09010032 CITY OF CUPERTINO
41,
BUILDING DIVISION PERMIT �£ ` " ' � � � �
BUILDING ADDRESS: PERMIT NO.
10335 FINCH AVE TBD — TO BE DETERMINED
OWNER'S NAME: PERMIT ISSUE DATE
S A CONTROL NO.
ARCHITECrIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u O p LICENSED CONTRACTOR'S DECLARATION
1 m I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
U5 with Section 70(X0)of Division 3 of the Business and Professions Code,and my license is
H in full for«and effect REMV/RPLC WATER HEATER
gE License Class Llc.ff
n—a Date3W Contractor ARCHITECTS DECLARATION
I understand my plans shall be used as public records
�yU
L pH Licensed Professional
rn OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractors License Law for the
is a O following reason.(Section 7031.5,Business and Professions Code:Any city or county
e Pi which requires a permit to construct,miter,improve,demolish,or repair any structure
y prior to its issuance,also requires the applicant for such permit to rile a signed statement
E F_C that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
Y (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 1 0 O 0
y that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mom than five hundred dollars(M). 37543010. 00
❑1,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(s«.7044,Business Required Inspections
and Professions Code:The Contractor's License Law docs not apply to an owner of q p
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
C]1,as owner of the property.am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contracto(s)licensed pursuant to the Contractors
License Law.
❑1 am exeInnr- B&P C or thi reason
Owner 'L M"` Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a Certificate of Consent to self-insure for Workers Compen-
.aon,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 Workers Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Workers Compensation Insurance prier and Policy number am:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Phis section need not be completed if the permit is for one hundred dollars($100)
or less)
1 certify that in the performance of the work for which this permit is issued.I shall not
employ any person ig any manner so as to becomesYb- t r rs'Compensation
Laws of Califomi;!Q • X /
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
,J ,Z forthwith comply with such provisions or this permit shalt be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
Ri> the work for which this permit is issued(Sec.3097,Civ.C.)
WLL»Q Lenders Name
z Lenders Address
U 0 I certify that I have read this application and state that the above information is
�y► cmmcL I agree to comply with all city and county ordinances and state laws relating to
Vbuilding construction,and hereby authorize representatives of this city to enter upon the
a above-mentioned property for inspection purposes
(We)agree to save,indemnify and keep harmless the City of Cupertino against
CA liabilities,judgments,costs and expenses which may in any way accrue against said City r
V Z in consequence of the granting of this permit.
u-r APPLICANT UN ERSTANOS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGU oN
Re-roofs C7 —
Signature of Applicant/Conuactor D
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes Q],LVo
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
L hazardous air contaminants as
ncd by the Bay Arca Air Quality Management all new materials for inspection.
,trio? _
❑Yes .n No
I have mad the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health dr Safety Code,Sections 25505,25533 and 25534.1 understand that if the building
does not curet y ha a tenant,that it is my responsibility to notify the occupant of the
requirements hick t be met prior to i of certificate of C9tupa7y.
Signature of Applicant Date
Owner orauthorized agent`M` Date All roof coverings to be Class'n"or better
CITY OF CUPERTINO
5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 37543010 . 00
DATE ISSUED. . . . . . . . 01/08/2009
RECEIPT # . . . . . . . . . . BS000006931
REFERENCE ID # . . . : 09010032
SITE ADDRESS 10335 FINCH AVE
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER SREEKANTHAM, SREENATH
ADDRESS 10335 FINCH AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : SREENATH SREEKANTHA
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . . .
