13040120 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS; 1.0079 CRAFT DR CONTRACTOR:AAA FURNACE&AIR PERMIT NO:13040120
CONDITIONING
OWNER'S NAME--KUPIEC JULIAN M AND MEGHAN M 1712 STONE AVE DATE ISSUED:04/16/2013
OWNER'S.PHONE: 4088650691 SAN JOSE,CA 95125 PHONE NO:(408)293-4717
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL
11
License Class Lic.'#�6V-:/ REMOVE&REPLACE(E)WATER HEATER,SAME
LOCATION
Contractors Date `I�"�3
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(if 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:$1057
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:37502030.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify.that 1 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 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 D RO 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 sued Date �3
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
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
I,as owner of the property,or myemployees with wages as their sole compensation,
will do'the work,and the structure'islnot i itended.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 Workers Compensation Insurance,as provided for by the Health&Safety Code,Sectio s 25505,2 533,and 25534. (�.
Section 3700 of.the:Labor'Code,for the performance of the work for which this Owner or authorized agent: Date•1.`w�
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 Gahfomia. It 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. work's for which this permit is issued(Sec.3097,Civ C.)
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 herebylauthorize representatives of this city to enter
upon the above mentioned property for inspectionpurposes.(We)agree to save ARCHITECT'S DECLARATION
indemnify,and.keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue againstsaid 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
V
EP
GENERAL PERMIT APPLICATION `*�
COMMUNITY DEVELOPMENT DEPARTMENT, SUILDING DIVISION
10300 TORRE AVENUE , CUPERTINO, CA 95014-3255.1211
O
SUR }�T (408) 177-3228 , FAX (408) 777.3333 building(c),cupertino.org MISC
E INO \
PLUMBING ❑MECHAMCAL ❑ELECTRICAL ❑MISCELLANEOUS
PROTECT ADDRESS liI /1 / ���J APN k 3r Z 0 ZJ�
OWNER NAME P"I O E WAIL
S'TREETADDRESS �,`�[\ /,I ��/' r��, I �<. f��(\ �jIQ( FAX
CONTACT NAME
STREET ADDRESS./V.(IJJI MY.STATE, ZIP I FAX
o ❑OWNER M OWNER-BUILDER Q OWNERAGENT CONTRACTOR Cl CONTRACTOR AGENT ❑ ARCHrrECT ❑ ENGINEER ❑ ouvELOM ❑Tv4ANT
CONTRACTOR NAME1 J W I ��� B
COMPANYNAMP E-MAIL I
STREET ADDRESS C ' cmc A � 6# i � I(1
AJt0-(TECT/ENU1MX NAME v LICENSE NUMBER BUS.„ BUS.UC i
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP ?N.ONE
USE OF �SFD or Duplex C) Multi-Family PROJECT IN WILDLAND PROJECT T
slRticruRE: O Commercial UMANwTERFACE AREA �❑ Yes "PlIno FLOOD ZONE O Yea No
DESCRIPTION Of WORK
TOTAL VALUATION;
By my signature below,i certify to each of the following: lam the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information i have rovided is come . I have read the Description of Work and verify it is accurate. I agree to comply with all applicable loaf
ordinances and state laws relating to 1 ding co u o ze r sentatives of Cupertino to enter the aove-idjentifed yr pem for inspection purposes.
Signaturo of ApplicanVAgent: � '— Date; �
S PLE NTAL RMATION REQLTMED
d-fEPA,JeweApp_ oll.doerevised03/16/11
CITY OF CUPERTINO
EllFEEESTIMATOR-BUILDING DIVISION
ADDRESS: 10079 CRAFT DR DATE: 04/16/2013 REVIEWED BY: MELISSA
APN: 375 02 030 BP#: *VALUATION: $1,057
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Duplex PERMIT IEN PRWHEATR
USE: PERMIT TYPE: i
WORK REMOVE & REPLACE E WATER HEATER SAME LOCATION
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Water Heater 1PRWHEATR 1 # $27
TOTALS: $27.00 .'
Gtech.Plan C heck Plumb.Plan Check 0.0 hrs $0.00 Elee..Plan Check
L1ec.fr. Permit hee: Plumb.Permit Fee: IPPERMIT Elec.Permit Fee:
Other Alec h.Insp. Other Plumb Insp. 0.0 hrs $45.00 Other Elec.Insp. El
ivf,&Insp. Fee: Plump. hap.Fee: Elec.Insp Fee:
'NOTE:This estimate does not include fees due to other Departments(i.a Planning,Public Works,Fire,Sanitary Sewer District,School
District etc . These ees are based onahe relimina in ormation available and are onl an estimate. Contact the Dept or addn'Z in o.
