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13070100 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21426 AMULET DR CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 13070100 CONDITIONING OWNER'S NAME: SUSAN S AND ROBERT E SLAVIK 1712 STONE AVE DATE ISSUED:07/16/2013 OWNER'S PHONE: 4087359720 SAN JOSE,CA 95125 PHONE NO:(408)293-4717 S JOB DESCRIPTION: RESIDENTIAL COMMERCIAL 13 LICENSED CONTRACTOR'S DECLARATION License Class(—`G G ic.# /0�9 7 ' REMOVE AND REPLACE 40 GALLON WATER HEATER IN ^'6`(3 Contractor Date SAME LOCATION 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$1325 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:32643015.00 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 coup ordinances and state laws relating gr p y ty county 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 DAY M 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 Issued by: Date: 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. /c �j RE-ROOFS: Signature Date �/O- 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 1,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. Iwill 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,Secti �;25505,2553 ,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: A Date: /�,—1,5 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 Compensation laws of California. If,aftermaking this certificate of exemption,I CONSTRUCTION LENDING AGENCY 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 GENERAL PERMIT APPLICATION - �(7 M COMMUNITY DEVELOPMENT DEPARTMENT--8'UILDING DIVISION Q' ;Is 10300 TORRE AVENUE -CUPERTINO; CA 95014-3255 (408)777-3228 • FAX(408)777-3333 •building( cupertino.ora /�� MISC CUPIA0 1J PLUMBING ❑NIECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS 242& foo M �` f A'N S OWNER NAME KzkA\/„r\ •��f� \/ V F � `. ^i E-MAIL J STREETADDRESS2' V \�, ^� �\/Il'��p 2-0 E-MAIL FAX CONTACT NAME \J(^ V PHONE E-MrUL STREET ADDRESS CITY,STATE, ZIP FAX 0 ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CDNTRAcToR ❑CONTRACroR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME +��.(� LI 1 UM7W 2D EUS.LIC 6 COWANYNAME ASA , v�l !,�(� E-MAIL FAX uf�J ' STREET ADDRESS '�1� S�o�, �1 �. Cil ��2� �•��i AJ COUTECTIENGINEER NAME LICENSE NUMBER BUS.LIC t COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ,,eSFD or Duplex ❑ Multi-Family PROJECT IN WiLDLAND PROJECT W STRUCTURE: ❑ CortlII mial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ No DESCRDMON OF wORx Ty kb) WAX h ftk TOTAL VALUATION: 95 i By my signature below,I certify to ch of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I av provid s correct. •I have read the Description of Work and verify it is accurate. I agree to comply with ell applicable local ordinances and state laws relatin to ilding traction. I authorize representatives of Cupertino to enter thea a-ide tified property for inspection purposes. Signature of Applicant/Agent: - Date: S PLEIv1ENTAL INFORMATION REQUIRED MEPALfucApp 1011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 21426 amulet dr DATE: 07/16/2013 REVIEWED BY: mendez APN: BP#: *VALUATION: 1$1,325 -1 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex PENTAMATION PRWHEATR USE: P PERMIT TYPE: WORK SCOPE APPLIANCE%EQUIP TYPE FEE ID QTY UNITS BP FEES Water Heater 1PRWHEATR 1 # $28 TOTALS: MIN l $28.00 z un " A,&ch.Plan Check Plumb.Plan Check 0.0 hrs $0.00 Elec..Plan Check Xfech. Permit Fee: Plumb.Permit Fee: IPPERMIT Elec. Permit Fee: Ocher Gtech.Insp. Other Plumb Insp. 0.0 hrs $47.00 Other Elec.Insp. F-1- .Lech.Insp. F'ee: Plumb. Insp.Fee: Elec.Insp.Fee: NOTE:This estimate does not include fees due to other Departments(i.c Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These fees are based on the prelfinina information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS(Fee Resolution 11-053 Eff 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl.PC Fee PME Plan Check: $0.00 f errnit.Fee: Suppl. Jnsp Fee PME Unit Fee: $28.00 PME Permit Fee: $47.00 Consiruction Tax: Administrative Fee: 1ADMIN $44.00 Work Without Permit? 0 Yes Q No $0.00 Advanced Planning Fees: Travel Documentation Feer 1TRAVDOC $47.00 Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Blda Stds Commission Fee: 1BCBSC $1.00 $167.501 $0.00 , � OTAL E $1:67.50 Revised: 07/01/2013 (:,LA ie—T)IQ LJ F-1R-ALT Prescriptive CertifC cate of Compliance- Residential F(page 4 of 'I Residential Alterations Climate Zone #of Stories # Project Name: HVAC SYSTEMS-HEATING Configuration Minimum Duct or Piping Heating Equipment Efficiency Distribution Insulation Thermostat e or H dronic) (Central,Split, Type and Capacity'-23 ( 1,FUE or HSPF) Type and Location' R-Value T e Space, Packa 1.indicate Heating Type(Cenral Furnace,.WalI Furnace. Heat parmp, Boiler. Electric Resistance, etc.) 2,Electric resistance heating is allowed only in Component Package C, or except where electric heating is supplemental(i.e., if total capacity ,• , < 2 KW or 7,000 Btu/hr electric heating is controlled by a rime-limiting device not exceeding 30 minutes). See§151(b)3 exception. 3.Refer to the HERS Verification section on Page 4 of the CF-1 R-,ILT Form Jor additional requirements and check applicable boxes. 4. Indicate Type or Location(Ducts. F(vdronic in Floor, Radiators, etc.) HVAC SYSTEMS-COOLING Minimum Configuration Efficiency Duct or Piping g Cooling Equipment (SEER/EER or Distribution Insulation Thermostat (Central,Split, T '-e and Ca aeit '' COP) Type e and Location' R-Value Type Space,Package or H dronic 1. Indicate Cooling Tvpe(A/C. Heat pump, Evap. Cooling, etc) 2. Refer to the HERS Verification section on Page 4 of the CF-lR,4LT Form Jor additional requirements and check applicable bo-res. 3. Indicate Type or Location (Ducts, H dronic in Floor, Radiators, etc.) WATER HEATING dropic space heating. Individual dwelling DHW heaters must b. List water heaters and boilers for both domestic hot water(DHW)heaters and hy 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 water pipes is required in all com onent packages in all climate zones. External Tank Number in Tank Energy Factor or Insulation Water Heater Type/Fuel Distribution Type Type (Standard, Recirculatin I S stem Capacity(gal) Thermal Efficiency R-Vafue3 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 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§1509). SPECIAL FEATURES The enforcement agencv should pav special attention to the Special Features specified in this checklist below. These items may require written justincation and documentation andspecial verification NEW ROOF ASSEMBLY-Radiant Barrier The radiant barrier requirement of; 151( 2 does not apply to roof alterations. Slab Edge(Perimeter)Insulation O YES 0 NO YES: in Climate Zone 16 in Component Packages D,R-7 insulation is required. Heated Slab Insulation CJ YES CI NO YES:Slab ed a insulation required for all heated.slabs in all Climate Zones. See details in Table 1 18-A of the standards. Raised Slab Insulation O YES O NO YES: In Climate Zones I,2, 11, 13, 14& 16,R-8 insulation is required; in Climate Zones 12& 15,R-4 is re uired:under comonent Pa ID Thermal Mass To obtain Compliance Credit for the installation of thermal mass,use the.Performance Approach. Registration Date/Time: HERS Provider: Registration Number' August 10 2008 Residential Compliance Forms