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12120008CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10802 WILKINSON AVE CONTRACTOR: AAA FURNACE & AIR PERMIT NO: 12120008 CONDITIONING OWNER'S NAME: LEVY ROBERT J AND LOUISE W TRU 1712 STONE AVE DATE ISSUED: 12/042012 OWNER'S PHONE: 4087250275 SAN JOSE, CA 95125 PHONE NO: (408)293.4717 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL LJ COMMERCIALU Dt-2f License Class 20 C` Lie. # 26c REMOVE AND REPLACE WATER HEATER IN SAME Contractor `�i �U iy ° Date I: � `� �^ LOCATION I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions 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 Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $1052 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 APN Number: 35613039.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 1 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAY M LAST CALLED INSPECTION. 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 Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 07� �� RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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, Business & Professions Code) " I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(x) should I store or handle hazardous 1 have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sectiqns 25505,25503, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent r permit is issued. I certify that in the 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 Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, 1 must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harnless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 0 10300 TORRE AVENUE • CUPERTINO, CA 95014.3255 QP (408) 777-3228 • FAX (408) 777-3333 •-buildinG(c),cuoertino.oro FV' FLUMBING M &MCHAMCAL I—IF.IF.CTRICAI -\ 1P� 1 MiRCRr 1 ANprll IR MEP MISC PROJECT ADDRESS 1`� t r\5I� (�„ptgyp, �•�JL w APNA 1 OWNERNANIE PHONE /II'[`?,��•I�r�(.1^ 1 J[ (,J/,try1A4 EKAIL ' SI'RESTADDRESS �l�/r1 WIt t�(V�(1Q^ ,qAy rj J \/� CRY, STATF,,ff — t SEE FAX CONTACT NAM � ,� lf��► FH° • 3 •4111 -MAIL STREET ADDRESS„ S'tMPl�1`9✓1 � Cr1Y. A�,(\ZIP 1.,�._,... (Rb FAX ❑ OWNER ElOWNER-BUILDER ElOWNERAGENT VCONrRACTOR ❑CONTRACrORAGENr ❑ A✓HRC`❑ ENOMEER ❑ DEVELOPER ❑ TFNM CONTRACTORNAME /O /L,A_ r Ljp" ,(') F�CTIi\ r NCJr�V LJCF 2 E� 1 L10Ej„J� GZ� V}/j BUS. L1Cl (�� Tl�-J�7V COh1PANY NAME E-MAIL �a•Z�13• �'rt I STREET ADDRESS 1.--(l^L 6-vonU �W1 CT(p', �y7AA 0* !.CY�,IM ^� r "Y PHONE 2u3.4')n AACJm"CTJENOINEERNAbM LICENSENUM1IBER BUS. LIC# CO&TANYNAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF SFD Or Duplex ❑ Multi -Family SIAUCTURE: ❑ Commercial PROJECT IN wB.DLAND URBAN NTERFACE AREA ❑ Yes ❑ No PROJECT IN FLOODZONE ❑ Yes ❑ No OFSCRfPrION OR WORKMAYwo nrV GCIZ/ �^ -'N1 eb"A(I LVII UUJC - r f� TOTAL VALUATION: -AA 1 tjJi• ov i By my signature below, l certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information ve prov' 's 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 « I ng to ild' g c !ruction. I authorize representatives of Cupertino to enter the above -id tamed property ror inspection purposes. Signature of ApplicanVAgent: Date: l (� qTFPW.T7.?VTM1AT. rKmnRMAT7r1NRPnTNRRI) MEFAfuc.4pp_2011.doo revised 03/16/11 (ri(A I.l C,1 ,.v— HVAC 5 Y S LEMS - HEA t 1114k. Minimum Duct or Piping Configuration Heating Equipment Efficiency Distribution Insulation Thermostat (Central, Split, R Type Space, Packa a or H dronic Type and Ca aci i,Z,' AFUE or HSPF Type and Location' -Value Tank Energy Factor or Insulation 1. Indicate Heating Type (Central Furnace, Wall Furnace, Heat pump, Boiler, Electric Resistance, etc.) ?. Electric• resistance heating is allowed only in Component Package C, or except where electric heating is supplemental (i.e., if total capacity < 2 KW tar 7,000 Btu/hr electric heating is controlled by a time4imiring device not exceeding 30 minutes). See §151(b)3 exception. 3. Refer to the HERS Verification section on Page 4 of the CF -I R -ALT Form for additional requirements and check applicable boxes. 4. Indicate Type or Location (Ducts. Hydronic in Floor, Radiators, etc.) HVAC SYSTEMS - COOLING 6 Minimum Efficiency Duct or Piping Configuration Cooling Equipment (SEER/EER or Distribution Insulation R Thermostat (Central, Split, T e Space, Package or H dronic Type and Ca acct �' itOP) T e and Location' -Value 1. indicate Type (Storage Gas, Heat Pump, Instantaneous. em.) 2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of§ISO(n). The Prescriptive requirements do not allow the installation of a recirculating water heating system for single dwelling units. 3. The external water heating tank and i es shall be insulated to meet the requirements o 150 0) 1. Indicate Cooling Type (A/C. Heat pump. Evap. Cooling, etc)- 2. Refer to the HERS Verification section on Page 4 of the CF- IR -ALT Form for additional requirements and check applicable bones. 