15040107 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21670 STEVENS CREEK BLVD CONTRACTOR:TBD-TO BE PERMIT NO:15040107
OWNER'S NAME: KALMAN BARBARA TRUSTEE DATE ISSUED:04/14/2015
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OWNER'S PHONE: 4085560200 U PHONE NO:
❑ LICENSEDCONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL
3� 1c)� q THAI BANGKOK CUISINE- REMOVE AND REPLACE
License Class Lic.# WATER
{{��,,�� � Q + ^ 1 l 1 15 HEATER
Contractor 1 ��N� t IUh�J+Date l "1 J
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:$3500
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:35717012.21670 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 S F 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 DAYS F M AST CALLED INSPE TI N.
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: �fl LJJ�6
granting of this permit. Additionally,the applicant understands and will comply
with al - t sour a regulations per the Cupertino Municipal Code,Section
918..
l RE-ROOFS:
Signa re Date l + 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)
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 wit Cup tino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code, ctions- 5 ,and 25534. f�'
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized age. . Date:' 1J
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 bdilding 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
918.
Signature Date
.......................................
GENERAL PERMIT APPLICATION jeYMEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 MMISC
CUPERI'tNt} (408)777-3228• FAX(408)777-3333•building(ftupertino.or4
LUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS LVAO
Qx i APN#
OVVNERNAME E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑ OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOJ!q, 1�\n.�_ LICENSE LICENSE TYPE BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
ARCHITECT/ENGATEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF '❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WII.DLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUII.DING: OMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK \ t^
TOTAL VALUAT w
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the erty owner' ehalf. I have read this
application and the information I have vided is orrec have read the Description of Work and verify it is acc te. I agre comply with all applicable local
ordinances and state laws relating t ildmg co c on. I orize representatives of Cupertino to enter the ab e-i ed property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL.INFORMATION RE D SEOI�I,1
OF'kZCE�U
O�ER=TfiEjCOUNTER'��"
H O EXP.RES �� a., �
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MEPMiscApp_2011.doc revised 06/21/ll
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 21670 scb I DATE: 04/14/2015 REVIEWED BY: Mendez
APN: BP#: *VALUATION: $3,500
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY PENTAMATION PCWHEATR
USE: Commercial Building I PERMIT TYPE: i
woRx 1 thai ban kok cuisine- remove and replace water heater
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Water Heater 1PCWHEATR 1 # $29
TOTALS: x $29.00
Tmw,
Mech. Plan Check Plumb.Plan Check 0.0 hrs $0.00 Elec.flan Check
:ale: , 1'em it Fee: Plumb.Permit Fee: IPPERMIT l lec 1,ermir Fe:
C)tf�err ;t(c ch. Irtslr. EI-1- Other Plumb Insp. 0.0 hrs $48.00 orhes l�'lec�.Insp.
E3
A,lech. Insp. Fee: Thallb. has/. Tee: Elec.Insp. Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These fees are based on the pnelimina information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7ff /1/13) FEE QTY/FEE MISC ITEMS
Plan C'he'ck Fee:
Suppl. PC'/'e6l
PME Plan Check: $0.00
permit Fee:
sup'T'rl. Jars/2 Fee
PME Unit Fee: $29.00
PME Permit Fee: $48.00
('Onslj-uction Tax:
Administrative Fee: ]ADMIN $45.00
Work Without Permit? ®Yes 0 No $0.00
11dvanced Planning Fees:
Travel Documentation Fee: ITRAVDOC $48.00
StroniMotion Fee: IBSEISMICO $0.98 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
$171.98 $0.00 1
TO`�'AL FEE: $171.98
Revised: 04/01/2015
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FORCE TM 90+
96% THERMAL EFFICIENCY
VERSATILE POWER DIRECT VENT
The 100,000 BTU ForceTM 90+light-duty commercial gas water heaters are equipped with a fully
submerged,spiral-shaped condensing heat exchanger with 50 and 75 gallons of storage capacity.
This design provides much greater heat transfer surface than a standard straight flue tube,resulting
In 96%thermal efficiency and higher hot water output than comparable 80%efficient water heaters.
SHESO 10ONE and ENERGY 5TARO Qualified Commercial Grade Glass Lining
SHE7510ONE • Provides superior protection against corrosion
Helical Internal Heat Exchanger . Protects all interior tank surfaces including
• Spiral heat exchanger keeps hot combustion inside and outside of the helical heat exchanger
gases in the tank which lengthens the heat
transfer cycle Advanced Electronic Control
• Positioned in the center of the tank for more • large LCD display
even heat distribution • Precise temperature control
• Operates at 96%thermal efficiency,which saves • Advanced diagnostics
money on operating costs compared to a • iCOMM-Compatible iCoh
a
standard 80%efficient gas water heater and can be monitored from
remote locations.Call
_ Versatile Power Direct 1.888.WATER02 for more information.
