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B-2016-2665 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2665 10426 AVENIDA IN CUPERTINO,CA 95014-3947(342 45 032) OWNER BUILDER OWNER'S NAME: BE QI ET AL DATE ISSUED:09/07/2016 OWNER'S PHONE:408-506-7369 PHONE NO: LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lie.# Contractor OWNER BUILDER Date X BLDG —ELECT _PLUMB MECH X RESIDENTIAL COMMERCLA:L 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. JOB DESCRIPTION: 1st FLOOR GUEST BATH&MASTER BATH REMODEL-MEP(142 I hereby affirm under penalty of perjury one of the following two declarations: SF) 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. 1 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. Sq.Ft Floor Area: Valuation:$5000.00 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 "N Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 342 45 032 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 097/2016 Issued by:Kim Dunbar Date:09/07/201 b OWNER-BUILDER D AR ATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is d4,,l 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) 2. I,as owner of the property,am exclusively contracting with licensed Signature ofApplicant: contractors to construct the project(See.7044,Business&Professions Code). Date:09/7/2016 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. I 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 forwhich this California Health&Safety Code,Sections 25505,25533,and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 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 shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous 62. 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: APPLICANT CERTIFICATION Date:09/7/2016 1 certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.) 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, judgments,costs,and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature ���'— l� Date 09/7/2016 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•buildingCaD-cupertino.org 3_ jP — / IV ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/Ti ❑ REVISION/DEFERRED ORIGINAL PERMIIT`?# PROJECT ADDRESS AN# 10426 Avenida Ln, Cupertino,CA 95014 [34]245032 OWNER NAME PHONE E-MAIL Qi He, Chris DeRoche 408-506-7369 IQHEQHE@GMAIL.COM STREET ADDRESS CITY, STATE,ZIP FAX 10426 Avenida Ln Cupertino,CA,95014 CONTACT NAME Qi He PHONE QHEQHE@GMAIL.COM STREET ADDRESS CITY,STATE, ZIP FF 10426 Avenida Ln Cupertino,CA,95014 EZ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEERNAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK Replace shower,toiler,bath tub,vanity,and flooring in master bathroom and one other bathroom. Remove the second vanity in master bathroom. Install recessed lights in master bathroom.Install ceiling fans in both bathrooms. EXISTINGUSE PROPOSED USE CONSTR.TYPE - #STORIES USE TYPE OCC.. SQ.FT. VALUATION($) EXISTG NEW FLOORDEMO TOTAL - AREA AREA AREA NETAREA BATHROOM ..KITCHEN OTHER - - REMODEL AREA REMODEL AREA REMODEL AREA 142.2 PORCH AREA DECK AREA -TOTAL DECK/PORCH AREA I GARAGE AREA: DETACH[]ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECONDSTORY ❑YES BEINGADDED? ❑NO ADDITION? []NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF - IS THE BLDGAN ❑YES RECEIVED BY; - TOTAL VALUATION: PLANNING APPL# 10 NO PLANNING APPROVAL LETTER EICHLER HOME? ©NO - w a 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 construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE RoiJ'rINc SLIP New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OYER THE-COUNTER ❑ BUILDING PLAN REVIEW 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 L7! PUBLICWORKS form if any Hazardous Materials are being used as part of this project. 0 , BARGE ❑ FIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to Submittal of Building Permit application. El MAJOR., SANITARY SEWER DISTRICT El ENvrRoNMENTA-L HEALTH BldgApp 201 Ldoc revised 06/21/11 f OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION' 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 11PIERTENt� (408)777-3228•FAX(408)777-3333•building(a).cupertino.om Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS / ,, / tfPa�/°' � (ll/ °��7 G /C� APN��Z- 1—P � , 1 L( ✓ G-t� OWNER P NAME OWNER e P'k P6C j%o- o-"ntj> &' �}b DESCRIPTION OF WORK: kP� Y1 glgier bafk Itr15f I�i'�ri�i`vtG V ° �Y et^��'U`7 k v{ sal Irk% Li tv q*-bee-A.� fiu6/i� �2a`fii i�► i, lr�S G `�c' U , We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision,signed,and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.) 