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13040082 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7496 TIPTOE LN CONTRACTOR:ROBIDART CHARLES M PERMIT NO:13040082' . JR AND MARY OWNER'S NAME: ROBIDART CHARLES M JR AND MARY 7496 TIPTOE LN DATE ISSUED:04/09/2013 OWNER'S PHONE: 4082160808 CUPERTINO, 95014-5819 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALE] License Class Lic.# REPLACE(E)WATER HEATER IN INTERIOR CLOSET WITH Contractor Date (N)TANKLESS WATER HEATER MOUNTED ONSIDE OF I hereby affirm that I am licensed under the provisions of Chapter 9 HOME (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:$5000 1 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:35932054.00 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 F T LED 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 JY ? 3 granting of this permit. Additionally,the applicant understands and will comply Iss Date: 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. 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 1,as owner of the property,or my employees with wages as their sole compensation, will do the.work,.and the structure isnot 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 wr71 . . 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 �Z4�l Owner or authorized 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs',and expenses.whieh 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. C/ Signatu Date O GENERAL PERMIT APPLICATION MER COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION .10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 n _U CUPERTFN© (408)777-3228• FAX(408)777-3333• building0cuoertino.orgMISC EOLUMBING ❑MECHANICAL PfLECTRICAL [:]MISCELLANEOUS PROJECT ADDRESS ` � t Ite APN n �Q 32_ f1"ALL O�tfiERNAME�( (� �S(J v LXk4+1 7r PHONEe/&'6 Z''`LT STREET ADDRESS fit, ,1 CITY, STATE,ZIP ,ZA2 F IV col.*r cr N idl 0�� C� 4 d e C GS - ' "�° m cw'®C STREET ADDRESG CITY,r F.-?16 L$Y<ER ❑ OwNER-BUIIDER ❑OWNERAGENT ❑ CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTR2e r`J LICENSE NUMB C NT E r�f U `C etf l' GOMP�� E-MAIL STREETADDRESS �jZV�I /1 _ L CITY�SSA L 1 PHOTS ARCHITECTIENGINEER NAME (/A A v LICENSE NUNMEER L'/ /1 BUS..'Jc#,/p//A CO.NlPANTY NAME' yy / /� E-MAIL (/ FAX �a STREET ADDRESS / MCITY,STATE,Zip PHONE USE OF EKFD.DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND - ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HONE? ❑NO DEscluPnoN of woRx `e TOTAL VALUATION: By my signature below,I certify to each of the following: I am the property owner or autho a 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 relating to building construction. I authorize representatives of Cupertino to enter the above-iiddeen'ti ed prope]`ry for inspection purposes. Signature of Applicant/Agent: Date: �` � // SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY OVER-THE-COUNTER ❑ EXTRESS U ❑ STANDARD U ❑ LARGE ❑ ]%AJOR A�EPAIiscApp 2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION JJJJADD.RESS: 7496 TIPTOE LN DATE: 04/09/2013 REVIEWED BY: MELISSA 359 32 054 BP#: "VALUATION: $5,000 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/Repair PRIMARY SFD or Duplex PENTAMATION PRWHEATR USE: PERMIT TYPE: WORK REPLACE E WATER HEATER IN INTERIOR CLOSET WITH N TANKLESS WATER HEATER SCOPE MOUNTED ON SIDE OF HOME APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Water Heater 1PRWHEATR 1 # $27 TOTALS: $27.00 m _mm ,, :..-..: .» ..:�.'!.... .< ...: �...- _-� ._ -. .P'im,.-,_.'. .. .-.T.., �= _......--••___-....._ aa_.....` ...,n� - _....-oma.....-�..... '�. Afee/r. f'lon(..'i.ez'c Plumb.Plan Check 0.0 hrs $0.00 I?le<;,Plan,(."'heel; Lfarlr.Perrnit foie: Plumb.Permit Fee: 1PPERMIT Z lec:..?'errrzii 1 : (Jaye, :tI=c.,1 Xr1sj. Other Plumbinsp. 0.0 hrs 9r<,li.bail.C rr: PIU10z Ina;z3.Fi'e f'ieC;..lat:c;a.1'ee: NOTE:This estimate does not includefees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These'fees are based on the preffinWha information available and are only an estimate. Contact the De t or addn'Tin o. FEE ITEMS (Fee Resolution 11-053 E . 7111121 FEE QTY/FEE MISC ITEMS Phan Check Fee: SZtppL ./'C.'P-ee PME Plan Check: $0.00 Permit Tee: 3uppl. Insp Fess PME Unit Fee:, $27.00 PME Permit Fee: $45.00 C.`onsfruc tion Tan': Administrative Fee: IADMIN $42.00 Work Without Permit? ®Yes (E) No $0.00 2.clvurrcccl.l'tcz r ar` ;.Fees; Travel Documentation Fee: ITRA VDOC $45.00 Strong;Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 $160.50 $0.00 Revised: 04/01/2013 . INSTALLATION CERTIFICATE CF-6R-MECH-01 Domestic Hot Water (Page 1 of 2 Site Addre s: �., Enforcement Agency: Permit Number: �(, 1. WATER HEATING SYSTEMS: Distribution Rated CEC Type If #of Input(kW Tank Standby Heater Certified Mfr Name&Model (Std,Point-of- Recirculation, Identical or Volume Efficiency Loss Type Number Use,etc) Control Type Systems BM/hr)' allons (EF,RE)1 (%)t /Vjri �--,z; �5� ; z$ /klA II l-o Y) 1 ZY04 Note 1:For small gas storage(rated input less than or equal to 75,000 Btu(r),electric resistance and heat pump water heaters,list Energy Factor(EF).For large gas storage water heaters(rated input of greater than 75,000 Btu/hr), list Recovery Efficiency(RE), Thermal Efficiency,Standby Loss and Rated Input. For instantaneous gas water heaters,list the Thermal Efficiency and Rated Input. 