12060125 CITY OF CUPERTINO BUILDING PERMIT
RUILDINGADDRFSS: 10016SPANISII OAK CI' CONTRACI'0I4:PAYLISS WAI'IT PF.RNIIT\0: 12060125
I lEATERS
O\\'?FN'S N,\\IF.: LliIi CRAIG MAND NANCY I'fRUS'rEE24895 AVENUE ROGRFFF11.1•ER DATE ISSUED:06/21r)(112
OWNER'S PHONE: 4084464773 VALENCIA,C\ 91355 PHONE NO:(661)775-2944
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r r ELECT PLUMB r
License Class G 3�0 Lic.N —D 3�0,I�O� r r r
-- - MECH RESIDENTIAL COMMERCIAL
Contractor , Date
1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REMOVE AND REPLACE 40 GALLON WA FR I II:A'I FR
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
1 hereby affirm under penalty of perjury one of the following two declarations:
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. Sq,Ft Floor Area: Valuation:S1000
1 have and will maintain Worker's Compensation Insurance•as provided for by
Section 3700 ollhe Labor Code,Ibr the performance of the work for which this
permit is issued APN Number.34232075.00 Occupancv rype:
APPLICANT CF-RTIFICATION
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 relating PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned properly for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION.
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally the applicant understands and will comply /E�/� /•�, �7 1
with all non-point source regulations per the Cupertino Municipal Code,Section Issued by: /'f / /��✓� Date:
9.18. /J J�,, Q� �-r� ��
Signature UP'- Dale
RE-ROOFS:
❑ O\VNT;R-BUILDER DECLARATION All roofs shall be inspected prior many roofing material being installed. If a roof is
installed without first obtaining an inspection.I agree to remove all new materials for
I hereby affirm that I am exempt from the Contractor's License Law for one of inspection.
the following two reasons:
f,ns owner of the property,or my employees with wages m their sole compensation. Signature of Applicant Date:
,rill do Elie work,and the structure is not intended or offered for sale(Sec7044,
Business&Professions Code)
L as owner ohhc property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BE ITER
construct the project(Sec 7044,Business&Professions Code).
1 hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS S DISCLOSURE
declarations: I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Cenificale of Consent to self-insure for Worker's California Ilealth&Safety Code,Sections 25505.25533.and 25534. 1 will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Ilcalth&
performance of the work for which this permit is issued. Safety Code,Section 25532(a)should 1 store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air
Section 3700 ofthe Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will
iid maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit sssue
Ilcalth&Safety Code,Sections 25505,25533,and_5534.
1 certify that in[lie performance of the work for which this permit is issued,I shall
not employ any person in any manner so as to become subject to the Worker's Owgy��, int or e n • ' �-S
Compensation laws of California. 11'.alter making this certificate orexemption,I �e''`` �J Date: lfl
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this peril shall be deemed revoked CONS'I'RUC-FION LENDING AGENCY
I hereby alfrm that there is a construction lending agency I-or the perRmmunce of work's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.1
I certify that I have read this application and state that the above information is Lender's Name
correct. I agree to comply with all city and county ordinances and slate laws relating
to budding construction,and hereby authorize representatives of this city to enter Lender's Address
upon the above mentioned property for inspection purposes.(We)agree to save
indemnily and keep hatless the City of Cupertino against liabilities,judgments, ARCHITECT'S DF-CLARA'FION'
costs,and expenses which may accrue against said City in consequence of the
