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B-2016-2837CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2837 22800 MERCEDES RD CUPERTINO, CA 95014-3920 (342 22 045) J G R CONSTRUCTION SAN JOSE, CA 95112 OWNER'S NAME: HAN ALEX SANGHUN AND GRACE JI -YOUNG TRUSTEE DTE ISSUED: 09/30/2016 OWNER'S PHONE: 408-234-0463 PONE NO: (408) 900-9999 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT O: License Class ]a Lic. #947086 Contractor J G R CONSTRUCTION Date 05/31/2018 X BLDG —ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing —MECH X RESIDENT AL _ —COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: REPAIR WATER DAMAGED FLOOR JOIST - FRONT ENTRY WAY I hereby affirm under penalty of perjury one of the following two declarations: REV#1 -FRAMING CONDITIONS PER FIELD CHANGES -ISSUED 1. I have and will maintain a certificate of consent to self -insure for Worker's 01/10/2017 Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ave 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: $8000.00 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 APN Number: O cupancy Type: and state laws relating to building construction, and hereby authorize 342 22 045 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 EXPIR KS IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point WITHIN 180 D SOF PERMIT ISSUANCE OR source regulations per Cupertino Municipal Code, Section 9.18. 1$0 DAYS FRO LAST CALLED INSPECTION. Signat e ! Date 01/10/2017 Issued by: AbbyAyende OWNEDate: R -B DER D N 09/30/2016 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 r rior to any roofing material being installed. If a roof is 1. I, as owner of the property, or my employees with wages as their sole installed without first obtainit g 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 (See.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to constrict the project (Sec.7044, Business & Professions Code). Date: 01/10/2017 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. HAZARD MATERIALS DISCLOSURE 2. 1 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 for which this California Health & Saf ty Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with t ie Cupertino Municipal Code, Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Se ction 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, shoi Id I use equipment or devices which emit hazardous 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 th the Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safe 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 agtr �-- APPLICANT CERTIFICATION Date: 01/10/2017 1 certify that I have read this application and state that the above information is CONS ZU 110k LENDING AGENCY' correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a cons ruction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this perr nit 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 AM HITRCTIS 1 understand my plans shal be used as public records. Code, Section 9.18. Licensed SiSignature Date 01/10/2017 g Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDIRE ION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 ® building(a�cupertino.m ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/ TI REVISION ORIGINAL PERMIT # l � � � ) ` 7 PROJECT ADDRESS )- eOo � ^ APN # OWNERN Z n Iv1PHONE MAIL , STREET ADDRESS CTTi STA ,ZIP, Ile FAX T� CONTACT NAME PHONE MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER-BUHAER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME`�o ®� %� --�, 'Li LIC NSE NUMBER LI NSE T E BUS. LIC # NAME E-MAIL FAX STREET ADDRi SS CITY, STATE,! IP P ONE _ ARCHITECTIENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK C- M I oz-4Z))(:)Nk - EXISTING USE PROPOSED USE CONSTR TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOMKITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: EIDETACH ❑ ATTACH I # DWELLING UNITS: IS A SECOND UNIT ❑YES SECONDSTORY E] YES BEINGADDED? ❑NO ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY: TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? E] NO By my signature below, I certify to each of the following: I aDi_ .1lie-propel owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is corre�3 ver the D cription of Work and verify it is accurate I agree t , comply with all applicable local ordinances and state laws relating to building constion. I authoriz resentatives of Cupertino to enter the above e e rerty fgr ins ection purposes. Signature of ApplicantfAgent: _ Date: SUPPLEMENTAL ORMA ION REQUIRED PLAN CHECK TYPEROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW New SFD or Multifamily dwel ' s: Appl for demolition permit for existing building(s). Demolition permit I uired 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 ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-12016-2837 22800 MERCEDES RD CUPERTINO, CA 95014-3920 (342 22 045) J G R CONSTRUCTION SAN JOSE, CA 95112 OWNER'S NAME: HAN ALEX SANGHUN AND GRACE JI-YOUNG TRUSTEE DATE ISSUED:1;09/30/2016 OWNER'S PHONE: 408-234-0462 PHONE NO: (408);900-9999 LICENSED CONTRACTOR'S D . DECLARATION BUILDING PERMIT INFO: 4 License Class 1a Lie. #947086 Contractor J G R CONSTRUCTION Date 05/31/2018 X BLDG _ELECT _PLUMB — 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 license is in full force and effect. JOB DESCRIPTION: REPAIR WATER DAMAGED FLOOR !JOIST - FRONT ENTRY WAY I hereby affirm under penalty of perjury one of the following two declarations: is 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 I erformance of the work for which this permit is issued. .' have and will maintain Worker's Compensation Insurance, as provided for by r Section 3700 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: Valuation: $8000.00 . 