12090223 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10162 FIRWOOD DR CONTRACI'OR:BENJAMIN FRANKLIN PERMIT NO: 12090223
PLUMBING
OWNER'S NANIE: SHAIi KETAN AND ALPA PO BOX 1072 DATE ISSUED:09262012
OWNER'SPHONE: 4084398954 CAM PBELI„CA 95009 PBONF.NO:(308)298-1776
[� LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r, ELECT n r1
PLUMB
License Class e3 6 'j
Lie.4 `5 S 7 3 .5 7 r_ r n
M1sCli RESIDENTIAL COMMERCIAL
Contractor 19 Ata./IJ Date /p Z(D`
1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REMOVE AND REPLACE WATER HEATER IN SAME
(commencing with Section 7000)of Division 3 of the Business&Professions LOCATION(40 GALI.ON)
Code and that my license is in full force and effect.
I 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 w'orker'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 Sq_F-1 Floor Area: Valuation:$1998
Section 3700 of the Labor Code,for the performance of die work 1'mr which this
permit is issued.
ANN Number:34235027.00 Occupancy'1)pe:
API'I,IC,kN I'CER'I'II'ICA'I'ION
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 Imus relating
to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the Igo DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Issued by: ��.zsaz /%�7l/fT Date: 9'plo`a—
Signature Dnte 9 �G (Z
❑ O ER- LDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to my roofing material being installed.If a roof is
1 hereby aft- m am exempt from the Contractor's License I,asr for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following tsva reasons: inspection.
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(Sec.7044, Signature of Applicant: Date:
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL.ROOF COVERINGS TO BF,CLASS"A"OR BE ITER
I hereby affirm under penalty of perjury one of the following three
declarations: IIA-"/,ARDOUS MATERLU S DISCLOSURE
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California IIca11h&Safely Code,Sections 25505.25533,and 25534, I will maintain
performance of the work for which this permit is issued. compliance with the Cupertinu Municipal Code.Chapter 9.12 and the Ilealth&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code.Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should )use equipment or devices which emit hazardous air
contaminants as defined by the Ray Area Air Quality Management District I will
permit is issued, maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the
I certify that in(lie performance of the work forwhich this pernit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I Owner or amhor' C
become subject to the Worker's Compensation provisions of the Labor Cade,I nmst Uatc
for iwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING.\GF\Cl'
APPLIo\Nf CERTIFICATION I hereby aff mm that there is a construction lending agency for the performance of work's
I certify that I.have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and sate laws relining Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
indemnify and keep harmless the City of Cupertino against liabilities,judgments•
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply .1RC11 rrEcrs DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
Prescriptive Cet•tificare of Cota fiance: Residential CF-IR-ALT
Resideutial.dlteradons Pagge-1 of 8)
Project Name: 1 r y�- �,7 Climate Zoned ii of Storie-.
5 /�Tf R�IL-l2 •! I CST('/\
General Information
Site Addre..: /016Z Ftr2c.�Ov17 �, Enforcement Agenq•:e,�L �4;7-1W0 Date:
Buildiag Type IPS'"nsgle Famil ❑Multi Family Circle the Fran:Orienration:!v,E.S,N,in degrees
Conditioned Floor Area(CFA): Aajec:Type: ❑Alterations ❑Envelope 0 Fene:na,:en ❑Rcuf C FVAC
Re !acemem os CLanee Om ❑Dur.Re laceme_t Rater Heater
\•OlEr This form is riot to be ured far Ae.alr Consmrered Buildings or.4ddidons
WATER HEATI\G
List water heaters and boilers for both domestic hot nerm•(DHII%hearers and Indronic space hearing. Individual dtrelling DHIPItea;ms nnist be
gas or proponr fired. Hot st•orer pipo insulation fi'ont ilia DHR'heatm•m the kirchmis)mid on all underground hot warer pipes is required in mi
conmonent pockqzos in all Climate_ones.
Estemal Tank,
Nater Hemet Typeffitel Distribution Type Number In Tank Energy Factor or htsularion
Type] (.Standard.Recirculating)2 System Capacity(pal) Thenal Efficiency R-l'alue`
G,a5 O C '4 - (9-z-
1.
1.Indicate 7)pa(Storage Gas,Hear Pump,Lummmneota,etc.)
1.Recirrulming srsrmns serving multiple dsralling units shall neer the recirculation requirmanwis of}I50(n). An Proscriotioa raquiremems do
not allow the installation ofer rocircuiaring umor heating s7stern for single duelling units.
3. The ertcrnal crater hamine tank and nines shall be insulated to nicer the remarmnenrs of o1506). e
Documentation Author's Declaration Statement
e I certify that this Certificate of Compliance documentation B accurate and complete.