2. Mandatory Measures TO COMPLY-ALL BOXES MUST BE CHECKED ❑ §110-§113:Water heaters,showerhead and faucets are certified by the California Energy Commission. §1500):Water System Pipe and Tank Insulation.And Cooling Line Insulation 1. Storage tank insulation ❑ A.Storage gas water heaters rated with an Energy Factor no greater than the federal minimal standard are externally wrapped with insulation having an installed thermal resistance of R-12 or greater;and ❑ B.Unfired storage tanks or other indirect hot water tanks have R-12 external insulation or R-16 internal insulation where the internal insulation R-value is indicated on the exterior of the tank. 2. Water piping and cooling system line insulation thickness and conductivity First 5 feet of hot and cold water.pipes closest to water heater tank,non-recirculating systems,and entire length of recirculating sections of hot water pipes are insulated per Standards Table 150-13;and Pipe insulation for steam hydronic heating systems or hot water systems>15 psi,meets the requirements of Standards Table 123-A. Insulation is protected from damage,including that due to sunlight,moisture,equipment maintenance,and wind. §151(f)8D:If indicated on the CF-1R,all hot water piping that runs from the hot water source to the kitchen fixtures is insulated per Standards Table 150-13. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MZC1t-01 Domestic Hot Watera e:2 of 2 ss: Enforcement'. r Enforcement Agency: Permit Number: r 4 ' L oef_ t4r, c— Gct'�"uWD ,7 3. Central Water Heating in Buildings with Mulfiple Dwelling Units(required for prescriptive) TO COMPLY-ALL BOXES MUST BE CHECKED IT All hot water,piping in main circulating loop is insulated to requirements of§1500) ❑ Central hot water systems serving six or fewer dwelling units which have(1)less than 25' of distribution piping outdoors;(2)zero distribution piping underground;(3)no recirculation pump;and(4)insulation on distribution piping that meets the requirements of Section 1500) ❑ Central hot water systems serving more than 6 dwelling units-presence of either a time control or a time/temperature control DECLARATION STATEMENT • I certify under penalty of perjury,under the laws of the State of California,the information provided on this form is true and correct. • I am eligible under Division 3 of the Business,and Professions Code to accept responsibility for construction,or an authorized, representative of the person responsible for construction(responsible person). • I certify that the installed features,materials,components,or manufactured devices identified on thiscertificate(the installation) conforms to all applicable codes and regulations,and the installation is consistent with the plans,and specifications approved by the enforcement agency. • I reviewed a copy of the Certificate of Compliance(CF-1R)form approved,by the.enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on`the CF-1R that apply to the installation have been met. • I will ensure that a completed,signed copy of this Installation Certificate shall be posted,or made available with the building permit(s)issued for-the building,and made available to the enforcement agency for all'`applicable inspections. I understand that a signed,copy of this Installation Certificate is required to be included with the documentation the builder provides to the building,owner at occupancy. Company Name: (Installing Subcontractor or C4eneral C ntractor or Builder/Owne`r) e j _Co6t 12o rem , r- Respons�ibblle//�Personf' Name: t Responsible Person's Signature: CSLB License: Date Signed Position With Company(Title): 2008 Residential Compliance Forms August 2009 . t 3 {{ 3 ,ater = r temperature. IlIng cifcal res item Specification NR111-OD i Outdoor,Wall Mounted Power Vented Direct Ignition 15-150 psi j 0.5 GPM Depth) £ 24.2"(Height)x 18.3"(Width)x 9.4"(Depth) 62 lbs. 0.3 Gallon 3/4" 3/4" 3/4" 120 VAC(60Hz) tion 250W NG :90W LP:95W Freeze Prevention 250W ating Zincified Steel Plate/Polyester Coating Stainless"Steel -Ig Copper Sheeting,Copper Tubing ction Device Flame Rod,Thermal Fuse, Lightning Protection Device ce(GFCI), (ZNR),Electric Leakage Prevention Device(GFCI), .ntion Device, Overheat Prevention Device,Freezing Prevention Device, Fan Rotation Detector er Cord, Remote Controller, Remote Controller Cord, rd Anchoring Screws f erfQrmanc { erfo(mance Item j „ Maximum Performance Minimum Perfflrmance; J btuh 250,000 btuh 11,000 btuh btuh 250,000 btuh 11,000 btuh 9.3 Gal./min. J 0.5-11.1 Gal./min. 100-150°F(In 5°F intervals), 1 Options) 160, 170, 180°F(In 10°F intervals) (14 Options) !0°F) 120,130,140,180°F(Original is 120°F) 1 j { i { 29 OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 (408)777-3228-FAX(408)777-3333-buildina(c)cupertino.org CUPERTINO Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS ��� �� ` �� APN 3 S 3 Z� y BP# J (•Ca OWNER ADDRESS �� OWNE N�ME L - / l DESCRIPTION OF.WORK: We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision,signed,and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner,obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information) 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an"Owner r"building permit that erroneously implies that the property owner is providing his or her own labor and material personally. 