15120088CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
10201 PHAR LAP DR CUPERTINO CA 95014 (326 39 052)
OWNER'SNAME: MA ROBERT KAND TINAM
OWNER'S PHONE: 4082528295
LICENSED CONTRACTOR'S DECLARATION
License Class B Lic. #544911
Contractor ( FARR-GILL INC ) Date 2/22/2016
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:
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.
2. 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 permit is issued.
APPLICANT CERTIFICATION
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, costs, and
expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will
comply with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
Signature L/ Date 2/22/2016
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. 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 construct the project(See.7044, Business & Professions Code)..
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
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 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 become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
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 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, costs, and expenses whichmayaccrue against said City in
consequence of the granting of this permit. Additionally, the applicant
understands and will comply with all non -point source regulations per the
Cupertino Municipal Code, Section 9.18.
CONTRACTOR: PERMIT NO: 15120088
(FARR-GILL INC)
SAN JOSE, CA 95112
DATE ISSUED: 02/22/2016
PHONE NO: 4082871221
BUILDING PERMIT INFO:
—BLDG —ELECT PLUMB
_ MECH _ RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
RECONSTRUCTION OF ADDITION DESTROYED BY TREE FROM
FOUNDATION UP (432 SQ FT).
Sq. Ft Floor Area: Valuation: $50000.00
APN Number: Occupancy Type:
326 39 052
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: PAUL O'SULLIVAN"Cao*[,
Date: 2/22/2016
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.
Signature of Applicant:
Date: 2/22/2016
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, -Sections 25505, 25533, and 25534.
Owner or authorized agent:-� —n
Date: 2/22/2016
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional
Signature Date 2/22/2016
CCIIISTRUCTION PERMIT APPLICATION
E T-DEP-r`,RTr\4 ENT -.--B-u rm-mTa owrsi b -N -- ------- --
MiUNI i Y DEVELOPK4Etq
10300TORREAVENIUE-CUP;-rR7111\C),CA85C)14-3255
CUPERTINO: (408) 777-3228 - FAX (408) 77 7-3333'- bufldjno(d�cimertino.ora
117-W CONSTRUCT IOu M; ADDITION ❑Al.-T-HP-kTl0'N / TI ❑ REVIS10N / DEF=EED CRICTIKA —T P
nolzc'r ADDRESS
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/0711MR Q OVT---?,B11ILDZR ❑ 0"W111�zRAGENT CONMKILCTIOR 01COI17?LkCTO?,AG 7 E3 A2,CT=-,-CT
COI'meAc-'Op, LICENSE: TYPE
TC
I BUS. MC
CC)I,gAxy N'ua
E -NAIL
FAX
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C -11-Y, STA —Iz, ZIP
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STREET A.DDR:- SS
CITY, STAT---, ZIP
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734 - 03
DESCRIPTON OF WOPK
CONSIMn-PE 1TOP—TES
USE
TYPIE I occ. I
SQ.FT. I
VALUATION'(S)
F-la-STO
N`.W FLOOR
DMI/O
TOTAJ-
AJEA
APIA.
I
I
NFr ARBA
I
BATKkOO!V
LFC`=`� - Oir=R.
-
- -
TK
l
- I
PORCH,Q�-.A
DECKAR-E.A.
TOTAL DECKPORaq ARSA
G -RAGE A.R7--A. DETACH
E) AT TAMH
I
VATELLING -u-qj IS:
IS A SECOND UNIT [3 YES
SECOND STORY EIYZS
I
BEING ADDED? [],\.O
ADDITION? E]NO
P?Z-.i,PPLICATj-ON 171 YES IF Y::S. FROMM:: COPY OF
PLANNrNG A 9 r-1 NO PLAM\TDqG AIPROVAL LE -TITER
ISTHE BLDG AN [3 YES
EICHLERTIOME? NO
QE I i— a
T
TOTAL VA-LUATION:
-PPL
o 0 a
By my signature belo,,v, I certiffY to each of the following: larn the property ow=r or authorized agent to Bet on the property o%vner's behalf. I have read this
application andthe information lhave prop idedis correct. I hay read the Description of Work and 1 any it is aacurate. I P-27reeto -comply with all applicable local
ordinances and State 1EWS I'CIFtiR.- to thoriz-- rtpreseniatiyes,-of Cupertino to enter the a-bovt-identifled property ior'InSpection purposcs.
