11120040CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11001 NORTHSKY SQ I CONDITIONINGACTOR: AAA FURNACE & AIR I PERMIT NO: 11120040
OWNER'S NAME: VICTOR R, BELL
PHONE: 4088294853
❑ LICENSED CONTRACTOR'S DECLARATION
-2c C -`i3
License Class Lic. q % (p 0 D6 ? /
Contractor RM F(J/ d &,e_ Date 12-4— L /
I hereby affirm that l em licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 or the Business & 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 which this permit is issued.
1 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 1 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. 1 /
Date/ I., - 6-</
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Low for one of
the following two reasons:
1, 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)
1, 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.
1 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 exemption, 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
iftnify and keep harmless the City of Cupertino against liabilities, judgments,
Fend expenses which may accrue against said City in consequence of the
ling 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
1712 STONE. AVE
SAN JOSE, CA 95125
DATE ISSUED: 12106/2011
PHONE NO: (408)2934717
BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
MECH r RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: REMOVE & REPLACE FURNACE Q SAME LOCATION
Sq. FI Floor Area: I Valuation: $3200
APN Number: 31640003.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPE7CTION.
Issued by: V(_ ilM Date:
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, 1 agree to remove all new materials for
inspection.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(x) 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
Health & Safety Code, Sections 25505, 25533, and 25534.
Own r or authorizeda eulr�"
Date:_/
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
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records.
Licensed Professional
v
0 6 ITEMS OF 12
Ll
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 31640003.00
DATE ISSUED.......: 12/06/2011
RECEIPT #......... BS000015502
REFERENCE ID # ...: 11120040
SITE ADDRESS .....: 11001 NORTHSKY SQ
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............: VICTOR R. BELL
ADDRESS ..........: P. O BOX 311
CITY/STATE/ZIP ...: LOS ALTOS, CA 94023
OPERATOR: patg
COPY # : 1
RECEIVED FROM ....: JAMES RANDO
CONTRACTOR .......: RANDO, JIM LIC # 8050
COMPANY ..........: AAA FURNACE & AIR CONDITIONING
ADDRESS ..........: 1712 STONE AVE
CITY/STATE/ZIP ...: SAN JOSE, CA 95125
TELEPHONE ........: (408)293-4717
FEE ID
----------
UNIT
-------------
QUANTITY
----------
AMOUNT
PD -TO -DT
THIS REC
NEW SAL
-ADMIN
HOURS
1.00
----------
41.00
----------
0.00
----------
41.00
----------
0.00
1BCBSC
VALUATION
3,200.00
1.00
0.00
1.00
0.00
1BSEISMICR
VALUATION
3,200.00
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
1TRAVDOC
FLAT RATE
1.00
44.00
0.00
44.00
0.00
TOTAL PERMIT
----------
260.50
----------
0.00
----------
260.50
----------
0.00
VOICE ID DESCRIPTION
-------- ----------------------------
505 FINAL ELECTRICAL
508 FINAL MECHANICAL
VOICE ID DESCRIPTION
-------- ----------------------------
507 FINAL PLUMBING
•
•
•
CITY OF CUPERTINO
I D�"rSDy1 FEE ESTIMATOR - BUILDING DIVISION
APPLIANCE / EQUIP TYPE
ADDRESS: 11001 northsky sq DATE: 12/06/2011
APN: BP#:
REVIEWED BY: larry s
"VALUATION: $3,200
*PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
lita<. 1'erntrr Fee:
PENTAMATION FURN/AC
PERMIT TYPE:
WORK
remove and replace furnace
SCOPE
#
APPLIANCE / EQUIP TYPE
FEE ID
Plumb. flan Check
QTY
UNITS
BP FEES
lita<. 1'erntrr Fee:
Furnace, Forced -Air
1MFR=<100
Other Eler.. Imp.
1
#
$130
Permit Fee.
