14080242I CITY OF CUPERTINO BUILDING PERMIT
1 BUILDING ADDRESS: 22386 RANCHO VENTURA ST I COANTRACTOR: PAYLESS WATER I PERMIT NO: 14080242
OWNER'S NAME: GUO YIHONG AND WANG HONGYI TRUSTEE 1 27919 SMYTH DR I DATE ISSUED: 08/25/2014
OWNER'S PHONE: 4089730633 VALENCIA, CA 91355 PHONE NO: (661) 775 -2944
10 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL E]
��**
APT B- REPLACE 40 GAL WATER HEATER
License Class C3(O Li,.. #��Sr3�P a < <o
Contracto,TCt(.t 18% �.�t'A�2( t �'�i s Date
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.
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
permit is issued.
APPLICANT CERTIFICATION
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
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
with all non -point source regulations per the Cupertino Municipal Code, Section
9 18.
Signature INS Date
❑ OWNER- BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
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)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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
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
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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
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
with all non -point source regulations per the Cupertino Municipal Code, Section
9 18.
Signature.
Date
Sq. Ft Floor Area: I Valuation: $1500
APN Number: 35703020 00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 18 ERMIT ISSUANCE OR
180 DAYS F OM LAST C LLED IN7,7,�_
Issued by: Date:
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.
Signature of Applicant: Date-
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, S�Z7:��7
Owner or authorized agent Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C )
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CUPERTINO
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION UAL
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 - 3228• FAX (408) 777 -3333 • buildingCaD-cupertino.org \�
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APN # 2 �% 1 OC)
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OWNER NAME �u� 4 a
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B-MAH,
STREET A Q ADDRESS (l 4 `� 9 l � W a Sf
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FA7C
CONTACT NAME
PHONE
E -MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OwNER ❑ OWNER - BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER 2� _ ^ I (
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LICENSE TJt F
BUS. I
COMPANY?f4W Le� Wa iJ��, S
E-MAIL
FAX
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ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF SFD.r DUPLEX ❑ MULTI -nmmy
BUILDING: ❑ COMMERCIAL
PROJECT IN WII.DLAND ❑ YES
URBAN INTERFACE AREA ❑ NO
PROLE' IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
Ql Wa n r/' 0-6EG'r
TOTAL VALUATION: 00 .
RECEIVED BY:
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property o half. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relatin to u>Y ' co on. I authorize representatives of Cupertino to enter the above- identified tp perty for inspection purposes.
Signature of Applicant(Agent: Date:
StMPLEMENTAL INFORMATION REQUIRED
oT ICE usE ONLY
per.
❑: OVER-THE-COUNTER
EXPRESS
STANDARD
LARGE
D'. MAJOR
MEPMiscApp_2011.doc revised 06121111
F,M--7 CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 22386 rancho ventura #b
FEE ID
DATE: 08/25/2014
REVIEWED BY: Mendez
APN:
BP #:
$0.00
*VALUATION: 1$1,500
*PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
#
$29
PENTAMATION PRWHEAT
PERMIT TYPE:
WORK
replace 40 qal water heater
lc is , fate, V,'e
SCOPE
IJec, Mst free:
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
$0.00
Water Heater
1PRWHEATR
Plumb. Permit Fee:
1
#
$29
Other Plumb Insp. 0.0 hrs
$48.00
�) ! ei. , ,�:c. his") ,
lc is , fate, V,'e
Plumb. hasp. Fees:
IJec, Mst free:
PME Unit Fee:
$29.00
PME Permit Fee:
$48.00
-T-1
Administrative Fee: 1ADMIN
$45.00
Work Without Permit? ® Yes 0 No
$0.00
TOTALS:
Travel Documentation Fee: ITRAVDOC
$29.00
Strong Motion Fee: 1BSEISMICR
5:
r
QTY/FEE
MISC ITEMS
,�A ;cbt, iPt�,Srr t= ":',<;rt-
Plumb. Plan Check 0.0 hrs
$0.00
SvTj)1, PC
F/111,17 Pes relit flee'
Plumb. Permit Fee:
IPPERMIT
/,'-c
Ch1rc � -Wcc /r. / �s;r�.
Other Plumb Insp. 0.0 hrs
$48.00
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lc is , fate, V,'e
Plumb. hasp. Fees:
IJec, Mst free:
NOTE: This estimate does not include fees due to other Departments ('tie. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the nreliminary information available and are only an estimate. Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11 -053 E . 711113)
FEE
QTY/FEE
MISC ITEMS
Plarl "" ,heed FCC,
SvTj)1, PC
PME Plan Check:
$0.00
hisn F,C
PME Unit Fee:
$29.00
PME Permit Fee:
$48.00
-T-1
Administrative Fee: 1ADMIN
$45.00
Work Without Permit? ® Yes 0 No
$0.00
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: 1BSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission .Fee: IBCBSC
$1.00
i;s a
ke ., . .
$171.50
$0.00 TOTAL FEE:
$171.50
Revised: 07/10/2014
Prescriptive Certificate of Com fiance: Residential
WATER HEATER CF -IR ALT- Water Heater
Date: Enforcement Agency:
Climate Zone # # of Stories Permit #
Site Address:
a53g(, kaKAO _ Omiw�k
Sf
Building Type X Single Family a Multi Family
NOTE: This form is not to be usedforNewly-ConstructedBuit&ngs
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 ar 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
3tQ a c �a
Recirculating)2
Phone:
-We 1. 7 ?� - 2 I q`
(gal)
Thermal
Insulation
Efficient
R- Value3
C>
1. Indicate type (Storage Gas> Heat Pump, Instantaneous, etc.)
1.
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
• 1 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
reg uirements of Title 24, Parts I and 6 of the California Code of Regulations.
Name: 6
Signature:,
Company
t' 4e61e4--,&
Date: 9-2 S- f y
Address:
License:
pgggs_AU-epue, g -efedte r'
3tQ a c �a
City /State/Zip: - -- - _
Phone:
-We 1. 7 ?� - 2 I q`
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at 1-800-112-1300-
CF -1R ALT,5 /17 /10 Page 1 of 1
CUPERTINO
Address *4
SMOKE f CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • build inaCa-cuperti no. org
Perm
'moo " �•' #of Alarms Smoke:
PURPOSE
This affidavit is a self- certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
inspections are required.
GENERAL INFORMATION
Existing single- family and multi- family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds
$1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and /or Carbon
Monoxide Alarms be installed in the following locations:
AREA
SMOKE ALARM
CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the
bedroom(s)
X
X
On every level of a dwelling unit including basements
X
X
Within each sleeping room
X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel- burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply: Iii dwelling units with no commercial power supply, alarm(s) may be solely battery operated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl
space. Refer to CRC Section 8314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for
alarms which must be connected to the building wiring.
As owner of the above- referenced property, I hereby certify that the alarm(s) referenced above has/1-lave been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms have been tested and are operational, as of the date signed
below.
f^ ^n 111 —ifh tha tams anr! cnnditions of this statement
I'I10M luau
r Owner Agents} Name:
anu aylac w vvn q.+.� ..,... •. .....- ..,. -- -..- _- -- -- --
...... ............................... Date: Si nature............ ... ..... ..... ................. .... ........
LName:
lConctor
{� yi2L�
Si nature .... .......... ...... .................Liu.# ...... Date:
Smoke and CO form.doc revised 03118114