino Municipal
I understand my plans shall be used as public records.
Code, Section 9.18.
Licensed
Signature Date 02/23/2017
Professional
0 4-
CUPERTINO
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT * BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014.3266 A
(408) 777-3228 - FAX (408) 7773333
PROJECT ADDRESS q U11 1_ I (
2 4T "M pq— 7
—4
APN#-31(o — 31 —
OWNER NAME
A
STREET ADDRESS
16 CT.
M STATE, iZIP
j., QA
CONTACT NAME Mark Londre
PHONE (408)289-9725
I E-MAIL office C&wIllowglenelectric.com
STREET ADDRESS p
0. Box 8430
CITY, STATE, ZIP San Jose, CA 96155 1
FAX (408)289-9725
El OWNER
11 OWNER 13 OWNER-BUILDFR OWNER AGENT VCONTRACTOR 13 CONTRACTOR AGENT 1:1 ARCHITECT 13 ENGINEER 0 DEVELOPER 0 TENANT
CONTRACTOR NAME Mark Londre
LICENSE NUMBER 591918
LICENSETYPE c -lo
BUS. LIC ff 15897
COMPANY NAME Willow Glen Electric, Inc.
E-MAIL office @willowg lenelectric COM
FAX (408)289-9725
STREET ADDRESS P. 0. Box 8430
CITY. STATE, ZIP San Jose, CA 95155
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 SFD or Duplex [I Multi-F77
STRUCTURE: ❑ Commercial 7
PROJECT IN WILDLAND
URBAN INTERFACE AREA ❑ Yes ❑ No
PROJECT IN
FLOOD ZONE F1 Yes El No
❑ SOLAR PANELS
_7
ELECTRIC VEHICLE CHARGING STATION
0 SOLAR WATER HEATING
11 OTHER:
FOR SOLAR PANELS, NUMBER OFPANFLS/UNITS: KILOWATTS (COMMERCIAL ONLY):
TOTAL VALUATION:,* 21
0 CID
DESCRIPTION OF WORK Electric Vehicle Charging Circuit: P)taMISH IA)!�,7A-u_ !yD?q%4p
A,(:7 �- iF 1 'fS CA /"Z &Z— Is
vED
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 construwizetepr es 'yes of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: PSve Date: C2 —
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
W
CI OVER-THFCOWN'TER
EXPRESS.
FSTANDARD
E3
171 MAJOR
PVApp_.2011.doc revised 03116111
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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 • building(Dcupertino.oM
Permit No.B-2017-0303
Address 19987 Twilight Court # of AIarms Smoke: 5 Carbon Monoxide: 1
PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE
HAS BEEN SIGNED AND BETTL D TO 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 8314, 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 907.211.5 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
bedroom(s)
X
X
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 have been tested and are operational, as of the date signed
below.
1 haves read and aaree to comply with the terms and conditions of this statement
Owner (or Owner Agent's) Name:
Docuftned by:
Kamal Go i neni
Si natur.................. I ....... Dat�/2.5.120
Contractor Name:
D782F18FCE9742A...
Sinature ..................... .............................................. Lic.#......................... ............ . Date:...................
Smoke and CO fornt.doc revised 03118114
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WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
CUP EiiTiNO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 • buildinaC&cupertino.org
Owner Name Kamal Gogi neni Permit No. B-2017-0303
Address 19987 Twilight court, Cupertino, CA 95014
)PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE
HAS BEEN SIGNED AND RETURNED TO THE BUILDING DIVISION
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 110 1. 1 through 1101.8 do not apply. Sign below and skip the rest of the form.
Owner Signature: Date:
DocuSigned by: 2/25/2017
�
1:9No Go to Question 2.E ,J\�%�i
18FCr:9742A
2. Does your regi 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.
DocuSigned by: 2 /2 5/2017
Owner' Signature: Date:
13 No Go to Question 3.
ED782F18FCE9742A
3. .Is water service pennanently disconnected for your building?
El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form.
Owner DocuSigned by:
Signature: �v Date: 2/25/2017
13 No Go to Question 4. �
D782F18FCE9742A...
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
0 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: ' (- Date: 2/25/2017
® Yes My real property i a miei 4able for use or occupancy on or before January 1, 1994.
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.
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).
❑ My property is a multifan dly 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 coni»iercial 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.
SB4072015.doc revised 02104115
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DocuSign Envelope ID: 9115CAA1-6F21-4E46-88EE-3CC38A24D74B
R
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).
UWe, 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 -cons fix es comply with the requirements as indicated in the table below.
Owner's (or Owner Agent's) Signature Date.
Upon completing and signing this Certificate, please return it to the Building Division in order to final your permit.
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 2015Aac revised 02104115
Non -Compliant
Water -Conserving Plumbing Fixture
Plumbing Fixturel
(Fixture Complying with Current Code Applicable to New Construction)
Maximum Water Usa elFlow Rate
Fixture Type
Water Usage
2013 CPC Ch. 4
2013 CPC Ch. 4
2013 CPC Ch. 4
/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
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 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 2015Aac revised 02104115