11110106 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20214 NORTHGLEN SQ CONTRACTOR:COOPER BROTHERS,INC. PERMIT NO: 11110106
OWNER'S NAME: VENKATESH KESAVAN 6017 SNELL AVE STE 331 DATE ISSUED: II/182011
O` ER'S PHONE: 4082524742 SAN JOSE,CA 95123 PHONE NO:(408)437-2442
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r. PLUMB r
License Class CZ0,r 43_ Lic.N !27(-1 - MECHr RESIDENTIAL COMMERCIAL
Contractor Coofy.�i ero-t4,rS�Date I �B I
I hereby affirm that I am licensed under the provisions of Chapter!) JOB DESCRIPTION:REPLACE FURNACE AT SAME LOCATION,ADD NEW GAS
(commencing with Section 7000)of Division 3 of the Business&Professions LINE
Code and that my license is In full force and effect. FOR NEW GAS STOVE TOP
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 Sq.Ft Floor Area: Valuation:$3150
permit is issued.
APPLICANT CERTIFICATION APN Number:31641054.00 Occupancy Type:
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 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 Municipal Code,Section
9.18. ///r N
Issued by;�_ — Date.
Signature� G.� Date (( IS l .�
OWNER-BUILDER DECLARATION
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 berg 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(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
I,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
1 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
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
1 have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
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 Health&Safety 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 Ow nep or aq[ho'Ized agent:
forthwith comply with such provisions or this permit shall be deemed revoked. L'/�G�`i Date: j
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,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
Iftand expenses which may accrue against said City in consequence of the
g of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
w._,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
• CITY OF CUPERTINO
8 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31641054.00
DATE ISSUED. . . . . . . : 11/18/2011
RECEIPT #. . . . . . . . . : BS000015355
REFERENCE ID # . . . : 11110106
SITE ADDRESS . . . . . : 20214 NORTHGLEN SQ
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : VENKATESH KESAVAN
ADDRESS . . . . . . . . . . : 20214 NORTHGLEN SQ
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : VENKATESH BABU KESA
CONTRACTOR . . . . . . . : TROY COOPER LIC # 26734
COMPANY . . . . . . . . . . : COOPER BROTHERS, INC.
ADDRESS . . . . . . . . . . : 6017 SNELL AVE STE 331
CITY/STATE/ZIP . . . : SAN JOSE, CA 95123
TELEPHONE . . . . . . . . : (408) 437-2442
• 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 3, 150 . 00 1.00 0.00 1.00 0 .00
1BSEISMICR VALUATION 3, 150. 00 0 .50 0 . 00 0.50 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
1PGASRES OUTLETS 1. 00 65 .00 0 .00 65.00 0.00
1PPERMITFE 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 369.50 0 . 00 369.50 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 369.50 VISA
---------------
TOTAL RECEIPT 369.50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- --------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
•
C)6
GENERAL PERMIT APPLICATION M E P
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
•CUPERTINO (408)777-3228• FAX(408)777-3333• buildinafr1icuoertlno.ara M I S C
UMBING M
MFCHACAL ELECTRICAL MISCELLANEOUS
PROTECT ADDRPss , Irr�G�+�G[El✓ SO . �t�J'F�i�Wa�(� 5i-n� '�Ny t�1 /o-64
OWNER NAME e}IONB 1..,�' E-MAm
STREET ADDRESS . S CRY, STATE.ZI' W�K7il.� 9'a FAX
CONTACT NAME PHONE E-MAIL
STREETADORUS CITY,STATE Z@ FAX
13 OWNER ❑ OWNER-BUBDER ❑ OwNFAAGENT 0 CONTRACTOR ❑CONTRACTOR AGENT ❑ AROIBTECT ❑ENGOTEflI ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER UCENSE TYPE BUS.LIC N
Co < 4 C 9 S czo 3
COMPANY NAME Q H-MAB. FAx
er V fOT('Kf /-rC � 7Zde Ye C C 2
STREET ADDRESS CRY.STATE,ZIP PH
GO 0 5 r A �49 ZaaB
ARCH3TECTTII40TNEER NAME LICENSE NUMBER BUS.LIC 0
COMPANY NAME E-MAIL FAX
STREET ADDRESS CRY,STATE,ZIP PHONE
OP OWD.DUPLEX ❑ MULTI-FAMILY PRO=N WI.uLAND ❑ Y0 PROIECTM ❑YEE to THE BLDG AN [IYES
BUBDNG. 13CDMMERgAL URBAN PITERFACB AREA � NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
OEBCAEPTION OF WOAX %S
rnn
TOTAL VALUATION: �� RECEIVED BY: r
By my signature below,I certify to each of the follawmg. I am the property owner or authorized agent to act on the property owner's behalf I have read this
application and tha ietormation I have provided is correcL j have read the Description of Work and verify it is accurate. I agree to comply withal]applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection pu@oses.
