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12120013CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10211 STERN AVE CONTRACTOR: SERVICE CHAMPIONS PERMIT NO: 12120013 OWNER'S NAME: KAPOOR AMARJEET AND CHARU ET AL 7020 COMMERCE DR DATE ISSUED: 12/04/2012 OWNER'S PHONE: 4089279362 PLEASANTON, CA 94588 PHONE NO: (925) 444-4444 0 LICENSED CONTRACTOR'S DECLARATION License Class C�q Lic. M ' 9r / b 1-7() 0 Contractorflil.LE l;Vu(➢,I4�.Wff37j�8te la" 1;(-%L 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 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. APPLICANT CERTIFICATION 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 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 with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. ,^, ,_j,�� U. Signature�(S�CJAWUV� Date ❑ OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I hereby alarm under penalty of perjury one of the following three 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. 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. 1 unity 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 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 with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r MECH r RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: REMOVE AND REPLACE WATER BEATER Sq. Ft Floor Area: 1 Valuation: $1566 APN Number: 37511068.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: �E>�N /14l7,11 Date: /a -Y•/19 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(x) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. 09yn�r ry-p puthgpi a t: �� Date: I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECF'S DECLARATION I understand my plans shall be used as public records. Licensed Professional - GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUDDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 950143255 t 1 (408) 7773228 - FAX (408) 7773333 . bLuld' O0( cuaeruno_ac CUPERTINOy/� Ill9f.. rIMFTWAN rer Fl==CAL 1 MISCEI ANROUS 1212 CDO �3 MEP mist FRDJECTADDRESS y AFKx L OwNMNAME -eek Ka wog Rz-7-95(o2- BUM MEETADDRESS 1C>a-(l AiN SFATE n- gSUty FAX R7NTACT MIM PECRE STREETADDR= QTY, STATE F.tP FAX ow mt ❑ cwHmaumm R L1 oV txm.%'ENT loomamcm Q covr"c=Amm I1 A&m= ❑Efl1�CA� O vrvm rr ❑ TES `PSS 3 I1�r�TCE I ✓W r��tan� a 1Two 65,0 Bm=ff IG p/ COWANYNAME E7a.Uf. FAX sc Tl A8m^M^'EafNFFBNAlE LImNENUIMM ffm=0 QAPANYNAMc' E -MAX FAX SIRMADDRESS crrf.MTEm PHONE =OF S'Data %= Q YfII.TFFAimY PROULTRNWIILIAND ❑ YES PROLR"TIN Q =TEE3I " ❑Ya guaim Q00MLEMA tm"Vf SFACEAREA NO FLOW Z Ei =cRarIION or wom - La� 5v md, wol-r- TOTAL VAt.UAT[O!C' , oV BECBY(D BY_ . By myagnamobduw Iujadym adsoftbe I=dtepmpatyownaOratmag=t3=OHd=pMptatyuw Sbt3aM Ibmradthss apptiadoa mddxi as IlmeptaFidedb:rffieet bavetodtbe De�da¢ofWodca v=ifYits Iag=ta camPh/ with aH apptiablcla®I o[dima¢as aids= Imm=Iadng Ia xgac�Rva oft anom idle abavo-idr>�edP�P�Y imp la-`f-rZ Sika ofAppGwVAg= SMTLEWENTAL MORMAIIONREQUIRID OFFICE USE ONLY 7HL(,'OL7YfFIt }r E ❑ =".Tm Y U 't ❑ SF mmw i O 3 ❑ LancR ❑ MAwx MEPbfiscA� Z011.doc revised 06121171 CITY OF CUPERTINO 11' FEE ESTIMATOR — BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 10211 Stern Ave DATE: 12/04/2012 APN: BP#: REVIEWED BY: Sean VALUATION: $1,566 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: SFD Or Duplex Elec. Plan Check P ENTAMATION PERMIT TYPE: PRWHEATR WORK REMOVE AND REPLACE WATER HEATER. SCOPE # APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES Elec. Plan Check Water Heater 1PRWHEATR I Glee, Permit Fee: 1 # $27 Ade -ch. /nsp. Fee: Plumb. Insp. ree: Ele.c. Insp. fee: Suppl. Insp Fee PME Unit Fee: $27.00 PME Permit Fee: $45.00 LonsinictIon Tar: Administrative Fee: IADMIN $42.00 Work Without Permit? 