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12030118CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: 10417ANSONAVE CONTRACTOR: SOLARCITY PEIRMITNO: 12030118 OWNER'S NAME: ANUI'AN & CIIANCIIAL SAIIAI 3055 CLEARVIEW WAY DATE ISSIIFD: 03222012 OWNFR'S NIONE: 4082191004 SAN MATEO, CA 94402 PHONE NO: (650) 638-1028 LICENSED CON I'RACTOR'S DECLARATION License Class1Z Li . q COmmQnr e1C7Z 7 -,y I hereby aflir 1 that 1 at n tcensed under the prurisions of Chapter') (commencing with Seeti n 711(10) of Division 3 of the Business & Professions Code and that my license is in full force and effect. hereby affirm under penalty of perjury one of the following boo 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 Section 3700 of the Labor Code, for the perfommnce of die work forwhich this permit is issued. C- I , \ .\I'1'I,IC,\N'1'CISR'1'IFIC\'I'I(1N �j�//- I cerlil}'that I have read this application and state thin the above inlonnation is correct. I agree to comply with all city and county ordinances and slate laws relating to building construction, mid hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additi rally, ill "applicam understands- and will comply Willi all non -point sou cc regu a ms pe the open no Municipal Code, Section 9.18. Signalure ❑ OWNER-BIIILDER DEICLARATION 1 hereby affirm that I ani exempt frtnl the Contractor's License Law for One of the following Iwo reasons: I, as owner of the properly, 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) L as owner of the property, 11111 exclusively contracting With licensed contractors to construct the project(Sec.7044, Business &Professions Code). hereby affirm under penalty of perjury one of the following three declarations: I have and Will maintain a Certificate of Consent to self insure for Worker's Compensation, as provided fur by Section 3700 of Ih c Labor Code, for the perfommnce of the work for which this permit is issued. I have and Will maintain Worker's Compensation Insurance, as provided for be Section 3700 of the Lubar Code, for the performance ollhe Work fur Which this penitis is issued I certify that in the perlbrinance of Ole Work I'or which this permit is issued, 1 shall not employ any person in only manner so as to become subject to the Worker's Compensation laws of California. If, alter making this certificate ofexemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with Such provisions or this permit shall be deemed revoked. APPLICANT CFRTI FICTION I certify that 1 have read this application acid state that the above information is correct. I agree to connply with all city anxl county or(linances mid sutie laws relating to building construction, mid hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to sae indemnify and keep hamiless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permil. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Sectiol 9.18. BUILDING PERMIT INFO: BLDG r ELECT r PLUMB ri NISCH r RESIDENTIAL r COMMERCIAL r� JOB DESCRIPTION: REMOVE AND REPLACE RFSIDFIITIAL FAU DUCTING WITH R-8 Sy. Ft Floor Area: I Valuation: $3100 APN Number: 32611001.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. IsVl I� I ✓mac rJ Date: RIS -ROOFS: All roofs shall be inspected prior to any roofing material beiig installed If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Dale: ALI, ROOFCOVE.RINGSTO BF, CLASS "A" OR BETITR IL\%ARDOUS NIAT'ERIA S DISCLOSURE, have read the hazardous materials requirements under Chapter 6.95 of the California Ilealth & Safery Code. Sections 25505. 25533, and 25534. 1 will maintain compliance With the Cupertino Municipal Code, Chapter 9.12 and the Ilealth & Safety Code. Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emil hazardous air cunmminanls as defined by the Bay Area Air Quality Management District I will maintain compliance 'lh the Cupertino NItnucipal Code, Chapter 9.12 and the Ilealth & Safety Cod . Section. 255115. 2553 , and 25534. 01vnc 1r uthorized cola CONSTRUCTION LENDING AGFNCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCIIITECI"S DECLARA'T'ION I understand my plans shall be used as public records. Dale I Licensed Professional Prescriptive Certificate of Compliance: Residential CF -IR -ALT Residential Alterations to Existing Buildings (Page 3 of 4) Site Address: Enforcement Agency: Date: 7� HVAC SYSTEMS - HEATING Heating Equipment Type and Capacity Minimum Efficiency (AFUE or HSPF) Distribution Type and Location Duct or Piping Insulation R -Value° Thermostat Type Configuration (Split or Package) I. Indicate Heating Type (Central Furnace. {Nall Furnace, Heat pump. Boiler, Electric Resistance. etc.) 2. New heating equipment shall be limited to natural gas, liquefied perroleum gas. or the existing fuel type. Electric resistance heating is allowed as supplemental heating if the total capacity:S 1 KW and electric heating is controlled by a rime -limiting device not exceeding 60 minutes 3. Refer to the HERS Verification section on Page 4 of the CF -IR -ALT Form for additional requirements and check applicable boxes. 