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B-2016-2739 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2739 22156 CLEARCREEK CT CUPERTINO,CA 95014-1101(326 18 020) BELLOWS PLUMBING HEATING&AIR INC SOQUEL,CA 95073 OWNER'S NAME: LIU QIANYE K TRUSTEE DATE ISSUED:09/15/2016 OWNER'S PHONE:408-861-0127 PHONE NO:(831)477-7150 LICENSED CONTRACTOR'S DECLARATION ATION BUILDING PERMIT INFO: License Class C-20:36 Lic.#483881 Contractor BELLOWS PLUMBING HEATING&AIR INCDate 12/31/2017 X BLDG —ELECT —PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing X 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: I hereby affirm under penalty of perjury one of the following two declarations: REPLACE FURNACE;AIR CONDITIONING;(SAME LOCATION) 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. 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:$10304.00 APPLICANT CERTIFICATION certify that I have read this application and state that the above information is correct.l agree to comply with all city and county ordinances APN Number: Occupancy Type:: and state laws relating to building construction,and hereby authorize 326 18 020 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 Cupertin unicipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. C Signature Date 9-15-2016 Issued by:Kim Dunbar Date:09/15/2016 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 t. 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) z. I,as owner of the property,am exclusively contracting with licensed Signature ofAppficant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:9-15-2016 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 2. 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 r %j be deemed revoked. ` Owner or authorized agent: APPLICANT CERTIFICATION Date:9-15-2016 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 1 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'S DECLARATION Code,Section 9.18. I understand my plans shall be used as public records. Licensed Signature Date 9-15-2016 Professional 4 , GENERAL PERMIT APPLICATION M E P"' � COMMUNITY DEVELOPMiENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333 building ancuoertinoCUPERTINO. .ong qMISC ❑PLUMINGlI ECIiANICAL ❑ELECTRICAL ❑TjISCEL.LA]\EOUS PROJECT ADDRESS n � tv kP?`'T ONVNZER'NAIIIEP �j E-MAIL, � � I IIOrE 0 S, � (o C)t 9 STREET ADDP.ESS / ,,00.„„ 'S.J�y� ` CITY,STATE;ZIP f /n} ,q �_ r�ls7W C�rC..f`7-.1� � l< ct C,1 95C1�1 FAX CO\T.ACT NA JE (� c t I PHO-\ E•I,iAIL , riZ J h 5 7 -0 FRe-STro�J C�L� cLar sS��2ircc STREETS DDRESS CITY,STAT ZIP �° FAX (,� kr-5 EO ke w Mat)- OAS so %�L `A 95-07-5 � ❑ OW-KM ❑ OWN`ER-BU'II,DER ❑ ONVINERSGD,'T ❑ CO?`TRtiCTOR CONTR4CTORAGENT ❑ ARCHITECT ❑m�GLN?ER ❑ DEVELOPER ❑ TE?\AxT CONTP.ACTOP.N.A!E I LICENSE'NUOERI(� } LICENSE C—AQ ? I BUS.LIC" 2 f COIJ2.k\7y N 4hiE IL jZ55 1 I F.AY, T� 00-5 @I�u.r�&tj&- rzav ✓6- �-1� t✓5 h1� r> L�c�sS r c ,cd r� 3 " Y77S 7I STREET A ,DRESS CITY;STATE.ZIP PHONE 177, 715 77 �1 49r�S�r� C 6 t i< QfZ, I F i_ A 9507-3 j , R ARCHITECT/ENWEER N=-ME LICEASE NUMBER BUS.LIC COL A Y '1,4E E-NL4IL FAX STREET ADDRESS I CITY,STATE,ZIP I PHOKE USE OF �SFD.,DLPLEX El ?„l%LTI-FAT ILY I PROTECT L'-IVILDLAND ❑ 1 is PROJECT IN El).-Es IS THE BLDG AN ❑ liS. .BUILDLNG: ❑COH\1ERC?AL LY.BAN IIATERF.ACE AREA ❑ "0 FLOOD ZONE ❑NO EICHLERHOA_E? 9r NO r DESCRIPTION OF IVORR r�3 0 1-T-10/01 A) LL IV t .S SAME ©c-fA� 0 rJ ST �—L t N6- (--EA)rte'O G. 0 -re)P6 70 Ik Pj7R A)& C TOTALI%.LUATIOv: B. J By my signature below,I ce tifv to each of the follov,dng: I am the property owner or authorized agent to action-the—property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of'Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to build s Con ae . - au h ze representatives of Cupertino to enter the abov 'dentif-d/prrop�erty for inspection purposes. SiezatureofApplicant%Aeent: ��t- Date: !S ( (� SUPPLEMENTAL INFORMATION REQUIRED -_ y 1K A gg ❑ {)E`ER THF�OU�TER> ` j t ❑ E?FR£SS -:E ❑ ST - c ❑ A24JOR3^...;' AiEPA%isc,Syp_?011.doc remised 06121111 L--j F1 , SMOKE I CARSON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE 7 11- In 11b . COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUPERT1111"40_ 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228•FAX(408)777-3333•building((Zcupertino.or.Q 00,16 Permit No. 00 — Address CKU1 V`�_ #of Alarms. Smoke: Carbon Monoxide: a i E MIT CAIITNOT BE kINALED AND COMPLETED,'U THIS CERTIFICATE IAS BEEN SNI)RFT iR , rT{ TIIBUILDI�VG�I' IOI�I 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 Id314 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 ever level of a dwellin unit including basements X X p` 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 8314 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. have read and a ree to comply with the terms and conditions of this statement Owner(or Owner Agent's)Name: Signature_,�f.�1 U �,1(J ......... .� ......... :........ ......... .........................................Date: ,. ............. Contractor Name: Signature...................................................................Lic.#......................................Date: Smoke and CO form.doe revised 03118114 F I L .. , WATER-CONSERVING PLUMBING FIXTURES 1,0 jL OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUprzi.mpm 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 408)777-3228•FAX(408)777-3333•building(c�cupertino.org � f Owner Name YE , L /V �1 Permit No Address 2-24,5Z 1. : Is your real property a registered historical site? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. 19. 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? El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. lel '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. Check one of the three following statements and sign bottom of form.. 5. Please check ONE of the following: X..xMy 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 properly. 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 noncompliant 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. Owner or Owner Agent's Signature: 14 Date: /0 Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit. SB407 2015.doc revised 08126115 G A.� �. Water-Conserving Plumbing Fixture Plum ir€. Fig e� i (Fixture Cornp€ging with Current Code Applicable to New Construction) Fixture Type F Maximum Water Usage/Flow Rate Water usage i 2013 CPC Ch.4 2093 CPC Ch.4 2013 CPC Ch.4 ,/Flow Rets 2013 CALGreen Div.4.3 2093 CALGreen Div.4.3 2013 CALGreen Div. 5.3 i ingie Family Multi-Family Commercial Residential kesidential Wafer Closets Exceed 9.6 Single flush toilets: 1.28 gallons/flush (Toilets) Gallons/flush 6 Dual flush toilets: I>28 gallons/flush effective flush volume(the composite, iJrinals average flush volume of two reduced flushes and one full flush Exceed '!.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 handheld shower is considered a showerhead.) For muitiple 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— allow only one shower outlet to be in operation at a time: i Exceed 2.2'ga ionv Lavatory per minute Maximum 1.5 gallons per Within units: 0.5 gallons per minute @ 60 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 g :;ons ; 1.8 gallons per minute @ 1.8 gallons per minute 1.8 gallons per minute @ 60 Kitchen per minute = 6ij psi @ 60 psi psi Faucets 11 May temporarily increase May temporarily up,to 2.2 gallons per increase up to 2.2 f n=r jute @ 60 psi,and must gallons per minute @ default to maximum 60 psi,and must 1.8 gallons per minute @ default to maximum 60 csi 1.8 gallons per minute I I Where faucets meating @ 60 psi t the above are unavailable, Where faucets meeting i aerators or other means the above are may be used to achieve unavailable,aerators or reduction. other means may be Iused to achieve reduction. 1. If the existing plumbing�xtuy e orator=asag�,1��!ow rate is aqua=_to or lower than.the figure shown,it is not required to be upgraded. 504072013.docravised 08126115