11120039 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20306 NORTHBROOK SQ CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 11120039
CONDITIONING
OWNER'S NAME: BAKER MARY M 1712 STONE AVE. DATE ISSUED: 121062011
R'S PHONE: 4082529286 SAN JOSE,CA 95125 PHONE NO:(408)293-4717
❑ LICENSED CONTRACTOR'S DECLARATION
y C, BUILDING PERMIT INFO: BLDG r ELECT r-, PLUMB r
License Class C-2 c) C Lic.t! 7rz % 7 1
Contractor AAA 2JtJV � Date R'
6- 11
MECH r RESIDENTIAL r COMMERCIAL r
I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE&REPLACE FURNACE SAME LOCATION
(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:$2565
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
permit is issued. APN Number:31639016.00 Occupancy Type:
APPLICANT CERTIFICATION
I certify that I 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 PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION.
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply 1 12-10—
with all non-point source regulations per the Cupertino Municipal Code,Section Issued by: (//,`''/ Date:
9.18.
Signature Date
0-7 47---�Z- - I I RE-ROOFS:
OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is
hereby affirm that t am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,1 agree to remove all new materials for
inspection.
the following two reasons:
1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date:
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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE.
declarations: I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
performance of the work for which this permit is issued. Safety Code,Section 25532(x)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District 1 will
permit is issued.
maintain compliance with the Cupertino Municipal Cade,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 Ow r or autho• 8171
Compensation laws of California. If,after making this certificate of exemption,I Dater ��
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. CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of cork's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and state that the above information is Lender's Name
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 Lender's Address
u on the above mentioned property for inspection purposes.(We)agree to save
im and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18, Licensed Professional
Signature Date
• CITY OF CUPERTINO
6 ITEMS OF 12 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31639016.00
DATE ISSUED. . . . . . . : 12/06/2011
RECEIPT #. . . . . . . . . : BS000015502
REFERENCE ID # . . . : 11120039
SITE ADDRESS . . . . . : 20306 NORTHBROOK SQ
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : BAKER MARY M
ADDRESS . . . . . . . . . . : 20306 NORTHBROOK SQ
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-0504
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 BAL
---------- ------------ ---------- ---------- ---------- ---------- ----------
-ADMIN HOURS 1. 00 41.00 0. 00 41 .00 0. 00
1BCBSC VALUATION 2, 565.00 1.00 0. 00 1 .00 0. 00
1BSEISMICR VALUATION 2, 565.00 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
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 521 .00 VISA
---------------
TOTAL RECEIPT 521.00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
• Imi I ADDRESS: 20306 northbrook sq DATE: 12/06/2011 REVIEWED BY: larry a
APN: BP#: "VALUATION: $
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION FURN/AC
USE: PERMIT TYPE:
WORK remove and replace furnace
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced-Air 1MFR=<100 1 # $130
TOTALS: $130.00
i r i
Mech.Plan Check 0.0 hrs $0.00 Ph,n,ta 3'lr,:a Cbe<:k Elan.111nv Check
Mech.Permit Fee: IMPERMIT Mundt,Perini,Fee: Etac. Pernia Few:
Other Mech.Insp. 0.0 hrs 1 $44.00 Otho Phunh hrs/,. oth<o 1.3'x-hirp.
11':ch.Inep. Fuse: Plunrb. 101,,p.J've' Etcr. /nq,. Fee:
NOTE: This estimate does not Include fees due to other Deparlments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District etc. . These fees are based on the prefint in ormatlon available and are only an estimate. Contact the Dept for addn'I info.