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 342 22 045 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 1$0 DAYS OF PERMIT ISSUANCE OR Additionally, the applicant understands and will comply with all non-point source regulations per the Cupp. Municipal Code, Section 9.18. 180 DAYS FRO LED INSPECTION. Signatur ,:=- / ate 11116/2016 Issued by: f f OWNE6 Date:O /� 4f I hereby affirm a I am exempt from the Contractor's License Law for one of the RF ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: a. 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. 1, as owner of the property, am exclusively contracting with licensed Signature ofApplicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 11/16/2016 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 z. ' 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 for which this California Health & Safety Code, Sections 25505, 25533, and 25534. i will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the permit is issued. Health & Safety Code, Section 25532(aj should I store or handle hazardous d. 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 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, 2553- , 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agerkt� APPLICANT CERTIFICATION Date: 11/16/2016 „'l _ certify that I have read this application and state that the above information is I hereby affirm that there is a const ctio ending agency 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 C.) 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 ARC HITECT'S DECLARATION and 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 Signature Date 11/16/2016 Professional From: Alex Han Address: 22800 Mercedes Rd, Cupertino, CA 95014 Re: Request for Change of Contractor, Permit #2016-2837 I, Alex Han, the owner of the said address request the general contractor for the above permit changed from Building & Home Repair Service to JGR Construction, effective 11/9/2016. regards, alex han 5"MA wvvb-AC4-L-�r -pCy- 0.6OVe 0 ftW7� f3WldTo 4dowe, s vr yvz 1d e. e-4TVe, ct q 12 f 8 X�'X s 4"" tl"I" I g. 1 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2837 22800 MERCEDES RD CUPERTINO, CA 95014-3920 (342 22 045) BUILDING & HOME REPAIR SERVICE SAN JOSE, CA 95157 OWNER'S NAME:. HAN ALEX SANGHUN AND GRACE JI -YOUNG TRUSTEE OWNER'S PHONE: 408-234-0462 LICENSED CONTRACTOR'S DECLARATION License Class a Lic. #879705 Contractor BUILDING & HOME REPAIR SERVICE Date 06/30/2018 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. 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 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 Munjgiipal Code, Section 9.18. Date 9/30/2016 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) 2. 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. 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 9/30/2016 ISSUED: 09/30/2016 PHONE NO: (408) 247-6565 BUILDING PERMIT INFO: X_ BLDG —ELECT -PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: REPAIR WATER DAMAGED FLOOR JOIST - FRONT ENTRY WAY Sq. Ft Floor Area: I Valuation: $8000.00 "N Number: Occupancy Type: 342 22 045 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: AbbyAvende Date: 09/30/2016 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: 9/30/2016 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 CodeWSecuti ns25505, 25533, and 25534. Owner or authorized agent: v Date: 9/30/2016 CONSTRUCTION LENDING AGENCY 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 CUPERTN O CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 FAX (408) 777-3333 • building aQcupertino.org NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI E3 REVISION /DEFERRED ORIGINAL PERMIT # PROIECTADDRESS 22800 Mercedes Road APN# 342-22-106 OWNER NAME Alex Han PHONE 408-234-0462 E-MAIL Alexhan@yahoo.com STREET ADDRESS 22800 Mercedes Road CITY, STATE, ZIP Cupertino, CA 950.14 FAX CONTACT NAME Kevin Coggins PHONE 408-247-6565 g p E-MAIL buiidinhomere air@p gacbell.net Kevin STREET ADDRESS CITY, STATE, ZIP FAX 1521 San Tomas Ct. San Jose, CA 95130 ❑ OWNER. ❑ OWNER -BUILDER ❑ OWNER AGENT 12 CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER El TENANT CONTRACTOR NAME Kevin Coggins LICENSE NUMBER B879705 LICENSE TYPE B BUS. LIC# 4o+� )p E-MAIL COMPANY NAME Building & Home Repair Service, Inc. E-MAILbuildinghomerepair@pacbell.net FAX 408-247-6"1565 STREET ADDRESS 1521 San Tomas Ct. CITY, STATE, ZIP San .lose, CA 95130 PHONE 408-247-6565 ARCMTECT/ENGINEERNAME N/A LICENSE