granting of this petit.Additionally,the applicant undersmnds and will comply I understand my plans shall be used as public records,
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Licensed Professional
Signature Dale
CITY OF- CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: suew
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN - 34232075 . 00
DATE ISSUED. . . . . . . : 06/21/2012
RECEIPT # . . . . . . . . . : BS000017124
REFERENCE ID # . . . : 12060125
SITE ADDRESS . . . . . : 10016 SPANISH OAK CT
SUBDIVISION . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER .. . . . . . . . . . . : LEE CRAIG M AND NANCY J TRUSTE -
ADDRESS 10016 SPANISH OAK CT
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5624
RECEIVED' FROM . . . . : IE INC 818-735-7876
CONTRACTOR . . . . : SCOTT OKSAS LIC # 33114
COMPANY . . . . . . I . . . : PAYLESS WATER HEATERS
ADDRESS . . . . . . . . . . : 24895 AVENUE ROCKEFELLER
CITY/STATE/ZIP . . . : VALENCIA, CA 91355
TELEPHONE . . . . . . . . : (661) 775-2944
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW SAL
---------- ------------- ---------- ---------- -- ---- ----
-ADMIN HOURS 1 .00 41 . 00 0 . 00 41 . 00 0 . 00
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 44 . 00 0 . 00 44 . 00 0 . 00
1PRWHEATR UNITS 1 .00 26 . 00 0 .00 26 . 00 0 . 00
1TRAVDOC FLAT RATE 1 . 00 44 . 00 0 .00 44 . 00 0 . 00
TOTAL PERMIT 156 . 50 0 .00 156 . 50 0 . 00
METHOD OF PAYMENT _AMOUNT REFERENCE NUMBER
- ---------------- --------------- --- ----- ---
CHECK 156 . 50 15389 PAYLESS WTRHTR
---------------
TOTAL RECEIPT 156 . 50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
----- -------------------- -------- -------- --------- - ---- - - -
518 WATER HEATER
GENERAL PERMIT APPLICATION I r i E P
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 w A ' [7
CUPERTINO (408)777.3228• FAX(408)777-3333•building(a cuoertino.orc m v\
I
ZPLUNMING EIMmau.NicAL ❑EI.ECfucAL ❑MISCMLANEOUS
PROJECT ADDRESS - ' Spun C 1 (�AlFJN'/� 'J -'F ./,70 ✓��- �- 7S—
OWNER NAME p ,I W I AV (.. PRONE
(�o D -(Yr[` '1 7 1 ' r1 E.KAa
'or
ST=ADDRFSS Ivo1La? I•S anJ s6l . � Ll �Lt �o L� 4sury FAX
CONTACT NAME FROM - E-MAIL
STREETADDRESS =.STATE, ffi FAX
❑DWNFA ❑ OWNEXAUBDER ❑I tOWNEER AGENT 1:1❑tDM1UCIOR AGENT ❑ AA�tECT ❑Enm+EER ❑ DEVVFS..DrFa ❑m+A.`+r -
CONTRACIORNAhf�J �ss r/�/ _UL.I 1�-V`r/"r Il@SENUMDER �/ 2.r(p 1.10ENSErYPE C�/_ RUM LICC
COMPANY NAME r �1 E-KAIL �1O /1 W FAX
STREET ADDRE55`6`S I7 U'�-ll u.li I'�W�^"C`c.l(� crtY,srpT�,�P - "� C("l� `'13�� �I�I T75 2`1 L(L/
ARCRT EC IENGU4M3 NAME Il@15E Nl1MBF7t �(�/L(/( Bus uc a
COMPANY NAME. E-MAO. FAX
STREET ADDRESS CITY.STATE.ffi PHONE
USE()F SFGwDUFLEX ❑ MULTFFA y PRO=Ba WBDLAND ❑ Yr3 PROIFLTW ❑Yr3 MTNE.MAN ❑YES
BIIDJ1D14 ❑m••••"••�r URBAN DITFAFACE= NO FLOOD ZONE NO Eu>=ROKE? NO
DESCRIPTION OF WORK
U`, RECEIVED BY:
ITTTAL VALUATION: OV 1 �
Ey my sigoaoae below,r eerdfy to each of the follavaing. I am the property awoa car aatboriad agm[m arl m the property mvBets behalf I hoot read this
apphcadm mad.the hdbrmadm 1 have provided is mrrsL.1 have read the Descriptio¢of Work a=d r_ify it is accurate. I agree to mu;ply with all applicable local
ordiDaaces and state laws relating m buildingI anth ' es of copertmo m enter the above-ideadfied for mspemm paf'poses
SigoaD¢e of Appli®r1AgeoE'
Date:
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
u OYER-TueiCOIf'rf0t
❑ Vu REm
u
= ❑ STANDARD
'u
_ ❑ LARGE
3
❑ MA OR
MPPmuCAPP_2011.d0C revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 10016 Spanish Oak Ct DATE: 06/21/2012 REVIEWED BY: Sean
APN: BP#: 5— -VALUATION: $1,000
-PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Duplex PENTAMATION PRWHEATR
USE: PERMIT TYPE:
WORK Remove and replace water heater.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Water Heater 1PRWHEATR 1 # $26
TOTALS: $26.00
1A,r, IVa" f !I,, Plumb. Plan Check 0.0 hrs $0.00
t t-;6- l,nidi P�,•: Plumb. Permit Fee: IPPERMIT ICi,-, Prn.m 1
ud,•, tl,,h, Iaq_
Other Plumb Insp. 0.0 hrs $44.00 U/hr, 0"'. 1ny,.
