B-2017-1471 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1471
10950 STEVENS CANYON RD CUPERTINO,CA 95014-3944(356 01 061) WILLOW`GLEN
ELECTRIC INC .
SAN JOSE,CA 95155
OWNER'S NAME: RAMCHANDANI RAJESH AND MANJUSHA DATE ISSUED:09/05/2017
OWNER'S PHONE:408-835-3187 - • 'PHONE NO:(408)289-9725
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-10 Lic.#591918
Contractor WILLOW GLEN ELECTRIC INC Date 04/30/2018 X BLDG X ELECT _PLUMB
MECH X RESIDENTIAL_COMMERCIAL
1 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:
. (N)EV CHAGING STATION(50 AMPS)-GARAGE;(1)DEDICATED
I hereby affirm under penalty of perjury one of the following two declarations: . CIRCUIT(50 AMPS)
i. 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
jterformance of the work for which this permit is issued.,
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:$1590.00
' 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: Occupancy Type:
and state laws relating to building construction,and hereby authorize 356 01 061 ,
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 perthe upertino Municipal Code,Section 9.18. "180'DAYS FROM LAST; CALLED INSPECTION.
a,
:4.10,-'.u e .,, Date 9/5/2017 Issued by:Jasmine Archbold
41Date:09/05/2017 i ,
OWNER-BUILDER DECLARATION
'i I hereby affirm that I ant exempt from the Contractor's License Law for one of the 'RE-ROOFS:
' I• following two reasons: All roofs shall be inspected prior 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 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(Scc.7044,Business&Professions Code)
' 2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:9/5/2017
' 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., ' HAZARDOUS MATERIALS DISCLOSURE
': 1: 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 for which 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
a. 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 airy manner so as to become subject to the material. Additionally,should 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 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 255 5,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall ;; %.� 11 ---1�be deemed revoked. Owla rlrh°sued ag ent. `l
APPLICANT CERTIFICATION D ` 4 2i : .
I 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 ereby 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. I understand my plans shall be used as public records.
Signature - Date 9/5/2017 Licensed
Professional
1 'l/LCA 1 1 f. AK..t
9"'5; .90 Tz.ee5
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CLiPE13TEt 0 (408)777-3228• FAX(408)777.3333•buiJding(acuPOfli ', I
B-2-0t1 N i l
PROJECT ADDRESS
O I o Q ro 6-1401/415 ` Ayf\fij APN#
/�✓1 Si
11NER NAME
1101-0 MICR-1i'0 D P4Nef-&S5- 3 I k I f ErnAIVlL`ttivfV thGU1
1 pJ1414
1 WY/A-
STREET ADDRESS i CITY, STATE,ZIP FAX
09517 STEVE/4S C'Akf#JON .1ea,4-D capgir l Aj o, CA-7 6166160114h0l
CONTACT NAME Mark Londre PIIONE (408)289-9725 E-MAIL
office@willowglenelectric.com
STREET ADDRESS
P. 0. Box 8430 CITY,STATE,ZIP San Jose, CA 95155 FAX(408)289-9725
❑OWNER 0 OWNER-BUILDER 0 OWNER AGENT Cr CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE SUS'.LIC f'
Mark Londre 591918 C-10 4 ;� 1
COMPANY NAME Willow Glen Electric, Inc. E MAIL office@willowglenelectric.com. FAX (408)289-9725
STREET ADDRESSPO BOX 8430 CITY,STATE,ZIP San Jose, CA 95155 PHONE (408)289-9725
ARCHITECT/ENGINEER NAME N/A LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF I 111 SFD or Duplex 0 Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE: ❑ Commercial URBAN INTERFACE AREA 0 Yes 0 No FLOOD ZONE 0 Yes 0 No
❑SOLAR PANELS it ELECTRIC VEHICLE CHARGING STATION A" 0 SOLAR WATER HEATING 0 OTHER:
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: KILOWATTS(COMMERCIAL ONLY): TOTAL VALUAT;ON:ij
{Jg
DESCRIPTION OF WORK L /1\177444... J i\ ,1
Electric Vehicle Charging Circuit: )-itl2/til s� l. ) �.lt
to ) c, --b 12; ( .1T 'u-)� xl �-
191.)44 i 6 it) Ct-F1 to S .
