B-2016-2278 CITY OF CUPERTINO BUILDING PERMIT
13UILDINGADDRESS: CONTRACTOR: PERMIT NO:B-2016-2278
10261 PHAR LAP DR CUPERTINO,CA 95014-1115(326 39 048) A R S AMERICAN
RESIDENTIAL
SERVICES OF
CALIFORNIA INC
MEMPHIS,TN 38120
OWNER'S NAME: REINHARDT PHYLLIS L TRUSTEE DATE ISSUED:07/08/2016
OWNER'S PHONE:408-446-0346 PHONE NO:(901)271-9700
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-36 Lic.#765155
Contractor R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INCX BLDG ELECT X PLUMB.
Date 07/3112018 MECH X RESIDENTIAL_COMMERCIAL
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 JOB DESCRIPTION:
license is in full force and effect. REPLACE WATER HEATER.
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.
'1_ I have and will maintain Worker's Compensation Insurance,as provided for by
ection 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$3000.00
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above APN Number: Occupancy Types
information is correct.I agree to comply with all city and county ordinances 326 39 048
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 PERMIT EXPIRES IF WORK IS NOT STARTED
City of Cupertino against liabilities,judgments,costs,and expenses which WITHIN 180 DAYS OF PERMIT ISSUANCE OR
may accrue against said City in consequence of the granting of this permit.
Additionally,the applicant understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION.
source regulations per the Cupertino Municipal Code,Section 9.18.
Issued by:SEAN HATCH
Signature Date 7/8/16 Date:07/08/2016
OWNER-BUILDER DECLARATION RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of the' All roofs shall be inspected prior to any roofing material beii ig installed.If a roof is
following two reasons: installed without first obtaining an inspection,I agree to remc ve all new materials for
1. I,as owner of the property,or my employees with wages as their sole inspection.
compensation,will do the work,and the structure is not intended or offered for
sale(Sec.7044,Business&Professions Code) Signature of Applicant:
2. I,as owner of the property,am exclusively contracting with licensed Date:7/8/16
contractors to construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A" R 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 HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued. I have read the hazardous materials requirements unde•Chapter 6.95 of the
2. I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,2553:3,and 25534. I will
Section 3700 of the Labor Code,for the performance of the work for which this maintain compliance with the Cupertino Municipal Code Chapter 9.12 and the
permit is issued. Health&Safety Code,Section 25532(x)should I store or handle hazardous
3. I certify that in the performance of the work for which this permit is issued,I material. Additionally;should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the 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
Worker's Compensation laws of California, If,after making this certificate of the Health&Safety Code,Sections 25505,2553 ,and 25534.
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
Owner or authorized agent:
be deemed revoked. Date'7/8/16
APPLICANT CERTIFICATION CONSTRUCTION LEND
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agen y 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 .)
relating to building construction,and hereby authorize representatives of this city Lender's Name
to enter upon the above mentioned property for inspection purposes. (We)agree
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 DE LA TION
ands°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
GENERAL MIT APPLICATIONIVIEP
COMMUNITY DEVELOPMIENT DEPARTMENT a BUILDING DIVISION'
10300 TORRE AVENUE a CUPERTINO, CA 95014-3255
II'E TIIN S. (408)777-3228- FAX(408)777-3333•bui(ding cJ.cupertino.org
LN11SC
UMBING ❑MECEANIC:AL []ELECTRICAL ❑1`4ISCELLANEOUS
PROJECT ADDRESS (6 4 0 �l ` 1 APN t'
OWNER NAA $
d N ati.
