13080054 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10265 E ESTATES DR CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 13080054
CONDITIONING
OWNER'S NAME: ALI AND ZOHREN TABATABAI 1712 STONE AVE DATE ISSUED:08/07/2013
OWNER'S PHONE: 4083430968 SAN JOSE,CA 95125 PHONE NO:(408)2934717
Jer LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALS
License Classl'y3 e2( Lic.# 701 Q 7 I REPLACE(E)40 GAL WATER HEATER,SAME LOCATION
Contractor en,--CA.—Date ^r3
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:$1431
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:36908011.00 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 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property forinspection purposes, (We)agree to save 180 DAYS FROM ALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against!liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the 3
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per dieCupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature;;: Date -1 3 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)
I,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 Cupertin unicipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code, 15505, 55 3,and 5
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: —1
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 CONSTCTION LENDING AGENCY
RU
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
n
5A
CN'ERAL PERMIT APPLICATION o M'
EP
COMMUNITY DEVELOPMENT DEPARTMENT-' .ILDING DIVISION �v
10300 TORRE AVENUE +CUPERTINO; CA 95014-3255 (1
' (408)777-3228 + FAX(408)777.3333 +buildingecupedno.org 0 MISC,
C U P ERTPiy`s3 \
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UMBING 0 MEC(HAMeCAAL ELECTRICAL , p ❑MISCELLANEOUS
PROJECT ADDRESS 36 /�N s r 08— 0
OWNER NAME �,^' 1�1„/] -hot,10 - P '.� ,,3'�!^� E.MAII
SrRnT ADDRESS ,�-.�-,Q. .6`•".N�'�r CY. C !���U � C15D =AX
GONTACrNAMB `�J/JG�� �VI�� lit/K/11W ✓1 PHO
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4--71-1 E-tviAII
STREET ADDRESS 11121 �Q 1 ale` 1 C � FFG Wn6_ FAX
• ❑ OWNER ❑ OWNER-BUILDER,�✓10` OWNER AGENT -,-a I.ONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHMCT ❑ eNGINEER ❑ OEVELOPER ❑TENANT
CONTRACTOR NAME V0 fvrn rD LICENSE N /�, L! Fr HUS.UC i QdD
COMPANY NAME � - ::t: MCI
C �1`i1/` t� E-MAIL `•I,`(1 („ FAX ��`/
STREET ADDRESS ' V4L
`4-1 11
ARCHr ECr/ENaMEERNAOM l LICENSE NUMBER BUS.UC I
COMPANY NAME E-MAIL FAX
T EEr ADDRESS CM,STATE,ZIP PHONE
USE OF ,--ffVD or Duplex ❑ Multi-Family PROIECT IN WILDLAND PROJECr IN
STRUCTURE: EI COIAIACrOIaI URBAN WFERFACE AREA ❑ Yes � FLOOD ZONE C] Yes -9-�
DEstaUMON of WORK ' { kD
TOTAL VALUATION:
i
5Y my signature below,I certify to ea of a followi 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 haw provi d is co . I have read the Description of Work and wetify it is accurate. I agree to comply wit all applicable local
ordinances and state laws relating to uildin constru I authorize representatives of Cupertino to enter the v idle fled property for inspection purposes.
Signature of Applicant/Agent: Date: s �
SUPPLElYIENTAL INFORMATION REQUEUD
O �
MBPAfucApp 101 I.doc revved 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10265E ESTATES DR DATE: 08/07/2013 REVIEWED BY: MELISSA
APN: 369 08 011 BP#: "VALUATION: $1,431
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY PENTAMATION PRWHEATR
USE: SFD or Duplex PERMIT TYPE:
WORK REPLACE E 40 GAL WATER HEATER SAME LOCATION
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Water Heater 1PRWHEATR 1 # $28
TOTALS: $28 00 ,. 2�
r
Xlech. Plan Check Plumb.Plan Check 0.0 hrs $0.00 Elec..Ptan Check
,Vfec:h.Perin it Fee: Plumb.Permit Fee: 1PPERMIT Elec.Permit 1,ee:
Other Afech.Insp. Other Plumb Insp. ETrs 1 $47.00 Other Elee.Insp.