0 Yes Q No $0.00 TOTALS: TravelDocumentation Fee: ITRAVDOC $27.00 Strong Motion Fee: IBSEISMICR NOTE: This estimate does not include fees due to other Departments (Ie. Planning, Public Works, Fire, Sanitary Sewer District, School District. elc). These tees are based on the Drefiminarv, information available and are onlv an estimate. Contact the Dear for addn'1 into. FEE ITEMS (Fee Resolution 11-053 E8" 7/1/12) FEE QTY/FEE MISC ITEMS 214ech. Plan Check Plumb. Plan Check 0.0 hrs $0.00 Elec. Plan Check ,bfech. Permit Fee: Plumb. Permit Fee: IPPERMIT I Glee, Permit Fee: Other Mech. Insp. Other Plumb Insp. 0.0 hrs$45.00 Other Elee. Insp. Ade -ch. /nsp. Fee: Plumb. Insp. ree: Ele.c. Insp. fee: NOTE: This estimate does not include fees due to other Departments (Ie. Planning, Public Works, Fire, Sanitary Sewer District, School District. elc). These tees are based on the Drefiminarv, information available and are onlv an estimate. Contact the Dear for addn'1 into. FEE ITEMS (Fee Resolution 11-053 E8" 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: Supp/. PC Fee PME Plan Check: $0.00 Perinit Fee: Suppl. Insp Fee PME Unit Fee: $27.00 PME Permit Fee: $45.00 LonsinictIon Tar: Administrative Fee: IADMIN $42.00 Work Without Permit? 0 Yes Q No $0.00 Advanced Planning Fees.- ees:Travel TravelDocumentation Fee: ITRAVDOC $45.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $160.50 $0.001:11' OTALTEEe; $160.50 Revised: 10101/2012 Prescriptive Certificate of Compliance: Residential WATER HEATER CF -IR -ALT- Water Heater Date: i '�q-1z- Enforcement Agency: Climate Zone # 12 # of Stories Permit # Site Addre s• JOV I Building Type X Single Family ❑ Multi Family NOTE. This orm is not to be used for Newly Constructed Buildings or Additions WATER HEATING List water heaters and boilers for both domestic hot water (DHW) heaters and hydropic space heating. Individual dwelling DHW heaters must 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 waterpipes is required in all corn onent packages in all climate zones. Water Heater T7pe/ Distribution Type Number Tank Energy Factor External Fuel Type (Standard, in System Capacity or Tank Reeireulatingf (gal) Thermal Insulation Efficiency R-Value3 ctt 005 Goa ar 1 a (to 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 pi !es shall be insulated to meet the requirements off 150 ' . Declaration Statement • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is accurate and complete. • I certify that the energy features and performance specifications identified on this Certificate of Compliance conform to the requirements of Title 24, Parts I and 6 of the California Code of Regulations. Name: Signature: JI JjV Company: /� / . V U iG l�Y l01/1 5 Date: l a _t/—(Z Address: License: [C�/St—ate/Zipt'j}y�� .lsa�r�� Ca , Phone: - For assistande or questions regarding the Energy Standards, contact the Energy Hotline at 1-800-772-3300. CF-IR-ALT;5117/10 I Page 1 of 1 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: [Coil fill aU�' PERMIT # OWNER'S NAME:6r' e42* yA . r PHONE # q 0 S GENERAL CONTRACTOR•, - byLS BUSINESS LICENSE # ADDRESS: 1020 t° %AkAjfC,2 1J CITY/ZIPCODE: IA& -101 00 *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 AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable ntractors and complete the following information: Owner Contractor Signature. Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner Contractor Signature. Date