09090010 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10238 CRESTON DR CONTRACTOR:FLAAGAN JOHN K PERMIT NO:09090010
AND YVONNE H
"NER'S NAME: FLAAGAN JOHN K AND YVONNE H 10238 CRESTON DR DATE ISSUED:09/02/2009
vWNER'S PHONE: 4086919410 CUPERTINO CA, 95014-1014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION r I—
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class_ Lic.# f—
MECH RESIDENTIAL COMMERCIAL
Contractor _ Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REPLACE WATER HEATER WITH
(commencing with Section 7000)of Division 3 of the Business&Professions TANKLESS WATER HEATER
Code and that my license is in full force and effect.
1 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:$4000
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:32637050.00 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 (� 2--01
granting of this permit. Additionally,the applicant understands and will comply Issued by: �)� Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
ial!ire 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:
1 hereby affirm that 1 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 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 have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. 1 will
1 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 1 store or handle hazardous
I have and will maintain.a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 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 1
performance of the work for which this pennit 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&Safe'y Code,Sections 25505,25533,and 25534.
Section 3700 of the Laror Code,for the performance of the work for which this Owner or authorized agent: % Date:
permit is issued. ;
1 certify that in the p�r+-�rmance 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,1 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions oCthe 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
building cogstructior.,and hereby authorize representatives of this city to enter
+"he above mentioned property for inspection purposes.(We)agree to save
...rslify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
costs,and expenses which may accrue against said City in consequence of the I understand my pians shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations Lie t e Cupertino Municipal Code,Section Licensed Professionai
9.18 7
z"r
Signature_ .. ___ _Date_ / _ /
CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: SylviaM
COPY $# 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32637050 . 00
DATE ISSUED. . . . . . . : 09/02/2009
RECEIPT #. . . . . . . . . : BS000008585
REFERENCE ID # . . . : 09090010
SITE ADDRESS . . . . . : 10238 CRESTON DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : FLAAGAN JOHN K AND YVONNE H
ADDRESS . . . . . . . . . . : 10238 CRESTON DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1014
RECEIVED FROM . . . . : YVONNE FLAAGAM
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY FLAAGAN JOHN K AND YVONNE H
ADDRESS . . . . . . . . . . : 10238 CRESTON DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1014
TELEPHONE . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 4, 000 . 00 1 .00 0 . 00 1. 00 0 . 00
1BSEISMICR VALUATION 4, 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 24 .48 0 . 00 24 .48 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 67 . 98 0 . 00 67. 98 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 67 . 98 me
---------------
TOTAL RECEIPT 67 . 98
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
518 WATER HEATER
OWNER-BUILDER VERIFICATION
1. (Check one) I or my immediate family (parent,spouse or child) will perform:
A. ✓ All the work authorized by this permit
B. _ A portion of the work
C. _ None of the work
If B or C is checked,complete 2 or 3 below.
2. A state licensed contractor will be hired to do:
A. _ All of the work
B. _ A portion of the work (complete section below)
Contractor Address/City Phone # State License # Type of work to
be performed
3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand that I may be an employer (see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
PersorVFirm Address/City Phone Number Type of work to be
erformed
.....................................................................................................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information (reverse side).
Property Owner's Signature: Z. �' Date:
�1
Job Address: J65 2 Permit#
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.
CITY OF CUPERTINO
WATER HEATER
CITY OF
CUPEkTINO PERMIT APPLICATION FORM
CSI bqW10
Li
APNDate:
6P 37 6 5-0 DO t
Building Address:
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ICL2- 'A
Owner's Name: Phone #:
44-
Contractor: 0 �t3C2 Phoney L- i - ei
Fax #:
Cupertino Business License #: Contractor State License #:
Contact: Phone #:
Fax #:
Building Permit Info:
Bldg Elect E5— Plumb Mech
Residential Commercial El
Job Description:
"Y\k 0
V-C
Strapped F-1 On Platform F-1 Bonded New Location ❑ Replacement
Valuation (cost of project):
Project Size: Express Standard F-1 LargeE] Major 0
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.
Green Building Points achieved:
Revised 01/07/09
CITY OF CUPERTINO
WATER HEATER
:.UPERTINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Permit Type
Group
1PCWHEATR Commercial Water B PCWHEATR
HeaterNent
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICOM Seismic Commercial B
1 PRWHEATR Residential Water B PRWHEATR
HeaterNent
/ 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Residential B
J 1 PPERMITFEE Plumbing Permit P
1 TRAVDOC Travel & B
Documentation
1 BUSLIC Business License B
INPUT Resources Energy AQ
D.Extenor Funs
1.Use Sustainable Decking Materials
a.Recycled content 3.Resource pts y=yes 0
b.FSC Certified Wood 3 Resource pts y=yes 0
2.Use Treated Wood That Does Not Contain ChromiunUArsenic 1 IAQ/Health pt y=yes 0
3.Install l immWrap undw Siding 1 IAQ/Health pt y=yes 0
4.Use Fibar-Canent Siding Materials 1 Resource pt y=yes 0
E.Plumbing
1.Install Water Heater Jacket 1 Energy pt y=yes 0
2.Insulate Hot and Cold Water Pipes 2 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.Showedmads(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 pants) Up to 3 Resource pts. 0
5.Install Chlorine Filter on Showerhead 1 IAQ/Health pt y=yes 0
C2_1';bnvert 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
8.Install On-Demand Hot Water Circulation Pump 4 Resource pts y=yes 0
1 1 i
r.tiectncai
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
1 1 1
G.Appliances
1.Install Energy Star Dishwasher. 1 Energy pt y=yes 0
2.Install Washing Machine with Water and Energy
Conservation Features 1 Energy pt y=yes 0
3.Install Energy Star Refrigerator 1 Energy pt y=yes 0
4.Install Built-In Recycling Center 3 Resource pts y=yes 1 0
1 1 1
H.Insulation
1.Upgrade Insulation to Exceed Title 24 Requirements
a.Walls 2 Energy pts y=yes 0
b.Ceilings 2 Energy pts y=yes 0
2.Install Floor Insulation over Crawl Space 4 Energy pts y-yes 0
3.Install Recycled-Content,Fiberglass Insulation with
No Added Formaldehyde 3 IAQ/Health pts y=yes 0
4.Use Advanced Infiltration Reduction Practices 2 Energy pts y=yes 0
5.Use Cellulose Insulation
a.Walls 4 Resource pts y=yes 0
b.Ceilings 4 Resource pts y=yes 0
6.Alternative Insulation Products(Cotton,spray-foam)
a.Walls 4 Resource pts y=yes 0
b.L;eilings 4 Resource pts y=yes 0
1 1 1
INPUT Resources • IAO/Health
M.Indoor Air Quality and Finishes
1.Use Low/No-VOC Paint 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0
3.Use Low/No VOC Adhesives 3 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 61AQ/Health pts y=yes 0
D
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes
7.Seal all Exposed Particleboard or MDF 4 IAQ/Health. pts y=yes 0
B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes Ed 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 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 1
Total Points Available: 1 1401 13057
Total Points Project Received: 01 0 0
G:data/progs/greenbuildingguidelines/remodelerslgreenpointsfinal2.12.04protected.xis