RECEIVED B `,
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 cluctiptiut riEe r ;Esgntatives of Cupertino to enter the above-identified plropertyy for inspection purposes.
Signature of Applicant/Agent: west
/ "' Date: R
SUPPLEMENTAL INFORMATION REQUIRED i.:= OFFICE USEONLY.
M ( 0 OVER ThE•COUNTER
❑t ;EXPRESS
❑, STANDARD `:
`h D LARGE'` a
MAYOR„ •
PVApp_2011.doc revised 03/16/11
DocuSign`tnvelope ID:2845C5E7-A8AD-48DA-BAF7-C8295C9D7052
S
\\ / SMOKE/CARBON MONOXIDE ALARMS
r OWNER CERTIFICATE OF COMPLIANCE
/vSt,Ds� COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildina(o7cupertino.orq
Permit No.B—2017-14 71
Address 10950 Stevens Canyon Road #of Alarms Smoke: 1 Carbon Monoxide: 2
PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE
HAS BEEN,SIGNED AND RETURNED TO THE BUILDING DIVISION
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 907.2.11.5 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 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 R314 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 tocomply with the terms and conditions of this statement
Ower or Owner Agent's).Name: —Docusigned by: pp
0. eS� 1 e'/ / 7
Man Ramchandani Signature...4r Dat . 6/ 201
Contractor Name:
`—A03CD2FD47DE43A...
Signature Lic.# Date:
Smoke and CO form.doe revised 03/18/14
DocuSign Envelope ID:2845C5E7-A8AD-48DA-BAF7-C8295C9D7052 '
\\1 IV WATER-CONSERVING PLUMBING FIXTURES
1.:#6> OWNER CERTIFICATE OF COMPLIANCE
4,0-19,,,, COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
QJesl7 (408)777-3228•FAX(408)777-3333•buildinq(a.cupertino.orq
Owner Name Manj u Ramchandani Permit No. B-2017-1471
Address. 10950 Stevens Canyon Road, Cupertino, CA 95014
f PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE
HAS BEEN Man AND RETURNED TO THE BUILDING DIVISION
Please refer to the attached California Civil Code Sections 1101.1 — 1101.8 which are part of this Certification form.
1. Is your real property a registered historical site?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form.
Docusigned by: 9/6/2017
Owner'Signature: Date:
C No Go to Question'2. �,+�
AO3CD2FD47DE43A...
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.
Sign below and skip the rest of the form.
DocuSigned by: 9/6/2017
Owner'Signature: al,
Date:
9/6/2017
• No Go to Question 3. A
AO3CD2FD47DE43A...
3. Is water service permanently disconnected for your building?
O Yes Civil Code Sections 1101.1 through 1101:8 do not apply. Sign below and skip the rest of the form.
Owner'Signature: DouSignedby: Date: 9/6/2017
[21 No Go to Question 4. 1410,
AO3CD2FD47DE43A...
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. Sign below and skip the rest of the form.
Litc`uSigned by:
Owner'Signature: Date:9/6/2017
❑ Yes My real property ianduavailskle for useor occupancy on or before January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 apply. Refer to the attached.
EX 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 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. Sec 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.
SB407'2015.doc revised 02/04/15
DocuSign t nvelope ID:2845C5E7-A8AD-48DA-BAF7-C8295C9D7052
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/We,the owner(s)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-cons= 6 Nothing fixtures comply with the requirements as indicated in the table below.
Owner's(or Owner Agent's)Signature ' 'y/ Date:9'6/2017
AO3CD2FD47DE43A...
Upon completing and signing this Certificate,please return it to the Building Division in order to final your permit.
Non-Compliant Water-Conserving Plumbing Fixture
Plumbing Fixture1 (Fixture Complying with Current Code Applicable to New 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
/Flow Rate 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 0.5 gallons/flush
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 bein operation at a time.
Faucets— Exceed 2.2 gallons Maximum 1.5 gallons per Within units: 10.5 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 @ 1.8 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.
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 2015doc revised 02/04/15