Nallle: /J $IHtta[me: -
� 12 in
Company: Dat .
en1Ji17Nr n k�/A) I�IJeNt3IJ� ��z`f��2
Address:ZZ l 1 If Applicable O CEA or O CEPS
G/��L_ %Z. (Ceniflcation=):
Ciry;StatdZip: oJ/f-70GA Pyne:15
. its g 3 2 6
For assistance or questions regarding ilie Energy Standards,cnrrtnet the£nergr Hotline m:I-800-772-3300.
Regisnruion Number: Regisnvtion Dnte/Time: HERS pr'oridm:
3005 Residential CoaDliance FOroitS Ai4gusr 3000
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10162 Firwood Drive DATE: 09/26/2012 REVIE\YED BY: Sean
APN: 'BP#: 'VALUATION: 1$1,99
8
*PERMIT TYPE: Plumbing Permit. PLAN CHECK TYPE: Alteration/Addition / Repair
PRIMARY 'SFD or Duplex PENTARIATION PRWHEATR
USE: - PERMITTYPE:
WORK Remove and relace water heater in same location 40 gallon).
SCOPE:
. APPLIANCE%EQUIP TYPE FEE ID QTY UNITS BP FEES
Water,Heater- 1PRWHEATR 1 # $27
TOTALS: $27.00
A1ech. Plan Check Plumb. Plan Check 0.0 hrs $0.00 Elec. Plan Check
Mech.Permit Fee: Plumb. Permit Fee: IPPERAHT Elect Permit Fee:
Orber Afech. Insp. Other Plumb Insp. 0.0 hrs $45.00 Other Elec. Insp. El
.Meeh.Insp. Fec: Plumb. bup.Fee: Mee.Insp.Fee:
NOTE: This estimate does not include fees due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School
District,etc.). These ees are ha.sed on the prelitninart information available and are only an estimate. Contact the De t or addn7 info.
FEE ITEMS /Fee Resolution i1-053 Efl' 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Chuck Fee:
Supp/. PC Fec
PME Plan Check: $0.00
Permit Fee:
.Supp/. Insp Fee
PME Unit Fee: $27.00
PME Permit Fee: $45.00
Constriction Tax:
Administrative Fee: IADAaIN $42.00
Work Without Permit? 0 Yes (j) No $0.00
iic/vancect Planning Fees:
Travel Documentation Fee: /TRAVDOC $45.00
i
Strong Motion Fee: IBSEISAIICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $160.50 $0.001 TOTAL FEE: $160.50
Revised: 07/01/2012
Z09 o ZZ3
GENERAL PERMIT APPLICATION M E P
EM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO,CA 95014-3255 MIA
CUPERTINO (408)777-3228•FAX(408)777-3333•building0cuoenino.orcl v\
PLUMBING q ❑MECHANICAL El ELECTRICAL ❑MISCELLANI:OUS^
PROTECT ADDRESS 1 101
6z 1—I ^ Ooop ) f J� ^PNS ,,j �� O
OWNERNAME E I MAN 1
T&3
LMAIL O_
STRF. ADDRESS �- CITY,STATE.ZIP FAX
10 62 )—IRocsv -D/2/0E GcJ csZ7/.10 G/I • 95oN
CONTACT NAME KIM AT BEMJAMIN FRANKLIN PHONE 415-459-3266 E-MAIL
STREETADDRFSS CITY,STATE,ZIP FAx
22 DIGITAL DR. STE ONE NOVATO, CA 94949 415-506-0410
❑OWNER ❑ OWNER-BUILDER ❑ OWNFRAGENT ® CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LICE
857357 C36
COMPANY NAME E-MAIL FAX
BENJAMIN FRANKLIN PLUMBING 415-506-0410
STREET ADDRESS CITY,STATE,ZIP PHONE 415-459-3266
22 DIGITAL DR. STE ONE NOVATO, CA 94949
ARCHITECTIENGINEER NAME /v ^ LTCENSEN'UMBER BUS.LIC.
COMPANYNAME K E-MAIL FAX
STRINI T ADDRESS CITY,STATE.ZIP PHONE
USE OF IF SPD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE: ❑ Commercial URBAN INTERFACEAREA ❑ Yes ❑ NO FLOODZONE ❑ Yes ❑ No
DESCRIPTION OF WORK
C7 lj pr7e HC
E A)O tt-A-C-7uz
N: Z
TOTAL VALUATIO / ro RECEIVEDBY:
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the properly 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 slate laws relating to building comIrUcti I authorize represe o o enter the above-identified property for inspection purposes.
Signature ofApplicanUAgene Dale: 2 7 Z
SUPPLE ORMATION REQUIRED OFFICE.USE ONLY
WOVER-1'IIF.-COUN'TF.R
❑ F.x PiDSti
1
U
=' ❑ FIANDAnn
V
❑ LARGE
❑ MAJOR
MEPA1iscApp_101 Ldoc revised 0311611/