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B-2016-2589CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2016-2589 21373 DEXTER DR CUPERTINO, CA 95014-1316 (326 41 087) COMFORT ENERGY INC MILPITAS, CA 95035 OWNER'S NAME: CHAMBERLAIN PARK AND JOAN B TRUSTEE DATE ISSUED; 08/25/2016 OWNER'S PHONE: 408-446-4704 PHONE NO: (408) 263-3100 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-20 Lic. # 77 Contractor COMFORT ENERGY INC Date 01/31/2018 X BLDG —ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing X MECH X RESII)ENTLAL _ COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: REPLACE AC UNIT (SAME LOCATION) I hereby affirm under penalty of perjury one of the following two declarations: 1. I have and will maintain a certificate of consent to self-insure for Worker's mpensation, as provided for by Section 3700 of the Labor Code, for the ormance of the work for which this pempt is issued. veand will maintain Worker's Compensation Insurance, as provided for by tion 3700 ofthe Labor Code, for the performance ofthe work for which this kcerfftiifyt tis issued, Sq. Ft Floor Area: Valuation: $5868.00 APPLICANT CERTIFICATION have read this application and state that the above information is correct. I agree to comply with all city and county ordinances APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 326 41 087 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, costs, and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. Additionally, th pplicant understands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regul io er the., upertino Munic' awl Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature 25 0 6 Signature Date 1 ar .Issued by: Kim DunbEvmu— 1 1 � r Date: 08/25/2016 RF-ROOFS All roofs shall be inspected prior to any roofing material being installed. If a roof is I hereby of it t I am exe t from the Con actor's License Law for one of the following reasons• 1. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 08/25/2026 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. 1 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, HAZARDOUS MATERIALS DISCLOSURE 2. 1 have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 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 hazardous shall not employ any person in any manner so as to become subject to the Worker's Compensation laws California. If, making this material. Additionally, should Mf equip A or devices which emit hazardous air contaminants as defined by he ay Are Air Quality Management District I ' of after certificate of will maintain compliance with e 8 er Muni al Co(e, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety ode c '0 2 5,M 533, a i�hZ5534. S Labor Code, I must forthwith comply with such provisions or this permit shall /j be deemed revoked. ,Owner or authorized agent: /Y1 APPLICANT CERTIFICATION Date: 08/25/2016 tT 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 9 p y ty ty NCY CON;A(G' Cy I hereby affirm that there i, a cog ruction le ding agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this er its issued Sec. 3097, Civ C. I ( ) to enter upon the above 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 granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 08/25/2016 Professional MOM CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, GA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 building(�Dcupertino.org LJ NEW CONSTRUCTION ❑ ADDITION ®`ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS 2-13-t3 j`3 v q OWNER NAME: C,++AM tom', d PHONE d / " C -C ;lt-� i -f %-^ E-MAIL d STREET ADDRESS AS 10 V� CITY, STATE, ZIP � r t FAX CONTACT NAME c. ' 4 - l H AAA - PHONE STREET ADDRESS i[.[.fN, } ! S CITY, STATE, ZIP 4D r `q p I 3 FAX i 0 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR XCONTRACTOR AGENT ❑ ARCHITECT '❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME i cfi'°f' LIC - B LICENSE &—E2,o BUS. LIC # 3 MOS COMPANY NAME Cc rY I 6a -T- E'we � / y . {r4� E MAIL g , 66i✓I *g�i g I v K PAX 'f. b Y / CITY, STATE, ZIP l ru ! l' t"- g -A PH 'foa 2(03&10J ARCHITECT/ENGINEER NAME LICENSE NUMBER - BUS. LIC # I COMPANYNAME I STREET ADDRESS DESCRIPTION OF WORK E-MAIL I. FAX CITY, STATE, ZIP I.. PHONE P�c C,"Oeq-157 ®cL-F, c. Wig.