Suppl. Insp Fie
PME Unit Fee:
$130.00
PME Permit Fee:
$44.00
Con,gruction Tins
Administrative Fee: IADMIN
$41.00
Work Without Permit? O Yes (F) No
$0.00
TOTALS:
Travel Documentation Fee: ITRAVDOC
$130.00
Strong Motion Fee: IBSEISMICR
NOTE. This estimate does not includejees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.. These fees are based on the Prellmina Information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 EfC 711111)
Mech. Plan Check 0.0 hrs $0.00
Plumb. flan Check
Lien Plnu Ch "I
Mech. Permit Fee: IMPERMIT
Plmufi..Ile-nrir free:
lita<. 1'erntrr Fee:
Other Mech. Insp. 0.0 hrs $44.00
01/10, Ptunrh Insp.
Other Eler.. Imp.
Voch. Imp. ic'ew
Plwnh. (na'p. I""r
Eiec. Imp. I -eta.
NOTE. This estimate does not includejees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.. These fees are based on the Prellmina Information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 EfC 711111)
FEE
QTY/FEE
MISC ITEMS
Nan C:heuk Fe::
.Supp/. PC Pee
PME Plan Check:
$0.00
Permit Fee.
Suppl. Insp Fie
PME Unit Fee:
$130.00
PME Permit Fee:
$44.00
Con,gruction Tins
Administrative Fee: IADMIN
$41.00
Work Without Permit? O Yes (F) No
$0.00
AJr,pncesd Planning Fees:
Travel Documentation Fee: ITRAVDOC
$44.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBT(JTALS: 1
$260.50
0.00 TOTAL FEE:
$0.001'
$260.50
Revised: 10/01/2011
AI
CUPERTINO
l I ► z��I
GENERAL PERMIT APPLICATION lll/(J
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION u ti/ I1
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 n n
(408) 777-3228 •FAX (408) 777-3333 • buddina(aDcuoertino orD IIJ\„\ffIfl
PLUMBING 54<ECHAhrICA:. I IELE=C.4L F7MTqrWTl aucnrm
PROJECT ADDRESS
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STREET ADDRES ``
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CONTACT NAh@
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STREETADDRESS -
❑ OWNER ❑ OWNER -BUILDER ❑ pWNEA AGENT
Ul CONTRALTp0. ❑CON'IAACTp0. AGBNT ❑ ARCHJJECT ❑ ENGMEER
❑ DEVELOPER ❑ TEry ANT
COMAACTOR NAME
LICENSENTrvo
Z9 R 1
LY.i CFr 2 c,
Hus.ucx
COMPANY NAME ,/I /J
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MAIL ^ C
(rs. GQ -fur 'CUwLJC
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STRADDRESS I i I G- �J( yr Aee
•37 ATE.
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ARCFE3ECT/EN(iINEEA N/AM1R
LICFNEE MJ Be
HVS. LIC x
COMPANYNAh[E
E-MAIL
FAX
STREET ADDRESS
CITY. STATE, P3
PHONE
USE OF SFD pT Duple, ❑ Nfulti-Family
PROJECT N WE.DLAND
PROJECT EJ
STRUCTURE. ❑ COrrrDMial
URBAN TNIERPACE AREA ❑ Yes ❑ No
FLOODZONE ❑ Yes ❑ No
DESCRIPT1ON OF WORK
Sri 1. C."Cm 4-1 bb
TOTAL VALUATION.
J�i.l/C%
ecE+•.d' - ._ -:--:}p', ._ ,,, --; _
avmHr ,' t
By my signature below, I certify to each of th owm
application and the informed
I a the property Owner or authorized agent to act an the property owner's behalf. I have read this
Dr, ed is o ct
ordinances and state laws re sting to bu ng conr c
Signature ApplicanVAgmc
ave read the Desedpnon of Work and verify it is accurate. I agree to comply with all applicable local
1 authorize mprosentatrves Of Cupertino W enter the above iderd )ed property for inspecnon purposes.
of
Date:
- IEM'AL INF!7NFLEQUIRED
::v]LHtva`DsperDt - ..•
JtiaaEDx-tri-:'.n)
u A
-� L1-RDIaJfIR
MEPMIscApp_201 I doc revised 03/16/11
•
is
•
Prescriptive Certificate of Compliance: Residential CF -IR -AI
Residential Alterations Page 4 of
P11t Name: �� Climate Zone # # of Stories
1 II r :i _ PN (?
HVAC SYSTEMS - HEATING
Minimum Duct or Piping Configuration
Heating Equipment Efficiency Insulation Thermostat (Central, Split,
T S ace, Packa a or H dronic)
jDistribution
T e and Capacity '''"� (AFUE or HSPF) nd Location' R -Value e
External Tank
Water Heater Type/Fuel
Type'
Distribution Type
(Standard, Recirculating)'-
Number In
system
0..LeTDO
Energy Factor or
Thermal Efficiency
Insulation
R -Values
Z O %6A V Pr 714
1. hrdicate Heating Type (Central Furnace. Wall Furnace, Heat pump, Boiler. Electric Resistance, etc.)
