13050082 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10175 AVOCADO PL CONTRACTOR:CALIFORNIA DELTA PERMIT NO:13050082
MECHANICAL INC
OWNER'S NAME: MICHAEL WONG 6056 E BASELINE RD STE 155 DATE ISSUED:05/09/2013
OWNER'S PHONE: 6505045118 MESA,AZ 85206 PHONE NO:(866)692-5273
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALU .
License Class Lic:#' ll� REPLACE(E)WATER HEATER WITH(N)TANKLESS
WATER
Contractor % l Date- s HEATER,SAME LOCATION
I herebyfirm 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 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:$3200
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:36909010.00 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 LED INSPECTION.
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS
indemnify and keep harmless the City of Cupertino against•liabilities,judgments, e�
costs,and expenses which may accrue against said City in consequence of the Issued ate:
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' 9 !� 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 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)
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 Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505 3,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: 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 sous 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. 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 which 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.
Signature Date
-�I ^
GENERAL PERMIT APPLICATION
CQMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
o MEP
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408).777-3228•FAX(408)777-3333•buildingocugertino.org
misc .
CUpIERTIN
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By signature below,I: ertify to each of the following: I am the property owner or authorized agent to properly owner' ehalf. I have read this
application and {ie inforination!I•have provided is correct. I have read the Description of Work and yerify_it is accurate. I agree omply'with all applicable local"
orduiances ands�ate laws',gelating to buildin traction. I authoi iegFeserit�ff es of Cupertino to enter the above-identified property for inspection purposes
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Sign atwe ofAppL`ant/Agent:' I Date:
1 PLEMENTAL INFORMATION REQUIRED ,
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MEPMiscA 2011.doc revised 06/21/11
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CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10175 AVOCADO PL DATE: 05/09/2013 REVIEWED BY: melissa
APN: 369 09 010 BP#: *VALUATION: $3,200
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Du lex PENTAMATION PRWHEATR
USE: p PERMIT TYPE:
WORK REPLACE E WATER HEATER WITH N TANKLESS WATER HEATER SAME LOCATION
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Water Heater 1PRWHEATR 1 # $27
TOTALS: $27.00Mill
-
SIM
�r-0,^s�"''�1,
: �,
Mech. Plan Check Plumb.Plan Check 0.0 Ins $0.00 Faee. Plan Check
Ltech.Per trait Fce:. Plumb.Permit Fee: IPPERMIT Elec.Permit Fee:
E)laer Mech.Insp. Other Plumb Insp. 0.0 hrs $45.00 Cltlrer Elec.Insp.
11ech.Inrp.Fee: Plumb.hrsp. ree: L-:le(.Insp,Fee:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These fees are based on the prefindna information available and are onl an estimate. Contact the Dept for addn'l info,
FEE ITEMS 6Fee Resolution 11-053 E 7f� /1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. P('Fee
PME Plan Check: $0.00
Permit Fee.:
Suppl. Insp Fee
PME Unit Fee: $27.00
PME Permit Fee: $45.00
Construction Tax:
Administrative Fee: 1ADIWN $42.00
Work Without Permit? ®Yes (E) No $0.00
Advanced Pkrnrling Fees:
Travel Documentation Fee: 1TRAVDOC $45.00 i
Strong;Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
RM
$160.50
`1 t "IA$160.50 $0.00
�\ Revised: 04/29/2013
INSTALLATION CERTIFICATE CF-6R-MECH-01
Domestic Hot Water (Page I of 2
Site Address: Enforcement Agency: Permit Number:
4Lpraxlo
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 Btu/hr)1 (gallons) (EF,RE)i (%)t
C-
L/
-
71
Note 1:For small gas storage(rated input less than or equal to 75,000 Btu/hr),electric resistance and heat pump water heaters,list
Energy Factor(EF).For large gas storage water heaters(rated input of greater than 75,000 BtuAr),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
ID 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
El 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
El 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
El Pipe insulation for steam hydropic heating systems or hot water systems>15 psi,meets the requirements of
Standards Table 123-A.
El Insulation is protected from damage,including that due to sunlight,moisture,equipment maintenance,and
wind.
E §151(08D:If indicated on the CF-IR,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
INSTALLATIQN CERTIFICATE CF-6R-MECI3-01
Domestic Hot Water
(Page 2 of-2
Sife Address:.- Enforcement Agency: Permit Number:
D v
3. Central Water Heating in Buildings with Multiple Dwelling Units(required for prescriptive)
TO COMPLY-ALL BOXES MUST BE CHECKED
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 this certificate(the installation)
conforms to all applicable codes and regulations,and the installation is consistent with the plans;and specifications approved by the
enforcement agency.
• 1 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`ihe 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'age"iicy for allapplicable 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.
Comp y ame: (Installing Subcontractor or General Contracto r Builder/Owner)
/1 1
Responsible Person's Nam Responsible Person's Signature:
CS-LB License: Date Signed: Position With Company(Title):
2008 Residential Compliance Forms August 2009