12030001 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7765 HUNTRIDGE LN CONTRACTOR:KATZ RONIT AND ROBERT PERMIT NO: 12030001
I
OWNER'S NAME: KATZ RONIT AND ROBERT I P.O.BOX 1990 DATE ISSUED:03/012012
OWNER'SPHONE: 4084381785 CUPERTINO.CA 9.50144262 PHONENO:
❑ LICENSED CONTRACTORS DECLARATION BUILDING PERNIIT INFO: BLDG r ELECT I—, PLUMB Ci
License Chas Lich r r Ul
�IECH RESIDENTIAL COMMERCIAL
Contractor Date
hereby affirm that I am licensed under Ute provisions of Chapter JOB DESCRIPTION:FURNACE REPLACEMENT SAME LOCATION NOT IN
(commencing with Section 7008)of Division 3 of the Business S Professions 'ATTIC
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
perfonnance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by Sq.FI Floor Area: Valuation.52800
Section 3700 of the Labor Code,for the Performance of the work for which this
permit is issued.
ANN Number:35906024.00 Occupancy-Type:
APPLICANT CERTIFICATION
I certify that I have read this application mid state that die above information is
correct.I agree to comply with all city and county ordinances mid state laws relating
to building construction,and hereby audiorize representatives ofthis city to enter PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property 6x inspection purposes. (We)agree to save
indemnify and keep harmless the 6tyofCupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting ofthis penult. Additionally,the applicmht understands mid will comply
with all non-point source regulations per the Cupertino Municipal Code.Section
9.18. Issued by: �Eq/✓ yi 7—e bl Date: j•/'
Sicu ature Date
❑ OIVNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material beire installed.If a roof is
1 hereby affirm that 1 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,mid the structure is nm intended or offered for sale(Sec.7044, Siguaure of Applicant: Date:
Business&Professions Code)
I,as owner ofthe 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
hereby affirm under penalty of perjury one of the following three ,
declarations: HAZARDOUS MATERIALS DISCLOSURE
I have mid will maintain a Certificate of Consent to self-insure for Worker's 1 have read the hazardous,materials requirements under Chapter 6.95 of the
Compensation,As provided for by Section 3700 of the Labor Code,for tire California Health R 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&
I have mid will maintain Worker's Compensation Insurance,as provided for by Safety Code.Section 25532(a)should 1 store or handle h27Ardous material.
Section 3700 of the Labor Code,for tine rerfornance of the work for which this Additionally.should 1 use equipment or devices which emit hazardous air
permit is issued. 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
p certify(fiat in the performance of the wort:for which this permit is issued,I shall Health&Safety Code,Sections 255115.25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's j
Compensation laws of California. If,aftermaking Uiiscaniftcmeofexeniption,l Owner rynhorize
become subject to the Worker's Compensation provisions of the Labor Code,I must Date:
torthwfth comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby afLrn thatthere is a construction lending agency for the performance of work's
I certify that p 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 Leader's Address
indenmily and keep harmless the City of Cupertino against liabilities,judgnnents,
costs,and expenses which may accrue against said City in consequence of the
grinning of this permit.Additionally,the applicant understands and will comply ARCHITECF'S DECLARATION
with 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: B1k: Lot :
APN . . . . . . . . : 35906024 .00
DATE ISSUED. . . . . . . : 03/01/2012
RECEIPT # . . . . . . . . . : BS000016154
REFERENCE ID # . . . : 12030001
SITE ADDRESS . . . . . : 7765 HUNTRIDGE LN
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : KATZ RONIT AND ROBERT I
ADDRESS . . . . . . . . . . : P. O. BOX 1990
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4262
RECEIVED FROM . . . . : ROBERT I KATZ
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : KATZ RONIT AND ROBERT I
ADDRESS . . . . . . . . . . : P. O. BOX 1990
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4262
TELEPHONE . . . . . . . . :
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, 800 .00 1.00 0 .00 1 .00 0 . 00
1BSEISMICR VALUATION 2, 800 .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
----------------- --------------- ------------------
CHECK 260 .50 #1144
---------------
TOTAL RECEIPT 260.50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- --------------------------'
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 7765 huntridge lane DATE: 02/29/2012 REVIEWED BV: larry s
APN: BP#: 'VALUATION: $2,800
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition /Repair
PRIMARYSFD or Duplex PE
FURN/AC
USE: PERPIIT TYPE:
WORK furnace replacement, same location not in attic
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced-Air 1MFR=<100 1 # $130
TOTALS: $130.00
Nfech.Plan Check 0.0 hrs $0.00 Pluntb. Plan Che(k Elac,Plan Cbcck
Mech.Permit Fee: 611PERMIT Plund'. Prraut Few Ele—Permit Feer
Other Mech. Insp. 1 0.0 hrs L$44.00 ofilty Plumb 111-4pEl
Other laee Imp. El
HC,h insp. Fee: P/mnb. Insp.Fee: Eler.Imp. Fee.
NOTE: This coimate does not include fees dire to other Departments(i.e. Planning, Public 11 arks. Fire,Sanitary Sewer District,School
District,etc.). Thesefees are based on the prelininain3 in orntation nvrdlnble and are on/v an estimate. Contact the Dept for addu'l info.
