13110088CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20041 NORTHWOOD DR
CONTRACTOR: AAA FURNACE &AIR
PERMIT NO: 13110088
CONDITIONING
OWNER'S NAME: LEE JAMES B ET AL
1712 STONE AVE
DATE ISSUED: 11/13/2013
OWNER'S PHONE: 4082556806
SAN JOSE, CA 95125
PHONE NO: (408)293 -4717
13 LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
1180D�
ZZ — # ` - _;
REMOVE AND REPLACE 40 GAL WATER HEATER
License Class Lic.
� rN
Contractor CA Date
I hereby affirm that I am licensed under the provisions o 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
erformance of the work for which this permit issued.
Sq. Ft Floor Area:
Valuation: $1250
have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 31637059.00
Occupancy Type:
Section 3700 of the Labor Code, for the performance of the work for which this
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
180 DA ROM LAST CALLED 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 the
Date: l/, 4 �7 �?
granting of this permit. Additionally, the applicantim lerstands and will comply
Issued by
with all non -point source regulations per the Cupertino Municipal Code, Section
/ _ _
Siai►ahtri t/ " `� Date: �6
RE- ROOFS:
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(x) 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 he Bay Area Air Quality Management District I
Municipal Code, Chapter 9.12 and
performance of the work for which this permit is issued.
will maintain compl' a with the ertino
the Health Code, Sections 2 05 2 , and 25534.
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
Owner or d agen t Date: «
ruthorize
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
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
CUPERTINO
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 misc
(408) 777 -3228 • FAX (408) 777 -3333 • building cDcupertino.org i
MEPMiscApp_2011.doc revised 06121111
j CITY OF CUPERTINO
I i "-N7 FF.F. F.CTiM A TnR — RI III ,I)ING DIVISION
kfech. Plan ('Beck
L1ech. Permit .Fee:
Other ttlech. Insp.
Allech, Insp. Fee:
Plumb. Plan Check 10.0 1 hrs $0.00 Elec:..Plan Check
Plumb. Permit Fee: IPPERMIT Elec. Permit Fee:
Other Plumb Insp. 10.0 1 hrs 1 $47.001 Other Elec. Insp.
Plurtth. htsp. Fue:
Elea, Inrp, Fee:
NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public worlrs, rlre, aanlrary Sewer vlsrrlct, acnuut
mL.. r _ L --- 4 ♦L., .,1:.« s. fn nfinn nvnilnhlo and aro nnly not vctimaty_ Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11 -053 E . 711/13}
ADDRESS: 20041 Northwood dr
DATE: 11/13/2013
REVIEWED BY: Mendez
APN:
BP #:
*VALUATION: $1,250
*PERMIT TYPE: Building Permit.
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
p
0.0
PENTAMATION PRWHEATR
USE:
PME Plan Check:
PERMIT TYPE:
WORK
remove and replace 40 gallon water heater
Permit Fee:
SCOPE
Suppl. Insp. Fee1q Reg. ® OT
kfech. Plan ('Beck
L1ech. Permit .Fee:
Other ttlech. Insp.
Allech, Insp. Fee:
Plumb. Plan Check 10.0 1 hrs $0.00 Elec:..Plan Check
Plumb. Permit Fee: IPPERMIT Elec. Permit Fee:
Other Plumb Insp. 10.0 1 hrs 1 $47.001 Other Elec. Insp.
Plurtth. htsp. Fue:
Elea, Inrp, Fee:
NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public worlrs, rlre, aanlrary Sewer vlsrrlct, acnuut
mL.. r _ L --- 4 ♦L., .,1:.« s. fn nfinn nvnilnhlo and aro nnly not vctimaty_ Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11 -053 E . 711/13}
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
F 71 # Plumbing
$28.00 1PRwHEATR Water Heater
Suppl. PC Fee: (E) Reg. ® OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee1q Reg. ® OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$47.00
('Onso- tictlon Tax:
wd
$44.00
f NuM
kfech. Plan ('Beck
L1ech. Permit .Fee:
Other ttlech. Insp.
Allech, Insp. Fee:
Plumb. Plan Check 10.0 1 hrs $0.00 Elec:..Plan Check
Plumb. Permit Fee: IPPERMIT Elec. Permit Fee:
Other Plumb Insp. 10.0 1 hrs 1 $47.001 Other Elec. Insp.