- L -t r r CONSTR TYPE 1. # USE I TYPE I OCC. I SQ:FT. I VALUATION ($) ' AREA G I ARENEWA OOR I. AREADEMTOTAL I NET AREA - _-- I REMODEL AREA I REMODEL AREA I I REMODEL AREA ATTACH # DWELLING UNITS: ISA SECOND UNrr- LJ YES SECONDSTORY ❑YES' BEING ADDED? []NO ADDITION? ❑NO PRE -APPLICATION YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEL'IrI) $Y T;ON; PLANNING APPL# NO PLANNING. APPROVAL LETTER EICHLER HOME? NO By my signature below, I certify to eac o 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 information I have ro i d is correct. I have read the D scription of Work and verify it is accurate. I agree to comply With all applicable local ordinances and state laws relating to b it n on tion. I author s t'ves of Cupertino to enter the above-iden. *fled to i�Ispeetion purposes. Signature of Applicant/Agent: Dater q111Z _ New SFD or Multifamily d6wringj Apply Tor demolition permit for existing building(s). Demolition pW p'is required prior to issuance of building permit for new building. _ 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. 0- 3 a B1dg4pp 2011.doc revised 06121111 WATER -CONSERVING PLUMBING FIXTURES ..OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION CUPS TI NO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 X408) 777-3228 • FAX (408) 777-3333 • building(a�cupertino:org Owner Name - I t c) Com/ t Permit No. � 6 Address .--2/373 ,r 9 1. Is your real property, a,. registered historical site? ❑ Yes Civil Code Sections 110 1. 1 through 110 1. 8 do not apply. Skip the rest of the form and sign bottom of form. TK 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. Skip the rest of the form and sign bottom of form. No Go to Question 3. 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. No 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 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 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. Chedk one of the three following statements and sign bottom of form.. 5. Please check ONE of the following: My property is a single-family resid6ntial 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 areal property. See Civil Code Section 11011.5. 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 wheth er property undergoes alterations or improvements). 1, 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 pate. IOwner or Owner Agent's Signature: 4_(;C; (,W (fln Date: 1G jNcZ Upon completing and signing this Certificate, please return it to the Building Division in order to final your building permit. SB407 2015.doc revised 08/26115 1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shown, it is not required to oe upgraaeu. SB407 2015.doc revised 08126/15 Non -Compliant Water -Conserving Plumbing Fixture Plumbin Fixturel (Fixture COM plying with Current Code Applicable to New Construction) Fixture Type Maximum Water Usa a/Flaw Rate Water Usage 2013 CPC Ch. 4 2013 CPC Ch. 4 2013 CPC Ch. 4 /Flow bate 2013 CALGreen Div. 4.3 2013 CALGreen Div. 4.3 2013 CALGreen Div. 5.3 Single -Family If ultPFamily Commercial Water Closets Exceed 1.6 Residential Residential Single flush toilets: 1.28 gallons/flush Dual flush toilets: 1.28 gallons/flush effective flush volume (the composite, (Toilets) Gallons/flush urinalsExceed 1.0 -average flush volume of two reduced flushes and one full flush Gallons/fiush 0.5 gallons/flush Showerheads Exceed No 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 Faucets — Exceed 2.2 galions allow onlyone shower outlet to be in operation at a time. Maximum 1.5 gallons per Within units: 0.5 gallons per minute @ 60 Lavatory Faucets per minute 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 i E In common and public use areas 0.5 gallons per minute @ 60 psi 1.8 gallons per minute 60 psl Faucets -- Exceed 2.2 gallons 11.8 gallons per minute @ 1.8 gallons per minute 1.8 gallons per minute @ 60 Kitchen per minute 60 psi @ 60 psi psi Faucets I 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 E aerators or other means the above are maybe 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 oe upgraaeu. SB407 2015.doc revised 08126/15 SMOKE / CARBON,MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION CUPRT#NQ 10300 TORRE AVENUE • CUPERTINO, CA.95014-3255 (408) 777-3228 • FAX (408) 777-3333 e building (aD-cupertino.om • .., ,� Permit 1�To:� Address X% 7 � �� V # of Alarms Smoke: q Carbon Monoxide: 9, :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 X X bedroom(s) Signature............................................................... .... Lic.#...................................... Date:................... _- On every level of a dwellin 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. fha farmc an'f r nnrtitinns of this statemelnt Owner (or Owner Agent's) Name: ? t C �ti�1ESCv�liG dt Si nature ..:C�`!t'. f�✓f'!L ..... Date. ......:.... Contractor Name:6 Signature............................................................... .... Lic.#...................................... Date:................... Smoke a77d CO form.doc revised 03/18/14