2. Electric resistance heating is allowed only in Component Package C, a) -except where electric heating is supplemental (i.e., if total capacity
< i KW or 7.000 Btu/hr electric heating is controlled by a time -limiting device not exceeding 30 minutes). See §751(6)3 exception.
3. Refer to the HERS Verification section on Page 4 of the CF -I R -.I LT Form for additional requirements and check applicable boxes.
4. Indicate Type or Location (Ducts. Hvdronic in Floor, Radiators, ere.)
HVAC SYSTEMS - COOLING
Minimum
Efficiency
Duct or Piping
Configuration
Cooling Equipment (SEER/EER or
Distribution Insulation Thermostat
Type
(Central, Split,
Space, Package or H dronic)
a acit '' COP)
Typeand Capacity,,
Type and Locations R -Value
1. Indicate Cooling Type (.UC, Heat pump, Evap. Cooling, etc) - -
2. Refer to the HERS Verification section on Page 4 of the CF -1 R-.4LT Form for additional requirements and check applicable boxes.
3. Indicate Type or Location (Ducts, Hvdronic in Floor, Radiators, etc.)
WATER HEATING
List water heaters and boilers for both domestic hot water (DHW) heaters and hydronic space heating. Individual dwelling DHW heaters must be
gas or propane fired, and may not exceed 30 gallons. Hot water pipe insulation from the DHW heater to the kitchens) and on all underground
hot water pipes is re uirea in all
cont onem PaGKUXr, o, (491
External Tank
Water Heater Type/Fuel
Type'
Distribution Type
(Standard, Recirculating)'-
Number In
system
Tank
Capacity (gal)
Energy Factor or
Thermal Efficiency
Insulation
R -Values
1. Indicate Tvpe (Storage Gas, Heat Pump, instantaneous, etc.)
2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of§I SO(n). The Prescriptive requirements do
not allow the installation of a recirculating water heating system jor single dwelling units.
3. The external water heating tank and pipes shall be insulated to meet the requirements o 1 SO ).
SPECIAL FEATURES The enforcement agency should pc v special attention to the Special Features specified in this checklist below.
These items may require written justification and documentation ands ecial verification.
NEW. ROOF ASSEMBLY - Radiant Barrier
The radiant barrier requirement of § 151(f)2 does not apply to roof alterations.
Slab Edge (Perimeter) Insulation ❑ YES ❑ NO
YES: In Climate Zone 16 in Component Packages D, R-7 insulation is required.
Heated Slab Insulation ❑ YES ❑ NO
YES: Slab ed a insulation required for all heated slabs in all Climate Zones. See details in Table I f 8-A of the standards.
Raised Slab Insulation ❑ YES O NO
YES: In Climate Zones I, 2, 11, 13, 14 & 16, R-8 insulation is required; in Climate Zones 12 & 15, R-4 is required under compo ent Package D.
Thermal Mass
To obtain Compliance Credit for the installation of thermal mass, use the Performance Approach.
Registration Number: Registration Date/Time: HERS Provider:
2008 Residential Compliance Forms August 2005
Building Department
City Of Cupertino
•10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
! U P E RT I N O Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
*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 S BCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
1 am not using any subcontractors: /
Signature Date
Please check applicable subcontractors and complete the to owing information:
JOBADDRESS: oe— PERMIT#
SUBCONTRACTOR
OWNER'S NAME: Z C.IL be -11 I PHONE # (?`6 1% -417 /%
BUSINESS LICENSE #
GENERAL CONTRACTOR: A e— BUSINESS LICENSE #
ADDRESS: 1-711– ff— CITY/ZIPCODE: 15 -
*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 S BCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
1 am not using any subcontractors: /
Signature Date
Please check applicable subcontractors and complete the to owing information:
Owner / Contractor Signature
Date
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