13070077CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10596 LONNA LN
CONTRACTOR: PAYLESS WATER
PERMIT NO: 13070077
HEATERS
OWNER'S NAME: VARADACHEVI RENGARAJAN
24895 AVENUE ROCKEFELLER
DATE ISSUED: 07/11/2013
OWNER'S PHONE: 6104705678
VALENCIA, CA 91355 PHONE NO: (661) 775-2944
JOB DESCRIPTION: RESIDENTIAL LJ COMMERCIALS
9 LICENSED CONTRACTOR'S DECLARATION
t- NP # 3'b (0
REPLACE (E) WATER HEATER, SAME LOCATION
License Class Laic. _
Contracto,TgN 6e&5 VviTIX.I ��ate✓ �� ✓/�
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 of consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
Valuation: $2900
performance of the work for which this permit is issued.
Sq. Ft Floor Area:
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: 35919014.00 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
WITIIIN 180 DAYS T ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
180 DAYS LAS LLED INSPECTION.
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 theIs
y Date:
granting of this permit. Additionally, the applicant understands and will comply
with all non-poin source regulati s per the Cupertino Municipal Code, Section
9.18.
�( f`3
Date l
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
Signature
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
❑ OWNER -BUILDER DECLARATION
Date:
Signature of Applicant: .
I hereby affirm that I am exempt from the Contractor's License Law for one of
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
the following two reasons:
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)
HAZARDOUS MATERIALS DISCLOSURE
1, as owner of the property, am exclusively contracting with licensed contractors to
the (Sec.7044, Business &Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
construct project
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
Code, Section 25532(a) should I store or handle hazardous
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
Health & Safety
material. Additionally, should I use equipment or devices which emit hazardous
defined by the Bay Area Air Quality Management District I
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sect' n 255 , 25533 nd 2 534.
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 so as to become subject to the Worker's
CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
I
I hereby affirm that there is a construction lending agency for the performance of
become subject to the Worker's Compensation provisions of the Labor Code, must
work's for which this permit is issued (Sec. 3097, Civ C.)
forthwith comply with such provisions or this permit shall be deemed revoked.
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
GENERAL PERMIT APPLICATION ION p'\ MEP
cowm-wf f `! D 1�3 +Hy i I DEAR hl 9501,4-32—= ffr - BuMNG DIMON
jI� �� AVENUE LKi TSL {'f '�_ MO misc
) 777-3333 - bu&tm0m-merww-wa
cupemnNo
V
PI.U3S3iNCs AMCAL ri Fr -s aTrnr naa t nMOUS .
tosgcp Longo- Ln 57?-- 19 -ol Lf
- Kai 6:yx -� J q �o- �7g
mis ErAmREm j D S'clb wY101 Ut ` �-�' �I SalI FAX
CONrACr ru+M--- S-WAM
a oars D awmLZmL m II fl Azcw= ❑ a+ iI II r�u�er
CMeAPF7CMW. E bi��i"s FAX
WHO -
K s .. a•.
zartwv.i uAxxm A00,00
R7tnxY bdaw, I=zd& ft==h aE!&=S%wim—F E�tim�gatYaaasds m tat�C bCbaiF Zhave
i�aa�aa�ca�vemo��is�xt��es�rheac-,�o�tc��w�r�is� ��T���'�ca�2eto�
t-
axsas�tt'sfTf'h7 ii►iF[l$�i46A5TDNQL1TRFii CFFKX1SEORi.Y
if a 71-:7
V
0 mmom
�i
6 0 TAR=
CITY OF CUPERTINO
-VU1V Ti QTTM A TnR _ R1T11.i11N(i' DIV1910N
APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES
Water Heater 1PRWHEATR 1 # $28
TOTALS: m
$28.00 ,
Ntech. Plan Check Plumb. Plan Check 10.0 1 hrs $0.00 Elec:..Plan Check
;ilech. Perna it Fee: Plumb. Permit Fee: 1PPERMIT Elec. Permit tee:
Other Aleck. InspLi Other Plumb Insp. 0.0 hrs $47.00 Ocher Elec. Insp. Li
.Alech. Insp. Fee: Plurnh. Insp. Fee: Elec. Insp. Fee:
NOTE: This estimate does not tnctuae fees aue to orner ueparrmenrs ttiw «u -mg, u—IL .r "'no, •�, ��••••�•y ��••� - -�• -�-�- -
District, etG . These fees. are based on the prelhWdna information available and are only an estimate. Contact the Dept -for addn'1 info.
