09100067 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7592 HOLLANDERRY PL CONTRACTOR:BETTER WATER HEATERS PERMIT NO:09100067
OWNER'S NAME: FARKAS STANLEY R AND HILLARY J 3010 RIDGEGATE DR DATE ISSUED: 10/12/2009
1ER'S PHONE: 4082576487 SAN JOSE,CA 95133 PHONE NO:(408)250-6672
❑ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.#
MECH r- RESIDENTIAL� COMMERCIAL
Contractor Date
I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:NEW TANKLESS WATER HEAD_.
(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:
1 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:$3400 -s
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:36229007.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that 1 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
to building construction,and hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE OR
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM 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: ( l
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
Signature Date
RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
G OWNER-BUILDER DECLARATION installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: Signature of Applicant: Date:
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) ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). HAZARDOUS MATERIALS DISCLOSURE
1 hereby affirm under penalty of perjury one of the following three 1 have read the hazardous materials requirements under Chapter 6.95 of the
declarations: California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain a Certificate of Consent to self-insure for Worker's compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Compensation,as provided for by Section 3700 of the Labor Code,for the Safety Code,Section 25532(a)should I store or handle hazardous material.
performance of the work for which this permit is issued. Additionally,should I use equipment or devices which emit hazardous air
I have and will maintain Worker's Compensation Insurance,as provided for by contaminants as defined by the Bay Area Air Quality Management District 1 will
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Section 3700 of the Labor Code,for the performance of the work for which this Health fety Code,Sections 25505,25533,and 25534.
permit is issued.
I certify that in the performance of the work for which this permit is issued,I shall Owner r t ent:
not employ any person in any manner so as to become subject to the Worker's Date: G
Compensation laws of California. If,after making this certificate of exemption,I _'%
become subject to the Worker's Compensation provisions of the Labor Code,1 must CONSTRUCTION LENDING AGENCY
forthwith comply with such provisions or this permit shall be deemed revoked. 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.)
APPLICANT CERTIFICATION Lender's Name
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 Lender's Address
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
nify and keep harmless the City of Cupertino against liabilities,judgments,
and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of thi permit.Additionally,the applicant understands and will comply
with all non- nt source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36229007 .00
DATE ISSUED. . . . . . . : 10/12/2009
RECEIPT #. . . . . . . . . : BS000008880
REFERENCE ID # . . . : 09100067
SITE ADDRESS . . . . . : 7592 HOLLANDERRY PL
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER FARKAS STANLEY R AND HILLARY J
ADDRESS 7592 HOLLANDERRY PL
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-5040
RECEIVED FROM . . . . : STANLEY R FARKAS
CONTRACTOR . . . . . . . : FRANS CARTWRIGHT LIC # 26514
COMPANY BETTER WATER HEATERS
ADDRESS 3010 RIDGEGATE DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95133
TELEPHONE . . . . . . . . : (408) 250-6672
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 3, 400. 00 1 . 00 0. 00 1. 00 0 . 00
1BSEISMICR VALUATION 3,400. 00 0 .50 0. 00 0 . 50 0 . 00
1PPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00
1PRWHEATR UNITS 1. 00 25 .00 0 . 00 25. 00 0 . 00
1TRAVDOC FLAT RATE 1. 00 42 .00 0 . 00 42 . 00 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 110 .50 0 . 00 110.50 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 110 . 50 MC
---------------
TOTAL RECEIPT 110 .50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
518 WATER HEATER
LMCITY OF CUPERTINO
WATER HEATER
C U P S RT I N O PERMIT APPLICATION FORM
APN # Date.
Building Address:
oq<�?,
Owner's Name: Phone #:
f ' 4-6 L1
Contractor: �( Phone #:
�vT-e , �G�� C� L AOY 5-0 '
Fax #:
Cupertino Business License #: Contractor State License #:
Contact: Phone #:
0
Fax #:
Building Permit Info:
Bldg EEf— Elect [ ''� Plumb Mech��
Residential G-- Commercial ❑ Solar ❑ If solar, number of kilowatts:
Strapped ❑ On Platform ❑ Bonded [ New Location ❑ Replacement E�—
Valuation (cost of project):
Project Size: Express' Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to
the application or if applicable, include in plan set & the sheet index..
Green Building Points achieved:
Revised 08/20/09
CITY OF CUPERTINO
WATER HEATER
C O P E RT I N O PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Permit Type
Group
1 PCWHEATR Commercial Water B PCWHEATR
HeaterNent
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICOM Seismic Commercial B
J 1 PRWHEATR Residential Water B PRWHEATR
f HeaterNent
f 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Residential B
r 1 PPERMITFEE Plumbing Permit P
1 TRAVDOC Travel & B
Documentation
1 BUSLIC Business License B
n oor Atr ua ity and Finishes INPUT Resources Enerc.� ADimpalth
1.Used-VOC Paint 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0
3.Use Loy"VOC Adhesives 3 IAQ/Health pts y=yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/Health pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
7.Seal all EVosed P-arrtieolaboard or MDF 4 IAQ/Health. pts y=yes 0
8.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0
1 1
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes I0
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0
2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health Is y=yes 0
5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0
1 1 1
Total Points Available: 1 1401 130 57
Total Points Project Received: 0 0 0
G:data/progstgreenbuilcfinoguidelineshemodelersVgreenpointsfina12.12.04protected.xls
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
XPEI�TINO
Building Department
JOB ADDRESS: PERMIT #
bq ( Q--)vv
OWNER'S N ( S PHONE #
GENERAL CONTRACTOR:BCA. - FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
60 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
' e
10 - 12-, 0
caner/Contractor Signature Date