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15080147CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7612 RAINBOW DR
CONTRACTOR: MIKE COUNSIL
PERMIT NO: 15080147
PLUMBING INC
OWNER'S NAME: LEWIS HELEN L TRUSTEE
1915 O'TOOLE WAY
DATE ISSUED: 08/19/2015
OWNER'S PHONE: 4082534443
SAN JOSE, CA 95131
PHONE NO: (408) 272-4900
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
)/ -
�
REPLACE (E) BUILDING SEWER (NO SANITARY)
License Class � i0 Lic. 4—i63-1?
Contractor ate lid 1.57
I hereby a rm tha I am licensed under the provisions of Chapter 9
(commen ng with ection 7000) of Division 3 of the Business & Professions
Code and at my cense 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
Sq. Ft Floor Area:
Valuation: $14741
performance of the work for which this permit is issued.
lltrre 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
APN Number: 36611036.00
Occupancy Type:
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
180 AYS FRO LED INSPEC ION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
C
Iss Da /
granting of this permit. Additionally, the applicant understands and will comp y
source regulations per the Cupertino Municipal Code, Sec
with all no7�R
9.18.
SignatureDate/ �j
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.
❑ O�E-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
1, 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)
1, 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.
12 and
will maintain compliance with the Cupertino Municipal Code, Chapter 9�jW
I have and will maintain Worker's Compensation Insurance, as provided for by
25505, 25533, and 25534.
the Health & Safety Code,PRUCT
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agentDate:
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
Compensation laws of California. If, after making this certificate of exemption, I
CONSON LENDINGAGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must
I hereby affirm that there is aonst ction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked.
work's for which this permit i iss d (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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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
_............................... .
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 •FAX (408) 777-3333 • build! na(a)cuoertino.org rh����
CUPERTENt� (J m I�
OPLUIvIBING ❑ MECHANICAL ❑ ELECTRICAL ❑ 1,4ISCELLA2,1EOUS
PROJECT ADDRESS f_ G► R.OL�Y1 d/ O �� • I APN n 0 3 6
ONTJNER NAME !/ /7 , j " E-NLAIL
STREET ADDRESS CITY, STATE, ZIP FAX
Lk
CONTACT NAME � s
PHONE O � � � � � � O E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ owmER-BuiLDER ❑ mNERAG•m\7 CO>*IRACTOR ❑ COhTRACTORAGENT ❑ ARCHITECT ❑ ENGAMER ❑ D--,,cLOPIIt ❑ T=? e]vP
CONTRACTOR T ,hF + Q! I C LICENSE ' l / LICE TYPE �`
6 6
I BUS. LIC:
,
COMPANY N. i E-MAIL
FAX
1 -
STREET ADDRESS I S O e CITY, STSTB� ZIP !"T j�Ci 5-1-61
J
PHONE n _ dO
L
ARCHITECT/ENGINEERNAME I LICENSE NUMBER
BUS. LIC
COMPANY NAME
E-MAIL
I FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF FD or DUPLEX ❑ MULTI-FANELY . I . PROJECT LN wIIALAND ❑ YES PROJECT IN ❑ YES
BUIIDAG: ❑ COMMERCIAL URBAN'' L+QTERFACE AREA ❑ I'm FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
Lk,1
TOTAL VALUATION: / �::
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the s behalf. I have read this
application and the information I a rovided is correct. I have read the Description of \TJork and verify it is agree to comply with all applicable local
ordinances and state la��'s relating o bu ing cons ction. I authorize representatives of Cupertino to enter abo 'e-identifi d property for inspection purposes.
Signature ofA.pplicant/Agent: Date: 2
SPLEA NTAL WFOR-MATIONr REQUIRED
r
.,.. �OFFICEgLSE:OI�L1,� K..
IS
01 -IT
AfEPA1iscA4pp_2011.doc remised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
APPLIANCE / EQUIP TYPE
7612 RAINBOW DR
DATE: 08/19/2015
REVIEWED BY: MELISSA
IlaADDRESS:
APN: 36611036
BP#:
*VALUATION: 1$14,741
*PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
I
PENTAMATION 1 RPSS
I PERMIT TYPE:
WORK
REPLACE Q BUILDING SEWER NO SANITARY
SCOPE
suppl. Imp Fee
APPLIANCE / EQUIP TYPE
FEE ID
1-7ec. flan Check
Nec. 1'ermif Fee
QTY
UNITS
BP FEES
Sewer, Building
1PRSEWER
1
#
$25
Permit Fee:
suppl. Imp Fee
PME Unit Fee:
$25.00
PME Permit Fee:
$48.00
Construction :Tar:
Administrative Fee: IADMIN
$45.00
Work Without Permit? ® Yes (E) No
$0.00
TOTALS:
N* ;
$25.00
Strong Motion Fee: 1BSEISMICR
;llech. !'tart (:'heck
tlech. Permit Fee:
Other .t tech. fru -
Plumb. Plan Check 0.0 1 hrs $0.00
Plumb. Permit Fee: 1PPERMIT
Other Plumb Insp. 0.0hrs $48.00
1-7ec. flan Check
Nec. 1'ermif Fee
ollter h lec. insp.
Plan Check Fee:
;14ech. Insp. Fee: I /'/urnh. Irish Fee: I Flee. Insp. Fee:
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
rli.irini of, 1 Th— foo. pro hn.od nn fho nrolimiwanr infarmntinn avnilahlo and am nnly nn ostimato_ 1-a"tact tho Dont for addn'1 info -
FEE ITEMS (Fee Resolution 11-053 E . 711/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
Suppl..PC:' Fee
PME Plan Check:
$0.00
Permit Fee:
suppl. Imp Fee
PME Unit Fee:
$25.00
PME Permit Fee:
$48.00
Construction :Tar:
Administrative Fee: IADMIN
$45.00
Work Without Permit? ® Yes (E) No
$0.00
Advanced Planning Fees:
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: 1BSEISMICR
$1.92
Select an Administrative Item
Bldg, Stds Commission. Fee: 1BCBSC
$1.00
$168.92
$0.00© 4'
$168.92
Revised: 07/02/2015
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 cDcuoertino.org
a 15 5
LJ- �
-4-1
Address
# of
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
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 alarms) 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 vrith the terms and conditions of this statement
(or Owner Agent's) Name:
Z
nature........G................................... Date: .. .......
C tractor Name:
Signature... ......... ........... Lic.#...................................... Dat e?/Jt,
Puyvk 161 Y11 \\j Smoke and CO form.doc revised 03/18/I4
1 LU
CUPERTINO
Owner Name
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 77��7-pp3228 - FAX (408) 777-3333 • buildina(&cuaertino.org
117
JAC) IPV) Permit No. 1 S G
Address �l� � 1r\ X1gA
PERNUT CANNOT BE FINALED AND CONtPLETED 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:
INo Go to Question 2.
Date:
ql�a�� �s.
FILE
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 110 1. 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:
11"'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' Signature: Date:
/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. 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 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.
SB407 2015. doc remised 02/04/15
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 r
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 alifomia Green Building Standards Code, and manufacturer's installation
requirements, and that the water-conse lu ixtures compl ith the requirements as indicated in the table below.
Owner's (or Owner Agent's) SignatureDate:
Upon completing and signing this"�e, please returl'i it to the Building Division in order to final your permit.
\j
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 2015.doc revised 02/04/15
Non -Compliant
Wa ing Plumbing Fixture
Plumbing Fixture
(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 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 2015.doc revised 02/04/15