Signatum of Applicant/Agentr Dam: P -1,5-11
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
v OVFA-TEE-COUNTER
6
❑ RXPRESS
Y
_ ❑ STANDARD
u
❑ LARGE
6
❑ MAJOR
MEPMfscApp_2011.doc revised 06121111
• r�
r •
Pre scOWN Certificate of Compliance: Residential CF-IR-ALT
Residential Alterations Page 4 of 5
Project Name: �� tlegW Climate Zone# �l #of Stories
�J I
HVAC SYSTEMS-HEATING
Minimum Duct or Piping Configuration
Heating Equipment Efficiency Distribution Insulation Thermostat (Central,Split,
Type and Capacity"2,3 (AFUE or HSPF) Type and Location" R-Value Type S ace,Package or H dronic
O
1.Indicate Heating 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 hearing is supplemental(i.e., if total capacity
<2 KW or•7,000 Btu/hn•electric heating is controlled by a time-limiting device nor exceeding 30 minutes). See§151(b)3 exception.
3.Refer to the HERS Verification section on Page 4 of the CF-IR-ALT Form for additional requirements and check applicable boxes.
4. Indicate Type or Location(Ducts,Hvdronic in Floor, Radiators, etc.)
HVAC SYSTEMS-COOLING
Minimum
Efficiency Duct or Piping Configuration
Cooling Equipment (SEER/EER or Distribution Insulation Thermostat (Central,Split,
Type and Capacity" COP) Type and Location R-Value Type Space,Package or H dronic
1.Indicate Cooling Type(A/C,Heat pump,Evap. Cooling, etc)
2. Refer to the HERS Verification section on Page 4 of the CF-1 R-ALT Form for additional requirements and check applicable boxes.
3.Indicate Type e or Location(Ducts, H rdronic in Floor,Radiators, etc.)
`WATER HEATING
List water heaters and boilers for bods domestic hot water(DHW)heaters and hydronic space heating. Individual dwelling DHW hearers must be
gas orpropane fired, and may not exceed 50 ga//ens. I-lot waterpipe insulation from the DHW heater to the kitchen(s)and on all underground
hot water pipes is required in all tett overt packages in all clunale zones.
External Tank
Water Heater Type/Fuel Distribution Type Number In Tank Energy Factor or - Insulation
Type, (Standard,Recirculating)' System Capacity( al) Thermal Efficiency R-Value3
}
1.Indicate Type(Storage Gas,Heat Punnp,Instantaneous, e1c.)
2.Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of§150(n). The Prescriptive requi{g�rr utz-do
not allow the installation ofa recirculating water heating System for single dwelling units. lJ
3. The external water heating tank and pipes shall be insulated to meet the requirements o ¢150 ').
SPECIAL FEATURES The enforcement agency should pay special attention to the Special Features specified in this checklist b(&.
These itens may require written 'usti motion and documentation and special vel-i nation. .1
NEW ROOF ASSEMBLY-Radiant Barrier U U u
The radiant barrier requirement of 151 2 does not apply to roof alterations.
Slab Edge(Perimeter)Insulation ❑YES ❑NO
Gi
YES:In Climate Zone 16 in Component Packages D,R-7 insulation is required.
Heated Slab Institution ❑YES ❑NO
YES:Slab edge insulation required for all heated slabs in all Climate Zones. See details in Table 118-A of the standards.
Raised Slab Insulation ❑YES ❑NO t'
YES:In Climate Zones 1,2, 11, 13, 14& 16,R-8 insulation is required;in Climate Zones 12& 15,R-4 is required under co acka a D.
Thermal Mass v
To obtain Compliance Credit for the installation of thermal mass,use the Performance Approach. Al"
Registration Number: Registration Date/Time: HERS Provider:
2008 Residential Compliance Forms August 2009
.