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an"Owner- Builder"building permit that erroneously implies that the property owner is providing his or her own labor and material personally. 1, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. 1 am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. 2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. ,/ 3.I understand as an"Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. *" / 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 5. 1 understand if I employ or otherwise engage any persons,other than California licensed Contractors,and the total value of my construction is at least five hundred dollars($500), including labor and materials, 1 may be considered an"employer"under state and federal law. `f 6. I understand if I am considered an "employer"under state and federal law, I must register with the state and federal government,withhold payroll taxes, provide workers'compensation disability insurance, and contribute to unemployment compensation for each"employee." I also understand my failure to abide by these laws may subject me to serious financial risk. 7. l understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. 8. 1 understand as an Owner-Builder if I sell the property for whichythis permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. OwnerBuilderForn2 2010.doe revised 04114110 S 4 9. I understand I may obtain more information regarding my obligations as an"employer from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments,. and the California Division of Industrial Accidents. I also understand I may contact the California Contractors'State License Board(CSLB)at 1-800-321-CSLB(2752)or www.cslb.ca.gov for more information about licensed contractors. �/ 10. 1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. V_ 11. 1 agree that,as the party legally and financially responsible for this proposed construction activity, I will abide by,all applicable laws and requirements that govern Owner-Builders as well as employers. 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information 1 have provided on this form. Licensed contractors are regulated by laws designed to protect the public. if you contract with someone who does not have a license,the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property,you may be held'liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors,you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers'compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS:Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued,this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: q1 7 2-z,"/ ------- ---------------_---------------------------- ----------------------------------------------------------------------------- --------- (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner,the execution of which I understand is my personal responsibility, I hereby authorize the following person(s)to act as my agent(s)to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project(or Description of Work): Project Location or Address: Name of Authorized Agent: Tel No Address of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy.Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwnerBuildeYFonn 2010.doc revised 04/14/10 e F I Li EE- SMOKE / CARBON MONOXIDE ALARMS ) 30 OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ,ld1,h, T1N0 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228 FAX(408)777-3333•buiiding(a)cupertino org Permit No. 2 va 6 r x'61 S Address J-0\1 1-4 AV t l\l t .} L #of Alarms Smoke: 9 Carbon Monoxide . 3 , PERMIT CANNOT B kNALED AND COMPLETED UNTIL T ITS)Q ERT TE NMI, HSS EEN +[S AND TUFT 7R T±", 'O4'H BU-LI)I1 GDT SIJN 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 907.2.31.5 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 X X bedroom(s) 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 8314 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. I have read and agree to comply with the terms andconditionsof this statement Owner(or Owner Agent's)Name: j Si nature. ......... ......... ......... ..L.Date: Contractor Name: r Sinature...................................................................Lie.#................................... Date: i Smoke and CO form.doc revised 03/18114 I CM F 1 7 WA ER-CONSERVING PLUMBING FIXTURES 16 OW ER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUPEkTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408) 77-3228•FAX(408)777-3333 _building(a)cupertino.org Owner Name Permit No Address O H A V i OA- -- L^j 1. Is your real property a registered historical site? ❑_,Yes Civil Code Sections 1 01.