14080248 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11525 SUNSET SPRING CT CONTRACTOR:ALL VALLEY PLUMBING PERMIT NO: 14080248
OWNER'S NAME: HO YU-LAM AND YEN-PING L 3345 SELDON CT STE B DATE ISSUED:08/26/2014
OWNER'S PHONE: 4082539433 FREMONT,CA 94539 PHONE NO:(510)376-4816
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL E]
I REMOVE AND REPLACE WATER HEATER LIKE FOR
License Class /9 Lic.# �Z`T �SLIKE
Contractor 4u o a nv� Date ag 1 2co N 1-t
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:$750
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:36652020.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT ttZES t ORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WIT�IIN 1 0 DAYS OF P RMIT 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 DAYS OM LAST CALLED INSPE TIO .
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. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source re ulations per the Cupertino Municipal Code,Section
9 18.
RE-ROOFS:
Signature Date ) 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
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
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)
1,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' and 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
GENL`RAL PERMIT APPLICATION
MEP
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 O�
CUPERTINO (408)777-3228 FAX(408)777-3333•buildingc@cupertino.org f� MISC
LUMBINQ Ej MECHANICAL RELECTRICAL MISCELLANEOUS
PROJECT ADDRESS 5 APN# coo.
a
,
OWNERNAME HONE E-MAIL( UV
STREETx`525 CITY, STATE,ZIP �d� L FAX
CONTACT NAME PHONE E-MAILT
STREET ADDRESS - CITY,STATE,ZIP FAX
❑OWNER ❑.-OWNER-BUILDER ❑ OWNER AGENT 12 CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT. ❑ENGINEER ❑ DEVELOPER ❑.TENANT
CONTRACTOR NAME LICENSE'NUMBER LICENSE TYPE BUS.LIC#
COMPANY NAME E-MAIL FAX
ALL c t -409 y
STREET ADDRESS CITY,STATE,ZIP - - PHONE
- ,r 6 r (20k s3 s�o-lolel-�o
ARCHITECT/ENGINEERNAME LICENSE NUMBER - BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF -WFD or DUPLEX ❑.MULTI-FAM]LY PROJECT IN WILDLAND .❑ YES PROJECT IN ❑YES - IS THE BLDG AN YES
BUILDING: ❑COMMERCIAL _ - - URBAN INTERFACE AREA ❑ NO- FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTIONOF-WORK
c a-
TOTAL VALUATION: jam. CEIYEDEY By my signature below,I certify to each 6f.-the following; I am the prop' owner or authorized agent to act on the prop owner's behalf. I hav d this
application and the information I have provided is correct.'I have read the Description of Work and verify it is accurate. Lagree le local
ordinances and state laws relating to building, Icti:o I authon� fresentatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION"REQUIRED
s
._. ,o►w,
MEPMiSCAPP_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 11252 sunset spring ct DATE: 08/26/2014 REVIEWED BY: Mendez
APN: BP#: *VALUATION: $750
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION PRWHEAT
USE: PERMIT TYPE:
WORK remove and replace water heater like for like
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Water Heater 1 PRWHEATR 1 # $29
TOTALS: $29.00
� Olt
Plumb.Plan Check 0.0 hrs $0.00 Nal c l� cis
L eci�. t'erw;l Fee: Plumb.Permit Fee: IPPERMIT
[J-; ticch, hi,vr Other Plumb Insp. 0.0 hrs
Ll.ir�_ <;>(z' {'Iasrrtt.�. Irrr��. (cre- 1-,�<:'e. .,.�ta, f'°1>
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 prefinddna information available and are only an estimate. Contact the De t or addn'l info,
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Che(.-4- /,e!P:
PME Plan Check: $0.00
'et'�ttit I'esu'
Siq,fel, losp Fe
PME Unit Fee: $29.00
PME Permit Fee: $48.00
,(J 2517`LE `Ztflf7 T 7.
Administrative Fee: ]ADMIN $45.00
Work Without Permit? 0 Yes 0 No $0.00
Phrri"Zing, Pees:
Travel Documentation Fee: 1TRAVDOC $48.00
Strom;Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg;Stds Commission Fee: 1BCBSC $1.00
4212
#1` . , $171.50 $0.00 TOTAL FEE,• $171.50
Revised: 07/10/2014
Prescriptive Certificate of Com lianee: Residential Water Heating CF-IR-ALT-WH
General Information
Site Address: 2 Climate Zone: Date:
NOTE.Thisorm is only used for alteration or advition of water heating systems.
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 water pipes is required in all component packages in all climate zones.
Energy Factor or
Water Heater Type/ Distribution Type Number of Tank Capacity Thermal External Tank
Fuel Type' (Standard)2 System al Efficiency Insulation R-Value3
aA 457-1L>
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 water heating tank and pipes shall be insulated to meet the requirements of 1506).