Presei4 ti, a Certificate of Compliance: Residential CF-IR-ALT
Residential Alterations (Page 5 of 5)
Project Name: fled 0 S ll Climate Zone# #of Stories
HERS VERIFICATION SUMMARY The enforcement agency should pay special attention to the HERS Measures specified in this
checklist below. A completed and signed CF-41?Form far all the measures specified shall be submitted to the building inspector before final
inspection.
Duct Sealing& Testing HERS verification is requiredfor this measure.
❑YES ❑ NO YES:In Climate Zones 2 and 9-16,if more than 40 linear feet of new or replacement ducts are installed in unconditioned
space,the ducts are to be sealed per§152(6)1 Dii and the newly installed ducts are to be insulated per§151(f)]0.
❑ EXCEPTION:Existing duct systems that are extended,which are constructed,insulated or sealed with asbestos.
❑YES ❑NO YES:In Climate Zones 2 and 9-16,if the existing space-conditioning system(HVAC equipment and ducting)is replaced,the
ducts are to be sealed per§152(b)1Di.
❑ YES ❑NO YES:In Climate Zones 2 and 9-16,if the existing HVAC equipment is replaced(including the replacement of the air handler,
outdoor condensing unit of a split system,cooling or heating coil,or the furnace heat exchanger)the ducts are to be
sealed per§152(b)1 E.
❑ EXCEPTION:Duct systems that are documented to have been previously sealed confirmed through HERS
verification in accordance with procedures in the Reference Residential Appendix RA3.
❑ EXCEPTION:Duct systems with less than 40 linear feet in unconditioned space.
❑ EXCEPTION:Existing ducts stems constructed,insulated or sealed with asbestos.
Refrigerant Charge- Split System HERS verification is requiredfor this measure.
❑YES ❑NO YES:In Climate Zones 2 and 8-15,when the existing HVAC equipment is replaced(including the replacement of the air
handler,outdoor condensing unit of a split system A/C or heat pump,cooling or heating coil,or the furnace heat
exchanger)a refrigerant charge measurement shall be verified per§152(6)1 F.
Central Fan Integrated (CFI) Ventilation System and Fan Watt Draw
The ventilation requirements of§150(o)do not apply to existing residential homes.
Ducted Split Systems-Air Conditioners and Heat Pumps:Airflow HERS verification is requiredfor this measure.
❑YES ❑NO YES:In Climate Zones 10 through 15,when the existing space-conditioning system(HVAC equipment and ducting)is
replaced,the airflow and fan watt draw shall be verified per§152(b)]Ci to meet the requirements of§151(07B.
•
Documentation Author's Declaration Statement
• I certify that this Certificate of Compliance documentation is accurate and complete.
Name: Signature:
Company: Date:
—119 — l
Address: If Applicable O CEA or❑CEPE
O 0txeel it =33 (Certification#):
City/State/Zi Phone:
6 CR T 2 410S 6q.7 ZC> R
Responsible Building Designer's Declaration Statement
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design identified on
this Certificate of Compliance.
• I certify that the energy features and performance specifications for the building design identified on this Certificate of Compliance conform
to the requirements of Title 24,Parts I and 6 of the California Code of Regulations.
• The building design features identified on this Certificate of Compliance are consistent with the information provided to document this
building design on the other applicable compliance forms,worksheets,calculations,plans and specifications submitted to the enforcement
agency for approval with this building permit application.
Name: Signature
o n
Company: I IDate:
(ICY512,1l 13 .c>C -
Address: License:
S Ave � 33
City/State/Zip: Phone:
n o 9 2 0 S 629-2068
� or assistance or questions regarding the Energy Standards,contact the Energy Hotline at.1-800-771-3300.
Registration Number: Registration Date/Time: HERS Provider:
2008 Residential Compliance Forms August 2009
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
U PE RTI N O Telephone: 408-777-3228
Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: 1p L f PERMIT#
OWNER'S NAME: PHONE# q019 �(
GENERAL CONTRACTOR: per BUSINESS LICENSE# Z(. 7
ADDRESS: 6017 Sr,c Ave*3 SU. o Ce Z CITY/ZIPCODE: Sa, .Jas � 9S 123
*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 LICENSE.
1 am not using any subcontractors: �a w It
Signature Date
Please check applicable subcontractors and complete the following information:
✓ 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