Si --nature of -'pDl!canVA.E:=t:-Z
SUPPLE -Mi -ENTAL IRFORMATION REQUIRED
82-7
OF
W-1
r-
, -BL7II,DLiGYT
New SFD or MuhiAnily d-,vellings: AD -ply for de.molition D. nit Or
Cs n t -.red -orior to 'Ssijance ofbuildl'na
). e ion per. -initis rtqui
isting bj;Jd,'naol; D
ISM
PTO.
pennit for new building-.
S
Coy,nerc;ad Bldgs: Provide a completed Hazardous Materials Disclosure-
S -T
- -----
.L 0 Bl I y I-1 F-7- al CA 0 115 '-N 4 at e r i a 13 are b e in used a s p Bit o this T) r oj c t.
Copy ofPlawiing Approval Letter or -Mletting ith Planning prior to
. . . . . . .
submittal ofDuildin.g Pen -nit application.
Bidggl-pp_2011, doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS, 10201 Phar Lap Dr DATE: 1210912015
APN: BP#:
REVIEWED BY: Sean
*VALUATION-, 1$50,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE:
Addition
PRIMARY SFD or Dulex
USE: p
2nd Unit? 0 Yes G No
OTC? 0 Yes No
E)
PENTAMATION 1R3SFDADQ
PERMIT TYPE:
WORK
Reconstruction of addition destroyed
by tree from foundation up (432 sq ft).
SCOPE
hours
Plan Check, Hourly
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR,
R-3 (Custom) 11-B,111-B,1V,V-B MOO $0.00
Vech. 11hin Ch&,k
EJ L
MOTF- This Pvtimatp does not include
TOTALS: 0 $0.00 $0.00
Chect',.
e to other Departments (i.e. Planning, Public
1;f
E,ec,� Plwt
I
El I
orks, Fire, Sanitary Sewer District,
District, etc.). Thesefiees are based on the ereliminar
information available ana are omy
an estimate. uumact ine '"upt-jut ""ur,, t wiv.
FEE ITEMS (Tee Resolution 11-053 Eff 7/,7/743
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes (D No
$0.00
2
hours
Plan Check, Hourly
Suppl. PC Fee: (j) Reg. 0 OT J
0.0 1
hrs
$0.00
$286.0000
ISTPLNCK
PME Plan Check:
$0.00
Permit Fee: Hourly Only? 0 Yes (F) No
$0.00
Suppl. Insp. Fed Reg. 0 ar
oo
T—I
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
(.'�Onslrucfion
0
E)
Work Without Permit? 0 Yes (D No
$0.00
Advanced Plannjag_EeL$0.00
hours
Inspections
E)
Fees:
$858.001
-7
ISTINSP
Inspection, Hourly
0
Strong Motion Fee: IBSEISMICR
$6.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$2.00-
"Su
8.0
$ 5
$1,144.00
1
0
$1,152, 10
J
MUVjbt:W, 1U1V114V1"z
CITY OF CUPERTINO BUILDING PERMIT
BUELDING ADDRESS: CONTRACTOR: PERMIT NO: 15120088
10201 PHAR LAP DR CUPERTINO CA 95014 (326 39 052) FARR-GILL INC.
SAN JOSE, CA 95112
OWNER'S NAME: MA ROBERT K AND TINA M
OWNER'S PHONE: 4082528295
LICENSED CONTRACTOR'S DECLARATION
License Class LANDSCAPING Lic. #544911
Contractor FARR-GILL INC. Date 05/31/2017
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:
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
rformance of the work for which this permit is issued.
�•, I ve and will maintain Worker's Compensation Insurance, as provided for by
USection 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 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, costs, and expenses which
may accrue against said City in consequence of the granting of this permit.
Additionally, the applicant understands and will comply with all non -point
source regulations per Ahe Cupertino Municipal Code, Section 9.18.
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
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 construct the project (Sec.7044, Business & Professions Code).
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
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
2. 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
permit is issued.
3. 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 become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
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 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, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
Signature.
Date 3/14/2016
ISSUED: 02/22/2016
PHONE NO: (408) 287-1221
BUILDING PERMIT INFO:
—BLDG —ELECT —PLUMB
MECH RESIDENTIAL COMMERCIAL
JOB DESCRIPTION:
RECONSTRUCTION OF ADDITION DESTROYED BY TREE FROM
FOUNDATION UP (432 SQ FT)
REVISION #1 - ADD 2 (N) WINDOWS BETWEEN FAMILY ROOM
AND BREAKFAST ROOM - ISSUED 3/14/2016
Sq. Ft Floor Area: I Valuation: $50000.00
APN Number: Occupancy Type:
326 39 052
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED'INSPECTION.
