10070053 CITY OF CUPERTIN O BUILDING PERMIT
BUILDING ADDRESS: 10380 LOCKWOOD DR CONTRACTOR H , {_.� PERMIT NO: 10070053
OWNER'S NAME: BAYHA BARBARA A DATE ISSUED:07/07/2010
lER'S PHONE: 4089662275 PHONE NO:
LICENSED CONTRACT% 'S DECLARATION r r r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.#
MECH r RESIDENTIAL (_ COMMERCIAL r
Contractor Date 0 0 X/6
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: INSTALL TWO TANKLESS WATER HEATERS,150 BTU
(commencing with Section 7000)of Division 3 of the Business&Professions EACH
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 Sq.Ft Floor Area: Valuation:$8000
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:34229017.00 Occupancy Type:
APPLICANT CERTIFICATION
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 PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-point sour c 7;on�sthe Cupertino Municipal Code,Section —]
9.18. Issued b •,",-��` -� Date: ��• -�� C
Signature a e
OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
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, Signature of Applicant: Date:
Business&Professions Code)
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 HAZARDOUS MATERIALS DISCLOSURE
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
performance of the work for which this permit is issued. i compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534.
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 Ow r adtho ' agent: 7/�
become subject to the Worker's Compensation provisions of the Labor Code,I must a O
forthwith comply with such provisions or this permit shall be deemed revoked
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
-nnify and keep harmless the City of Cupertino against liabilities,judgments,
and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
CITY OF CUPERTINO
FEEFEE ESTIMATOR--BUILDING DIVISION
ADDRESS: rr�Yr�� DATE: REVIEWED BY:
APN: 3�2�-�t� l �- BP#: W O0 S-7?:: "VALUATION: 1$8,000
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARYSFD or Duplex t y; APPLICATION
USE: TYPE:
W
a
00
3 �
APPLIANCE/EQUIP TYPE CAPACITY FR;,ID QTY BP FEES
Water Heater 1 BPV'HEAT 2 $50
TOTALS: $50.00
Plumb. Plan Chec 10.0 hrs $0.00
FPlun,b. Per
mit Fee: IPPERMITT
Other Plumb Insp. 1 0.0 1 hrs $42.00
NOTE: Thesefees are based on the preliminary information a vailable and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS(Fee Resolution 09-051 Ef..' 7/1/09) FEE QTY/FEE MISC ITEMS
j7 by {
PME Plan Check: $C.00
PME Unit Fee: $5C.00
PME Permit Fee: $42.00
Travel Documentation Fee: ITIM VDOC $42.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $131r.00 $0.00 TOTAL FEE: $135.00
Revised: 6/30/2010
CITY OF CUPERTINO
5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk.: Lot:
APN . . . . . . . . : 3429017 . 00
DATE ISSUED. . . . . . . : 07/ 07/2010
RECEIPT #. . . . . . . . . : BS( 00010798
REFERENCE ID # . . . : 10( 70053
SITE ADDRESS . . . . . : 10_ 80 LOCKWOOD DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : BA)'HA BARBARA A
ADDRESS . . . . . . . . . . : 10: 80 LOCKWOOD DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2616
RECEIVED FROM . . . . : HTS:
CONTRACTOR . . . . . . . : TBI - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBI - TO BE DETERMINED
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- -- -------- ---------- ---------- ----------
1BCBSC VALUATION 8, 000. 00 1 .00 0 . 00 1 . 00 0 .00
1BSEISMICR VALUATION 8, 000 . 00 0 .80 0 . 00 0 . 80 0 .00
1PPERMITFE FLAT RATE 1 . 00 42 .00 0 . 00 42 . 00 0 .00
1TRAVDOC FLAT RATE 1 . 00 42 .00 0 . 00 42 . 00 0 .00
PRWHEATR UNITS 2 . 00 48 .96 0 . 00 48 . 96 0 .00
- -- -------- ---------- ---------- ----------
TOTAL PERMIT 134 .76 0. 00 134 . 76 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 134 .76 492359
---------------
TOTAL RECEIPT 134 .76
CITY OF C.UPERTINO
WATER HEATER
CUPEkTINO PERMIT APPLICATION FORM
APN# r I I � Date:
Building Address:
/ a3 .P ip -
Owner's Name: Phone #:
ILA c5y C4
Contractor: Phone #:
14-TX Fax #:
Cupertino Business License #: Contractor State License #:
Contact: Phone #:
� v_ �� C- � �7 �
(e cul " ,.� Fax #:
Building Permit Info:
Bldg [�_ - Elect ❑' Plumb Mech
Residential E Commercial ❑
Job escription:
Strapped ❑ On Platform ❑ Bonded New Location ❑ Replacement ❑
Valuation (cost of project �
v() J 0
Project Size: Express ❑ Standard Large ❑ Major ❑
Green Building: Please complete relevant port;.on of the Green Building Checklist & attach it to
the application or if applicable, include in plan set & the sheet index.