3. Indicate Type or Location (Ducts, H dronic in Floor. Radiators, etc.) List water heaters and boilers for both domestic hot water (DHW) heaters and hydronic space heating. Individual dwelling DHW eaters must 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 re uired to aii Coln onenr antra es m au cumum cv„=+. External Tank Water Heater Type/Fuel Distribution Type Number In Tank Energy Factor or Insulation T ei (Standard, Recirculating)'- System Capacity (al) Thermal Efficient R -Value' 6 1. indicate Type (Storage Gas, Heat Pump, Instantaneous. em.) 2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of§ISO(n). The Prescriptive requirements do not allow the installation of a recirculating water heating system for single dwelling units. 3. The external water heating tank and i es shall be insulated to meet the requirements o 150 0) SPECIAL FEATURES The enforcement agencv should pay special attention to the Special t eatures speeyiea to rna CnIC41.1 These items may require written justification and documentation and s ecial verification, NEW. ROOF ASSEMBLY - Radiant Barrier The radiant barrier requirement of § 151( 2 does not apply to roof alterations. Slab Edge (Perimeter) Insulation ❑ YES ❑ NO YES: In Climate Zone 16 in Component Packages D, R-7 insulation is required. Heated Slab Insulation ❑ YES ❑ NO YES: Slab edge insulation required for all heated slabs in all Climate Zones. See details in Table 118-A of the standards. Raised Slab Insulation ❑ YES ❑ NO YES: In Climate Zones I, 2, 11, 13, 14 & 16, R-8 insulation is required; in Climate Zones 12 & 15, R-4 is required under component Package D. Thermal Mass To obtain Compliance Credit for the installation of thermal mass, use the Performance Approach. Registration Number: Registration Dare/Time: HERS Provider: 2008 Residential Compliance Forms August 201 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (de. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These fees are based on the preliminary information available and are only an estimate. Contact the Deptjor addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 711/12) ADDRESS: 10802 Wilkinson Ave DATE: 12/04/2012 REVIEWED BY: mendez Mech. Plan Check APN: BP#: *VALUATION: $1,052 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD Or Duplex USE: Ele.c. Permit Fee: PENTAMATION pRWHEATR PERMIT TYPE: WORK remove and replace water heater in same location SCOPE Other Dec. Insp. Li NOTE: This estimate does not include fees due to other Departments (de. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These fees are based on the preliminary information available and are only an estimate. Contact the Deptjor addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 711/12) FEE Ai",4ry.r, Mech. Plan Check Plumb. Plan Check 1 0.0 1 hrs $0.00 D,% lila, Check Mee./t. Permit Fee: Plumb. Permit Fee: IPPERAIIT Ele.c. Permit Fee: Other Meeh. Imp. Other Plumb Insp. 0.0 hrs$45.00 Other Dec. Insp. Li 'Vech. Inst'. Fee: Plumb. Insp. Fee: Suppl. Insp. Fee -.0 Reg. 0 OT O,p Elec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (de. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These fees are based on the preliminary information available and are only an estimate. Contact the Deptjor addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 711/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 # $27.00 Plumbing IPRWHEATR I Water Heater Suppl. PC Fee: Q Reg. 0 OTE-01hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -.0 Reg. 0 OT O,p hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $45.00 Construction Tax Administrative Fee: IADMIN W2110,0 0 0 Work Without Permit? 0 Yes E) No $0.00 Advanced Planning Fee: $0.00 Select Non -Residential 0 Building or Structure 0 A Travel Documentation Fee: ITRAVDOC $45.00 Strong Motion Fee: IBSEISA1ICR $0.50 Select an Administrative Item O Bldg Stds Commission Fee: 1BCBSC $1.00 $133.50 $27.00 � , , , TOTAL FEE::: $160.50 Revised: 10/01/2012 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: ( (t1 3 0/1 (1Q PERMIT # OWNER'S NAME: PHONE # W1 �- 0 75 GENERAL CONTRACTOR: A) BUSINESS LICENSE # 7br67 / ADDRESS: (7 Iz 6104 d CITY/ZIPCODE: 0 C � g/`lis *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR ANWALL S BCONTRACT RS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. ZZ I am not using any subcontractors: : Signature Date Please check applicable sub contra ors and complete the following information: 1a - q—/z- Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing: < Electrical Excavation Fencing Flooring / Carpe'ting. Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper.<, .. Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile 1a - q—/z- Date