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. %C( No Go to Question 2. 2. Does your real property have a licensed plumber certifying that,due to the age or configuration ofthe 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. - Skip the rest of the form and sign bottom of form. K-No Go to Question 3. 3. Is water service permanently disc onnected for your building? 0-,Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. -No Go to Question 4. 4. Is your real property built and av ' able for use or occupancy on or before January 1, 1994? ❑ No My real property is bu It and available for use or occupancy after January 1, 1994. Civil Code Sections 1 01.1 through 1101.8 do not apply. Skip the rest of the fora and sign bottom of fonn. Yes My real property is bu It and available for use or occupancy on or before January 1, 1994. Civil Code Sections 11,01.1 through 1101.8 apply. Check one of the three following statements and sign bottom of form.. 5. Please check ONE of the followin : [R' 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-cons ruing 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, pecified building alterations or improvements shall require non compliant plumbing fixtures to be replac d with water-conserving plumbing fixtures. On or before January 1,2019,all non-compliant plumbing fixtures shall be replaced with water conserving plumbing fixtures ffiroughout 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, pecified building alterations or improvements shall require non-compliant plumbing fixtures to be replac d 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 tie building(regardless of whether property undergoes alterations or improvements). I,as the owner or owner's agent o 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 Califc mia Plumbing Code and California Green Building Standards Code,and manufacturer's installation requirements,and that the water-conserving plumbing fixtures comply with the requirements as indicated in the table on the following page. Owner or Owner Agent's Signatur Date: QIS*b I Zo(t Upon completing and signing th s Certificate,please return it to the Building Division in order to final your building permit. SB4072015.doc revised 08/26/15 WILDLNGF AM .. r.. ...-,- ..-.�. -.w�M''�'�,.k�..�.^'6•`4L'^`F�+.m.Lz.u.c,u.-s.a�ux..:.��q,�,m•S.i�:� +� C, fan.Compliant Water-Conserving Plumbing Fixture Pdumbin Fl cturel (Fixture Complying with Current Code Applicable to New,Construction) HF Maxiimum Water Usa elFlow Rate Water usage 2013 CPC Ch.4 2013 CPC Ch.4 2013 CPC Ch.4 /Flow Fate 201.3 CALGreen Div,4.3 2013 CALGreen Div.4.3 2013 CALGreen Div. 5.3 Single-Family Multi-Family Commercial Exceed 1.6 Residential Residential Single flush toilets: 1.28 gallons/flush Gallons/flush Dual flush toilets: 1.28 gallons/flush effective flush volume (the composite, avera e flush volume of two reduced flushes and one full flushExceed 1.0sh0.5 gallons/flush Exceed 2.5 .0 gallons per minute @ 80 psi. Also°certified to the performance criteria of gallons per minute .S. EPA WaterSense Specification for Showerheads t hand-held shower is considered a showerhead.) For multiple Showerheads serving one shower,the combined flow rate of all howerheads and/or other shower outlets controlled by a single valve shall not ' xceed 2.0 gallons per minute @ 80 psi,or the shower shall be designed to How only one shower outlet to be in operation at a time. Faucets- Exceed 2.2 galions aximum 1.5 gallons per Within units: 0.5 gallons per minute @ 60 Lavatory per minute r iinute @ 60 psi; minimum Maximum 1.5 gallons psi Faucets .8 gallons per minute @ per minute @ 60 psi; 0 psi minimum 0.8 gallons per minute @ 20 psi In common and public use areas: 0.5 gallons l per minute @ 60 psi ( 1.8 gallons per minute 60 psi Faucets– Exceed 2.2 gallons —1.8 aallons per minute @ 1.8 gallons per minute 1.8 gallons per minute @ 60 Kitchen per minute 63 psi @ 60 psi psi Faucets N lay temporarily increase May temporarily u to 2.2 gallons per increase up to 2.2 inute r13 60 psi, arid must gallons per minute @ d fault to maximum 60 psi,and must 18 gallons per minute @ default to maximum 60 psi 1.8 gallons per minute �1 fhere faucets meeting @ 60 psi t e above are unavailable, Where faucets meeting a rators or other means the above are may be used to achieve unavailable, aerators or reduction. other means may be used to achieve reduction. 1. 1. If the existing plumbing fixture water uskg e/flow rate is equal to or lower than the figure shown,it is not required to be upgraded. f SB407 2015.doc revised 08/26/15