15120072FE
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10160 IMPERIAL AVE
CONTRACTOR: AAA FURNACE & AIR PERMIT NO: 15120072
CONDITIONING
OWNER'S NAME: CHEN XIN AND ZHANG YING TRUSTEE
1712 STONE AVE DATE ISSUED: 12/08/2015
OWNER'S PHONE: 4089669656
SAN JOSE, CA 95125 PHONE NO: (408)293-4717
Zr tow LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIALE]
r�
REPLACE (E) WATER HEATER, SAME LOCATION
License Class �(J L�ic�# pU
Contractor G� J�JHC_ G Date
---tea
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:
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
of the work for which this permit is issued.
Sq. Ft Floor Area:
Valuation: $1548
Vper_ormance
ave and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 35722055.00
Occupancy Type:
Section 3700 of the Labor Code, for the performance of the work for which this
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 D -S -9F -P RMIT 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 D ROM ED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in cohsequence of theI
— 2
granting of this permit. Additionally, the applicant understands and will comply
with all non -point so 'ce re ila ' r the Cupertino Municipal Code, Section
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
9.18. f;
�t
Signat re Da O
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. 1 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(x) 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, Sectns 5505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agents Date
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
CONSTRUCTION LENDING AGENCY
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
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
lij
I=I
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(5)cupertino.Org
Ma A1T AT 71r;TrrMTreT
MEP
MISC
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PROJECT ADDRESS ' h\ i Q r1 1/
FAPN#
OWNERNAME1 `nl I ^ ^
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PHONE r/�- j� Q�l (,� I I _ %� �C,
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E-MAIL
STREET ADDRESS
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CITY. STATE,ZIP V I' 1 " U�•) C/� rjII
FAX
CONTACT NAME n T
PHONE ^ n3 `
E-MAIL
STREET ADDRESS I �+ /] i r'E
CITY, STATE, Z&", --f
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
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LICENSE NUMBER -7 J Q "1 I
LICENSE TYPE e J
BUS. LIC # �O
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COMPANY NAME W Fj ' /�/
E-MAIL
FAX
STREET ADDRESS I I� l .}-(, �-((
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CITY, STATE. ZIPn �a (�Q m q5I �✓
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PHON> 4 Og�2q 3 �:-� I�,
AR.CHITECTIENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF AFD or DUPLEX ❑ MULTI-FAMII Y PROJECT IN WILDLAND ❑ YES
PROJECT IN ❑ YES
IS THE BLDG AN [:],YES
❑
BUILDING: ❑ COMMERCIAL URBAN INTERFACE AREA NO
FLOOD ZONE ❑ NO
EICHLER HOME? NO
DESCRIPTION OFWORK f �ISrI
1 /h
K_�L �1,
r � Lour o�
TOTAL VALUATION:
By my signature below! I certify to each of the following: I am the property ownerorethorize prope er's behalf. I have read this
application and the information I havelprovided is correct. I have read the Description of W and verify it is accura agree to comply with all applicable local
ordinances and state laws relating to/ uilding ott9truc ion. I authorize representatives of Cupertino to enter the above-ider,rifiP 4 n���P� ;nspection purposes.
5
Signature of ApplicanUAgent: Date:
iJPPLEA131,TTAL INFORMATION REQUIRED
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MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FFT FSTMATOR - BUILDING DIVISION
APPLIANCE EQUIP TYPE FEE ID QTY UNITS BP FEES
Water Heater 1 PRWHEATR 1 # $29
TOTALS: $29.00
ADDRESS. 10160 IMPERIAL AVE
T—DATE: 12/08/2015
REVIEWED BY: MELISSA
Afech. Ilan ("lieck
APN: 357 22 055
BP#:
*VALUATION: 1$1,548
*PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
$0.00
PENTAMATION
PRWHEATR
I
USE:
permil
PERMIT TYPE:
WORK
REPLACE (E) WATER HEATER, SAME LOCATION
[Plumb. Permit Fee:
SCOPE
PME Unit Fee:
APPLIANCE EQUIP TYPE FEE ID QTY UNITS BP FEES
Water Heater 1 PRWHEATR 1 # $29
TOTALS: $29.00
\10TE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Eire, Sanitary Sewer District, lycnoot
District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact theDeptjor attan't info.
