B-2016-2724 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2724
21391 COLUMBUS AVE CUPERTINO,CA 95014-4921(362 04 007) SAFE STEP WALK-IN
TUB COMPANY INC
HUNTINGTON
BEACH,CA 92649
OWNER'SNAME: GREELEY PATRICIA A TRUSTEE DATE ISSUED:09114/2016
OWNER'S PHONE:650-814-6502 PHONE NO:(714)373-8545
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class a Lic.#983603 X BLDG X ELECT X PLUMB
Contractor SAFE STEP WALK-IN TUB COMPANY INC Date 05/31/2017
—
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
MASTER BATH;REPLACE(E)BATHTUB WITH(N)WALK-IN(SAME
I hereby affirm under penalty of perjury one of the following two declarations: LOCATION WITH(I)DEDICATED CIRCUIT
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.
C:
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 issued. Sq.Ft Floor Area: Valuation:$17200.00
APPLICANT CERTIFICATION
`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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 362 04 007
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. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FR ED INSPECTION.
Signature% > Date 09/14/2016 Issued by:MELISSA
Date:09/14/2016
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. 1,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. 1,as owner of the property,am exclusively contracting with licensed Signature ofApplicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:09/14/2016
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. 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. HAZARDOUS MATERIALS DISCLOSURE
z. I 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 material. Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent
APPLICANT CERTIFICATION Date:09/14/2016 �%`
certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction 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 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'S1bused
DECLARATION
Code,Section 9.15. I understand my plans shall be used as public records.
Licensed
Signature Date 09/14/2016 Professional
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMiiENT DEPARTMIEN T• BUILDING DIVISION M E
10300 T ORRE AVENUE• CUPER T INO, CA 95014-3255
x (408)777-3228 FAX(408)777-3333 building0cuDerino.org
CUPER.TINO
ZMISC
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DESCRIPTIO\OF WOPJ
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By my signature below-,I cerif" to each of:.he following: I am she propel owner or authorized agent to act on the 'r „ vner s behalf I have read this
application and tLe information I have provided is correct. I have read the Description of-W707-l:and verify it is accurate. I as;ee to comply with all applicable local
ordinances and state laws relating to n Dding cons�u�OI' anuhorize rep* _e-1-tiv es of Cuper tiro to enter the above-identin/ed prop--'--t'for inspection purposes.
Signature Date;
SUPPLEMENTAL INFORM TIONI REQUIRED -
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_'<EP.7�/isc.4vv_'011.doc rericed 06/111.11
PLUMBING FIXTURES,
OWNER CERTIFICATEF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION '
1 € 10300 TORRE AVENUE--CUPERTINO,CA 96014-3255
CUPERT
(408)777-3228•FAX(4£38)777-3333 12dineala)xcuu�rt�no
Owner Name *^,cam+ Bcranit.l'ac�: - . :7 -`
Address
l Is your real property a registered historical site?
171 'Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Slip the rest of the form and sign bottom:of form.
No Go to Question 2.
2. 'Roes your real property have a licensed plumber certifying that,due to the age or configuration of the property or its
plurmbing,installation of water-conserving plumbing fixtures is not technically feaeible?
0 Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
Cil The licensed plurnber's certification has been provided to the Building Division.
Skip the rest of the form and sign,bottom of form.
04 No Go to Question 3,
3� Is water service pernra eptly disconnected for your building?
❑ Yes Civil;Code Sections 1101.1 through 1101.8 oto not apply. Skip(lie rest of the,faun and sign bottom of form,
25 No Go to Question 4;
4 Is your real property built and available for use or occupancy can or before January 11 1994?
0 No My real property is built and available for use or occupancy after January 1,.l 994,
Civil Code Sections 1101.1 through 1141.8 do not apply. Skip the rest cf 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. Check one of the three following statements and sign
bottom of form.,,
S Please check ONE of the following:
My property is a single-faara ly residential real propel=. See Civil.Cade Section 1101,4.
On and after°January 1,2014,building alterations or improvements shall require all noxi-compliant pl rnbing fixtures
to be replaced with water-conserving plumbing fixtures throughout the building.On or before January 1,2417,all
non-compliant, plumbing fixtures shall. be replaced with water-conser-,ing plumbing fixtures (regardless•of whether
property undergoes alterations or improvements).
( My property is a multifamily residential real property. See Civil Coote Section 1101.5.
