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B-2017-0120CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0120
7611 SQUIREWOOD WAY CUPERTINO, CA 95014-5054 (362 27 008) TOP CONSTRUCTION
EDGEWATER, FL 32132
OWNER'S NAME: LEE DI ET AL DATE ISSUED: 01/24/2017
OWNER'S PHONE: 408-996-1694 PHONE NO: (408) 892-3449
LICENSED ONT TOR' DECLARATION BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRACTOR Lic. #680832
Contractor TOP CONSTRUCTION Date 11/30/2017
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
performance of the work for which this permit is issued.
,2' I have and will maintain Worker's Compensation Insurance, as provided for by
-,,,E% Section 3700 of the Labor Code, for the performance of the work for which this
1 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 Municipal Code, Section 9.18.
Sig_naiun % Date 1/24/2017
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.
3. T 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 11241207
X BLDG —ELECT _PLUMB
X MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
REPLACE WOOD FIREPLACE TO GAS; INSTALL GAS LINE
Sq. Ft Floor Area: I Valuation: $9500.00
APN Number: Occupancy Type:
362 27 008
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Abby A e� tide
Date: 01/24/2017
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: 1/24/2017
. 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 ;C/o�de�, Sections 25505, 25533, and 25534.
Owner or authorized agentf !'7'
Date: 1/2412017
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 T'S D . RATION
I understand my plans shall be used as public records.
Licensed
Professional
•
b- IT ®12o
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333.• building(ftupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION/ DEFERRED ORIGINAL PERMIT #
PROJECT G ADDRESS
"7 f/ S Gt:.r L'1N���9 I.✓� i
APN # 21— o /y o
l'ilXl
OWNER NAME
PHONE
E-MAIL
STREET ADDRESS
?(I>f S(Si i �l���� kV4'r
CITY, STATE, ZIP
1P(51� • &0 Gf
FX
CONTACT NAME
M (r f =Z--I-C 7`f rdV�.i S
PHONE
E-MAIL
STREET ADDRESSCITY,
I <n c, 6�� -oAo ✓�
STATE, ZIP
��Gt ks�l-�h Fi- 32/32
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
ACIL r�6�.f(�/z-i (�s�r,
LIC SE NUMBER
LICENSE TYPE
BUS. LIC #
31.5-r8
."ll(C
© 2_
ii c 1
COMPANY NAME
E-MAILFAX
G/ omQ4,11 Gv /
ST ET ADDRESS
© fLAO
CITY STATE, ZIP
' C w4/-Z�h C L 3.)-1 3 2
PHONE
2©?- 2 � f 9
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
7-0 GX S . %� r''i 10 U C-4-( S I'L. 13 /L i W ,i, "
M- C a4,I[-� `_.0 c -am -L 4- rI jVFLL VL -t-, f"f YFL �t/E"Z.
EXISTING USE
PROPOSED USE CONSTR
TYPE
# STORIES
I
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
PORCHAREA
DECKAREA
TOTAL DECK/PORCHAREA
GARAGE AREA: DETACH
❑ ATTACH
I
# DWELLING UNITS:
IS A SECOND UNIP ❑ YES
SECOND STORY ❑ YES
BEING ADDED? []NO
ADDITION? []NO
-
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
RgUIVED BY-
TOjFAL VALUATION:
PLANNING APPL # F]NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO
+
AL
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act o 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, v)bb�uilding 0 ction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applieant/Agent: // / ff` � Date: 2--y / -7
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER-THE-COUNTER
El 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
11 MAJOR
El SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
B1dgApp_2011.doc revised 06/21/11
CUPERTINO
SMOKE CARBON MONOXIDE ALARMS
OWNER, CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORR8 AVENUE • CUPERTINO, CA 95014-3255
(408) 777-32 • FAX (408) 777-3333 • buildinga-cupertino.ord
PURPOSE
This affidavit is a self -certification for f ae 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:
AREA
SMOKE ALARM
CO ALARM
Outside of each separate sleeping area in the
bedroom(s) - (Smoke alarms shall not be located
immediate vicinity of the
within 3 feet of bathroom door)
X
X
On every level of a dwelling unit includin4
basements and habitable attics
X
X
Within each sleeping room
I
X
_
J
Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances and that
do not have an attached garage. Carb n monoxide alarms combined with. smoke alarms shall comply with
CBC Section 420.6 and shall be approv d by the Office of the State Fire Marshal.
Power Supply: In dwelling units with ' o commercial power supply, alarm(s) maybe 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 fetishes 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 th 6 building wiring.
As owner of the above -referenced pro erty, I hereby certify that the alarm(s) referenced above has/have been
installed in accordance with the man acturer'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.
