12100211 (5) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10310 BONNY DR CONTRACI'OR: WATER HEATERS PERMIT NO: 12100211
ONLY
OWNER'S NAME: LA WVER DARELL J AND DIANE J 970 E MAIN ST DA'Z'E ISSUED: 10/30/2012
OWNER'S PHONE: 4058651550 GRASS VALLEY, CA 95945 PHONE NO:(800)835-5946
❑ LICENSED CON I'RACI'OR'S DECLARATION
Iir r BUILDING PP:RJI I'I'INFO: IILIIC ELM'r-
Class Lie.4 r r r
Nl EcII RESIDIW. flAL COMMERCIAL
Contractor Date JOR DESCRIPTION:R17MOVI7 AND REPLACG WA'rCR IlrATCR IN SAME
LOCATION
hereby affirm that I am licensed under the provisions of Chapter 9 50 GAIL
(commencing with Section 7000)of Division 3 of the Business S Professions
Code and that my license is in full force and effect.
1 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 w'hichthis permit is issued. Sq.Ft Fluor Arca: Valuation:$1594
1 have and will mainmin Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the perfarrhance of the work far which this
APS Number:35914046.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify thin I have read this application and slate that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.l agree to complywith all city and countyordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives ofthis city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupenino against liabilities.judgments,
costs,and expenses which may,accme against said City in consequence of the
granting ofthis permit. Additionally,the applicantnd
uerstands and will comply Issued by; Dale:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RF.-ROOF'S:
Signature Date All roots shall be inspected prior to any rooting 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:
hereby affirm that I am e<empt from the Contractor's License Law fur one of
the following two reasons: ALI.ROOF COVERINGS TO HE CLASS"A"OR IWITER
1,as owner of the property,or my errployces with wages as their sole comlcnsation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business B Professions Code)
1,as owner of the property,am exclu ively contracting with licensed contmctors to ILVLARDOUS NIATERIA S DISCLOSURE
construct the project(Sce.7044,Business R Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the
California health&Safety Code,Sections'_%115,?5533,and 25534. [.ill
hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Nlunicipal Code.Chapter 9.12 and the
declarations: health S Safety Code.Section 25532(a)should I store or handle hazardous
1 have and will maintain a Certificate of Consent to setfinsure 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 QualityNlanagenhent District 1
performance of the work for whichthis 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 I Iealth S Safety Code Sections 25505.25533,and 25534.
Section 3700 of the Labor Code,for the performance of dhe work for which this
Owner or authorized ague: Untr.
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 my manner so as to become subject to the Worker's
Compensation laws ofCalifornia. If,after making this certificate of exemption,I CONS'fRl1CI'IUN 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 CER-I'IIICATION Lender's Address
I cenify 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 stile Imps relating
to building construction,and hereby authorize representatives ofthis city to enter
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City ofCupertino against liabilities,judgments, ARCHITF.CfS DECLARATION
costs,and expenses which may accrue against said City in consequence of the 1 understand my plans shall be used us public records.
granting ofthis permit.Additionally,the applicant understands and will comply
with all non-paint source regulatiau per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
Y ...�...�— _ _� <'•� a —ery .— .. _. . . ..� .. .._ _... . .. .�, ,-_ ., �- ,_
IN NO
Building Department
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22328 CUPERTINO RD COINTRACI'OR:BENJAMIN FRANKLIN PERMIT NO: 12100197
PLUMBING
OWNER'S NAME: NGUYEN BINH QUOC AND CHU-NGUYE I'D BOX 1072 DATE ISSUED: 10262012
OWNER'S PIIONE: 4083914373 CAJIPBELL,C\ 95009 PDONENO:(408)298-1776
N LICENSED CON I'RACI'OR'S DECLARATION r r F-
/ n BUILDING PERi�11T INFO: BLDG ELECT PLUMB License Class C 3 1r Lie.N j} �7 3
L
p c .e 1 1 Z_ i11EC11 ❑ RESIDENTIAL r COMMERCIAL r
Contractor 3 ijzA .J F4-wif h.t1 Dale 10 1
I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: RBMOVE ANI)RBI'IACE 50 GALLON WATT7R IIEATIiR IN
(commencing with Section 7000)of Division 3 of the Business& Professions LOOG\CA
TION
Code and that my license is in full force and effect.