Green Building Points achieved: 9—
Revised
03/10/10
CITY OF CUPERTINO
4WATER [EATER
CUPEI� TINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Descriptioa Fee Permit Type
Group
1PCWHEATR Commercial Water B PCWHEATR
HeaterNent
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICOM Seismic Commi:rcial B
1PCSWHTR Commercial Solar B PCSWHTR
Thermal Water Htr
1 PRWHEATR Residential Wa::er B PRWHEATR
HeaterNent
1PRSWHTR Residential Solar B PRSWHTR
Thermal Water Htr
/ 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fc e
1BSEISMICRE Seismic Reside ritial B
1 PPERMITFEE Plumbing Permit P
/ 1 TRAVDOC Travel & B
Documentation
1BUSLIC Business License B
INPUT Resourres Energy •!
D.Exterior Finish
1.Use Sustainable_Do 'ng Materials
a,Rec�►cerflorltetat Resource pts y=yes 0
b,FSC,Ca 0bal Wood Resource pts y--yes 0
2.Use Treated AWd That Does Not Contain Chr+omiurniAasenic IAQ/Health pt y=yes 0
3.1r1'Sicng IAQ/Health pt y--yes 0
- es
4.Usoe Fiber=Cernhnt Siring Materiats 1 F esource pt y=yes F 0
1 1 1
E.Plumbing ■
1.Install Water Heater Jacket 1 Energy pt y=yes 0
2.Insulate Hot and Cold Water Pipes Energy pts y=yes 0
3.Retrofit all faucets and Showerheads with Flow Reducers
a.Faucets(1 point each,up to 2 points) Up to 2 Resource pts. 0
b.Showerheads(1 point each,up to 2 points) Up to 2 Resource pts. 0
4.Replace Toilest with Ultra-Low Flush Toilets
(1 point each,up to 3 points) Up to 3 Resource pts. 0
5.Install Chlorine Filter on Showerhead IAQ/Health pt y-yes 0
6.Convert Gas to Tankless Water Heater 4 Energy pts y=yes 0
7.Install Water Filtration Units at Faucets
(2 points each,up to 4 points) Up to 4 IAQ/Health pts. 0
S.Install On-Demand Hot Water Circulation Pump 4 Resource pts y=yes 0
■ 1 1 1
r.rrecurcai
1.Install Compact Fluorescent Light Bulbs(CFLs)
(6 bulbs=2 points,10 bulbs=3 points,12 bulbs=4 points) Up to 4 Energy pts. 0
2.Install IC-AT Recessed Fixtures with CFLs(1 point each,up to
5 points) Up to 5 Energy pts. 0
3.Install Lighting Controls(1 point per fixture,up to 4 points) Up to 4 Energy pts. 0
4.Install High Efficiency Ceiling Fans with CFLs
(1 point each,up to 4 points) Up to 4 Energy pts. 0
■ 1LM 1
G.Appliances
1.Install Energy Star Dishwasher Energy pt y=yes 0
2.Install Washing Machine with Water and Energy
Conservation Features Energy pt y=yes 0
3.Install Energy Star Refrigerator Energy pt y=yes 0
4.Install Built-In Recycling Center 3 Resource pts y=yes 1 01 1
■ i 1 1
H.Insulation
1.Upgrade Insulation to Exceed Title 24 Requirements
a.Walls Energy pts y=yes 0
b.Ceilings Energy pts y=yes 0
2, Install Floor Insulation over Crawl Space Energy pts y=yes 0
3.Install Recycled-Content,Fiberglass Insulation with
No Added Formaldehyde IAQ/Health pts y=yes 0
4.Use Advanced infiltration Reduction Practices L Energy pts y-yes 0
5.Use Celluiose Insulation
a.Walls 4 Resource pts y=yes 0
b.Ceilincs 4 Resource pts y=yes 0
6.Alternative Insulation Products(Cotton,spray-foam)
a.Walls 4 Resource pts y=yes 0
D.UeMngs' 4 Resource pts y=yes 0
■ i i 1
M.Indoor Air Quality and Finishes--
Use
inis esUse LowMo-VOC Paint IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes IAQ/Health pts y=yes 0
3.Use LowMo VOC Adhesives :;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 6IAQ/Health pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses IAQ/Health pts y=yes 0
7.Seal Al Exposed Particleboard or MDF IAQ/Health. pts y=yes 0
8.Use FSC Certified Materials for Interior Finish 3 Resource pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim i Resource pts y=yes 0
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yesl 0
Em1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 4
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 E IAQ/Health pts 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 i
Total Points= 1 1401 130 57
Total Points Project Received:1 r 01 01 0
G:data/props/greerwildingguidelines/remodelers/greenpointsfinal2.12.D4prolected.xis
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: 0 , Zoe— r— PERMIT#
OWNER'S NAM : PHONE# U (o 6�2
GENERAL CONTRACTOR: XL(by,., BUSINESS LICENSE#
ADDRESS: A CITY/ZIPCODE: e
*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 SUB RA� S HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subc ntractors 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
caner/Contractor Signature Date