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13030129 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11091 SANTA TERESA DR CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 13030129 CONDITIONING OWNER'S NAME: COLEMAN EUGENE M AND FRANCES.S 1712 STONE AVE DATE ISSUED:03/25/2013 OWNER'S PHONE: 4082523690 SAN JOSE,CA 95125 PHONE NO:(408)293-4717 ❑ LICENSED CONTRACTO*S'DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIALL License Clan _J3_C_t Lic. REPLACE(E)50 GAL WATER HEATER,SAME LOCATION Contractor Date 3 Z S� 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. Sq.Ft Floor Area: Valuation:$1500 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:35616005.00 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 180 DAY =LLED IT 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 DAYS LA 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 Date: Z� j with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 2 _ RE-ROOFS: Signature v Date 3 � I 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 I,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) 1,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(a)should I store or,handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emithazardous.. 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,Sectio 25505,2553 ,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Owner or authorized agent: Dat 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,aftermaking this certificate of exemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, 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 MEP* GENERAL PERMIT APPLICATION C. COMMUNITY DEVELOPMENT DEPARTMENT— DIVISION O 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 O/1•) (408)777-3228 , FAX(408)777-3333 -building(a cupertino.org MISC '�URE.RTINC> �� PLUMBING ❑MECHAMCAL ELECTRICAL E N93CELLANEOUS PROJECT ADDRESS `Uq Sao TejtQ 1YI j►t AFN S 356 1 6 00 57 OWNER NAME ��r V PNONE •2S2/. r � E-MAII 3rltEET ADDRESS Il�il S�nt�TSA yn� L� ��l FAX �� COM ACl NAME Cha fiq� PHONE-'M3•4-111 E-MAIL STREET ADDRESS (�IL S `/�UIVIY, r W• 1 C(T ATE ZIP f0' J F -2,jj- ?J ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGarr -E CONTRACTOR ❑CONI-RAcTOR AGENT ❑ ARCHMCT ❑ ENGNM ❑ DEVELOPER ❑ TENNR CONTRACrORNAME TUVIA .p� LICENNTNIffl �+ Ll E Bus.WCI(�j)('f) COtvtPANYNAM£ \\��•,N^W4�`�vvp `Eu/`(f`(�l1015 I`VV VI- 95 34 STREET ADDRESS n a Slot M/'Y vW�, �� �i 4 61J�%l�J PHONE .Z I' A3tCHTTECT/ENOII(EER NRME LICENSE NUMBER BUS.LIC f COMPANY NAME E-MAIL FAX TrRIMT ADORESS CrrY,STATE,ZIP PHONE USE OF SFD or Duplex C) Multi-Family PROJECT'IN WILOLAND PROJECT!N STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yd ❑ NO DEscRlFrlox of woRx TOTAL VALUATION: o e L - By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the p operty owner's behalf. I have read this application and the information I h e Oviq1olu ect. I have read the Description of Work and verify it is accurate. Iagree to comply withall applicable local ordinancesandstatelawsrelatin to buil inoon, I authorize representatives of Cupertino to enter the abov -iden'led22propeity for inspection purposes. Signature of Applicant/Agent: Date; J 3 U—P ?t RYMPtL INFORMATION REQUIRED ikE? ucApp 1011.doe revved 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 11091 SANTA TERESA DR DATE: 03/25/2013 REVIEWED BY: MELISSA APN: 356 16 005 BP#: "VALUATION: 1$1,500 *PERMIT TYPE: Plumbing,Permit PLAN CHECK TYPE: Alteration/Addition/Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: PRWHEAT woRK REPLACE. E 50 GAL WATER HEATER SAME LOCATION SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Water Heater 1 PRWHEATR 1 # $27 TOTALS: enc $27.00 ll&ch,flan Check Plumb.Plan Check 0.0 hrs $0.00 Elec.Plan(.;heck Mech.Pern9it Fee: Plumb.Permit Fee: 1PPERmT Elec. Permit Fee: Other a9ech.Insp. Other Plumb Insp. L2-0J hrs $45.00 Other Elec_Insp. EIF-L- Heck Imp,Dere: Plumb. Insp.Fee., Elec.