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B-2016-2549CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRE S: CONTRACTOR: PERMIT NO: B-2016-2549 20047 SOMERSET DR CUPERTINO, CA 95014-3115 (369 32 021) HOMEOWNER/BUILD ER OWNER'S NAME: SANDY C DATE ISSUED: 08/19/2016 OWNER'S PHONE: 08-507-5480 PHONE NO: LICENSED NT ACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic. j Contractor HOME NE UILD R Date Leitw X BLDG X ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing _ MECH X RESIDENTIAL _ COMMERCIAL with Section 7000) of ivision 3 of the Business & Professions Code and that my license is in full force nd effect. JOB DESCRIPTION: REPLACE PANEL (100 AMP); SAME LOCATION I hereby affirm under penalty of perjury one of the following two declarations: 1. I have andv 7ill maintain a certificate of consent to self-insure for Worker's Compensate 3n, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 2. 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 permit is is ed. Sq. Ft Floor Area: Valuation: $1000.00 certify that I,have re APPLICANT CERTIFICATION ad this application and state that the above APN Number: Occupancy Type: information is correct I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 369 32 021 representatives of the 5 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 Additionally, the apple City in consequence of the granting of this permit. ant understands and will comply with all non-point WITHIN 1$0 DAYS OF PERMIT ISSUANCE OR source regulations Per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 8/19/201 6 Issued by: Abby Ayende Date: 08/19/2016 RE-ROOFS: WNER-B DER DE LARATI am exempt from the Contractor's License Law for one of the I hereby affirm that I following two reasons All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. I, as owner f the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensatic n, will do the work, and the structure is not intended or offered for inspection. sa (Sec.70 4, Business & Professions Code) as owner ofthe property, am exclusively contracting, with licensed Signature of Applicant: (F contractors to construct the iproject (Sec.7044, Business & Professions Code). Date: 8/19/2016 I hereby affirm under penalty of perjury one of the following three declarations: A1.11. ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. I have and mill maintain a Certificate of Consent to self-insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the erf rmanc of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE i ave and ill maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 370 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 3. 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 hazardou shall not em loy any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hh dous Worker's Compensation laws of California. If, after making this certificate of air contaminants as defined by the Bay Area Air Quality Manage a District I will maintain compliance with the Cupertino Municipal Co :, hapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, S 505, 3, and 25534. Labor Code I must forthwith comply with such provisions or this permit shall -' be deemed r yoked. Owner or authorized age APPLICANT CERTIFICATION Date: 8/19/2016 1 certify that I have re ad this application and state that the above information is t correct. I agree to coi nply with all city and county ordinances and state laws I hereby affirm that th e ' onstruction 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 ab ve 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 C ranting of this permit. Additionally, the applicant understands and will comply with II non-point-source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Sectio f I understand my plans shall be used as public records. Licensed Signatur Date 8/19/2016 Professional �cr GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building (c�cupertino.org M I PLUMBING ❑ MECHANICAL RELECTRICAL E MISCELLANTEOUS - = ---oil "I ,/"( C _ APr\ # M 2 N OWNER NAME Wct U P -5o ! 5 * V E-I`CAIL S TA1 S OVA4t 1�� ST IP B%® CDC [ FAX AC(�C✓ ^ uo ProS® 7 ro C/ �o E-MAIL TS CJ Il l t ♦t, 0 e AWP c FAX KOWINER ❑ OVA TER-BT1ILDER ❑ ORT'ERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑' DEVELOPER ❑. TENANT CONTRACTOR NAME LICENSE NTUMBER LICENSE TYPE BUS. LIC T COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITFCT/ENGI N -EE R NAME LICENSE NUMBER BUS. LIC r COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE of ❑ STRUCTUREi ❑ FD or Duplex ❑ Multi -Family Commercial PROJECT IN WILDLANTD I PROJECTN URBAN INTERFACE AREA ❑ Yes ❑ No FLOODZONE ❑ Yes ❑ No DESCRIPTION OF w0go- t�—^^ I'(- too C� , 'j TOTAL VALUATION: 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 formation I have provi 's correct. I have r rphon of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to ing nstru 'sn authori . eta of Cupertino to enter the above-Iden/tified property fojr inspection puiposes. Signature ofApplica at/Agent: Date: [ ,KGPPLEMENTAL INTFORMATION REQUIRED oFFicE vsE o: Y _ ❑ O\ ER THE-COLTTER I' � EXPRESS U ST NDARD U v DLARGE R7EPNIiscApp_2011.doc revised 03/16/11 OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE CUPERTINO, CA 95014-3255 iJPERTtN (408) 777-3228 • FAX (408) 777-3333 • building(aDcupertino.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: ADD �� ®.<✓l C Jr� APN C.. BP# Lap " ?A(jq 0 ` C[U %WNE6 ., - ESS DESCRIPTION F WORK: Cl k Y [ / We are ;providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision,, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. RECTIONS: Please read and initial each statement below to signify you understand or verify this information.) Ozlll�l understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. 1, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. I understand building permits are not required to be signed by property owners unless they are responsible for he const uction and are riot hiring a licensed Contractor to assume this responsibility. I nderstand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. 5W4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. ��5. I u nderstand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total valu of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. IL nderstand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "-employee." I also understand my failure to abide by these laws may subject me.to serous financial risk. s I L nderstand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is perforrr ed under contract with a licensed general building Contractor. . I nderstand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04114110 k I understand I may obtain more information regarding my obligations as an "employer" from +the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. e;710. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that am the pE rty legally and financially responsible for proposed construction activity at the site address listed above. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide y all app icab aws and requirements that govern Owner -Builders as well as employers. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtaina permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Cotactors are properly licensed and the status of their workers' compensation insurance coverage. (DIRECTION : Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 CN.) Lender Name Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned tot the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarizaton, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the p -opert owner's signature. Property Own is Signature: Date: ---- --------------------- ----------------- --------------------------------------------- ----------------- (NOTE:; The ollowing Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project.% %IScope of Con truction Project (or Description of Work): ,ELecd:: (er Project Locati n or Address:b �7 5a -e &L Name ofi Auth rized Agent: 75— /K e 5� 'L/ tC est. 4 C—J Tei No 0& Address of A thorized Agent: I declare undE r penalty of perjury that I am the property owner for the address listed above and I personally filled out the above informe tion and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification ac eptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwnefBuilderFonn 2010.doc revised 04114110 scxnd� W" 4 2(y) be hie` O�sa Address SMOKE / CARBON-, MONOXIDE ALARMS rte+ OWNER CERTIFICATE OF COMPLIANCE � � Ll � �} COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333i! building(a cupertino.org Permit No. '1-0 1 q This affda it is a self -certification for the installation of all required Smoke and ;Carbon Monoxide. Alarms for complianc with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspection are required. GENERAL INFORMATION Existing s' gle-family and multi -family dwellings shall be provided with Smoke Alarms .and Carbon Monoxide 31arms. 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 larms be installed in the following locations: Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances and that do nothave 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 Sup.ply: 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 Califo nia Residential Codes. The alarms have been tested and are operational, as of the date signed below. I have read and agree to comply with the terms and conditions of this statement' Owner (or /� AREA SMOKE ALARM CO ALARM Contract Outside bedro of each separate sleeping area in the immediate vicinity of the m(s) X X On eVE ry level of a dwelling unit including basements X X Wit each sleeping room - X Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances and that do nothave 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 Sup.ply: 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 Califo nia Residential Codes. The alarms have been tested and are operational, as of the date signed below. I have read and agree to comply with the terms and conditions of this statement' Smoke a77d CO form. doe revised 03118114 Owner (or /� Owner Agent's) Name: (% Signature.....:..: .. ............. ................... Date: ... ......... Contract Dr N me: Signature...................................................................Lic.#...................................... Date: Smoke a77d CO form. doe revised 03118114 CUPEATINO Owner Name _ Address 1 1. Is your rea Yes No' 2. Does your plumbing, ❑ Yes. No WATER -CONSERVING PLUMBING FIXTURES i L OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 D (408) 777-3 28 : FAX (408) 777-3333 • building(cr)cupertino orq m 't1 Permit No. J SV x56_7 =W _P77V0' 04 ' *-6 property a registered historical site? :ivil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the' form and sign bottom of form. io to Question 2, eal property have a licensed plumber certifying that, due to the age or configuration of the property or its nstallation of water -conserving plumbing fixtures is not technically feasible?; :ivil Code Sections 1101.1 through 1101.8 do not apply. I The licensed plumber's certification has been provided to the Building Division. ;kip the rest of the form and sign bottom of form. o to Question 3. 3. Is water sei vice, permanently disconnected for your building? Yes- Civil Code Sections 1101.1 through 1101.8 do not apply No Go to Question 4. Skip the rest of the; form and sign bottom of form. 4. Is your real property built and available for use or occupancy on or before January 1, 1994?. El No I v1y 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. Yes y real property is built and available for use or occupancy on or before January 1, 1994. ivil Code Sections 1101..1 through 1101.8 apply. Check one of the three following statements and sign ottom of form.. 5. Please chec ONE of the following: OMy property is a single-family residential real property. See Civil Code Section 1101.4. ri 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). El 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 plumb' g fixtures to be replaced with water -conserving plumbing fixtures. On or b fore January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- consery g plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). My pro erty 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 plumb' g fixtures to be replaced with water -conserving plumbing fixtures. On or efore January 'l, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving plumbWg 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 p `or to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 through 11 0 1.8, 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 th' following page. , Owner or 0\6erAgent's Signature: %c%i Date: / /. Upon c nipleting and signing this Certificat , lease return it to the Building Division in order to final your building permit. SB407 2015.doc revised 08126115 vIIT CAIVNQT. `BE FTAT.,F r a NTa=rn-vrvr HT1, ri,:7mrr. , Tr on. 1. 1f 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 08126/15 Non -Compliant ' Water -Conserving Plumbing Fixture PlumbingFixture (Fixture Complying with Current Code Applicable to New Construction) Fixture Type Maximum Water Usage/ Rate 013 CPC Ch. 4 2 2013 CPC Ch. 4 2013 CPC Ch. 4 2013 CALGreen Div. 4.3 2013 CALGreen Div., . 2013 CALGreen Div. 5.3 Water Usage /Flow Rate Single -Family Multi -Family Commercial Water Closets Exceed 1.6 Residential Residential (Toilets) Gallons/flush Single flush toilets: 1.28 gallons/flush Dual flush toilets: 1.28 gallons/flush effective flush volume (the composite, Urinals Exceed 1.0 average flush volume of two reduced flushes and one full flush Gallons/flush 0.5 gallons/flush 2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of U.S. EPA WaterSense Specification for,Showerheads Showerhead Exceed 2.5 gallons per minute (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 Faucets — Exceed 2.2 gallons allP toWboperation ataGime. Max mum 1.5 gallons peonly one shower r Within , Lavatory Faucets per minute nits 0.5 gallons per minute @ 60 minute @ 60 psi, minimum Maximum 1.5 gallons" psi 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 - Kitchen Exceed 2.2 gallons per minute 1.8 gallons per minute @ 1.8 gallons per minute 1.8 gallons per minute @ 60 60 Faucets : psi @ 60 psi psi 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 maybe used to achieve reducti on. 1. 1f 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 08126/15