ADDRESS: 10596 LONNA LN
DATE: 07/11/2013
REVIEWED BY: MELISSA
QTY/FEE
APN: 359 19 014
BP#:
`'VALUATION:
1$2,900
%PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Du lex
p
PENTAMATION PRWHEATR
PERMIT TYPE:
USE:
PME Plan Check:
$0.00
Permit Fee:
WORK
REPLACE E WATER HEATER SAME LOCATION
Suppl, Insr) Fee
SCOPE
APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES
Water Heater 1PRWHEATR 1 # $28
TOTALS: m
$28.00 ,
Ntech. Plan Check Plumb. Plan Check 10.0 1 hrs $0.00 Elec:..Plan Check
;ilech. Perna it Fee: Plumb. Permit Fee: 1PPERMIT Elec. Permit tee:
Other Aleck. InspLi Other Plumb Insp. 0.0 hrs $47.00 Ocher Elec. Insp. Li
.Alech. Insp. Fee: Plurnh. Insp. Fee: Elec. Insp. Fee:
NOTE: This estimate does not tnctuae fees aue to orner ueparrmenrs ttiw «u -mg, u—IL .r "'no, •�, ��••••�•y ��••� - -�• -�-�- -
District, etG . These fees. are based on the prelhWdna information available and are only an estimate. Contact the Dept -for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 7/11121
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
Suppl. PC.Fc>e
PME Plan Check:
$0.00
Permit Fee:
Suppl, Insr) Fee
PME Unit Fee:
$28.00
PME Permit Fee:
$47.00
Construction Tax:
FT
Administrative Fee: IADMIN
$44.00
Work Without Permit? ® Yes (E) No
$0.00
A(Ivaneed Planning Fees:
Travel Documentation Fee: ITRAVDOC
$47.00
Strong, Motion Fee: 1BSEISMICR
$0.50
Select an Administrative Item
Bldjz Stds Commission Fee: IBCBSC
$1.00
$167.50
$0.00 - _ $167.50
`� Revised: 07/U1/2013
Prescriptive Certificate of Compliance: Residential WATER HEATER CF -IR -ALT- Water Heater
Date: Enforcement Agency: Climate Zone # # of Stories Permit #
12
Site Address:
Building Type W Single Family o Multi Family
NOTE: Thisform is not to be used or Newly -Constructed Buildings or Additions
WATER HEATING
List water heaters and boilers for both domestic hot water (DHW) heaters and hydropic space heating.
Individual dwelling DHW heaters must be gas or propane fired, and may not exceed 50 gallons. Hot water pipe
insulation from the DHW heater to the kitchen(s) and on all underground hot waterpipes is required in all
component packages in all climate zones.
Water Heater Type/ Distribution Type Number Tank Energy Factor External
Fuel Type` (Standard, in System Capacity or Tank
Recireulating)2 (gal) Thermal Insulation
Efficiency R-Value3
1. Indicate type (Storage Gas, Heat Pump, Instantaneous, etc.)
2_ Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of
§150(n)_ The Prescriptive requirements do not allow installation of a recirculating water heating system
for single dwelling units.
3. The external water heating tanks and pipes shall be insulated to meet the requirements o 150
Declaration Statement
• I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is accurate
and complete_
• I certify that the energy features and performance specifications identified on this Certificate of Compliance conform to the
requirements of Title 24, Parts I and 6 of the California Code of Re lations_
Name:
��.,1:a"Llyt-� �'k s
Signature:
���
� f���,.1/
Company:
Lc},ss U)O�Lr
Date:
Address:
License:
pu�g zs
y/Stateip:Cit
� �cal
Phone:Oie:
l 7-7
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at 1-800-772-3300.
CF-IR-ALT;5/17/10 Page 1 of I