11040036 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21744 REGNART CT CONTRACTOR:WATER HEATERS PERMIT NO: 11040036
ONLY
OWNER'S NAME: ANTAL BRUCE G AND MAUREEN S 970 E MAIN ST DATE ISSUED:04/06/2011
'NER'S PHONE: 4082533494 GRASS VALLEY,CA 95945 PHONE NO:(800)835-5946
LICENSED CONTRACTOR'S DECLARATIONr
�!_� BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class �-�G7 Lic.# 3� LIT-73 r F
' `/r MECH RESIDENTIAL COMMERCIAL
Contractor C Irs L)� Date
JOB DESCRIPTION: REPLACE 50 GAL WATER HEATER
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:$2100
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:35624033.00 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 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 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
Date:
granting of this permit. Additionally,the applicant understands and will comply Issued by: ^V
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
� RE-ROOFS:
Signature Date 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.
u 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)
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(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 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,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agenN. V`�' Date:
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,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
�mnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
,s,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
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 21744 regnart ct. DATE: 04/06/2011 REVIEWED BY: bobs.
APN: BP#: "VALUATION: 1$2,100
rPERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION PRWHEATR
USE: p PERMIT TYPE:
wORK replace water heater
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Water Heater 1PRWHEATR 1 # $25
TOTALS: $25.00
Plumb.Plan Check 0.0 hrs $0.00
F-7, Plumb.Permit Fee: IPPERMIT
Other Plumb Insp. 0.0 hrs L $42.00F I L
NOTE. These fees are based on the preliminary information available and are only an estimate. Contact the Dept-for addn'l info.
FEE ITEMS (lee Resolution 09-051 Eft.' 1.-10) FEE QTY/FEE MISC ITEMS
f
PME Plan Check: $0.00
PME Unit Fee: $25.00
PME Permit Fee: $42.00
Work Without Permit? 0 Yes No $0.00
Travel Documentation Fee: ITRA VDOC $42.00
Strom Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
BId�7 Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $110.50 $0.00 TOTAL FEE $110.50
Revised: 01/15/2011
Prescriptive Certificate of Compliance: Residential CF-IR-ALT
Residential Alterations WATER HEATER e 1 of 1
Project Name: Climate Zone# 12 #of Stories
At W &S I a,_,n Ce
General Information
Site Address: a)7 4 r Ct. Enforcement Agency: Date:
Building Type 10 Single Family 0 Multi Family Circle the Front Orientation:N,E,S,W,or degrees
Conditioned Floor Area(CFR): Project Type: 17 Alterations 0 Envelope 0 Fenestration 0 Roof 0 HVAC
Replacement or Change Out 0 Dud lieplacement 0 Water Heater
WATER HEATING
List water heaters and boilers for both domestic hot water(DHii7 heaters and hydronic 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
water pipes is required in all corn Hentpackages in all climate zones.
External Tank
Water Heater Type/Fuel Distribution Type Number In Tank Energy Factor or Insulation
Type' (Standard,Recirculating 2 System Capacity(gal) Thermal Efficiency R-Value3
(:i u S tra a.r CA t 50 P & t
1.Indicaate Type(Storage Gas,Heat Pump,Instantaneous,etc.)
2.Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of§1 S0(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§1 506).
Documentation Author's Declaration Statement
• I certify that this Certificate of Compliance documentation is accurate and co
Name: Signature:
Company:
Date:
Address:
-7 !til 0 EA st 4 i A 5 fr e e-t U (Certification#)CEA or 0 CEPE
City/State/Lip: Phone:
C-1 r0 Vc:,IIE CA �74`1�
Responsible Building Designer's Declaration Statement
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design identified on this
Certificate of Compliance.
• I certify that the energy features and performance specifications for the building design identified on this Certificate of Compliance conform to
the requirements of Title 24,Parts 1 and 6 of the California Code of Regulations.
• The building design features identified on this Certificate of Compliance are consistent with the information provided to document this
building design on the other applicable compliance forms,worksheets,calculations,plans and specifications submitted to the enforcement
agency for approval with this building it application.
Name:
G,i4t✓� 3 l (>O k S Signature:
Company: Date:
WcAt&r eatel's Ctrl Lhc: ,
Address:
10 E,+st ,4tn Srreet ff2oc> 378573
City/State/Zip r G S s Va l I E L'/
��Y� Pboner�o
For assistance or questions regarding the Energy Standards,contact the Energy Hotline at:1,800-773300.
Registration Number: Regismrtion Dbte/Time: HERS Provider:
2008 Residential Compliance Forms February 2010
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: f-7 Lf Gtd'f PERMIT#
OWNER'S NAME: u 'e e4q uta PHONE# '0*6 X5.3- 3 cf9
GENERAL CONTRACTOR: j4e-Cx U,/d'S ()14L44 BUSINESS LICENSE#
ADDRESS: X170Rsf AO-14 5 f- • Z-00 CITY/ZIPCODE: 1-055 (dal Ltq Q 5` 5
*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 subcontractors and complete the following information:
V 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
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228 •FAX(408)777-3333•building -cuDertino.orgMIS C
CUPERTINO 110<lap,47
PLUMBING MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS �1-7` /q n e �� ^f .t
OWNER NAME W a ^Q 6?piG A Lk t—�l PH04EO CJ 2 s 3-3*rj! .E-MAIL
STREET ADDRESS j 1 `7 L-1 Lf a CrrY,UATE,ZIPQ( �j�S(} Ll
Fnx
CONTACT NAPHONE E-MAIL
ME
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-suiLoER ❑ OWNER AGENT 51CONTRACTOR ❑CONTRACTOR AGENT 11 ARCHrTECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE. ER LIC11V TYPE, BUS.LIC 9
YI►'� l�cS 7 5'� 3 �.3�
COMPANY {% r u LD s �n l E-MAIL FAX
STREET DRESS r l `I vL s =.sr S S VCL I LW N J'' E0 -14-/ 73CO
ARCHITECTIENGWEER NAME LICENSE NUMBER BUS.LIC 9
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF 05 SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE: ❑ Commercial URBAN aTTERFACE AREA Cl Yes ❑ No FLOOD zoNE ❑ Yes ❑ No
DESCRIPTION OF WORK
IC.c' lug. u-f Uj C I eat r
TOTAL VALUATION: V� v 'RECEiYETk13Y = = _
By my signature below,I certify to each of the following: 1 am the property owner or authorized agent to act on the property 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 state laws relatin uildingjconstruction.,4 authorize representatives of Cupertino to enter the above-idenpfied roperty for inspection purposes.
Signature of Applicant/Agent: Date: l•[/! /)I
SUPPLEMENTAL INFORMATION REQUTEtED
MEPMiscApp_2011.doc revised 03/16111