CITY/STATE/ZIP . . . :
TELEPHONE . . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 1, 000 . 00 1. 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 1, 000 .00 0 . 50 0 . 00 0 . 50 0 . 00
1PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 .79 0 . 00
1PRWHEATR UNITS 1 . 00 24 . 48 0 . 00 24 .48 0 . 00
1TRAVDOC FLAT RATE 1 . 00 40 .79 0 . 00 40 . 79 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 107 . 56 0 . 00 107 . 56 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 107 . 56 VISA
---------------
TOTAL RECEIPT 107 . 56
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- -------------------------
518 WATER HEATER
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
rUPEkTINO
Building Department
JOB ADDRESS: 10335- Ft IYCm AVE PERMIT #
C- PCI2?tNo A —41 50(
OWNER'S NAME: 5n-jC—rj&g Ffi Z5P—eEXAjs(rjjAM PHONE #
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
Oct 0
CITY OF CUPERTINO
* WATER HEATER
CUPEkTINO PERMIT APPLICATION FORM
APN # O Date:
Building Address: JOS35 Fl fvc m A v t C UPFRIrI ND ,CA - 5 0!�
Owner's Name: S tZL(FN STH 'SR€EkANTI,44 M Phone #:
Contractor: IT c3 D Phone #:
Fax #:
Cupertino Business License #: Contractor State License #:
Contact: Phone #:
Fax #:
Building Permit Info:
Bldg Elect ❑� Plumb --- Mech El---
Residential Commercial ❑
Job Description: RE PCA GE Ex X57/NGS OLD W A?EA- H EA?E!Z AVW
w 17 H New W A7E1c H EA7CX . 1�N S T A I-L DRY W A L1-(5 NE k ,0oCk)
i o -rkle still= OF wA?ER H EA7EA W eh/cc H is N07 "t5?/NG, LtJnRElV 7 y.
Strapped H--'On Platform Ei' Bonded E4--New Location ❑ . Replacement
Valuation (cost of project):
Project Size: Express [9—Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to
the application or if applicable, include in plan set & the sheet index.
Green Building Points achieved: C'
Revised 6/16/08
INPUT Resources Energy IAQ/Health
I.Windows
1.Install Energy-Efficient Windows
a.Double-Paned 1 Energy pt y--yes 0
b.Low-Emissivity(Low-E) 2 Energy pts y=yes 0
c.Low.Conductivity Frames 2 Energy pts y=yes 0
2.Install Low Heat Transmission Glazing 1 Energy pt y=yes 0
F::::]
1 1 1
J.Heating Ventilation and Air Conditioning
1.Use Duct Mastic on All Duct Joints 2 Energy pts y=yes 0
2.Install Ductwork within Conditioned Space 3 Energy pts y=yes 0
3.Vent Range Hood to the Outside 1 IAQ/Health pt y=yes 0
4.Clean all Ducts Before Occupancy 2 IAQ/Health pts y=yes 0
5.Install Solar Attic Fan 2 Energy pts y=yes 0
6.Install Attic Ventilation Systems 1 Energy pt y=yes 0
7.Install Whole House Fan 4 Energy pts y=yes 0
B.Install Sealed Combustion Units
a.Furnaces 3 IAQ/Health pts y=yes 0
b.Water Heaters 3 IAQ/Health pts y=yes 0
9.Replace Wall-Mounted Electric and Gas Heaters with
Through-the-Wall Heat Pumps 3 Energy pts y=yes 0
10.Install 13 SEER/11 EER or higher AC with a TXV 3 Energy pts y=yes 0
11.Install AC with Non-HCFC Refrigerants 2 Resource pts y=yes 0
12.Install 90%Annual Fuel Utilization Efficiency(AFUE)Furnace 2 Energy pts y=yes 0
13.Retrofit Wood Burning Fireplaces
a.Install EPA certified wood stoves/inserts 1 IAQ/Health pt y=yes 0
b. Install/Replace Dampers 1 Energy pt y=yes 0
c.Install Airtight Doors 1 Energy pt y=yes 0
14.Install Zoned,Hydronic Radiant Heating 3 Energy pts y=yes 0
15.Install High Efficiency Filter 4 IAQ/Health pts y=yes 0
16.Install Heat Recovery Ventilation Unit(HRV) 5 IAQ/Health pts y=yes 0
17.Install Separate Garage Exhaust Fan 3 IAQ/Health pts y=yes 0
1 1 1
K.Renewable Energy and Roofing
1.Pre-Plumb for Solar Water Heating 4 Energy pts y=yes 0
2.Install Solar Water Heating System 10 Energy pts y=yes 0
3.Pre-Wire for Future Photovoltaic(PV)Installation 4 Energy pts y=yes 0
4.Install Photovoltaic(PV)System
(1.2 kw=6 points,2.4 kw=12 points,3.6 kw=18 points) Up to 18 Energy pts 0
6.Select Safe and Durable Roofing Materials 1 Resource pt y=yes 0
7.Install Radiant Barrier 3 Energy pts yqesL�j 0
1 1 1
L.Natural Heating and Cooling
1.Incorporate Passive Solar Heating 5 Energy pts y=yes 0
2.Install Overhangs or Awnings over South Facing Windows 3 Energy pts . y=yes 0
3.Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes 0
1 1 1
� oqr 001
I