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 Sq,Ft Flour Arca: Valuation:$1889
permit is issued.
APPLICANTCERTIFICVTION AI'NNumber.32650069.00 Occupancy.fype:
I certify that 1 have read this application and state that the above information is
correct.1 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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino h al Code,Section
9.18.
Signature Date
14
Zai /Z Issued by: �.q/y RTG/T Date: •C94--/,;L
❑ \\'N ER•BUII-DFR DF:CL.V2,\'PION
RE-ROOFS:
I hereby affirm that 1 am exempt from the Contractor's License law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sce.7044,
Business&Professions Code) Signature of Applicant: Date:
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code).
ALL ROOF COVERINGS TO BE,CLASS"A"OR BE I•I'ER
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 11,%ZAItDOUS\L\'1'ISRI,\IS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the 1 have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code.Sections 25505.25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino\lunicipal Code,Chapter 9.12 and the Ilealth&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(x)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's I Ieallh&Safely Code,Sections 25505,25533,and 25534.
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 Owner or authorized agent: /�
forthwith comply with such provisions or this permit shall be deemed revoked. Date:
APPLICA.M'CERTIFIC\'1'ION - CONS'I72I M10N 1, LADING AGENCY
I certify that 1 have read this application and stale that the above information is [her y allnot that there is a construction lending agency for the performance of work's
correct. 1 agree to comply with all city and county ordinances and state laws relating 1'or which(Itis permit is issued(Sec.3097,Civ C.)
to building con5tr➢ction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCA I"1'FCI"S DECLARATION
all non-point source regulations per the Cupertino Municipal Code,Section
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
GENERAL PERMIT APPLICATION `d{/yc't Irl E P
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 I
CUPERTINO (408)777-3228 • FAX (408) 777-3333 • building(a)cupertino.org
SIC
/,2/009
PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
I'ROJEc'1'AUURISS ZZ3Zg / !�Z I WO /? y - APNn �O
OWNER NAME e/�,/� IONEO 7 E-NIAII.
STREET ADDRESS/, I Y v Cll'Y, STATE,ZIP FAS
i z Cc�Pca�1 !o �� GtJPctz7WOI C-4 . 9 of Lf
CONTACT NAME KIM AT BEMJAMIN FRANKLIN PHONE 415-459-3266 E-NIAIL
STREETADDRESS CITY.STATE. ZIP FAN
22 DIGITAL DR. STE ONE NOVATO, CA 94949 415-506-0410
❑ OWNER ❑ OWNER-BUILDER ❑ OWNERAGFNT 91 CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENAN't
CONTRACTOR NAME LICENSENUMBER LICENSE TYPE BUS.LICA zQSo�G
857357 C36 ((JJ\/
COLI PANYNAME EMAIL FAS 41$-506-0410
BENJAMIN FRANKLIN PLUMBING
STREET ADDRESS CITY.STATE,ZIP PHONE 415-459-3266
22 DIGITAL DR. STE ONE NOVATO, CA 94949
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC P
COMPANY NAME E-MAIL FAN
STREET ADDRESS CITY.STATE.ZIP PHONE
USE OF ® SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCI'URF.: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ YeS ❑ NO
DESCRIPTION OF WORK
L Met -A-7n 7o J
S r(- A— - 6 z— C-,JO F- &Zz-4U?.
TOTAL VALUATION: f 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 owner's behalf. 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 relating to building construction. I authorize representatives of CUESU.l c above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: I U Z6 Z—
EMENTALINP REQUIRED OFFICE lisEONLY
❑ OVER=rHEcowmER
s
❑ ExPRCSS
❑ STANDARD
-u
❑ LMea:
❑ MAJOR
AIEPAJiscllpp_20/L.doc reviser/O3ll G/l l
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
:21ADDRESS: 22328 Cupertino Road DATE: 10/26/2012 REVIEWED Bl': Sean
N: BP#: /p`�/ 'VALUATION: $1,889
"PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD Or Duplex PENTAMATION PRWHEATR
USE: PERMIT TYPE:
WORK Remove and replace water heater in same location 50 gallons).