Issued by: PAUL O'SULLIVAN I t�L(.t,�
Date: 3/14 2016
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without fust obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant:
Date: 3/14/2016
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 2 5, 25533, and 25534.
Owner or authorized agent:
Date: 3/14/2016
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildin cu ertino.or F4W%_~'W
CUPERTINO*9
Q NEW CONSTRUCTION F-1ADDITION ALTERRATION / TI QoeREVISION /DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS ' /) (� 6 ` 1
l k ✓c44 y,
APN #'3 Z6
OWNER NAME —
J Y Y , ONE
51 '
STREET ADDRESS �
y
C , STATE, ZIP
C .
FAX1\61
CONTACT NAME O
L/6E27,_
E-MAL/V/
STREET ADDRESS
d U
CI STTAATE,ZIP lt a
i
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR fdRME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
(� (> J
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECT/EN NAME /
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK nn
y a b
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
I DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: H DETACH
ATTACH
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
BELNGADDED? ❑NO
SECOND STORY YES
ADDITION? [:]NO
PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑YES
RECEIVED BY:
TOTALVAL ATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ 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 h le 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 bu'Iding construction. I thorize representatives of Cupertino to enter the above-idegtified property for inspection purposes.
L/-/-4
�`�,t
Signature of Applicant/Agent: G! L,L!' � Date: 5—/
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER-THE-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
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
❑ PUBLIC WORKS
_
form if any Hazardous Materials are being used as part of this project.
❑ LARGE
❑ FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
❑ .ialoR
❑ SANITARY sE1YER DISTRICT
❑ EXVIRO\MENTAL HEALTH
BldgApp_201 1. doc revised 06/21/11
0 )1%
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
&VkAllal
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc). These fees are based on the preliminary information available and are only an estimate Contact the Dept for nddn'1 info.
FEE ITEMS (Fee Resolution 11-053 Ff.' ' 1'1 3)
ADDRESS: 10201 PHAR LAP DR
DATE: 03/14/2016
REVIEWED BY: PAUL
APN: 326 39 052
Only? () Yes (F) No
BP#: 15120088
VALUATION:
Iso
PERMIT TYPE: Building Permit
Supp/. PC Fee: Q Reg. OT
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE:
$0.00
PME Plan Check:
PENTAMATION 1 GENRE
PERMIT TYPE:
WORK REVISION #1 - ADD 2 N
WINDOWS BETWEEN FAMILY ROOM AND BREAKFAST ROOM -
SCOPE ISSUED 3/14/2016
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc). These fees are based on the preliminary information available and are only an estimate Contact the Dept for nddn'1 info.
FEE ITEMS (Fee Resolution 11-053 Ff.' ' 1'1 3)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly
Only? () Yes (F) No
$0.00
77hours
$143.00
Plan Check, Hourly
ISTPLNCK
Supp/. PC Fee: Q Reg. OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? C) Yes E) No
$0.00
Suppl. Insp. Fee -0 Reg.
Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
Work Without Permit? Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
i
71'(Wel I)oc !mentation Fee
Strong Motion Fee:
$0.00
1.0 hrs
$143.00
Inspections
1STINSP 7Inspection, H rly
I31d(T Stds Commission Fee:
$0.00
SUBTOTALS:
$0.00
$286.00
TOTAL FE :
$286.00
Revis d: 01/01/2016
'WATER-CONSERVINGPLUMBING FIXTURES
OWNER CERT11FICATE OF COMPLIANCE VIL
COMM't NTY-DEVELOPMEN ?D ARTMENT•,BUILONG'D!U{StON
CllFIERTINO 10300TORREA?JENUE,—CupE1TNO.CA,95014=825:5
(408)-3228 - FAX X408) 777-3333 - bui€dng(dc s ertho.ora
Tct
Permit No,�
Owner Nam 1 !I k 9
c�. r �" I
Address ®��► �r,r fs h Y.
L Is your real property a registered historical site?
<El Yes Civil CodeSections i 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
No Go to Question 2.
2. Does your real property have a licensed plumber certifying that, due to the age or configuration of thero ertS' or its
plumbing, installation ofwater-conserving plumbing fixtures is not technically feasible? p p
❑ 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..
Skip the rest of the form and sign bottom of form,
fiu ;( No Go to Question 3.
3. Is water service permatiently disconnected for your building?
ElYes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
AlNo Go to Question 4.
4. Is your real property built and available for use or occupancy on or before fanuary 1, 1994?'
❑ No My real property is built and available for use or occupancy after January 1, 1994.