Vent Design ¢'
Top-Fired Ultra-Low NOx
• Uses inexpensive PVC,CPVC,ABS or Gas Burner
polypropylene pipe for intake and exhaust
'l • Can be vented vertically tbm-the-roof or • Complies with California SCAQMD Rule
horizontally thin-thewall 1146.2 and other Air Quality Management a
• 2"pipe,vents up to 45 equivalent feet Districts with similar NOx emission �� Q
s • 3"pipe,vents up to 128 equivalent feet requirements of 14 ng/j C )
• Optional concentric vent and sidewall 9 0 0
' termination kits availablep l
CSA Certified and ASME Rated
T&P Relief Valve
Condensing Design +� Q
• 96%efficient condensing design Maximum Hydrostatic Working
• Equipped with condensate drain we Pressure:1SO psi Q
Side-Mounted Hot and Cold Codes and Standards
Recirculating Taps • Design-certified by CSA International
Model Shown • Allows Force 90+to be installed as part of according to ANSI Z21.10.3-CSA 4.3
SHE50100NE combination spaceheating/waterhearing standards 1
applications • These models mea the thetma4ippenFy and +r L/ Q)
Series 130/131 • Plugs for the recirculating taps are standby loss requirements of tFii .S.
factory installed Department of Energy and current edition of s
ASHRAELIESNA 90.1
Heavy-Duty Anodic Protection Three-Year Limited Tank and
E N • Provides superior protection ag*rstcorrosion One Year Limited Parts
sP® Available in Natural Gas Warranty
and Propane • For complete information,consult written
warranty or contact your local sales rep.
� N'
t M�ME R C�IA L�M
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FORCE TM 904P
POWER DIRECT VENT COMMERCIAL GAS WATER HEATERS
SPECIFICATIONS
MOpEI :BTUERINPROUUR'T S1EgY 0PH 1009F RISE _: APPROXIMATE
HUMBER P - GALLONS SNIPPINOWEIGNT'.`
'40TRISE "< 100RFRISE 140°FRISS , (LB)
SHESO100NE 100,000 50 291 116 83 255
SHE7510ONE 100,000 75 291 116 83 382
DIMENSIONS IN INCHES
:.�;MtflDELNIf.MBER R, , ^: B'.; • ° .C' . "D � F
SHE50100NE 66.3/4 49-1/4 22 15-3/4 3 8
SHE7510ONE 64.3/4 45-5/8 27-3/4 16 3-3/4 8
Available in Propane(LP)gas(N becomes P In the model number)
Inlet and outlet connections:3/4"male for model SHESO IODINE and 1"for SHE75100NE
circulation loop connections:3/4"female
Gas inlet:1/2"
Maximum Supply Pressure:14 Inches W.C.(3ABkPa)
Minimum Supply Pressure for Natural Gas:3.50 inches W.C.(.87kPa)
Minimum Supply Pressure for Propane Gas:8.00 Inches W.C.(1.99kPa) 1
Minimum pressure must be maintained under both load and no load(dynamic and static)conditions
Electrical Characteristics•120V,6OHz,Amperes<5 p
lew
ANODE ANODE INLET 2'Q I�
�
OUTLET
SHE50100NE SHE7510ONE a O
OUTLET INLET
eUP TOPNEW O
INSTALL IN ACCONDANCE VM LOCAL CODES. J
T&P
UPPER SIDE CONNECT C LJ
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LOWRSIDECONNECT w � �)�
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SUGGESTED SPECIFICATIONS
(Natural or Propane)Gas water heater(s)shall be State Force-90+model with 96%thermal efficiency,with storage capacity of gallons,an Input rating
of 100,000 BTU per hour,a recovery rating of 116 gallons per hour at 100°F rise and a maximum hydrostatic working pressure of 150 psi.Water heater(s)shall be
of power direct vent design,using 2 or 3-PVC,CPVC,ABS or polypropylene pipe for horizontal and/or vertical vent runs.Water heater(s)shall have:l:Glassllned
steel tank construction and a spiral shaped heat exchanger placed entirely Inside the tank,which shall be glasslined on the flue gas side to protect against acidic
condensate'2:Advanced electronic control with large LCD display and advanced diagnostics.Water heaters shall Incorporate the(COMM-system for remote
monitoring,leak detection and fault alert.3:A 3-year limited warranty against tank leaks.Water heater(s)shall meet the thermal efficiency and standby loss
requirements of the U.S.Department of Energy and current edition of ASHRAE/IESNA 90.1.
For complete information on limited warranties,consult written warranty or contact the State Customer Care Center at 1-800-365-0024.
State Industries,Inc.,reserves the right to make product changes or improvements without prior noticc
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