151002436
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10314 MIRA VISTA RD
CONTRACTOR: TATS INC DBA MR
PERMIT NO: 15100243
ROOTER PLUMBING
OWNER'S NAME: SUMNER ROBERT B AND BETTY M
2827 AIELLO DR
DATE ISSUED: 10/302015
OWNER'S PHONE: 4082572208
SAN JOSE, CA 95111
PHONE NO: (408) 227-1630
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
'192 I ^�
License Class J V Lic. # )96� b L3-
Install (I) property line cleanout and Replace 70' of trenchless building sewer
"Cupertino Sanitary"
Contractor `s , 1% m ot}:r� Date 0 —S
1 hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
a r
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: $11000
erformance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
t?ction 3700 of the Labor Code, for the performance of the work for which this
APN Number: 35702022.00
Occupancy Type:
p y
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 DAYS FROM LAST CALLED INSPECTI N.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
I.
granting of this permit. Additionally, the applicant understands and will comply
Issued by:*4:0u Date:
with all non -point source re lat' ns per the Cupertino Municipal Code, Section
RE -ROOFS:
9.18.
v
Signature Date b
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
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)
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. I will
I 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 Bay Area Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I have and, will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Section 25505, 25 3, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date: I-DIsell r
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
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
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
CUPERTINO
GENERAL PERMiIi APPLICATION )51()0943.
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildinO(DCUDeriinO.OrCI
[KPLuj\Bm NG ❑MECHANICAL, IIELECTRICAL F-1MISCELLANTEOUS
PROJECT ADDRESS Cc'3/'-( ` V ' /
t N I O 09
O TJI.'tRN
H01�E
-2-207�
't•NialL
STicFcT ADD 5lb?! n t �
J114 M,
CITY, ST. 7r, ZIP
�(
cl�
CONTACT I Ah,E
PHONE
STREET ADDRESS
(
CITY, STATE, ZIP
I FAX
❑ OWN M ❑ ORTM-BUILDER ❑ OW1. t AGENTT
(CO>\TIRgCTOR ❑ CONTRACTOR AGD.T ❑ ARC?E ECT ❑ ESGLT:=a ❑ D=t ELOPER❑ i _\ SI7
C i'R ORA??a l a
T ��
I Li e tgl:i
(
I LIC �.S� i E
C
I BUS. LIC
COI(PAN.Y' ✓,E
I E -N 4IL
I FAX
S` 'TAD RES t
STAT IP
o
.LtCHITECT/ENGIN`EERNAhS
I LICENSE NUMBER .
I BUS. LIC
COMPP?QY I.A)a
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, Z -1P
I PHONE
USE OF or DLPLEX ❑ 1✓I LTl-F 4h� Y ROJECT LN NN ILDLAND ❑ Y'rS
BUILDLNG: ❑ Col'S'i. iCL4T I URBI-NI A*fERFACE AREA NO
PROTECT IN ❑ YrS
I FLOOD ZONZE KNO
IS Ti—r BLDGAN ❑ ti =_S
I EICHI-IMHO)av �NO
DESCRIPTION OF WORK
� A
TOTALVAL.UATION:
�y F J "
J L
By my signature below, I ce i,'y to each of the foi]owinQ:
application and the information I h-ve provided is correct
ordinances and state laws rel- ' building cons
Si �ztere of Applicant/Agent:
zn the pro 1 y oy,ner or authorized agent to act on the pr pe,fty owner's behalf. I have read this
ave re a Description of Work and verify it is accurate. I agree to comply with all applicable local
o e representatives of Cupertino to enter the above -i entifle property for inspection purposes.
ate: � o i
SLIPPLNENTAL IKFORMATION REQUIRED
z
TR
A,FFPAIiscA.vp_2011.doc revised 06121/11
!`191'17 "U !'11T1DU1D9r1rXj"
APPLIANCE / EQUIP TYPE
%-11 1 "XI %-,v11.1X11i1v
FEE ESTIMATOR — BUILDING DIVISION 10«-13
Plumb. Plan Check 0.0 1 hrs $0.00
ADDRESS: 10314 Mira Vista Rd DATE: 10/30/2015 REVIEWED BY: PAUL
UNITS
APN: 357 02 022
BP#:
"VALUATION: Isi1,000
PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
#
PENTAMATION 1 RPSS
I
USE:
Sewer, Building
PERMIT TYPE:
WORK
Install N property line cleanout and Replace 70' of trenchless building sewer **Cupertino Sanita **
SCOPE
$25
APPLIANCE / EQUIP TYPE
FEE ID
Plumb. Plan Check 0.0 1 hrs $0.00
QTY
UNITS
BP FEES
Llec. Permit Fee.