Plurtth. htsp. Fue:
Elea, Inrp, Fee:
NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public worlrs, rlre, aanlrary Sewer vlsrrlct, acnuut
mL.. r _ L --- 4 ♦L., .,1:.« s. fn nfinn nvnilnhlo and aro nnly not vctimaty_ Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11 -053 E . 711/13}
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
F 71 # Plumbing
$28.00 1PRwHEATR Water Heater
Suppl. PC Fee: (E) Reg. ® OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee1q Reg. ® OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$47.00
('Onso- tictlon Tax:
Administrative Fee: IADMIN
$44.00
G
Work Without Permit? ® Yes (E) No
$0.00
Advanced Planning Fee.
$0.00
Select a Non - Residential
Building or Structure
Travel Documentation Fee: 1TRAVDOC
$47.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
$139.50
NO_M
$28.00 �G4�a�'OALE z
$167.50
Revised: 10/01/2013
Smrpiified Prescriptive Certificate of Compliane'e:1008 Residenad i�VACAlierations CF -IR- ALT -FfVAC
Cli irate Zones I and 3 - 7
Address
Enforcaxertt �tgettcy:
Dafe< 'e+ it+it:
n+n
Conditioned
Duct insulation
EqlfivrocntTypel
.1'✓3St�'�k�enr
l•1oC17111L8
• T�.�rIDO >la� � ., .
Packaged Uttrt
Funace
G� Af,TJE
COP IS
s } ri'
eaved- by'system
Over 40 8 4f dads
,added ai reglaad in +
Setback
readypreserrt be.
Indoor Cosh
O Itesist�a
unconditioned or ,
{jfnoto B..'. uri
Condensing Unit.
® EER
� SR6 (CZ 1"
�
06a
1. Equipmeat Type: Choose the equipment being installed, ifmote than one system, use another CF- IR-ALT- HVAC.for eacb system.
2. Afmimum Equipment E#Scienciev 13 SEER, 78 % AFUE, 7.7HSPF for typical residential:systsms.
Contractor (Documentation Aathar's /Responsible Designer's Declaration Statement)
• I certify that this Certificate of Compliance documentation is accurate. and'cOinplete
• I am eligible under Division 3 ofthe California Business and Professions Code to acce=pt responsibility for the design identified on this
Certificate of Compliance.
• I cm y that the energy features and performance•specificadons for the design identified on this Certificate of Compliance conform to the
requirements of Tins 24, Parts I and 6 of the California Code of Regulations.
• The desigi.feau res identified on this Certificate of Compliance are consistent with the info n documented on other applicable
compliance forms, worksheets, calculations, plans and specifications submitted to en cut agency for approval .with the. .permit .
lication. _:
Name:
Signattue:
I�'�.�I� Ili1V/K..
Company - C
D
Address: f"i (2 • Ste: &'( +
1
City /Stateizip: w -(Vt3V
Phone • .: l
"' ` 2008 Residential Compliance Forms.doc revised 04110112
Patricia Garcia
From:
Joan Lee Utlpix6 @yahoo.com]
Sent:
Friday, May 09, 2014 2:41 PM
To:
Patricia Garcia
Cc:
jt1pix6 _yahoo.corn
Subject:
Building Permit Expiration Notice (Request extension)
Hello Patricia,
RE:
Site Address: 20041 Northwood Drive, Cupertino, 95014 Building Permit Application #:
13110088 Expiration Date: 5/12/2014 (Permit for Water Heater Replacement)
We received your letter regarding our Building Permit Application Expiration. Would it be
possible to get a brief extension regarding the building permit we have for installing a new
water heater in our garage? The work has been completed by a professional water heating
service company, but we have been traveling quite a bit this past quarter which has prevented
us from scheduling an inspection. In fact, I will be out of town again next week (5/12 -
5/16).
We do not need a full 180 day extension - rather 30 -40 days. This should give us time to call
and schedule an inspection (given the availability of the inspectors).
Could you please let us know if this is possible, and what our next steps should be prior to
the current application's expiration.
Regards,
loan Tice Lee and James B. Lee
20041 Northwood Drive
Cupertino, Ca 95014
Application # 13110088
1