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). Theseees are based on the prelimina information available and are only an estimate Contact the Dept for addn'l info. FEE ITEMS(Fee Resolution 11-053 E . 711/121 FEE QTY/FEE MISC ITEMS Plan Check Fee: ;Suppl. PC Fee PME Plan Check: $0.00 Permit Fee: Suppl. Insp Fee PME,Unit Fee: $27.00 PME Permit Fee: $45.00 Consir action TaX. Administrative Fee: IADMIN $42.00 Work Without Permit? ®Yes (E) No $0.00 Advanced Planning Fees: Travel Documentation Fee: ITRA VDOC $45.00 Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Blda Stds Commission Fee: IBCBSC $1.00 $160.501 $0.00 , $1.60.50 Revised: 01/01/2013 trQu. CF-IR-ALT Prescri tive Certificate of Compliance: Residential pa e 4 of 5) Residential Alterations Climate Zone# #of Stories Project Name: HVAC SYSTEMS-HEATING Duct or Piping Configuration Minimum Central,Split,Heating Equipment Efficiency Distribution Insulation Thermostat ( P Type and Capacity',2,3 ( 1FUE or HSPF) T e and Location R-Value Type Space,Package or H dronic) 1.Indicate Heating Type(Cent.-al Furnace..Wall Furnace. Heat pump, Boiler. Electric Resistance, etc.) 2.Electric resistance heating is allowed only in Component Package C, or except where electric heating is supplemental(i.e., if total capaciry < 2 KW or 7,000 Btu/hr electric heating is controlled by a time-limiling device not exceeding 30 minutes). See§151(6)3 exception. 3.Refer to the HERS Verification section on Page 4 of the CF-IR-ALT Form for additional requirements and check applicable boxes. 4. Indicate Type or Location(Ducts. Hydronic in Floor, Radiators, etc.) HVAC SYSTEMS—COOLING Minimum Configuration Efficiency Duct or Piping Thermostat (Central,Split, Cooling Equipment (SEER/EER or Distribution Insulation Type Space,Package or H dronic Type and Capacity'-2 top) Type and Location} R-Value 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 boxes. 3. Indicate Type or Location(Ducts, H dronic in Floor, Radiators, etc.) WATER HEATING List water heaters and boilers for both domestic hot water(DHW)heaters and hydronic space heating. Individual dwelling DHW heaters must b( 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 eom onent packages in all climate zones. External Tank Number In Tank Energy Factor or Insulation Water Heater Type/Fuel Distribution Type Thermal EfficiencyR-Value3 Ty e' (Standard, Recirculating))' System Capacity(gal),. 5 StG I. Indicate Tvpe(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 the installation of a recirculating water heating system for single dwelling units. 3. The external water heating tank and pipes shall be insulated to meet the requirements of§1506). SPECIAL FEATURES The enforcement agency should pay special attention to the Special Features specified in this checklist below. These items may require written justification and documentation andspecial verification. NEW ROOF ASSEMBLY-Radiant Barrier The radiant barrier re uirement of; l51( 2 does nota I to roof alterations. Slab Edge(Perimeter)Insulation O YES U NO YES: In Climate Zone 16 in Component Packages D;R-7 insulation is required. Heated Slab Insulation 0 YES `C7 NO YES:Slab edge insulation re uired for all heated slabs in all Climate Zones. See details in Table 118-A of the standards. Raised Slab Insulation ❑YES C] NO YES:In Climate Zones I,2, 11, 13, 14& 16,R-8 insulation is re uired; in Climate Zones 12& 15,R-4 is required under com onent Pa `V' ' Thermal Mass lation of thermal mass,use the Performance Approach. To obtain Com liance Credit for the instal Registration Dote/Time: HERS Provider: Registration Number: August I© 2008 Residential Compliance Forms