Contractor(Documentation Author's/Responsible Designer's Declaration Statement)
• I certify that this Certificate of Compliance documentation is accurate and complete.
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design identified on
this Certificate of Compliance.
• . I certify that the energy features and performance specifications for the building design identified on this Certificate of Compliance conform
to the requirements of Title 24,Parts 1 and 6 of the California Code of Regulations.
• The building design features identified on this Certificate of Compliance are consistent with the information provided to document this
building design on the other applicable compliance forms,worksheets,calculations,plans and specifications submitted to the enforcement
agency for approval with this building permit application.
Name: Signature:
Company: Date:
Address: Licens�,�
k17'
City/ to/Zip: Phone:
2008 Residential Compliance Forms
March 2010
INSTALLATION CERTIFICATE CF-6R-MECH-01
Domestic Hot Water-C (Page 1 of 2
Site Address: Enforcement Agency: Permit Number:
t 5Z � �
1. WATER HEATING SYSTEMS:
Distribution Rated
CEC Type If #of Input(kW Tank Standby
Heater Certified Mfr Name&Model (Std;Point-of- Recirculation, Identical or Volume Efficiency Loss
Type Number Use,etc) Control Type Systems Btu/hr)] (gallons) (EF,RE)'
Note 1:For small gas storage(rated input less than or equal to 75,000 Btu/hr), electric resistance and heat pump water heaters, list
Energy Factor(EF),For large gas storage water heaters(rated.input of greater than 75,000 Btu/hr), list Recovery Efficiency(RE),
Thermal Efficiency,Standby Loss and Rated Input. For instantaneous gas water heaters, list the Thermal Efficiency and Rated Input.
2. Mandatory Measures
TO COMPLY-ALL BOXES MUST BE CHECKED
`§110-§113:Water heaters,showerhead and faucets are certified by the California Energy Commission.
1500):Water System Pipe and Tank Insulation.And Cooling Line Insulation
1. Storage tank insulation
A.Storage gas water heaters rated with an Energy Factor no greater than the federal minimal standard are
externally wrapped with.insulation having an installed thermal resistance of R-12 or greater;and
B.Unfired storage tanks or other indirect hot water tanks have R-12 external insulation or R-16 internal
insulation where the internal insulation R-value is indicated on the exterior of the tank.
2. Water piping and cooling system line insulation thickness and conductivity
First 5 feet of hot and cold water pipes closest to water heater tank,non-recirculating systems,and entire
length of recirculating sections of hot water pipes are insulated per Standards Table 150-13;and
Pipe insulation for steam hydropic heating systems or hot water systems>15 psi,meets the requirements of
Standards Table 123-A.
Insulation is protected from damage,including that due to sunlight,moisture,equipment maintenance,and
wind.
un 151(f)8D:If indicated on the CF-1R,all hot water piping that runs from the hot water source to the kitchen fixtures is
insulated per Standards Table 150-13.
2008 Residential Compliance Forms
August 2009
INSTALLATION CERTIFICATE CF-6R-MECH-01
Domestic Hot Water. , (Page 2 of 2
Site Address: Enforcement Agency: Permit Number:
3. Central Water Heating in Buildings with Multiple Dwelling Units(required for prescriptive)
TO COMPLY-ALL BOXES MUST BE CfECKED
All hot water piping in main circulating loop is insulated to requirements of§1500)
Central hot water systems serving six or fewer dwelling units which have(1)less than 25'of distribution piping
outdoors;(2)zero.distribution piping underground;(3)no recirculation pump;and(4)insulation on distribution
piping that meetsthe.requirements of Section 1500)
Central hot water systems serving more than 6 dwelling units-presence of either a time control or a
time/temperature control
DECLARATION STATEMENT
• Lcertify under penalty of perjury,under the laws of the State of California,the information provided on this form is true and correct.
• I am eligible under Division 3 ofthe Business and Professions Code to accept responsibility for construction,or an authorized
representative of the person responsible for construction(responsible person).
• I certify that the installed features,materials,components;or manufactured devices identified on this certificate(the installation)
conforms to all applicable codes and regulations;and the installation is consistent with the plans and specifications approved by the
enforcement agency.
• I reviewed a copy of the.Certificate of Compliance(CF-1R)form approved by the enforcement agency that identifies the specific
requirements for the installation. I certify thatthe requirements detailed on the CF-1R that apply to the installation have been meta
• I will ensure that acompleted,signed copy of-this Installation Certificate shall be posted,or made available with the building
permit(s)issued for the building,and made mailable to the enforcement agency for all applicable inspections. I understand
that a signed copy.of this Installation Certificate is required to be included with the documentation the builder provides to
the building owner at occupancy.
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
A L L A l € rL
Responsible Person's Name: Responsible P on's Signature:
CSLB License: Date Signed: Position With Company(Title):
2008.Residential Compliance Forms
August 2099