4. Indicate 'Type or Location (Ducts. Ilvdronic in Floor, Radiators, etc.) HVAC SYSTEMS - COOLING Cooling Equipment Type and Ca aci t' Minimum Efficiency (SEER/EER or COP) Distribution Type and Location Duct or Piping Insulation R -Value Thermostat Tye Configuration (Split or package) -l. Indicate Cooling Tvpe (A/C, Heat pump. Evap. Cooling, etc) Refer to the HERS Verification section on Page 4 of the CF -I R -ALT Form for additional requirements andcheck applicable boxes. . J. Indicate Type ar' Location (Ducts, Hvdronic in Floor, Radiators, etc.) WATER HEATING List water heaters and boilers for both domestic hot water (DHIV) heaters and hydronic space heating. Individual dwelling DHW heaters must be gas or propane fired, and nay not exceed 50 gallons. Hot water pipe insulation from the DHW heater to the kitchen(s) and on all underground hot water pipes is required it all component packages in all clinmte zones. Water Heater Type/Fuel Type''- Distribution Type (Standard. Recirculation)' Number In System Tank Capacity (gal) Energy Factor or ' Thermal Efficiency Tank Insulation R -Value' t 1. Indicate Type (Storage Gas. Heat Pump, Instantaneous, etc.) 1. The new water heater type shall be limited to natural gas, liquefied petroleum gas. or the existing fuel type. 3. Recirculating systems -serving multiple dwelling units shall meet the recirculation requirements of§150(n). The Prescriptive requirements do not allow the installation of a recirculating water heating srstenn for single dwelling units. 4. The external water heating tank and pipes shall be insulated to rneet the requirements oI5150(%). SPECIAL FEATURES The enforcement agency should pav special attention to the Special Features specified in this checklist below. These items may require written justification and documentation and special verification. .NEW ROOF ASSEMBLY -Radiant Barrier ❑ YES ❑ NO Yes: In C1Zs 2, 4, and 8-15, replacing the entire roofassembly requires the installation of a radiant barrier to meet §151(f)2. Slab Edge (Perimeter) Insulation ❑ YES ❑ NO YES: In Climate Zone 16 in Component Packages D, R-7 insulation is required. Heated Slab Insulation 13 YES ❑ NO YES: Slab edge insulation re aired for all heated slabs in all Climate Zones. See details in Table 118-A of the standards. Raised Slab Insulation ❑ YES ❑ NO VES: In Climate Zones 1, 2, 11, 13. 14 & 16, R-8 insulation is required; in Climate Zones 12 & 15, R-4 is're uired under coat onent Package D. hermal Mass Co obtain Compliance Credit for the installation of thermal mass, use the Performance .Approach. Registration Number: 2008 Residential Compliance Forms Registration Date/Time: HERS Provider: December 2008 3 ITEMS OF 3 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 32641001.00 DATE ISSUED.......: 03/22/2012 RECEIPT #.........: BS000016335 REFERENCE ID # ...: 12030118 SITE ADDRESS .....: 10417 ANSON AVE SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OPERATOR: patg COPY # : 1 OWNER ............: ANUPAN & CHANCHAL SAHAI ADDRESS ..........: 10417 ANSON AVE CITY/STATE/ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM ....: SOLARCITY CORPORATI CONTRACTOR .......: LYNDON RIVE LIC # 28844 COMPANY ..........: SOLARCITY ADDRESS ..........: 3055 CLEARVIEW WAY CITY/STATE/ZIP ...: SAN MATEO, CA 94402 TELEPHONE ........: (650) 638-1028 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ---------- 1BCBSC ------------- ---------- VALUATION 3,100.00 ---------- ---------- ---------- 1.00 0.00 1.00 ---------- 0.00 1BSEISMICR VALUATION 3,100.00 0.50 0.00 0.50 0.00 1STINSP UNITS 2.00 260.00 0.00 260.00 0.00 TOTAL PERMIT ---------- ---------- ---------- 261.50 0.00 261.50 ---------- 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- CHECK --------------- 261.50 --- #12048 TOTAL RECEIPT --------------- 261.50 3 ITEMS OF 3 CITY bF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 32641001.00 DATE ISSUED.......: 03/22/2012 RECEIPT #.........: BS000016335 REFERENCE ID # ...: 12030118 SITE ADDRESS .....: 10417 ANSON AVE SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OPERATOR: patg COPY # : 1 OWNER ............: ANUPAN & CHANCHAL SAHAI ADDRESS ..........: 10417 ANSON AVE CITY/STATE/ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM ....: SOLARCITY CORPORATI ' CONTRACTOR .......: LYNDON RIVE LIC # 28844 COMPANY ..........: SOLARCITY ADDRESS ..........: 3055 CLEARVIEW WAY CITY/STATE/ZIP ...: SAN MATEO, CA 94402 TELEPHONE ........: (650) 638-1028 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ---------- 1BCBSC ------- ---- --- — --- VALUATION 3,100.00 ---------- ---------- ---------- 1.00 0.00 1.00 ---------- 0.00 1BSEISMICR VALUATION 3,100.00 0.50 0.00 0.50 0.00 1STINSP UNITS 2.00 260.00 0.00 260.00 0.00 TOTAL PERMIT 261.50 0.00 261.50 ---------- 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- CHECK --------------- 261.50 -------- #12048 TOTAL RECEIPT --------------- 261.50 �� CITY OF CUPERTINO I►InwoI FEE ESTIMATOR- BUILDING DIVISION NOTE.: This eclinmle does not include feev due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees ore haved on the nrelininan' information available and are otdr all evrinuale. Contact the Dept for odt/n'l into. FEE ITEMS (Fee Resolution 11-053 EIT 7/1/11) ADDRESS: 10417 Anson Ave DATE.: 03/22/2012 REVIEWED BY: Sean Mech. Permit Peet APN: BP#: "VALUA'T'ION: $3,100 •PISRMITTYPE: Building Permit PLAN CIIECK'1'1'PE: Alteration / Repair PRIMARY USE: SFD or Duplex Fler. Inti. Fre: PENTAMATION PERMIT TYPE: WORK Remove and replace residential FAU ducting with R-8 insulation. SCOPE. 0.0 NOTE.: This eclinmle does not include feev due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees ore haved on the nrelininan' information available and are otdr all evrinuale. Contact the Dept for odt/n'l into. FEE ITEMS (Fee Resolution 11-053 EIT 7/1/11) Acerb, Plnu Check Phonh. Plan Check Elec. Plan C'hcck Mech. Permit Peet Plamh. Pcumia Gee: Flee. Permit Fee: Other dfech. hap. Other Phonh It p. Olhei Elec. Dnp.El dfech, Inq>. Pee: Plutrh. leap. Fee: Fler. Inti. Fre: NOTE.: This eclinmle does not include feev due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees ore haved on the nrelininan' information available and are otdr all evrinuale. Contact the Dept for odt/n'l into. FEE ITEMS (Fee Resolution 11-053 EIT 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building Supp!. PC Fee: Q Reg. 0 0'f 0.0 hrs $0.00 PML" Plan Check: $0.00 Permit Fee: IourIv Ooh'! Q Yes 0 No $0.00 Supp!. Insp. FeeQ Reg. 0 OT 0.0 hrs $0.00 PML' Unit Fee: $0.00 PME Permit Fee: $0.00 C; onstrueliun Tax: rlrlministrutlre Fee: 0 G Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: $0.00 0 hours Inspections 0 $260.00 FISTINSP Inspection, Hourly Trane/ Doc iallentation Fees: So one Motion Fee: IBSFISMICR $0.50 Select an Administrative Item Blde Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $260.00 TOTAL FEE: $261.50 Revised: 1/19/2012 2o3.DI1'R� GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 M' /� r. CUPERTINO �//� v\ ❑PLUMBING W mvl CAL ❑ELECTRICAL R CEIIANEOUS (408) 777-3228 •FAX (408) 777-3333 • building(�Jcuoertlno.o PROIER ADDRESS O i APN V OWNER NAME Avi u' A/wl Sq �� PHONE E -MAB. l I R S a c STREET ADDRESS /� I U / Wa� C q<LI y FAX CONTACT NAME PH NE - E -MAD. STREET ADDRESS .CTIY,STATE IIP FAX ❑ OWNER ❑ aw'-BUBDER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTORAGENT ❑ AROM= ❑ EJGLNEEt ❑ DEVELOPER ❑ TEUNr CONTRACTOR NAME 1JCENSENUM, EAr�/DL E U o ( BV S. LICA COMPANY NAME I r E-MAIL �(J - -l/ 1 LO�J STREET ADDRESS ��3 ti 1 V r (� CITY, STA ZIP ,Q 7�f��y ARCWTECTANGINEER NAME LICENSE NUMBER BITS. UC p COMPANY NAME ' E-MAIL FAX STREET ADDRV q CRY, STATE, IIP PHONE USE OF SFD m DUPLIX BUILDING: ❑ CO6CMERCLV. ❑ MULTI -FAMILY I PROTECT IN WI DIA.NO ❑ YFS PROTECT IN ❑YES URBAN O+tERFACE AAE1 ❑ NO FLOOD LANE ❑ NO IS THE BLOC AN ❑YES IICHLER HO.NET Cl NO DESCRUMON OF WORK 1 I TOTAL VALUATION: 7 �� RECEIVED BY: Cd� By my signature below, I certify m each of the following: I am the pro CITY owner or authorized agent to act on the property oowoa's behalf I have read this application and the information I have pro ' ed is cored, avc read a Description a- Work and VM'fy it is accu . I agree w cortatly wit all applicable local ordinances and state laws reladag m it ' constrn IZ I udroriz repro 1111ives Cuneremo,to =w the above-idendfied property fm inspccdou pulp oses. Signature of ApplicantlAgenc 1 - Daze: J `Z 2 -z�� ' S PLE1vfENTAL ORI�fATION REQUIRED oFPtcE useorvir y 0 OVER-THE-COUNTER Y ❑ EXPRESS u " u ❑ sI'A.NDARD 3 ❑ uRCE ❑ M OR MEPMacApp_2011.doc revised 06121/11