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14060155 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7719 CARRIAGE CIR CONTRACTOR:PAYLESS WATER PERMIT NO: 14060155 HEATERS OWNER'S NAME: RAVI ALLADI 27919 SMYTH DR DATE ISSUED:06/25/2014 OWNER'S PHONE: 4086435851 VALENCIA,CA 91355 PHONE NO:(661)775-2944 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL F] License Class�I1l � REPLACE(E)40 GAL WATER HEATER,SAME LOCATION " L,ijc�(,# g3�ocr^� Contractor l i G✓S WW[ Date L;_ 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 erformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$1000 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:35906048.00 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 upon the above mentioned property for inspection purposes. (We)agree to save 1 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 Z S granting of this permit. Additionally,the applicant understands and will comply Is te: with all non-point source regulations per the Cupertino Municipal Code,Section 9 18. RE- ROOFS: Signatur Date 6 [ 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,Sect' ns 505, 53 d 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 so as to become subject to the Worker's Compensation laws of California. If,after making 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 �� o MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•building[a� CUPERTINO cupertino.org , M 'S C PLUMBING MECHANICAL DELECTRICAL MISCELLANEOUS PROJECT ADDRESS {� Carr'O � /� i. AFN# �L s q 0 G O OWNERNAME I()� '/r (/ PHONE j /fl�S J E-MAIL qN STREETADDRESS ( V�I`}S„��l,el�L(/� 42 1(��• � � lJ-6), FAX 1 cwt tJy n E-MAILCONTACT NAMEeol �'(S- 5 STREET ADDRESS CITY,,STATE,ZIP FAX 14 OWNER ❑ OWNER BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAMELICENSE NUMBER 2�_^ f/ LICENSE TYPE -7 BUS.LIC# COMP7YNAM 06 E-MAIL �((Jp FAX ST `C4D rS CITY,STATE,ZIP ARCHITECT/ENGINEER NAME LICENSE NUMBER (J� BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF MSFD.,DUPLEX ❑ MULTI-FAMILY PROJECT INWILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK Ito qoJ UlLtgr AeOaj�� TOTAL VALUATION: 1 000 r OV By my signature below,I certify to each of the following: I am the property owner ora razed agent to act on perty own ' behalf. 1>6e read this application and the infonnation I have provided is correct. I have read the Description of Work and verify it is Mxurate. I agr complx.W6 all applicable local ordinances and state laws relating tgJbuilding co tru 'on. se tho' reprentatives of Cupertino to enter the above iden' ed for inspection purposes. Signature of Applicant/Agent: `I/I�� Date. �SJr SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY Y GVE'R-TK"OUNTER ❑ EXPRESS STANDARD aLARGE a_ MAJOR MEPMiscApp 2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION W�IPERMIT DDRESS: 7719 CARRIAGE CIR DATE: 06/25/2014 REVIEWED BY: MELISSA PN: 359 06 048 BP#: *VALUATION: $1,000 PE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition / Repair PRIMARY SFD or Duplex PENTAMATION PRWHEATR USE: p PERMIT TYPE: A WORK REPLACE E 40 GAL WATER HEATER SAME LOCATION SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Water Heater 1PRWHEATR 1 # $28 TOTALS: $28.00 Y aNMI,, ., rcc„ F`Icrrr t'rr-c,2 Plumb.Plan Check 0.0 hrs $0.00 1/ t�Er3�t';`ix>cfc Fee. Plumb.Permit Fee: IPPERMIT t!"Y 1 sr_ Other Plumb Insp. 0.0 hrs $47.00 Clrl,wi-!'zcc-Irs)?. els°r.h C,lvI ec. Phinih. hi"q). Fee 1:1Cc. Pce: 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 prelimina information available and are only an estimate. Contact the Dept-for addn I info. FEE ITEMS (Fee Resolution 11-053 Eff.' 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check /°'(w: PME Plan Check: $0.00 Perinit 1,"I>: Supp/, Lusl 11e- PME Unit Fee: $28.00 PME Permit Fee: -F-F $47.00 k-oyr str r,rc ifw7 T av: Administrative Fee: IADMIN $44.00 Work Without Permit? 0 Yes E) No $0.00 ilarming 7 Travel Documentation Fee: ITRAVDOC $47.00 Strong;Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bld,, Stds Commission Fee: IBCBSC $1.00 ter �� $167.50 $0.00 TOTAL FEE, F$167.501 �. - ; Revised: 04101/2014 Prescriptive Certificate of Compliance:Residential WATER HEATER CF-IR ALT-Water Heater Date: Enforcement Agency: Climate Zone# #of Stories Permit# 'Zc-1� 1 1 12 Site Address: Building Type* Single Family a Multi Family NOTE: Thisform is not to be used or New -Constructed Buildings or Additions WATER HEATING List water heaters and boilers for both domestic hot water(DHW)heaters and hydronic 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 water pipes 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 Recirculating) (gal) Thermal Insulation Efficient R-Value3 aV 6 0,!5 �c�zdc� ---- toa 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 i es shall be insulated to meet the requirements o 1 SO .. 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. • 1 certify that the energy features and performance specifications identified on this Certificate of Compliance conform to the requirements of Title 24,Parts 1 and 6 of the California Code of Regulations- Name: Signature:.. Company- Date: PauCees cep geoleys Address: License: City/StateMp: - -_ Phone: tc, ql Ms's For assistance or questions regarding the Energy Standards,contact the Energy Hotline at 1-800-712-1300- CF-IR-ALT,5117/10 Page 1 of 1