10060112 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 6595 CLIFFORD DR CO 14TRACTOR:BENJAMIN FRANKLIN PERMIT NO: 10060112
PLUMBING
—WNER'S NAME: RICHARD FRANCIS PO BOX 1072 DATE ISSUED:06/21/2010
UWNER'S PHONE: 4082574809 CA OPBELL,CA 95009 PHONE NO:(408)298-1776
XLICENSED CONTRACTOR'S DECLARATION JO 3 DESCRIPTION: RESIDENTIAL COMMERCIALE]
License Class(—' 3 Lic.# q� 2 3 s J INSTALL TANKLESS WATER HEATER WITH 3/4 GAS
LIVE
Contractor ate 6 1
I her y a t4 am licen �e provisions of Chapter 9
(com racing 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
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:36926006.00 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 Is,ued b Date:
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
�I RE-ROOFS:
";gnature ate AI roofs shall be inspected prior to any roofing material being installed.If a roof is
ins tailed without first obtaining an inspection,I agree to remove all new materials for
ins pection.
❑ OWN -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 is not 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 Dave read the hazardous materials requirements under Chapter 6.95 of the
CAifornia Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three in iintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: H:alth&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 in iterial. 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. w II 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 agent. ate:
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 CONSTRUCTION LENDING AGENCY
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 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. w3rk's for which this permit is issued(Sec.3097,Civ C.)
L-nder'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
on the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
jemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I ,mderstand 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
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN 36926006 . 00
DATE ISSUED. . . . . . . : 06/21/2010
RECEIPT # . . . . . . . . . BS000010663
REFERENCE ID # 10060112
SITE ADDRESS . . . . . : 6595 CLIFFORD DR
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER RICHAF'D FRANCIS
ADDRESS 6595 CLIFFORD DR
CITY/STATE/ZIP CUPER-INO CA, CA 95014-4555
RECEIVED FROM JEFF RAINEY
CONTRACTOR CHAD NELSON LIC # 28520
COMPANY BENJAMIN FRANKLIN PLUMBING
ADDRESS PO BOH 1072
CITY/STATE/ZIP CAMPB]3LL, CA 95009
TELEPHONE (408) :298-1776
FEE ID UNIT QUANTITY AMO'JNT PD-TO-DT THIS REC NEW BAL
---------- -------------
----------
---- ------ ------
1BCBSC VALUATION 5, 000 . 00 1. 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 5, 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1BUSLIC FLAT RATE 1 . 00 114 . 00 0 . 00 114 . 00 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 224 . 50 0 . 00 224 . 50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
-----------------
--------------- --------------------
CREDIT CARD 224 . 50 visa
---------------
TOTAL RECEIPT 224 . 50
CITY OF
CITY OF CU PERTINO
GENERAL BUILDING
CUPERTINO PERMIT APPLICATION FORM
pd�vll2
APN# qDate:
Building Address:
6595 CLIFFORD DR.
Mailing Address (if different from building address):
Are Hazardous Materials being used as part of this project? Yes ❑ No
HOA: Exterior work only) Yes ❑ No If yes, provide letter from HOA
Owner's Name: Phone#:
RICHARD FRANSIS 408-257-4809
Contractor: Phone: 415-459-5909
BENJAMIN FRANKLIN PLUMBING Fax: 415-459-3207
Contractor License#: 857357
Cupertino Business License #:
Contact: RAPHAEL, BENJAMIN FRANKLIN PLUMBING Phone: 415-459-5909
Fax:
Residential x❑ Commercial
Job Description: INSTALLATION OF TANKL6$ WATER HEATER WITH 3/4 GAS LINE
Building Permit Info:
Bldg ❑ Elect B/ Plumb 0 Mech �—
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B �2 —"3
Valuation: Square Footage:
$5000
Project Size: Express Standard ❑x Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it
to the application or if applicable, include in plan set& the sheet index.
Points Achieved:
For help, contact Build it Green at www.builditgreen.or
Revised 07/14/09
CITY OF CUP'ERTINO
WATER HEATER
AaF
"UPEI�TINO PERMIT APPLIC,.TION FORM
Quantity Fee ID Fee Description Fee Permit Type
Group
1PCWfMATR Commercial Wates- B PCWHEATR
HeaterNent
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICOM Seismic Commerc.al , B
1PCSWHTR Commercial Solar B PCSWHTR
Thermal Water Htr
1PRWIEATR Residential Water B PRWHEATR
/ HeaterNent
1PRSWHTR Residential Solar B PRSWHTR
Thermal Water Htr
I 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
/ 1BSEISMICRE Seismic Residential B
/ 1 PPERMITFEE Plumbing Permit P
/ 1 TRAVDOC Travel & B
Documentation
1BUSLIC Business License B
INPUT Resources • AQ
M.Indoor Aar Quality and Finishes
1.Use Low/No-VOC Paint 1 IAC/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAC/Health pts y=yes. 0
3.Use Low/No VOC Adhesives 3 IAC/Health pts y=yes 0
4.Use Salvaged Materials for Interior Finishes 3 Re:;ource pts y=yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 6IAC/Health pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAC/Health pts y--yess0
7.Seal all Exposed Particleboard or MDF 4 IAC/Health. pts y=yes 0
8.Use FSC Certified Materials for Interior Finish 4 Re:;ource pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Re!;ource pts y=yes 0
10.Install Whole House Vacuum System 3 IAO/Health pts y=yes LZ0
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 IAC(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
f ! 1
Total Points Available: —14—Or-1 30 57
Total Points Project Received: 01 01 0
Y L
1
G:data/progs/greenbuilcrh lguidelines/remodelers/greenpointsfinal2.12.04proteoted.xls
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/ SUB('ONTRACTOR LIST
JOB ADDRESS: sr'► Z/, -x- P P, PERMIT# �l
OWNER'S NAME: RIC-rt-?r ,V PHONE# 41 S 145 !— 590 `-
GENERAL CONTRACTOR: 1 �Jr--)I 0,4 BUSINESS LICENSE#
ADDRESS: S1 # CITY/ZIPCODE: 5 ,4 O
*Our municipal code requires dil 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.
1 am not using any subcontractors:
nature Date
Please check applicable ubcontr c s and o Tete I he following information:
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
z( IV
wn ontractor Si re Date