FEE ITEMS (Fee Resolution 11-053 L'f.. 711,112 FEE QTY/FEE MISC ITEMS
Plan Clu'clr(ire:
PME Plan Check: $0.00
Suppl. lu.s/) Fee
PME Unit Fee: $130.00
PME Permit Fee: $44.00
Construction Mx
Administrative Fee: IADMIN $41.00
Work Without Permit? O Yes (F) No $0.00
Advanced Planning Fees:
Travel Documentation Fee: ITRA VDOC 44.00
• StrongMotion Fee: 0 Select an Administrative Item
Bldg Stds Commission Fee: 0 '
SUBTOTALS: $259.00 $0.00 TOTAL FEE: 1 $259.00
Revised: 10/01/2011
GENERAL PERMIT APPLICATION
Lo COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO (408)777-322,,8,,__,•//FAX(408)777-3333 •bullCin➢(G�cuoetno.GrD IuwJ/IAL)
❑PLUMBING NMIECHANTCAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS C
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OWNER NAME y\^ a - --
STREET
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❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT 4YCONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME n LICE��ER. 7 1 i Sp HUS.LIC4
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CONE•ANY NAME A IA /� '( ,1 �/�/CI ` E
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STREET AnDREss 1., I 'L �` E��/�r h U cv 9.-/zj—
AACHCCER/ENGINEERMAME LICENEE NUMBER BUS.UC q
COF[PANYNAME E-MAE- FAX
STREET ADDRESS CTT`!,STATE,ZIP PHONE
USE OF SFD or Duplex ❑ Multi-Farnlly PROJECT PI WE.➢LAND PROJECT IN
STRUCTURE: ❑ Commercial UIMUANTNTERPACEARHA ❑ Yes Cl No FLOOD zoN ❑ Yes ❑ No
DESCRJFITON OF WORK p y� Cy1 C1 I
I r Lo,.�-e
TOTAL VALUATION yIg e _
\ J J 'AECENEQBY �x
By my signature hela W,I certify to each of the following: Zlhaut
e p ape er or authorized agent to act on the property owner's behalf. I have read this
application and[he information vided is cortectea ascription of Work and verify,it is accurate. I agree to comply with all applicable local
ordinances and state laws r ting t buil g construction. n presentatives ofCupertino to enter the above.identified property for mspecnon purposes.
SignatureofApplicant/ /a /_ �Li Date:_- '.i
EMENTAL INFORMATION
�'krar,4s +cu
e r. :M i in X�'
MISS
6u4 SL.tItNAAIl '�.,..
MEPMUcApp_201 Ldoc revised 03116111
. (r.uP 'V'-tIrJL,
FPrt
escritive Certificate of Com liance: Residential CF-IR-ALT
sidential Alterations Pa e 4 of 5)
'e t Na e: Climate Zone# #of Stories
HVAC SYSTEMS- HEATING
Minimum
Duc[or Piping Configuration
Heating Equipment Efficiency Distribution Insulation Thermostat (Central,Split,
Type and Ca aci i.z't (AFUE or HSPF) Type and Location' R-Value Type Space,Package or H dronic)
r rA
16 7v
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 heating is supplemental(i.e., if total capaci(v
< 2 KW or 7,000 Btu/hr electric heating is controlled by a tone-limiting device not exceeding 30 minutes). See§151(6)3 exception.
3.Refer to the HERS Verification section on Page 4 of the CF-I R-dLT Form for additional requirements and check applicable boxes.
4. Indicate Type or Location(Davis. Hvdromc 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
a acit �-' COP) Type and Location R-Value Type Space,Packa a or H dronic)
1. Indicate Cooling Tvpe(AIC, 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
• List water heaters and bolters for both domestic hot water(DHW)heaters and hydropic space heating. Individual dwelling DHW heaters must be
gas or propane fired, and may not exceed 50 gallons. Hot water pipe insulation from the DHW heater to the kitchen(s)and on all underground
hot mater pipes is required in all cont anent packages in all climate-ones.
External Tank
Water Heater Type/Fuel Distribution Type Number In Tank Energy Factor or Insulation
Type' (Standard,Recirculating)'' System Capacity( al) Thermal Efficient R-Value
1. Indicate Tvpe(Storage Gas, Heat Pump, Instantaneous.etc.)
2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of§150(n). The Prescriptive requirements do
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 of§1506).
SPECIAL FEATURES The enforcement agencv should pav special attention to the Special Features specified in this checklist below.
These items may require written justification and documentation andspecial verification.
NEW.ROOF ASSEMBLY-Radiant Barrier
The radiant barrier re uiremert of§15 t(f)2 does not app ly 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 O 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
YES: In Climate Zones L 2, 11, 13, 14& 16,R-8 insulation is required; in Climate Zones 12& IS,R-4 is required under component 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
U P E RT I N O Telephone: 408-777-3228
Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: 03 PERMIT#
OWNER'S NAME: 2 PHONE# ;'Y3 Y /
GENERAL CONTRACTOR. BUSINESS LICENSE# 6
ADDRESS: ('� —L CITY/ZIPCODE:
-5W V3f-
*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:
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