Sewer, Sanitary
1 PRSEWER
Other Elec. Insp.
1
#
$25
Sewer, Building
1 PRSEWER
iq)pl. Insp Fee
1
#
$25
PME Unit Fee:
$50.00
PME Permit Fee:
$48.00
('construct ion Tax:
Administrative Fee: (ADMIN
$45.00
Work Without Permit? 0 Yes (F) No
$0.00
TOTALS:
i
Travel Documentation Fee: ITRA VDOC
$50.00
Strong Motion Fee: IBSEISMICR
NOTE: This estimate does not include fees due to other Departments (i.e. 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 11-033 Elf. 7/1/13)
Rech. Plan Check
Plumb. Plan Check 0.0 1 hrs $0.00
%;lee. Plan Check
Plan Check Fee:
Plumb. Permit Fee: IPPERMIT
Llec. Permit Fee.
Other.dlech. I(isp.
Other Plumb Insp. 0.0 hrs $48.00
Other Elec. Insp.
Mech. Insp. Fee:
PCumb. Insp, Fe,)
Nlec. Insp. Fee
NOTE: This estimate does not include fees due to other Departments (i.e. 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 11-033 Elf. 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
'A
Suppt P('
F
PME Plan Check:
$0.00
Permit Fee:
iq)pl. Insp Fee
PME Unit Fee:
$50.00
PME Permit Fee:
$48.00
('construct ion Tax:
Administrative Fee: (ADMIN
$45.00
Work Without Permit? 0 Yes (F) No
$0.00
-advanced Planning Fees:
i
Travel Documentation Fee: ITRA VDOC
$48.00
Strong Motion Fee: IBSEISMICR
$1.43
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$193.43
$0.00 TOTAL FEE:T
$193.43
Revised: 10/01/2015
Vi SMOKE ! CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIAN
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING D Robert Sumner
10314 Mira Vista Rd
10300 TORRE AVENUE •CUPERTINO,CA 95014-3255
CUPERTINO Cupertino,a 95014
(408)777-3228•FAX(408)777-3333• building • cu gertino.or• *
TTAadr-6,--ss 10/6\Lk W. ff-oTAIinus
PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE
HAS BEEN SIGNED AND RETE. NED 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
S1000.00,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 to comply with he terms and conditions of this statement
Ditmer61--Owner Agents)Name:
IWV611-Wel/ 7.P1, 4J4/1/1 -
Signatiire '
1561A le
cotractor Name:
gO Colo( 47 5i-g-ridt6r6 -Lic,i1 Date:
Smoke and CO form.doc revised 03/18/14
*: Robert Sumne-r--- ----
- - VistaRd
CUPERTINO * "
'WATER-CONSERVING PLUMBING FIXTURES ' \
, ,
(OA' OWNER CERTIFICATE OF COMPLIANCE
,_.. ,
45".r COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10314 Mira
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CupertinoCA 95014
(- (408)777-3228• FAX(408)777-3333•buildincacupertin __o.orq _ __
__ _ _ --
, __ _ __-
Owner Name `; '\, -- pi-,--i- 6' ti,„_.v.,---- Permit No. 17(7' ICal-' .00 _ _ . -
Address ii'l r -0 7, i\ii io, „ IN.., if; A,T,
V 'KV
1. Is your real property a registered historical site? -
El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
,-----)
- ,SNo 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?
O Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
0 The licensed plumber's certification has been provided to the Building Division. _
Skip the rest of the form and sign bottom of form.
,-----,
t ) o Go to Question 3.
*N
3. Is water service permanently disconnected for your building?
O Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
n gr No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
O 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.
,-A
z_J 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.. ,
5. Please check ONE of the following:
7 ' My property is a single-family residential real property. See Civil Code Section 1101.4. •
i 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).
O 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).
El 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 fixtures comply with the requirements as indicated in the
table on the following page.r---'--, ,_ ,
Owner or Owner Agent's Signatarq: ,i 4/Vij i ________Date: '3.' 41 -'2,61t
Upon completing and signing this Certificate,pleareturn it to the Building Division in order to final your building permit.
SB407 2015.doc revised 08/26/15
BUILDING PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS •
CERTIFICATE HAS BEEN SIGNED ANI)RETURNED'Tfl TtiL BUILDTh G DIVISION
:.•r._. ... ._.--,r -wxM. a-.r.:xe r ..,.:•:•--z
Non-Compliant Water-Conserving Plumbing Fixture
Plumbing Fixture (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
Wafer 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 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.doc revised 08/26/15