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11120085 . 1` % • CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10494 FLORA VISTA AVE CONTRACTOR:A&H HEATING PERMIT NO: 11120085 OWNER'S NAME: MIKE&DEANNA ROANHAUS 770 CHESTNUT ST DATE ISSUED: 12/14/2011 O s' ER'S PHONE: 4089730973 SAN JOSE,CA 95110 PHONE NO:(408)279-0722 mr LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class C- Lic.k J �4�f Z (- r; 1 �. '� ,` MECH RESIDENTIAL COMMERCIAL Contractor 4- At Dale 12--144-1 /( hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE WALL FURNACE,REPLACE WITH FORCED AIR (commencing with Section 7000)of Division 3 of the Business&Professions FURANCE AT NEW ATTIC LOCATION 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 Sq.Ft Fluor Area: Valuation:$1 1000 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:32628082.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 D YS FROM T CALLED INSPECTION. 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. j��f / Issued by: / Date: Signature �/l.�ti/f��w✓!//iii Date �` f-E—� l OWNER-BUILDER DECLARATION RF.-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Date: Business&Professions Code) 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 BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& 1 have and will maintain Worker's Compensation Insurance,m provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Ouality Management District I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. 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 caner or authorized / become subject to the Worker's Compensation provisions of the Labor Code,I must ^ -� �� ,O Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION 1 hereby affirm that there is a construction lending agency for the performance of work's 1 certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) . correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION g of this permit.Additionally,the applicant understands and will comply all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18, Licensed Professional Signature Date • CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32628082 . 00 DATE ISSUED. . . . . . . : 12/14/2011 RECEIPT #. . . . . . . . . : BS000015567 REFERENCE ID # . . . : 11120085 SITE ADDRESS . . . . . : 10494 FLORA VISTA AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : MIKE & DEANNA ROANHAUS ADDRESS . . . . . . . . . . : 10494 FLORA VISTA AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : DALE PHELPS CONTRACTOR . . . . . . . : PHELPS, DALE LIC # 12079 COMPANY A & H HEATING ADDRESS . . . . . . . . . . : 770 CHESTNUT ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95110 TELEPHONE . . . . . . . . : (408) 279-0722 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 1. 00 41.00 0.00 41.00 0. 00 1BCBSC VALUATION 11, 000 . 00 1.00 0.00 1.00 0. 00 1BSEISMICR VALUATION 11, 000. 00 1.10 0.00 1.10 - 0.00 1MFR=<100 UNITS 1. 00 130.00 0 .00 130. 00 0 .00 1MPERMITFE FLAT RATE 1.00 44 . 00 0.00 44 . 00 0 .00 1TRAVDOC FLAT RATE 1.00 44 .00 0.00 44 . 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 261. 10 0. 00 261.10 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 261.10 VISA --------------- TOTAL RECEIPT 261.10 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL • GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 M ' sc • CUPERTINO (408)777-3228• FAX(408)777-3333• buildinD(d.)cuoer ino.orG PLUMBING g MECHANICAL RELFCMCAL MISCaLANEOUS PROJECTADDRESS Laz 5 I I/-L AP"�c2 - 0 OWNER NAAffi� R OA Le S PHONEC'I 7 E � !✓ I/'G J/L-• STREETADORESS CC C ,S7 TE,ZIP FAX CONTACT NAME I �' ✓I "t PHONE /r C STI EETADDRESs 770 ❑OWNER ❑ OWNER-BUILDER ❑ OWNFR.AGENT XCONTRACTOR ❑CONTRACTORAGFNT ❑ ARCHTTF-CT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRA ¢ L LICENSE NUMBER 2 qty,�7� LICENSE TYPE//_0 BUS.LTC,ep'��y COMP AA¢/ `G E ,/Cl7 / 2 FAX406// STREET DRESS r� �- CITY,STATE,Z@ _ PHONE !! S�'➢L�- l0 ND Z� ARCHrtECr/ENGINEER NAME LICENSE NUMBER BUS.LIC p COMPANY NAME' E-MAIL FAX tliTROM ADDRESS CITY,STATE,ZIP PHONE F FDwDUPIJ:''( ❑ MULTI-FAMD.Y PROTECTDNWDOL1Np ❑ YES PROIECfIN ❑YES ISTHEBLIX,ANWO: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICNIFR HOMEI ❑NO RIPTION OF WORK 14.2 /9 L-L / -- TOTAL VALUATION: [ © �� RECEIVED BY: J 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 informatiou I have provided is correct 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. 1 authorize tatives of Cupertino t enter the above-identified property for ins/pert6 poroses. Signature of Applicant/Agentate: l �_!—/ — C SUPPLEMENTAL INFORMATION REQUIRED OFFI9W<E ONLY 11 ❑ OVER-THE-COUNTER rL ❑ ®(PRESS Y U 2 ❑ STANDARD U 'j ❑ LARGE ❑ MAJOR 1vffPMtrcApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION • jai tADDRESS:/O��q DATE: 12/14/2011 REVIEWED BY: bobs. BP#: *VALUATION: 1$11,000 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: PERMIT TYPE: WORK remove wall furnace replace with forced air furnace at new attic location. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $130 TOTALS: $130.00 Mech.Plan Check 1 0.0 hrs $0.00 PG,»rb, h'inn C7rc.nk Fleo.Plan Chc"'h Mech. Permit Fee: IMPERMIT 111un,b.Parnm Fee. -_e Parma Fee: • Other Mech.Insp. 0.0 hrs $44.00 Otne,'I'haui;d;.p. 7 El Orde, Ii1ec. brsp. Ej ,1 f ch.Insp. Fire: Pluu,b. lmp.Fee: Rter.Imp. Fee. NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School District,etc. . These fees are based on the prelindna information available and are onfy an estimate. Contact the De t or addn7 in o. FEE ITEMS (fee Resolution 11-053 EV. 711111) FEE QTY/FEE MISC ITEMS Plein (Aleck Fee: Sr1pl,1. PCF`ce PME Plan Check: $0.00 Permit Fee: Stipp/ 111sp Vee PME Unit Fee: $130.00 PME Permit Fee: $44.00 Construction 7COL: Administrative Fee: ]ADMIN $41.00 Work Without Permit? () Yes 0 No $0.00 1l o%i10r1cad Plarming l•"e,�,: Travel Documentation Fee: ITRA VDOC $44.00 • Strong Motion Fee: IBSEISMICR $1.10 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $261.10 $0.001 , TOTAL FEE: 1 $261.10 Revised: 12/04/2011 Certificate of ce: 2008 Residential HVAC Altraidons CF IR ALT VAC Climate Zones 1 and 3-7 odelNI " K�l�vt Uz..r,= M i-���cc�;o Fl2�F Site Address: EnfonxmentAgmcy Datc Penit No. la1R'Er= zr4VisrrgR+�, @'tu-r�.ub ! z/'t//l Equipment Type List Minimum' Conditioned I Duct Ins lw= Tlte®ostat Rflitrim Floor Airs requirement ❑Packaged Unit I&VUE oCOP S�j Served by Over 40 ft of ducts �((SetUsck umace �e$EER oHSPF system Added orreplaced (tfnot already ther ❑Indoor Cool oEER oResistmoe sf in Unconditional present,must ❑Otondensing Unit space be installed) 6 CZ 1,3-5) 1. EquipmentTypc Choose the equipment beinginstaIlal;if moa than one system,use another CF-IR-ALT- HVAC F-1R ALT- HVAC for each system. 2 Mwimnm Equipment EtHc=wvec 13 SEER,78%ARM,7.7 HSPF fix typical residential systems. Contactor(Documentation Audwts/Responsible Design's Declaration Statement) • I cu*that this Certificate of Compliance documentation is naumre and complete. • I am eligible under Divisican 3 of the Califom6 Business and Professions Code to accept aesponsfLty • For the design identified on this Certificate of Compliance • I o=fy that the energy kamtes and pedonneore specifications for the design identified on this Certificate of Compliance conform to the requirements ofTide 24,Parts 1 and 6 of the rAbffimia Code of Regulations • The design feanues identified on this Certificate of Compliance are consistent with the information �a documented on other applicable comp6wce forms,worksheets,caklawns plans and Tecificanow submitted to the enforcement agency for approval with rite permit application. Natttc lC)A-t- f44G_P 5 Sianatum t>n o_ IL Date: f Z ` /y—/( Address 77 d License No.: Ci /Stare/ ' . i t-It Q — Phone No. Z 4 7Z Z— PlsnniogApprov Setback hum property L RECEIVED DEC 14 2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3229 SU P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: 10 _ r r 57 PERMIT# k 5 OWNER'S NAME: PHONE # 1/60r 27 Z GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: @� CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS E. 1 am not usingng any any s subcontractors: Signature Date Please check applicable subcontractors and complete the following information: t/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring /Carpeting Linoleum/Wood Glass/Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date Simplified Presaiptwe Certificate ofCompliance: 7008 Residential HVAC Alterations CF-SR ALT-VAC Climate Zones 1 and 3-7 T�f,mnfi,r'„n•,- Model Numbec K�urvtctzt� Site Address: EnforcementAgeucy: Date PamitNo. �Up�i ub EquipmentType' list Nlinim„ma Conditioned Duct Insulation Thermostat Efficiency Floor Area nxgriremeat D Packaged Unit �FUE oCOP S°r}j Seined by Over 40 ft of ducts (Setback XFumace �I$EER DH3PF / system Added or replaced (if not already D Indoor Coil DEER oResistarim sf in Ummnt itioned present,most Xtondeosing Unit space be installed) o Other 6 CZ 1,3-5) I. Equipment Type Choose the equipment beinginstalled;if more than one system,use another CF-IR-ALT- HVAC for each system. 2. Mn»mum Equipment Effideacu= 13 SEER,78"/u AFUE,7.7 HSPF for typical residential systems. Contractor(Documentation Author's/Responsible Designer's Declaration Statement) • I certify that this Certificate of Compliance documentation is accurate and complete. • • I am eligible under Division 3 of the California Business and Professions Code to accept responsbrlity For the design identified on this Certificate of Compliance • I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24,Parts 1 and 6 of the California Code of Regulations. • The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance foams worksheets,calculations,plans and specifications submitted to the enforcement agency for approval with the permit application Name t�01 L — i f��P 5 tuts cam¢ Co e Date 1 2- Address: Address: J z License No.: � Z Ci /State/ t�tit' — Phone No.: d -©7.2 Z_ PlimningApprovah Setback from property: r THIS PLAN SHALL REMAIN ON DEC 14 2011 THE JOB AT ALL TIMES DURING CONSTRUCTION