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Water Heater 1PRWHEATR 1 # $27
TOTALS: $27.00
,ltech. flan Check Plumb. Plan Check 0.0 hrs $0.00 Fl,,. Plan Check
Alech. Permit Fee: Plumb. Permit Fee: IPPERAHT Elec• Permit Fee:
Other Atech.Insp._ Other Plumb Insp. 0.0 hrs $45.00 Other Elce.Lap.
.Rech.Insp. Fee: Plumb. hist). Fee: /ileo Lap. Fee.'
!TOTE: This estinmte doer not inc/utlejees due to other Departments(i.e. Planning, Public IForks, Fire,Sanitary Sewer District,School
District, etc.). These feev are based on the prelintinai3 information available and are oub,an estimate. Contact the De t or athht'I info.
FEE ITEMS (Fee Resolution 11-653 Ef! 7/1/12) FEE QTY/FEE MISC ITEMS
Phan Check Fee:
Supph. PC Fee
PME Plan Check: $0.00
Permit Fee: . '
Supp!. btsp Fee
PME Unit Fee: $27.00
PME Permit Fee: $45.00
Construction Tac:
Administrative Fee: IADMIN $42.00
Work Without Permit? O Yes (j) No $0.00
Advanced Planning Fees:
Travel Documentation Fee: ITRA VDOC $45.00 A
Strome Motion Fee: IBSEISAIICR $0.50 Select an Administrative Item
Hlde Sids Commission Fee: IBCBSC $1.00
SUBTOTALS: 1 $160.50 $0.00 TOTAL FEE: $160.50
Revised: 10/01/2012
Prescri five Certificate of Com fiance: Residential CF-IR-ALT
Residential dlteratians (Pate I of c)
Project.Name: Climate Zone of Smrie:
LfGeneral Information
Site Address:'ZZ ZQ GU ,Z7rc.1U 2 Enforcement Agency: tz-r r,.l0 Date: / 11 /-Z
BrsiM;i -Type%Smz1e Fa=il; 0 Mtdfi Fa=ily Circle the crow:Oiie=mrion:N,E,S.CV,or degee:
C'o=cL:imed Fioor Area(CFA): Pmjecr Fype-: 0 Alterman:• 0 Envelope 0 Feuesnat'ou 0 Rcvf HVAC
Re !acen.mn,or C.hanEe Out 0 Duet Ree!acemeut %Fater Hearer
NOTP: This jornt is nor to be used jar.Newly Constructed Buildings or.dddino s
RATER HEATING
Lis;nwrar hearers and boilars for both donresric iron ware),(DHII'j heaters and Imdronic space hearing. individual dssrlling DHIT ha ers nnrsi be
ens orpropane.9red. Hot%rarer ptpo insidarion Rain the DHft•heaeer to ilia kirdren/s)and on alt underground hoe waver pines is required in i li
component parkaxes in all china re-ones.
External Tank
Water Heater TypeiFuel Distribution Type Nmnber In Tank Energy Factor or Insulation
Type! (Standard.Recirculating)r Svsiern Capaci y(gal) Thermal Efficiency R-Value`
fl" —/A-.s/Difi7-f7 O-jc C7 • �i Z
1.lndicae Type(Sromge Gas.Hear Rnnp,Instantaneous, erc)
-.Reciradnring sysrerus sorbing nndtlple drrolling rads.shall nicer rhe recirculation requirements of 6150(n). The Prescriptive requvanenrs do
nor allow rho intrallarion ofa recirculating a•arar hearing system for single dwelling rants.
3- The awnral water hearine tank and Pipes shall be insulated to nicer the reavireme is of 415010.
Documentation Author's Declaration Statement
• I certify that this Certificate of Compliance documentation is accurate and complete.
Tame. Signature:
Company: Date:
)iE AJJA W 1A) fF JK� In� I� /e1 i r t/ O l/ / Z
Address: If Applicable O CEA or 0 CEPE
ZZ— T) 16 rTA- � 17t2. 57E D ,J - (Certification'):
CSte/Zip: G ^ L Phone:
� QQ 4i45
Z96
For assistance or questions regarding de Errergs•.Smndards,
contact the Energs•Hotline at:1-800-772-7.400.
Registration Vnn)ber: Regisn•arion Dare/Tine: HERS Provider:
1005 Residential ConrPliarce Forms August 009