Can and after January 1,2014,specified builds g alterations or improvements shall require non-compliant
plumbing fixtures to be replaced with water conserving plumbing fixtures,
On or before January 1,2419,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 properly is a c"oannercieal real property. See Civil Code Section 1101.5,
On and after January 1,2014,specified building alterations or improvements shall requirenon-compliant
plumbing fixtures to be replaced with water-conserving plumbing fixtures;
On,.or before January 1, 2019, all non-cor'npliant plumbing fixtures shall be replaced with water- conserving
plumbing fixtures throughout t the building(regardless of whether property undergoes alterations or improvements),
I,as the ovnier 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 1141.1
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 can the followin` page;
e:
Owner or OwnerArgerit's Signature; Date:
Upon completing and signing this Cerdficaite,please return it to the Building Division in order to final your building pennit.
S'B40 2015,doe rea'zsed 118X26113
1.
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l� s
Non-Compliant
Water-Conserving Plumbing Fixture
Plumbing Fixture! (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 2913 CFTC Ch.4
�.
/Flow Rate 2013 CALGreen Div.4.3 2013 CALGreen Div.4.3 2013 CALGreen Div..5.3
Single-Family Multi-Family Corierolal
i
Residential Residential
Water Closets Exceed 1.6 Single flush toilets: 1.28 gallonsfflush
i(Toilets) Gallons/flush Dual flush toilets 1.26 gallons/flush effective flush volume(the composite,
average flush volume of two reduced flushes and one full flush
urinals Exceed 1.0 0.5 gallonslflush
Gallonslflush
lShowerheads Exceed 2.5 2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of
gallons per minute U.S. EPA WatrSense Specificationfor Showerheads
I (A hand-held shower is considered a showerhead.)
For multiple showerheads serving one shover,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 galloaas per minute @ 60
Lavatory per minute; minute@ 60 psi;minimum Maximum 1.5 gallons psi
,Famets (3.8 gallons per minute @ per minute @ 60 psi;
t
20 psi minimum 0.8 gallons
per minute a 20 psi
In common and public
use areas- 0.5 gallons
per minute c@s 60 psi'
18 gallons per.minute
[Faucets— Exceed 2.2 gallons 1.8 gallons per minute cr 1.8 gallons per minute l.8 gallons pe'r niinu 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 minutedefault to maximum
60 psi 1.8 gallons per minute
f Where faucets meeting 60 psi
the above are unavailable, Where faucets meeting
aerators or other means the above are
maybe used to achieve: unavailable,aerators or
reduction. other means may be
used to achieve
l reduction,,
t. If the existing plumbing fixture waterusage/flow rate is equal to or loafer than the figure slimm.it isnot required to be upgraded,
f
i
r,
I
.SB407 2015.doc revisal 08,06,I S
i
ALARMSSMOKE I CARBON MONOXIDE.
rOWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOP PENT IDEPARTMENT-BUILDING bivISI N
#' T 11"[ 10300 TORRE AVENUE•CUP'ERTI O,UA X5014-3255
(408)77'7-32211-FAX(408)777-3333-building@SupertPng.ore #p
i rMit No
Address 2(34( [ ' 4-s Aye- #of'Alarms Smoke: Carbon.Monoxide.-S
'l1 SAI lC3T B11 ii+v" D ND'CQ PLTED N--TI THIS CES I I'A K
� El
� 1IiR ""T Tb`lff, 4iI1 LD�G DI��I I �
PURPOSE
This affidavit is a self-certification for the installation of all required rnoke.and Carlson Monoxide Alarms for
compliance with 2013 CRC Section 8314,2013 CBC Sections 420.6 and 907.2.1.1.2 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 131.4 and CBC Sections 907.2.11.E and 420.6 require that Smoke Alarms and/or Carbon
Monoxide Alarms be installed in the following locations.
AREA SM KE ALARM Ctl ALARM
Outside of each separate sleeping area it the immediate vicinity of the X X
bedroom(s)
On every level of a dwelling unit including basements X X
Within each sleeping room. `C
j Carlson 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 4220.6 and shall be approved by the Office of tl-re Mate Fire Marshal..
Power Supply°,In-dwelling units with no commercial power supply,alarm(s)may be solely battery operated.
In existing dwelling units,warms 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.Defer to CRC Section R314 and CBC Sections 907.2.11.4 and 4201.6.2. 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 aoMe!Z with the terms and conditions§of this-taternent
Owner(or Owner Agent's)Name:
Al-'f'vic-ia. Gi-e-e-(ej Sim ture—, :. Date:
Oontraotor Name;
S-1-0 $+ im tc-od t j1co signature.../1rc. ..... ..,...63ats; .'€ -(6
Sm,--)ke and C'O fortn.doc revised 173/18:'14
t,