15050159 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21821 DOLORES AVE CONTRACTOR:WESTERN ROOFING PERMIT NO: 15050159
SYSTEMS
OWNER'S NAME: 1328 WHITE OAKS RD DATE ISSUED:05/28/2015
OWNER'S PHONE: CAMPBELL,CA 95008 PHONE NO:(
❑ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ELECT - PLUMB
License Class Lic.#
MECH RESIDENTIAL COMMERCIAL
Contractor Date
—
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF TEAR OFF ROOF&REPLACE WITH 28SQ OF
(commencing with Section 7000)of Division 3 of the Business&Professions METAL
Code and that my license is in full force and effect. ROOF
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
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 Sq.Ft Floor Area: Valuation:$18000
permit is issued.
APPLICANT CERTIFICATION APN Number:35714053.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
918.
Issued by: Date:
Signature Date ,
❑ OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
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 have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
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 Owner or authorized agent:
forthwith comply with such provisions or this permit shall be deemed revoked. Date:
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
918. I understand my plans shall be used as public records.
Signature Date Licensed Professional
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(d()Rl 777_'MR . FAX tAnR) 777-AAR3 • huilriinn(nbcunrtina-ora
Address
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
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 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.
1 have read and acree to cim"D\1 with the terms and editions of this statement`
Owner (oOwneP zgeQt s) Name
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Contrac r Narna
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Signature.......................
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......... ................. Date. ..................
Smoke and CO form.doc revised 03/18/14
1`
CVPERTIN0.
Owner Name
Address
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
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 110 1. 1 ough 1101.8 do not apply. Sign below and skip the rest of the form.
Owner' Signature: $ ' x Date:
�, +� fir„ "�.� -a'r�:r;_ �
Go to Question 2. / (-�
2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the properly 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 res o the form.
Owner' Signature: 1 Date:
Go to Question 3.
4�
3. Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not ap ly. ign below and skip the rest of the form.
Owner' Signature: > / Date:
o 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 avail le for use or occupancy a January 1, 1994.
Civil Code Sections 1101.1 throu 01. d not appI . Si b ow and skip the rest of the form.
Owner' Signature: V4, `_ �. ` : ; �'' Dater
es My real property is built a ai a le r s or o p cy on o ore January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 apply. Refer to the attached.
�'My property is a single faMily residential real property. See Civil Code Section 1101.4.
On . • d =after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing
ft-
ixtiues013e replaced with water -conserving plumbing fixtures throughout the building. On or before January 1,
2017, all n -compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless
of�101- It net t propel
undergoes alterations or improvements).
.,
3vlypoperty 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 -
W conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or
improvements).
❑ Mypropei ty 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.
SB407 2015. doc revised 02/04/15
On or beforeJammy Ok 19,, a 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 -copse g plumbin tures in aRFrequj
cith Civil Code Sections 1101.1 through
1101.8 the current California Plumbiri Cod an Calif a G een Buil • id Code,- and manufacturer's installation
g requirements, and that the water=conserving p ing es omply , itments as indicated in the table below.= a
Owner's (or Owner Agent's) Signature: fir _Uat*'
Upon completing and signing this Certificate, plead return it toythe Building limon 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.
SB4072015.doc revised 02/04115
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: 4*T$ V a1fo�,�fl�ts
(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
g"" allonelflusl�
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 @ .
de.fault.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: " "
o mer means, may be
used to`acf ieve
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.
SB4072015.doc revised 02/04115