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11030056 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7566 LOCKFORD CT CONTRACTOR:WATER HEATERS ONLY PERMIT NO: 11030056 OWNER'S NAME: SANDER WANDA J AND WENDELL B T 970 E MAIN ST DATE ISSUED:03/11/2011 4:1zz'NER'S PHONE: 4093562855 GRASS VALLEY,CA 95945 PHONE NO:(800)835-5946 Li LICENSED CONTRACTOR'S DECLARATIONF `�, / 3 BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class � 3�P Li,.# 3 7`,-,! 7 / MECH RESIDENTIAL COMMERCIAL Contractor# t/' ,tto/5 11A4 Date 3-11—�/ I hereby affirm that I am licensed under/the provisions of Chapter 9 JOB DESCRIPTION:REPLACE WATER HEATER,SME LOCATION,40 GALLON, (commencing with Section 7000)of Division 3 of the Business&Professions IST FLOOR 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 Sq.Ft Floor Area: Valuation:$1000 permit is issued. APPLICANT CERTIFICATION APN Number:36226048.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. F J / Signature Date //W /�` � Issued by: Date: OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. 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 Owr,qu ioriz 1 a�� ' forthwith comply with such provisions or this permit shall be deemed revoked. (�(� Date: CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address Is,and expenses which may accrue against said City in consequence of the ,ing of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION „,tn all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 5 ITEMS OF 11 PERMIT RECEIPT OPERATOR: TraciC COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36226048 . 00 DATE ISSUED. . . . . . . : 03/11/2011 RECEIPT #. . . . . . . . . : BS000012881 REFERENCE ID # . . . : 11030056 SITE ADDRESS . . . . . : 7566 LOCKFORD CT SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : SANDER WANDA J AND WENDELL B T ADDRESS : 7566 LOCKFORD CT CITY/STATE/ZIP . . . : CUPERTINO, 95014 RECEIVED FROM . . . . : IE INC CONTRACTOR . . . . . . . : MCGEE, PAT LIC # 18986 COMPANY . . . . . . . . . . : WATER HEATERS ONLY ADDRESS . . . . . . . . . . : 970 E MAIN ST CITY/STATE/ZIP . . . : GRASS VALLEY, CA 95945 TELEPHONE . . . . . . . . : (800) 835-5946 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 1, 000 . 00 1. 00 0 .00 1. 00 0 .00 1BSEISMICR VALUATION 1, 000. 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 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 518 WATER HEATER CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION F01 ADDRESS: 7566 lockford ct. DATE: 03/11/2011 REVIEWED BY: bob s. APN: BP#: '"VALUATION: $1,000 14PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY SFD or Duplex PENTAMATION PRWHEATR USE: PERMIT TYPE: wORK re lace water heater 1 st floor. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Water Heater 1 PRWHEATR 1 # $25 TOTALS: $25.00 T7Plumb.Plan Check 0.0 Frs $0.00 Plumb.Permit Fee: 1PPERMIT Other Plumb Insp. 0.0 hrs NOTE. Theseees are based on the preliminary information available and are only an estimate. Contact the De t or addh 7 info. FEE ITEMS (1 ee Resolution 09-051 Eff 7;7."10) FEE QTY/FEE MISC ITEMS i. 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: ITRAVDOC $42.00 Strom Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg;Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $110.50 $0.00 TOTAL FEE: $110.50 Revised: 01/15/2011 CITY OF CITY OF CUPERTINO FURNACE/AC C U P E RT I N O PERMIT APPLICATION FORM APN# Date: �Scot z � oq 3 - 4 - � � Building Address: souk -Pofd t0 btf` - Owner's Name: Phone#: 2n od,0-1I a-✓1 6L-p-r 1-10'6- 35'6 - 2'2 5 -95 Contractor: Phone#: Fax#: Contractor License#: Cupertino Business License#: � 7y5-73 C Contact: Phone#: Fax#: Building Permit Info: Elect M--' Plumb ] Mech ❑� Residential M Commercial Job Description: (� ac1_I o g ePlc,� lLJ u fig,'' For Residential Installations: Attic ❑ I"floor ® 2"d floor ❑ Adhere to minimum setback requirement ❑ For Commercial Installations: Replacement same weight ❑ Additional weight(structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction Usage Class): 6W , a 0 �- i StrappedEl On Platform Bonded New Location Replacement Project Size: Express ❑ Standard'® Large❑ Major❑ Valuation: 1 Doo 1 OCA 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. 6— Revised 01/07/09 Prescriptive Certificate of Compliance:Residential CF-IR-ALT Residential Alterations WATER BEA TER (Page 1 of 1 Project Name: Q n Cj p— y� S(cL- p c � Climate Zone# 12 #of Stories Genera!Information �I SiteAddress: Enforcement Agency:e-t Date: Building Type 1�Single Family ❑Multi Family Circle the Front Orientation:N,E,S,W,or degrees ' Conditioned FloorA w rt-F,e-�: Project Type: ❑Alterations (3 Envelope 11Fenestratiai 13 Roof C3 HVAC I•v- • Replacement or Change Out 0 Duct Replacement 13 Water Heater WATER BEATING List water heaters and boilers for both domestic hot water(DHW)heaters and hydronic space heating. Individual dwelling DHW heaters must be gas or propane fired and may not exceed 30 gallons. Hot water pipe insulation from the DHW heater to the latchen(s)and on all underground tear waterpipesis required in all cam Hentpackages in all climate zones. External Tank Water Heater Type/Fuel Distribution Type Number In Tank Energy Factor or Insulation Type' (Standard,Recircutating)Z System Capacity(gal) Thermal Efficiency R-Value3 �A-6Lwd 4L1( i L� a 5 l 2 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 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§150('1). Documentation Authors Declaration Statement 0 I certify that this Certificate of Co fiance documentation is accurate and coinpkte. Name: Signature ni ae roaJ< s � n,11-kWC�1 Company: - Date:: ateh�a -�r� a�� enc. 3 _/P_ it Address: If Applicable 0 CEA or❑CEPE 930 EA St MAill (Certification#): City/StateZp: Phone: V�1( E." 3 U -a 7y-30 0 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 requ tements 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 t application. Name: o 1e— I Signature' -Ad ck 1-1-� Company: ate/'S OrTl yy�L , Dam: -4 - 1 Address: �� : q -10 1 t� 1/Yl�+tn Srt^ee�- �`�oc> 37q573 City/StateJZip: _j/,a U/USS _ Phone (�t1IE CF3 ��`-�� X30 oL7� - 3UUf For assistance or quesrtions regarding the Energy Standards,contact the Energy Hotline at 1-800-772-3300. Registration Number: Registration Datelrune. 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: (,U,<< PERMIT# OWNER'S NAME: j PHONE # <�c� 35 GENERAL CONTRACTOR: ie4! OeaklS OA LV BUSINESS LICENSE# ADDRESS: 7G j. W '4%H CITY/ZIPCODE: logs dal QSW! *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