P2
:Rech.Insp.Fee: Plumb. Insp.Fee: El".Insp.Fee:
2i j
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Theseees are based on the prelindUna informaton availaan estimate Contact the Dept-for addnZ info.
FEE ITEMS(Fee Resolution 11-053 E . 711/121 FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PCTee
PME Plan Check: $0.00
Penn it free:
Suppl. Insp Fee
PME Unit Fee: $28.00
PME Permit Fee: $47.00
Construction Tqx.
Administrative Fee: IADMIN $44.00
Work Without Permit? ®Yes (E) No $0.00
Advanced Planning Flees:
Travel Documentation Fee: ITRAVDOC $47.00 i
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
$167.50 $0.00 - - - $167.50
A 'Revised: 07/01/2013
1� �
CF-1R-ALT
Prescri tive Certificate of-Com liance: Residential page 4 of 5)
Residential Alterations Climate Zone# #of Stories
Project Name:
r
HVAC SYSTEMS-HEATING
. Type Ducror,Piping Configuration
Minimum Disribution insulation Thermostat (Central,Split,,
HeatingEquipment Efficiency Space,Package or H
dronic)
Type and Ca aci \FUE or HSPF andLocation R-Value TUI_
1.indicate Hearing Type(Central Furnace,.Wall Furnace, Heat pump, Boiler. Electric Resistance, etc.)
2.Electric resistance heating is allowed only in Component Package C, or except where electric heating is supplemental(i.e.. if total capacity
< 2 KW or 7,000 Btulhr electric heating is controlled by a time-limiting device not exceeding 30 minutes). See§151(b)3 exception.
3.Refer to the HERS Verification section on Page 4 of the CF-i R-AT Form for additional requirements and check applicable boxes.
4. Indicate Type or Location(Ducts, Hydronic in Floor, Radiators,etc.)
HVAC SYSTEMS-COOLING
Minimum Configuration
Efficiency Duct or Piping Central,Split,
Cooling Equipment (SEER/EER or Distribution insulation Thermostat ( P
Type and Ca acit l'
COP) T e and Location R-Value T e Space,Package or H dronic
1. Indicate Cooling Tvpe(A/C: Heat pump, Evap. Cooling, etc)
2. Refer to the HERS Verification section on Page 4 of the CF-IR-ALT Form for•additional requirements and check applicable boxes.
3. Indicate Type or Location (Ducts, H dronic in Floor, Radiators, etc.)
WATER HEATING heaters must
List water hearers and boilers for both domestic ho[water(DHW)hearers einsulation frdom the DHW hearer to the kitchen(s)larnd o all underground b
gas or propane fired, and may not exceed 50 gallons. Hot wate p p
hot water i es is re aired in all component packages in all climate zones. External Tank
Water Heater Type/Fuel Distribution Type
Number in Tank Energy Factor or insulation
i System Ca acity( al) Thermal Efficient R Value
e (Standard, Recirettlatin )-
G. ✓
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 requiremena de
not allow the installation of a recirculating water heating system for single dwelling units.
3. The external water heating tank and pipes shall be insulated to meet the requirements o
f§150(j).
.
SPECIAL FEATURES The enforcement agency should pav special attention to the Special Features specified in this checklist below-
These items may re vire written 'ustt rcation and documentation and special verification
NEW.ROOF ASSEMBLY-Radiant Barrier
The radiant barrier requirement of 15 1( 2 does not apply, to roof alterations.
Slab Edge(Perimeter)Insulation Ely S 0 NO
YES: in Climate Zone 16 in Component Packages D,R-7 insulation is required.
Heated Slab Insulation d YES 0 NO
YES:Slab edge insulation re aired for all heated.slabs in all Climate Zones. See details in Table 118-A of the standards.
Raised Slab Insulation O YES C] NO
YES:In Climate Zones 1,2; 11, 13, 14& 16,R-8 insulation is required; in Climate Zonesuired.undercomponentPa
' Thermal Mass
To obtain Compliance Credit.for the installation of the mass, sse the.Performance Approach.
HERS Provider:
Registration Number: Registration DatelTime: August 20
2008 Residential Compliance Forms