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14030136CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10154 N PORTAL AVE CONTRACTOR: AAA FURNACE & AIR PERMIT NO: 14030136 CONDITIONING OWNER'S NAME: WONG KINNEY AND KAREN 1712 STONE AVE DATE ISSUED: 03/24/2014 OWNER'S PHONE: 4082531387 SAN JOSE, CA 95125 PHONE NO- (408)293-4717 11gI ICE SED CONTRACTOR'S DECLQARATION License Class I L,irc.�j# u �/ Contractor i� �N (. Date (/ I hereby affirm that I am licensed under the provisions of kapter 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 t source g t ions per the Cupertino Municipal Code, Section 91 � ignatur, Date J� ❑ 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 exemptio , 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 BUILDING PERMIT INFO• BLDG ELECT PLUMB' MECH RESIDENTIAL F COMMERCIAL F JOB DESCRIPTION' REMOVE AND REPLACE WATER HEATER Sq. Ft Floor Area: I Valuation: $1649 APN Number: 31628052.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS F M AST CALLED INSPECTION. Issued v1 Date: f 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 H th & S7djent: ctions 25505, 25533, and 25534. Owner o)ad n Date: L CONSTRUCTION LEND NG 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 Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT- #UILDING DIVISION KEP 103'00 TORRE AVENUE - CUPERTINO. CA 95014-3255 M IS C (408) 777-3228 , FAX (408) 777-3333 - buildin q(5,gugertino.org T riwvrwr�- A M7(A I I IRI RC—TR ICA I. 7 MISCELLANEOUS PROJECT ADDRESS *7 N. �bm1 aouo OWNER NANG! Vd t5n PHONE41& I Zq3 E-MAIL rMST ADDRESS 1015L4 N,QY-1nL AVe*)uke CA C�SQI e4 FAX CONTACT NAME E-MAIL STREET ADDRESS CrN. STATE, ZIP FAX OWNER ❑ OWNSK-BUILDER C3 OWNERAOCNT -E--CONTRAcTop. 0 comiLAcroK AGENT 0 AacfirrEc7 0 eNowEBR Q ouvzLoPeR 0 TENANT coNTxAcro? NAMIJ QC) nd LICENSE NU�an BUS U`t� Ljcn COMPANY NAME -KAJL FAX VY4 L cx� ctns ARM-TrECT/ENUINMNAN03 WCENSE NUMBER BUS. WC I COWANYNAM EMAIL FAX STRZET ADDRESS CM, STATE, ZIP PHONE USE Of C?FD or Duplex (:1 Multii-Fqpily PROJECT IN WILDLAND PROJECT [N STRUCTURE: crm; URBAN NTMVACE AREA 0 Yes �10 FLOOD ZONE 0 YC NO DESCR YTtON OF WORK rMove and yefloc-e 12/Asbrn �1VQjcr :i 11L TOTAL VALUATION: 1 (w4e-i 9�) By my sioature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf, i have read this application and the information I hay.%-Koyided Wrcct. -( have read the Description of Work and verify it is accurate. I a8mc to comPiv vft &H applicable local ordinances and 3utc 14w3 reladnbulijing c don, [authorize representatives of Cupertino w enter the above -id it property for inspection purposes. Signaturto fAppllc&nVAgdnt Date: 8-0?tt0fFAL UUOMZ::I'ION REQUEMD ,iffFhfucAppjOl I.doc revised 03176111 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION Af ech. T'ltp, 'fnE�; � Plumb. Plan Check 10.0 1 hrs $0.00 ts'l<c. lhlI l U" :sI c:tt. 1'ennit F<w., Plumb. Permit Fee: IPPERMIT 011"'r'I c%=.. Asp.F1 L Other Plumb Insp. 0.0 ��s$47.00 O1 her Der, IrntP, Alech, frz.tp. I't rrnt7. Zm; c"e; .=:E . huv. Fee: VOTE: 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 thepreliminary in ormation available and are only an estimate. Contact the Dept for addn'l into. FEE ITEMS (Fee Resolution 11-053 E . 711/13 10154 n portal ave DATE: 03/24/2014 REVIEWED BY: Mendez 11alADDRESS: APN: BP#: *VALUATION: 1$1,649 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: PME Plan Check: PENTAMATION PRWHEATR PERMIT TYPE: woRK remove and replace water heater SCOPE ggI= Af ech. T'ltp, 'fnE�; � Plumb. Plan Check 10.0 1 hrs $0.00 ts'l<c. lhlI l U" :sI c:tt. 1'ennit F<w., Plumb. Permit Fee: IPPERMIT 011"'r'I c%=.. Asp.F1 L Other Plumb Insp. 0.0 ��s$47.00 O1 her Der, IrntP, Alech, frz.tp. I't rrnt7. Zm; c"e; .=:E . huv. Fee: VOTE: 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 thepreliminary in ormation available and are only an estimate. Contact the Dept for addn'l into. FEE ITEMS (Fee Resolution 11-053 E . 711/13 FEEQTY/FEE MISC ITEMS Plan. Chec. l''ee: suppL PC I- F PME Plan Check: $0.00 /(('��$�mit ee: ggI= PME Unit Fee: $28.00 PME Permit Fee: $47.00 Co n,4'tr uf::PiorZ lldA: Administrative Fee: 1ADMIN $44.00 Work Without Permit? ® Yes (D No $0.00 .t A Travel Documentation Fee: 1TRAVDOC $47.00 Stroniz Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Cormnission Fee: 1BCBSC $1.00 .;.;y ��T :" $167.50 $0.00 TOTAL FEE: $167.50 Revised: 01/15/2014 .... .... .: : ........ . 7 W,-ALI'. 2008 Residential Compliance Forms.doc revised 04110112 (—,upas-ttrv�-r 'Pro)ect'f�ame: of Stories It'entral. $Flit, c Resistc, 1. Indicate Hearing Type (Central Furnace, NnlIt i wri en Packng6 C8o'lexcept where electric hearing is supplemental (i. e., iCeptio capacity ?; Electric resistance Nearing is allowe y 1 SI 6 3 exee tion. 2 KW or 7,000 Btu/hr is heating is controlled by �t � R-4 Tting device no Form I& additional requirements tand check applicable boxes. Configuration (Central, Split, — r-Ivrironlc ling, etc) _ ^ nnl reauiremenrs and check applicable boxes. FY:r� ER HATING tting 4/n exceed SO allots. Hot water pipe insulation from the DHW heater to the kitchen(s) and on all underground List water hearers and boilers jot both'dome.r.tic hot water (DHW) heaters and hydronic space hearing. Individual e gas or propane fired, and may norexc g External Tank Nor. varer. , 1 es is re uired in all corn. onenr acka es in all climate zones. 'Energy or Insulation r In Tank _. R_V3IuC} Ca.s. Hear Prrmp. /nslar7Yoneous, etc.) ulation requirements of § I50(n). The Prescriptive regWren�s du serving multiple dwelling units shall meet the recir�e dwelling units. on of a recircularing water heating system for sing pin tank and i es shall be insulated to meet the requirements o 150 the Special Features specified in this checklist belo- Registration Dale/Time: Registration Number: 2008 Residential Compliance Forms HERS Provider: August I