FEE ITEMS(Fee Resolution 11-053 Eff 711112) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
tSulip.l. PC Fee
PME Plan Check: $0.00
Permit.Fee:
Suppl. Insp Fee
PME Unit Fee: $27.00
PME Permit Fee: $45.00
Construction:Tar:
Administrative Fee: IADMIN $42.00
Work Without Permit? ®Yes Q No $0.00
Advanced Planning Fees:
Travel Docuinentation.Fee: ITRAVDOC $45.00
Stro>*Motion.Fee:. 1BSEISMICR $0.50 Select an Administrative Item
BW,Stds Commission Fee IBCBSC $1.00
$160.50 .$0.00 $160.50
Revised: 04/01/2013
CF-IR-ALT
Prescriptive Certificate of Compliance: Residential Pa e 4 of 5)
Residential Alterations Climate Zone# #of Stories
Project Name: v� C�
HVAC SYSTEIVIS-HEATING Configuration
Minimum Duct or Piping
Heatin Equipment Efficiency Distribution Insulation Thermosta (Central,Split,
i z a S ace,Packa a or H dronic)
FIndicate
e and a aci f �FUE or HSPF) Type and Location R-Value T
Heating\Bt
Furnace,.Wall Furnace. Heat pump, Boiler. Elec Resistance, etc.)
ric resistanclowed only in Component Package C, or e pt where electric heating is supplemental(i.e., if total capacity
KW or 7.000ic heating is controlled by a time-1'i ' ng device not exceeding 30 minutes). See§151(b)3 exception.
to the HERsection on Page 4 of the CF- �1LT FormJor additional requirements and check applicable boxes.
cate Type oris. Hydronic in Floor adiarors,etc.)
HVAC SYSTEMS COOLIN
Mt Configuration
cie Duct or Piping g
Insulation Thermostat (Central,Split,
Cooling Equipment EER/EER Distribution R-Value T e Space,Packa a or H dronic
T e and Ca acit r' SOP) T e and Location'
!. indicate oling Type(A/C, Heat pump, Evap. Cooling, etc
2. Refer o the KERS Verification section on Page 4 of the CF-1 �4LT Form Jor additional requirements and check applicable boxes.
3. I icate Type or Location(Ducts, H dronic in Floor, Radiators,etc.)
WATER HEATING
HW)heaters and hydropic space heating. Individual dwelling DHW heaters must b
List water heaters and boilers for both domestic hot water(D
gas or propane fired, and may not exceed 50 gallons. Hot water pipe insulation from the DHW heater to the kitchens)and on all underground
hot water pipes is required in all component packages in all climate zones. External Tank
Water Heater Type/Fuel Distribution Type Number In Tank Energy Factor or insulation
T e (Standa d, R irculatin )' System Ca acity( al) Thermal Efficienc R-Value;
/ �G
1. indicate Tvpe(Storage Gas, Heat Pump, instantaneous, etc.)
2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of§1 50(n). The Prescriptive requiretnencs 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§1506).
SPECIAL FEATURES The enforcement
d shouldpqv
ands ea attention to
cat n.the
Special Features specified in this checklist below-
These items may re wire written justification an
NEW.ROOF ASSEMBLY-Radiant Barrier
The radiant barrier re uirement of; I51( 2 does nota I to roof alterations.
Slab Edge(Perimeter)Insulation O YES ❑NO
YES: In Climate Zone 16 in Component Packages D,R-7 insulation is required.
Heated Slab Insulation 0 YES„ O NO
l Climate Zones. See details in Table 1 18-A of the standards.
YES:Slab edge insulation required for all heated slabs in al
Raised Slab Insulation O YES U NO
.14& 16,R-8 insulation is re: 'red; in Climate Zones 12& 15,R-4 is required under component Pa
YES:In Climate Zones 1,2, 11, 1.3, Q
' Thermal Mass
To obtain Compliance Credit for the installation of thermal mass,use the Performance Approach.
Registration Date/Time: HERS Provider.
Registration Number: August 20
2008 Residential Compliance Forms