.1-Ireh. Li,u. Frr' Phunh. Ga.p. I're lilrr.(nap. h�rr-
NOTE: This estimate does not includejees due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School
District,etc. . These fees are based on the prelintina information available and are only an estimate. Contact the Dept for addtr'l info.
FEE ITEMS (Fec Resolution 11-053 E/L 7/1.11) FEE QTY/FEE MISC ITEMS
Plan ('h"r 4 leer.
Snppl. 1'C 1 rr
PME Plan Check: $0.00
!'rrvnit
SnIppl. biap IrCc
PME Unit Fee: $26.00
PME Permit Fee: $44.00
(,'niearrn(rion Totr:
Administrative Fee: (ADMIN $41.00
Work Without Permit? 0 Yes E) No $0.00
.I1/10H,0l O'rimm.", /h4 cs:
Travel Documentation Fee: ITRAVDOC $44.00
Slrong, Minion Fee: IBSEISMICR $0.50 Select an Administrative Item
RI&I,Sids Commission Fee: IBCBSC $1.00
SUBTOTALS: $156.50 $0.00 TOTAL FEE: $156.50
Revised: 06/30/2012
Prescriptive Certificate of Compliance:.Residential WATER HEATER CF-IR-ALT-Water Heater
Date- Enforcement Agency: Climate Zone# #of Stories Permit #
-Zl- IZ 12
Site Address:
1oO1(o s rlt . C)A LF
Building Type ig Sinle.Farnil _❑Multi Family
NOTE: Thisform is not to be;used or NejJly Constructed Buildings or Additions
WATER HEATING
List water heaters and boilers for both domestic hot water(DHW) heaters and hydronic space heating.
Individual dwelling DHW.heaters rhust be gas or propane fired, and may not exceed 50 gallons. Hot water pipe
insulation from the DHW'heater to,the kitchen(s) and on all underground hot water pipes is required in all
component packages in all climate zones.
Water Heater Type/ Distribution Type Number Tank Energy Factor External
Fuel Type (Standard, in System Capacity or Tank
Recirculating)?, (gal) Thermal Insulation
Efficiency R-Value3
0.� s S�Gvi�lG t 1 , t;�L
1. Indicate type (Storage'Gas,.Heat Pump, Instantaneous, etc.)
2. Recirculating systems serving,multiple dwelling units shall meet the recirculation requirements of
§150(n). The Prescriptive "requirements do not allow installation of a recirculating water heating system
for single dwelling units.
3. The external water heating tanks and pipes shall be insulated to meet the requirements of§1500).
Declaration Statement--
• l certify under penalty of perjury.under the laws of the State ofCalifornia,the information provided on this form is accurate
and complete. -
e I certify that the energy featuresand performance specifications identified on this Certificate of Compliance conform to the
requirements of Title 24j Pans-1and 6 of the Califomia Code of Regulations.
Name: Signatur
6U�.tili1� . �roek s
Company Date:
a Less WaLr .�-Ee ZL6/_s b-zi-/z
Address: License:
x4895 Aoeoue, 'c�Fl--/(p-r (R3G) '�LCa
City/State/Zip: c Phone:
UO,l PA' 6A Q13ss (a�( 77� - 2-c?yy
For assistance or questions regardi6ethe Energy Standards,contact the Energy Hotline at I-800-772-3300.
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