FEE ITEMS (Fee Resohition 11-053 gff. 711113)
FEE
QTY/FEE
MISC ITEMS
Afech. Ilan ("lieck
Plumb. Plan Check
0.0
hrs
$0.00
permil
�,kejzj, 15 ern-,
[Plumb. Permit Fee:
IPPERMIT
PME Unit Fee:
P ,e.-
PME Permit Fee:
$48.00
('Onsirucfiofl 71m. —F
Other Plumb Insp.
El
hrs
$48-00
otii e r
Work Without Permit? 0 Yes @ No
$0.00
Travel Documentation Fee: ITRAVDOC
$48.00
/av�. Fee:
\10TE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Eire, Sanitary Sewer District, lycnoot
District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact theDeptjor attan't info.
FEE ITEMS (Fee Resohition 11-053 gff. 711113)
FEE
QTY/FEE
MISC ITEMS
Phm Check f"ee.-
PME Plan Check: ----$0.00
permil
Suppl,
PME Unit Fee:
$29.00
PME Permit Fee:
$48.00
('Onsirucfiofl 71m. —F
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? 0 Yes @ No
$0.00
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$171.501
$0.00 TOTAL FEE
$171.570
Revised: 10/01/2015
s
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• buildingCa)-cupertino.org
PERMIT .CANNOT BE FINALED UNTIL THIS CERTIFICATE HAS BEEN.
COMPLETED, SIfiNED,, 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 sirigle amply an mulfi Family dweffli s& shall be pr6vided 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 bedrooms)
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 removalof 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
l rrns-which_rnust be: connected -=to the building-wir-ing: ---- --
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 specified below have been tested and are operational, as of the
date signed below.
Address: f 016 0 Aw r C� z � ��c� ; C' �� 67
�-�i7
Permit No. 115 /42 74
Specify Number of Alarms: # Smoke Alarms: F-7-1 1 # Carbon Monoxide Detectors:
I have read and agree to comply with the terms and conditions of this statement
Owner (or Owner Agent's) Name:
-O TJ3�7
Signature...
C>vCH&f1ncI
.......................�............. ...............................................Date:
............................................. ..........................................................................................
Contractor Name:
Signature.................................................................. Lic.# ......................................Date:
Smoke and CO form. doe revised 09127116
�ZL
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building an"cupertino.orq
Owner Name XIAI CHEW Permit No
Address 10160 ���e,v�ie�� Atm-; r1�v�y '�2�. 64 �'5e '
PERM>CT- CANNOT: .,BE FINALED ANp COMPUTED UNTILCERTIFICATE .
HA,� BEEN S1C� AND RETURNED ') YJ THE BUIL ING.Dl('V19ION
-
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- C vi1`Ca le sections i=P01.1 thio h i`i 0`1 8' da`rrof apply` -S gn'li 16w izil skip the rest of the for`nr - -Y~
Owner' Signature: Date:„;,°
�' 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?
,E, Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
EX The licensed plumber's certification has been provided to the Building Division.
Sign below and skip the rest of the form.
Owner' Signature: Date: �Tus'y? j? , �20I7
No Go to Question 3.
3. Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 110 1. 1 through 1101.8 do not apply. Sign below and skip the rest of the form.
Owner' Signature: Date: '-7 ? �,, �Lsty--
CK No Go to Question 4. =�
4. Is -your real property built and available for use or occupancy on or before January 1, 1994?
56 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.
- -= — _ - - -- Owner' -Signature•---- --
❑ 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. Refer to the attached.
❑ 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.
SB407 2014.doc revised 03/18/14
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 have been replaced
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 co ply with the requirements as indicated in the table below:" -
Owner's (or Owner Agent's) Signature: , ' w Date: T�f.e1v,7i ,2,91
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 2014.doc revised 03/18/14
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
-2.013 CALGreen_D-iv-._4.-3- ..
_20.13-CALGreen, Div._, 4-3.
__20.1.3_CALGreen_D.iv 53_____
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 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
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 2014.doc revised 03/18/14