14110134�1
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 859 FERNGROVE DR
CONTRACTOR: DEMPSTER PLUMBING
PERMIT NO: 14110134
OWNER'S NAME:
SAN JOSE, CA 95110
PHONE NO: (408) 295-3911
Xr LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
COPPER REPIPE
License Class L Lic. # 'ge1-s-cly-
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Z1`u''��..(-11&ih_J
Contractor,D--n Date
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
erformance of the work for which this permit is issued.
Sq. Ft Floor Area:
Valuation: $8400
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 37539047 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
ES IF RK IS NOT STARTED
PERMITtODAYS
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN F P RMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enterupon the above mentioned property for inspection purposes. (We) agree to save
180 DAYAST ALLED INSP CTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Issued by: Date:
granting of this permit. Additionally, the applicant understands and will comply
with all non-point sour g tions per the Cupertino Municipal Code, Section
9 18.
/
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RE-ROOFS:
Date (l/ Zz%( ��
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 the Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, 25534. %
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date: / /_/e__ / eY l
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
CUPERTINO
@Ini
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 22I,� MISC
(408) 777-3228 • FAX (408) 777-3333 • building cDcuper ino.orq L4 f I ol3 I
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PROJECT ADDRESS
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OWNER -BUILDER ❑ OWNER AGENT
`CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CZTRACTOR
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FAX
C/f✓L`-T�4DVOESS
CITY, J E, ZIP �
PHONE
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY
BUILDING: ❑ COMMERCIAL _
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
f
TOTAL VALUATION: O
RECEIVED 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 ct. 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 b 'lding onstruc o . I authorize representatives of Cupertino to enter the above-identifie property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED,
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OFFICE USE ONLY
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STANDARD
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{MAJOR
MEPMiscApp_2011.doe revised 06/21/11
CITY OF CUPERTINO
W-0 FEE ESTIMATOR — BUILDING DIVISION
859 ferngrove dr
FEE
DATE: 11/24/2014
REVIEWED BY: Mendez
IlaADDRESS:
APN:
I BP#:
*VALUATION: 1$8,400
*PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Duplex
USE:
PME Plan Check:
PENTAMATION 1RPRP
PERMIT TYPE:
WORK
repipe
SCOPE
[7r
APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES
Re -Pipe Interior A 1PRREPIPE 1 # $14
TOTALS: $14.00
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
I)ivtr;rt ,tr ) Thavo fope arp haead nn tho nrolimim"n) i"fnrmtin" .H.hl, and .— ."h, — octiiv.nta r—i—i j1h, n i f— ndl. 11 ;.,r -
FEE ITEMS (Fee Resolution 11-053 Eff 711113)
FEE
QTY/FEE--
MISC ITEMS
1'16yri P'ee:
S1,"I')PI" 'I"C P",
PME Plan Check:
$0.00
PME Unit Fee:
$14.00
PME Permit Fee:
$48.00
Con.w"'I'icilon 7,UV.,
T
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? 0 Yes 0 No
$0.00
Travel Documentation Fee: ITR,4VDOC
$48.00
Strong Motion Fee: IBSEISMICR
$1.09
Select an Administrative Item
131da Stds Commission Fee: IBCBSC
$1.001
rim-, Nw�.Alw_
$157.09
$0.00 L FEE:
$157. L9
Revised: 10/01/2014
CUPERTINO
Address
SMOKE / CARBON MONOXIDE ALARMS FILE
OWNER CERTIFICATE OF COMPLIANCE r�
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • building(alcupertino.ora I ILl I , t-a tf
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
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
CSC 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.
d have read and arrree to cmmnly with the terms and conditions of this statement
Owner (or Owner Agent's) Name:
N Hi
nature ..........:......... . ............................... Date:
Contractor Name: �
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Si natur Lic.# .. 91 .. Q../........... Date: .... .. .
Smoke and CO form.doc revised 03118114
/�
CUPERTINO
Owner Name
Address
WATER- CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • building cDcupertino.org
BILE
ILo(3�
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:
EkNo 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:
ANo 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:
64,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 fonn.
0\Yes
Owner' Signature:
Date:
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. Refer to the attached.
(2�, 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 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.
SB4072014.doc revised 03118114
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 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 comply with the reqHt2jjjents as indicated in the table below.
Owner's (or Owner Agent's) Signature: Date: 4
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 Fixture
(Fixture Complying with Current Code Applicable to New Construction)
Maximum Water Usage/Flow 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,
Wherefaucets meeting
aerators or other means
the above are
maybe used to achieve
unavailable, aerators or
`reduction.,
other means maybe
used to achieve
reduction,
1. If the existing plumbing fixture water usage /flow rate is equal to or lowe'r.than the figure shown, it is not required to be upgraded.
SB4072014.doc revised 03118114