1, as an Owner-Builder,may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. e:? ' I understand building permits are not required to be signed by property owners unless they are responsible for t e construction and are not hiring a licensed Contractor to assume this responsibility. 3./1 understand as an"Owner-Builder" I am the responsible party of record on the permit. I understand that l may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. �I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars($500), including labor and materials, I may be considered.an"employer"under state and federal law. 6. I understand'if I am considered an"employer" under state and federal law, I must register with the state and federal government,withhold payroll taxes, provide workers'compensation disability insurance, and contribu g te to unemployment compensation for each"employee." I also understand my failure to abide by these laws may subject me to serious financial risk. 7. 1 understand under California Contractors' State License Law, an Owner-Builder who builds single-family esidential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is perfor ed under contract with a licensed general building Contractor. 8. 1 understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04/14/10 understand I may obtain more information regarding my obligations as an"employer"from the Internal Revenue Service,the United States Small Business Administration,the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB(2752)or www.cslb.ca.gov for more information about licensed contractors. 0. 1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the parry legally and financially responsible for proposed construction activity at the site address listed above. 11. 1 agree that,as the.party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. 12. I.agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the. information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property,you may be held liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors,you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS:Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.). Lender Name: Lender Address: Before a building permit can be issued,this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owne►'s si nature. Property Owner's Signatur Date: co Q --- ------------------------------------ -------------------------------------------------------------------------------------------------- - (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner,the execution of which I understand is my personal responsibility, I hereby_ authorize the following person(s).to act as my agent(s)to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project(or Description of Work): Project Location or Address: Name of Authorized Agent: Tel No Address of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwnerBuilderForm 2010.doc revised 04/14/10 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 C U P E RT 1 N O Fax: 408-777-3333 CONTRACTOR/SUBCONTRACTOR LIST JOB ADDRESS: � PERMIT# O OWNER'S NAME: S(, PHONE# 2l GENERAL CONTRACTOR: BUSINESS LICENSE°.# ADDRESS: CITY/ZIPCODE: *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: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE# Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass/Glazing Heating J Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing i /� .¢► u �� Roofing Septic Tank Sheet Metal Sheet Rock Tile _ �/� Owner/ ontrac Signature Date City of Cupertino -ftorx r 10e,46v- COMP. t'�"ITV DF11ELOPMENT DEPARTM'ENT ft�'-J BULDING GUPERT4,4c') A! Eck hem This Set of plans-and MUST he kentat the Basemap Labels job mit,,)(p-!!q is S 0 e Abc Street Names kvithoui appioval arc the I • Secondary Address Labels F';"' -- "T. - S!ii/d L NOT Primary Address Labels It o' tu OT V7,.i V? '!cn Freeway Qi a any CiLV O'din'Lalep Basemap RIM 11 NO. Street Centerline P E County Major Roads County Freeways Right-of-Way Parcels Community Development [3 City Boundary Aerials-April 2011 • PLOT PIANS On air 4AR &SOIZ®1377e 0 �/Vb V A2V '010,4,-Re���� DE "Yet FaR CO J2PX DA, JDC�JpT. N SCALE 1 :401 20 0 20 40 60 FEET qPM 09 I'V13 hftp://gissvr/cupertinointranet/home/mapFile.aspx Tuesday, April 09, 2013 2:26 PN ReVFir co went ew��gySd44A CrgNcF i rLor h CWXKW I eg DAVE �l PLAN NG DEFT. ATE Existing GFI Outlet Modified for Weather New Outlet with Resistance Weather Resistance Bath Window. Bath Bedroom Window Window i Bedroom North Sliding door Water New Electrical Conduit IF Heater New Gas Line Step Cold in/Hot out _ Gas Step Meter wl Space Vent + - / Pipes Scale 1" =4' W K4- ' ��- �C � fI d "t�°� VC9V