Civil Code Sections 1101.1 through 110-1.8 do not apply. Skip the rest of the form and sign bottom of form.
*Yes Ivey 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 followings
My property is asi gle 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
tube replaced with. wafer -conserving plumbing fixtures throughout the buildming. On or before January 1, 2017, all non-
compliant plumbing fixtures shall be replaced with water -conserving plumbing fimstures (regardless of whether
property undergoes alterations or improvements).
Myproperty'isam cltifamilyresidential real property. See Civil Code Section 1101.5.
Onond after January. 1, 2914,. specified building alterations or improvements shall require non. compliant
plumbing, fixtures toy be replaced with water -conserving plumbing fixtures.
On or before January 1, 2019, all non compliantplumbing fixtures shall be, replaced with water-
conserving plumbing fixtures throughout the building (regardless of wlietherproperty =, dergoes alterations or
improvements).
D 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 requite non compliant
plu mbing. fixtures to. be replaced with water.-conservingplumbing fixtures.
On or before January, 1,, 20,19;, all non-compliant plumbing fixtures shall be replaced with water- conserving.
plurnbkrg, fixtures throughout the; building (regardless of whether property undergoes alterations; or improvements}�.
I, as the awneror owner's agent of this property, certify under penalty of perjury that non-compliant plumbing fixtures will be
replaced prion to date specifted above, with water -conserving plumbing fixtures ins accordance wrth1 Civil Code Sections 110`1.1
through 1101.8, the current C`aliffomia. Plumbing Code and California Green Building Standar,&- Code,, and, manufacturer''s
installation requirements„ and that the: water -conserving plumbing, fixtures comply with the requirements, as indicated in the
table on, the followizr , a e;,
Owner or, GwnapAgent?s Si.gnature.�' Dates,,; 2-�
__ . _
Upon+ completing and3 signi g this Ceiti!ficate, please return: it to the Building Division in order toy final, your building: pemu t.
Sit9072015.doc revised 08/26/15
1. I'f the existinig pltlrabing f4x ,j e water usage/now rate is equar tom wwcr w114lu, ulu� llsul� . 'x a..,.T.- W- -ra ----.
304072015.doc revised 08126115
Non -Compliant
tftlater-'Conserving Plumbing Fixture
Plu . ffibi , ng Fixture
(Fixture Complying with Current Code Applicable`to Now 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
/Flew Mate
Single=Farnily
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
80 psi.
2.0 gallons per minute @ 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 j
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 $ 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' psis and must
1.8 gallons per minute @
default to mlaximum
60 psi
1.0 cgallamis per minute
Where faucets meeting
@ fifl psi
the above are unavailable,
Where faucets rneeling
aerators or other means
the above are
maybe used to achieve
unavamlab,'% aerators or
reduction.
other, mi ea ismaylie
used to, achieve-
u-ed'uc�€ort
1. I'f the existinig pltlrabing f4x ,j e water usage/now rate is equar tom wwcr w114lu, ulu� llsul� . 'x a..,.T.- W- -ra ----.
304072015.doc revised 08126115
ICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT ► BUILDING DIVISION F_ L
CUPERTINO
10300 TORRE AVENUE ► CUPERTINO, CA 95014-3255
(408) 777-3228 ► FAX (408) 777-3333 ► building(a.cupertino.org
WHOM
PFRIVUT C "OT EE'IR'A11'D AND COMPLETED UNTIL THIS CERTIFICATE
jftPIM
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.
GENE AlL IN, FORMATION
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
$1000.001 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
S1140K,E AJLA,-RM
C6 'At A,RM
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
j
Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances and that
do rtot 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 , dwelling units with no commercial power supply, alarm(s) may be solely battery operatedi.
In existing dwelhng units; alarms are permitfe- d to be solely battery operated where repairs or alterations do,
not result in the removal of wall and ceiling fimslles or there is no access by means of attic, basement or, crawls
space.. Refer to CR.0 Section 8314 and CBC Sections 907.2.11.4 and 420.6:2. An electrical permit is required for
alarms wl-dch mast be connected to- the burtdhag wiring..
As owner of' the abo,v,e-referenced property, I hereby certify that tine alarm(s)) refei.Yeilced above has(have bees-,
installed in accoTrdavice with the manui=acturer's ms : ctions arisd ' , eomnphi Rce with. the CaliforniaBtrrMi g,
and Califomxa Res derttital Codes. The alarms have been tested andl are operafllonal,as,of the date sign-eed
belo>w..
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