Address: i b t/ S f t�t�t��G1 /, WYNY C, i°C '7,*'6'4��9 r O Permit No.6-2 0/? ^ d712�J
Specify Number of Alarms: # Smoke Alarms: # Carbon Monoxide Detectors:
l have read and agree to comply with the terms and conditions of this statement
Owner (or Owner Agent's) Name:
6
P7?Yi- L•15' c
ame:
.............. Lic.# ... Rd-
...................... Date: ........•... �..
1� Smoke and OOform.doc revised 0111012017
Owner Name
WATER -C NSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE A`YI,ENUE • CUPERTINO, CA 95014-3255
777-3228 > rAX (44Q8) 777-3333 • building(ftupertino.org
Address 7 C f( S O.c-f
1. Is your real property a registered historical ite?
❑ Yes Civil Code Sections 1101.1 thro gh 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
Z No Go to Question 2.
2. Does your real property have a licensed ph ber 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 thro gh 1101.8 do not apply.
❑ The licensed plumber's certi kation has been provided to the Building Division.
Skip the rest of the form and sig bottom of form.
[Z No Go to Question 3.
3. Is water service permanently disconnected tor your building?
❑ Yes Civil Code Sections 1101.1 thro gh 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 luse or occupancy on or before January 1, 1994?
❑ No My real property is built and ava Jable for use or occupancy after January 1, 1994.
Civil Code Sections 1101.1 thro gh 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
R(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:
1� My property is a single-family residenti,
On and after January 1, 2014, building
to be replaced -with water -conserving pli
compliant plumbing fixtures shall be
property undergoes alterations or impro,
❑ My property is a multifamily residential
On and after January 1, 2014, specified
plumbing fixtures to be replaced with w
On or before January 1, 2019, all non -c(
conserving plumbing fixtures throughou
improvements).
❑ My property is a commercial real propel
On and after January 1, 2014, specified 1
plumbing fixtures to be replaced with w
On or before January 1, 2019, all no
plumbing fixtures throughout the buildir
real property. See Civil Code Section 1101.4.
terations or improvements shall require all non-compliant plumbing fixtures
ibing fixtures throughout the building. On or before January 1, 2017, all non-
eplaced with water -conserving plumbing fixtures (regardless of whether
-ments).
eal properly. See Civil Code Section 1101.5.
ailding alterations or improvements shall require non- compliant
ter -conserving plumbing fixtures.
npliant plumbing fixtures shall be replaced with water -
the building (regardless of whether property undergoes alterations or
See Civil Code Section 1101.5.
ilding alterations or improvements shall require non- compliant
;r -conserving plumbing fixtures.
-ompliant plumbing fixtures shall be replaced with water- conserving
(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 ater-conserving plumbing fixtures in accordance with Civil Code Sections 110 1. 1
through 1101.8, the current California Plum ing 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 DaLye.
Owner or Owner Agent's Signature: Date:.: 4Z
Upon completing and signing this Certific te, please return /to the Building Division in order to final your building permit.
SB4072015.doc revised 08126115
1. If the existing plumbing fixture water
rate is equal to or lower than the figure sho-,gni, it is not required to be upgraded.
SB4072015.doc revised 08/26/15
Non -Compliant
Water -Conserving Plumbing Fixture
Plumbing Fixture
(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
2
13 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
and -held shower is considered a showerhead.)
For
multiple showerheads serving one shower, the combined flow rate of all
sho
erheads and/or other shower outlets controlled by a single valve shall not
exc
ed 2.0 gallons per minute @ 80 psi, or the shower shall be designed to
allo
onl 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
min
to @ 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 tD
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
maybe
used to achieve
unavailable, aerators or
reduction.
other means may be
used to achieve
reduction.
1. If the existing plumbing fixture water
rate is equal to or lower than the figure sho-,gni, it is not required to be upgraded.
SB4072015.doc revised 08/26/15
HOME O%IVNL®rz� C-ONTkACTOR
CA '
COMMUNITY DEVELOi'hO:ENT DEPARTMENT
1 AFIFIROVED
r
This set of p(ans and sfru~dficati2ans f 4DIST be karat at ifrs jcfa
- — —" c ' changes or.
�itaa an�asrrnv„ ccrir,[ri.+r tirrir. It i m�.irrin�9`rr f�.irrrtlaa, any ch
nlfmaaflons on same, or to deviate tlra irlrcrrrr, Without approval
from the Buil*tr** C Mcia*I.
"- m starnpling of this frlarr and sporlIuzfarns SI-Al�-I-�qOT Itc
-
held to taa.rm4 or in f rc all Qapp[,Vsl oa theviolation er si iy
provision rr of any Lily 01 it �ariItate Law
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