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15070099T1 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20165 FOREST AVE CONTRACTC J q .5 ' 1z1�oe' PERMIT NO: 15070099 OWNER'S NAME: ZACHARIAH CHERIAN & MANJU ABRAHAM DATE ISSUED: 07/14/2015 OWNER'S PHONE: 4085073124 PHONE NO: EL LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL p � o g REPLACE (E) SEWER LINE & PROPERTY LINE CLEAN License Class Lic.4 % � J OUT Contractor �ffk hAtq IZOOl-er Date I hereby affirm that I am licensed under the provisions of Chapter 9 SANITAR (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: 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 Sq. Ft Floor Area: Valuation: $2800 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 APN Number: 31633072.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DA AST C LED INSPECTION. 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 ue y: Date: with all non -point source- Ian' orrs�er the Cupertino Municipal Code, Section 9.18. !� /) RE -ROOFS: Signature Date 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. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1, 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) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will 1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the -Ba} Area it Management District 1 performance of the work for which this permit is issued. will maintain compliance , the pertin Municipal C e, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health &Safety Co ,Sectio 2 2553 . Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized ag Date: yam' 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildin��cupertino.org /-� (vJ/► ❑ NEW CONSTRUCTION ❑ ADDITION . M ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT PROJECT ADDRESS �1 b r67fles 2ft ' n , _o V C -PHONE 2 2 - 0 - APN # -33; 4 OWNER NAME �% �/ �/ L1O Q 7i y E-MAIL/ , o }JL STREET ADDRESS O r Q_ ,� CITY, STATE, ZIP FAX U CONTACT NAME '77 � ' \ 'C PHONE S / O I � ^ � E-MAIL (a STREET ADDRESS CITY, STATE, ZIP FAX El O'AWM ❑. OWNER -BUILDER ❑ OWNER AGENT VCONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME EL6 LICENSE TYPE i2 � LICEATSE NUMBER 9 �O BUS. LIC # - 1 COMPANY NAME & B MAILa^4'J-FAX SAq STREET ADDRESS I D - ^J ` S (j n u CITY. STATE ZIP / HONE ARCHITECT/ENGINEERNAME) LICENSENUMBER BUS. LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK -eY >e I A , e � w t _n i- -eA� Ld L?,,4 EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG - NEW FLOOR DEMO T AL AREA AREA AREA NET AREA ._ BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LIDETACH E] ATTACH I R DWELLWGUNrrS: ISA SECOND UNrr []YES SECOND STORY E]YIS BEING ADDED! NO ADDITION' ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME+ 4.` By my signature below, I certify to each of the fo _I am the pro O\Nmer or authorize e property O N al£ I have read this application and the information I have pro vidis correct. I haa,<eiead-the cription of Work and verify it is accurate. I agree to comply all applicable local ordinances and state laws relating to buildi cons autho ' res ntatives -of Cupertino to enter the above -identified prop for inspection purposes. f/ Y_ S— Signature of ApplicanUAgent: Date: _ SUPPLEMENTAL INFO TI QU � .g aCHEC7 r;' I New SFD or Multifamily dwellings: Apply for demolition permit for j existing building(s). Demolition permit is required prior to issuance of building" permit for new building. 1; I d-tiN_ _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. _ _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. -� isn>tl�ovrr �ru.ii�,u,nr . B ldgApp_2 0 11. do c revised 06/21/11 Fm-� CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION LIM ADDRESS: 20165 FOREST AVE DATE: 07/14/2015 REVIEWED BY: MELISSA imN APN: 316 33 072 BP#: 'VALUATION: 1$2,800 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: # PENTAMATION 1 RPSS PERMIT TYPE: WORK REPLACE E SEWER LINE & PROPERTY LINE CLEAN OUT SCOPE Supp/. Insp f'er APPLIANCE / EQUIP TYPE FEE ID Plumb. Plan Check 0.0 1 hrs $0.00 QTY UNITS BP FEES Sewer, Sanitary 1PRSEWER Other l;lec. Insp. E3-L- 1 # $25 Permit Fec : Supp/. Insp f'er PME Unit Fee: $25.00 PME Permit Fee: $48.00 Construction Tax: Administrative Fee: (ADMIN $45.00 Work Without Permit? Yes Q No $0.00 TOTALS: Travel Documentation Fee: ITRA VDOC $25.00 Stromz Motion Fee: IBSEISMICR NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the Preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 1I-053 Eft.' T"T'13) Mech. Plan ('heck Plumb. Plan Check 0.0 1 hrs $0.00 -lec. Plan Check a1,>c1,_ Pormil 1, Plumb. Permit Fee: IPPERMIT other Alerh. Insp Other Plumb Insp. 0.0 hrs $48.00 Other l;lec. Insp. E3-L- i4ech. Insp. Fee: PME Plan Check: $0.00 NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the Preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 1I-053 Eft.' T"T'13) FEE QTY/FEE MISC ITEMS Plun Check Fee: Sulrpl..PC.' Fee PME Plan Check: $0.00 Permit Fec : Supp/. Insp f'er PME Unit Fee: $25.00 PME Permit Fee: $48.00 Construction Tax: Administrative Fee: (ADMIN $45.00 Work Without Permit? Yes Q No $0.00 ,s1c/VU11C d Plarming Fees: Travel Documentation Fee: ITRA VDOC $48.00 Stromz Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg, Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $167.501 $0.00 TOTAL FEE: $167.50 Revised: 07/02/2015 i CUPERTINO WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 747-33,22/I8 • FAX (408) 777-3333 • building0cupertino.org '�T q Owner Name Gi 1 `"t/l ����40 Permit No. `S Address 2©r 15 AP0,06k c,a-- PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE HAS BEEN SIGNED 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. Owner' Signature: Date: O'7PA/ Is- eV N/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. Sign below and skip the rest of the form. � �� Owner Signature: Date: D7/l6'IS ®'No Go to Question 3. !!! T 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form. Owner' Signature: G�- n(No Go to Question 4. Date: 0 7 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 -AIA Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the • / Owner' Signature: =11�able Date: 07 14'lC- N Yes My real property is built anfor use or occupancy on or before January 1, 1 Y94. / Civil Code Sections 1101.1 through 1101.8 apply. Refer to the attached. N 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. 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. SB4072015.doc revised 02/04/15 C 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 110 1. 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 fixtures comply with the requirements as indicated in the table below. Owner's (or Owner Agent's) Signature: Date: 07/(% / l S Upon completing and signing this Certificate, please return it to the Building Division in order to final your permit. 1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shown, it is not required to be upgraded. SB407 2015. doe revised 02/04/15 Non -Compliant Water -Conserving Plumbing Fixture PlumbingFixture (Fixture Complying with Current Code Applicable to New Construction) Maximum Water Usage/Flow Rate Fixture Type Water Usage 2013 CPC Ch. 4 2013 CPC Ch. 4 2013 CPC Ch. 4 /Flow Rate 2013 CALGreen Div. 4.3 2013 CALGreen Div. 4.3 2013 CALGreen Div. 5.3 Single -Family Multi -Family Commercial Residential 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 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 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 2015. doe revised 02/04/15 SMOKE / 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 • building(a1cupertino.org a foo Permit No. t j Address �i S ( " t ° # of Alarms Smoke: + (4)Carbon Monoxide: 0 ,� P:ERMIT CANNOT BE FINALED AND COMP fET.ED UNTIL�TI3IS CER'TIFICATE�� $I �� �� �����`� HAS�BEEN�fiI(�N +.DSA -ND RFT.- TRNF kTO HE B�D G�`D � SICO 1 9"1�� � PURPOSE This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for J 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 bedroom(s) X X 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 *baor crawl space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electired r alarms which must be connected to the building wiring.As owner of the above -referenced property, I hereby certify that the alarm(s) refereve be n installed in accordance with the manufacturer's instructions and in compliance wituilding and California Residential Codes. The alarms have been tested and are operational, as of the date signed below. 1 have read and agree to comply with the terms and conditions of this statement Owner (or Owner Agent's) Name: ZACHAPOPH CHEfZIAN ........................................................................Date:Q.1..�b.IS Signature ......................... .. ContractorN me: D... nature.................^.........................................Lic.# . .............. Date: Smoke and CO form.doc revised 03/18/14