NUMBER BUS, LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK Repair- like for like - floor joists that were water damaged EXISTING USE PROPOSED USE - CONSTR TYPE #STORIES - - - USE TYPE OCC• SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA - NET AREA BATHROOM. KITCHEN. OTHER REMODEL AREA REMODEL AREA. REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA UDETACH ATTACH #DWELLINGUNITS: IS ASECOND UNrr []YES SECONDSTORY []Ws ­ BEING ADDED? []NO ADDITION? ❑ NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES IVE BX7 T T V O� TION: PLANNING APPL # []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO r f`1J 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 bullArlg con stni ion.g I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent:�_ I I� 1 Date: 9-29-2016 SUPPLEMENTAL INFORMATION REQUIRED . axaisIrl tTrTr Y° _ New SFD or Multifamily dwellings: Apply for demolition permit for:,D-,-VVFR T eorllN� © BIIILIIINGY?IANAE3rEE�V existing building(s). Demolition permit is required prior to issuance of building o permit for new building. tcPlu Cj PI AYNIriC�PLANREW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure D "S'JANDARTI „ D rrB;Llcwclx a _' form if any Hazardous Materials are being used as part of this project. D s O Q �Txr DEPT AZI _ Copy of Planning Approval Letter or Meeting with Planning prior to D ��OR � D �iwrrA�� s�w�`;iuts�RlcT submittal of Building Permit application. ©.. > NVHtoIIt2T HES414 t.m..rv_ B1dgApp_2011.doc revised 06/21/11 CUPERTINO ruAr05t SMOKE I 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 • buildinq(a.cupertino.ora This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with. 2016 CRC Section R314, R315, 2016 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, R315, 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: F_ AREA SMOKE ALARM LO ALAP.AJ. j Outside of each separate sleeping area in the immediate vicinity of the X X bedroom(s) — (Smoke -alarms shall not be located within 3 feet of bathroom door) On every level of a dwelling unit including basements and habitable attics _ 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 all 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. lin existhac, 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 ,NThich 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 specified below have been tested and are operational, as of the date signed below. �y g Address: 2. X r6D K Permit No. 13_c3/�_ ���� Specify Number of Alarms: - Smoke Alamns: I .Y" I # Carbon Monoxide Detectors: f zf ! I have read and agree to comply with the terms and conditions of this statement Owner (or Owner Agent's) Name - j �/ ( A Iz;x � H � (� Dat /w Signature Si nature ...................��......... .........,?.......... ............................ �: �.......... Contractor Name: Signature.................................................................. Lica...................................... Date:.................. '1W Smoke and CO fore. doc remised 01/1012017 CUPERTINQ Owner Name WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228W (408) 777-3333 • building(tupertino.org f`I Perinit No.__ 1. Is your real property a registered historical site? I - D- 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 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? ❑ 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. ' No Go to Question 3. 3. Is water service permanently disconnected for your building? ❑ 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 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.. Please check ONE of the following: 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 niultifanidy 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. 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, as the owner or owner's agent°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 California Green Building Standards Code, and manufacturer's installation requirements, and that the water -conserving -plumbing fix es comply with the requirements as indicated in the table on the following page. _ J e o 6 I Owner or Owner Agent's Signature: "A M"M , ` - Date: _ /« $/ /`f' I upon compienng ana stgmng tuts uentrtcate, please retuni it to the buttamg liivtston in oraer to nnai your outlatng penmt. SB40 7 2015. doc revised 08/26/15 I. It the existing plumbing fixture water usage/flow rate is equal to or lower than the figure sho-,7,71i, it is not required to be upgraded. SB4072015.doc revised 08/26115 Non -Compliant Water -Conserving Plumbing Fixture —Plumbing Fixturel (Fixture Complying with Current Code Applicable to New Construction) Fixture Type Maximum Water Usage/Flow Rate 2013 CPC Ch. 4 2013 CPC Ch. 4 2013 CPC Ch. 4 Water Usage /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 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 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 y 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. I. It the existing plumbing fixture water usage/flow rate is equal to or lower than the figure sho-,7,71i, it is not required to be upgraded. SB4072015.doc revised 08/26115