PHO E-
_ • '`P 1 (r
STREET ADDP.E S CITY-STATE,ZIP n FAY
CONT,-CT NAME-"' PHONE, v'( 9 ^ �
encs Yqir��
STREET ADDRESS CITY:S TE, ZIP
b '� fir' cvt„'�p _ g S`f FAx
❑ o)Vn.ER ❑ OA'NER-BUILDER ❑ OA'NER.AGENT J[p CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVEL PER ❑TENANT
CONTRACT NAr�ME LICENSE NUMBER LICENSE TYPE BUS.LIC n
COMPANY-'.MF E-MAIL
co,�
FAX
�-(L-S
STREET A.DDRE� CITY,STATE-ZIP PHCQ0
ARCHITECT/ENGINEER N AME TLICENSE NUMBER
BUS.LIC
C01\1P.ANY NAME E-NIAIL
FAX
STREET ADDRESS CITY,STATE,ZIP
PHONE
USE OF _I91I•SFD orDUPLEX ❑ MULTI-FAMILY PROJECT LN WILDLA.N'D ❑ ITS PROJECT IN ❑YES 'IS THE BLDG AN ❑1-ES
BLZLDIIJG: COR�ih7ERCL4l URBAN INTERFACE AREA NO FLOOD ZONE `�NO I EICHLER HOME? NO
DESCRIPTION OF AVORK --
TOTAL VALUATION: 5 Q c) 0 RECEIVEDB3 u
y
By my signature below,I.certify to each of the following: I am the properly owner or authorized agent to act on the property owner's behalf. I have read this
application and the information 1 have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with aII app icable local
ordinances and state laws relay I authorize represe fives of Cupertino to enter the above-identified property for 111SPeCtIOT purposes.
Signature of Applicant/Agent: Date: Z.
SUPPLEMENTAL INFORMATION REQUIRED
FFICB USE leLi j.
OE ERTIiE C3UhER
" 0;fiJsPRESS
❑:sTAnZ3.A.RD i
z�
'3 CI TTAJOR ' _
AfEPAliscflpp 2011.doc r-el ised 06/21/110
WATE -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CL��EI CNS 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
f 40 7- 228• FAX )777-3333•building(a?cupertino.org
Owner Name ! Fermin No. A—gip 6 —z_-z�p
Address
kAv—
I Is your real property a registered historical site.
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
<<O Go to Question 2.
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.
�J 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.
Go to Question 4.
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. 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..
5.1%Ple e check ONE of the following:
My property is a single-family residbntial real property. See Civil Code Section 1101.4..
Ori 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).
El 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-compli :,-
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- g
plumbing fixtures throughout the building(regardless of whether property undergoes alterations or imp e
I,as the owner or owner's agent of this property,certify under penalty of peijury 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 thaLithe water-coq&ePA4gpluilibing fixtures comply with the requirements as indicated in the
table on the f6llowing page.
Owner or Owner Agent's Signature: Date: jy71 2. 6
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit.
SB4072015.doc revised 08126115
��;
..,..-v_2. �.,.--^,. fi-�..Hs..-,,,,.� w' TIMIS
`7.' .7
,,:..,....._.
- Non-Compliant Water-Conserving Plumbing Fixture
—Plumbing F'ixturel (Fixture Complying with Current Code Applicable to New Construction)
Fixture Typeaximum1later LisagelFiow Hate
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 1iesldential
Water Closets Exceed . ; Single flush toilets: 1.28 gallons/flush
(Toilets) Gallons/flush Dual flush toilets: 1.28 gallons/flush effective flush volume(the composite,
Urinals avert e flush volume of two reduced flushes and one full flush
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 D.S. IPA 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 a eration at a time.
Faucets— Exceed 2.2'gallo!;s ; Maximum 1.5 gallons per Within units: 0.5 gallons per minute @ 54
Lavatory per minute i minute @ 60 psi; minimum Maximum 1.5 gallons psi
Faucets l 0.8 gallons per minute @ per minute @ 60 psi;
20 psi minimum 0.8 gallons
per minute @ 20 psi
1
In common and public
( use areas: 0,5 gallons
per minute @ 60 psi
s 1.8 gallons per minute
60 psi
Faucets— Exceed 2.2 gallons 11.8 gallons per minute @ 1.8 gallons per minute 1.8 gallons per minute @ 60
kitchen per minute 00 psi @ 60 psi psi
FaucetsMay temporarilyincrease May temporarily
jp to 2.2 gallons per increase up to 2.2
l minute @ 60 psi,and must gallons per minute @
I default to maximum 60 psi,and must
� 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
maybe used to achieve unavailable, aerators or
reduction. other means may be
i 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 08126/15