FEE ITEMS (Fee Resolution 11-053 EB" 7111111 FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PCFee
PME Plan Check: $0.00
Pemtit Fee:
Suppl. Insp Fee
PME Unit Feer $130.00
PME Permit Fee: $44.00
Constrriclion Tax
Administrative Fee: ]ADMIN $41.00
Work Without Permit? 0 Yes Q No $0.00
AdrunLed Planning Fecw:
Travel Documentation Fee: ITRAVDOC $44.00
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCRSC $1.00
SUBTOTALS: $260.50 $0.001 TOTAL FEE: 1 $260.50
Revised: 1/19/2012
Sim lifted Prescri five Certificate of Cam
Climate"Lorliauce: 2008 Residential HVACAIrerations
ca 10 to 15 CF-IR-ALT-HVAC
S&e Addicts:
( FnjorcementAgency: Due: 2 Permit#.-
cut
:rot T r List Minimum ERcim a Conditioned Floor
Packaged Unit Duet insulation m ent Area Thermostat
mnace EfAFUE007u j[3COp_ Over 40 ft of ducts added or
nor Coil SEER 0 HSPreplaced in unconditioned space S�erve�d by stun hack
Condnor abeady
Other�ng Unit e EER_ 0 Resistance ®R 6 (CL 10-13) 1 A x0111 sf prerwm be
R 8 (CZ N-15) 4"-`e rwdlerq
1.Equfpmem Type:Cheose the equipment being fnstdled, ijmom than one tem,use another CF-IR
2.tNbri»atm Equipment Effidencie:13 SEER 78%AFUE, 77HSPFjar typical residem -ALT-HVACor eachial syrtrms. f syrrem.
HERS VERIFICATION SUMMARY Listed below are four HVAC alteration Optionst uyus, . The iastaller decides what-work being done and
Picks one of the eppropriate Options. Each Option lists the MRS
inspection Bad a copy given to the hoaxownec At final,the ir6pecrnvenn'fiesothat the work rk h ted this torn the firms shall be left on Site for final
si ed.
The inspector also verifies Unit each appmpriate CF-6R and registered CFAR forms(no hand filled CFARs alwas in lowed)are filled ot the work putt and
by the
si ed. B ionic October 1,2010,a registered m •of the CP-1R and CF-6R shall also be on site for final ins cation.
I.HVAC Changrout Required Farms:
• All HVAC Equipment replaced CF-6R forms: MECH-O4,MECH•21-FIF.ILS and(for split systems)MECH-25-HERS
• Condenser Coil and/or C174R forms: MECH-21 and fors lits stems MECH-25
• Indoor Coil and/or CF-6R forms: MECH-2I-HFRS and(f irsplit systems)MECH-
• Furnace
CF-4R forms: MECH-21 and(for split systems) MECH-25 IRS
For Split Systems: Duct leakage<15 percent; RC,CCA?300 CFMhon(Mmimum Air Flow Requirement),TMAH
For Packaged Units: Duct leakage< 15 percent
Exempted from duct leakage testing if•
Ij1.Dud system was documented to have been previously sealed and confirmed
throu
2.Duct systems with less than 40 linear fact in unconditioned space,or 'HERS verification,or
3.Existm duct me constructed,insulated or sealed with asbestos
2.New HVAC S stem Required Forms:
• Cut in or Changeom with new
ducts:(aB new ducting and all CF-6R forms: MECH-04,MECH-20-I1ERS,and fors lit stems)MECH-22-HERS,and• CF-4R forms: MECH-20,and for lit ( p s5 MECH-25-HERS
new nt ( sp systems)MECH•22,and MECH-25
For Split Systems:Duct leakage a percent;RC,CCA e 350 CFM/ton,FWD,TMAH,SIMS,and either HSPP or PSPP.
For Packaged Units:Duct leakage<6 rcent
03.New Ducts with Replacement Required Forms:
• Includes replacing or installing all new ducting CF-611 forms: MECH-04,MECH-20-HERS,and(for split systems)MECH 25-HERS
and/or outdoor condensing unit and/or indoor CF4R forms:MECH-20 and(for split systems)MECH-25
coil and/or f ora,=. Not all equipment changed.
For Split Systems:Duct leakage<6 percent,RC,CCA>300 CFM/ton, I MAH
For Packa ed Units:Duct leaks e<6 rcent
4.New Duct!n over 40 feet Re uired Forms:
• Includes adding or replacing more Hien 40
linear feet of duct in unconditioned s ace. CF-6R forms: MECH-04,MECH-2I-HERS CF4R fortes: MECH-21
For split system or packaged units: Duct leakage< 15 percent
EXCEPTION:Cat dun -stems constructed.insulmed or sealed with asbestos.
Contractor(Documentation Author's/Responsible Designer's Declaration Statement)
° 1 terrify that this Certificate of Compliance,documentation is ace,mare and eomplue.
° 1 am eligible under Division 3 of the California Business and Pmfessions Code to ecc,ptrrs
• I certify rim theenrJgy festutes and Performance specificatiom for the design identified on�s Certificatensibi[hy fey tofCorrrpiihe design artcetconform o the ron this equireficue encs of limrce.
Parti I and 6 ofa¢California Code of Regulations, requirements ofTitle 24,
• The design features identified on this Crain ate of Compliance arc consistent with the information comm;ed on ott pplirnWe compliance forms,workstre24,
calculati ans ands lection submitted to the enfnrcerrrcnt agency for ro.,e widt 't
Name: /� � ^— to
Company: y^ 1 signatum- Cc.
Address: V bU i I d Z- ate: "
1LA//yT0e/ c-v/flcLicense:
Ciry/Starely+P. v p��LT/
M1 Phone: 6 �, I7 .S—
.'2008Residenlyd(AMPlionce Forms .
July.7010. ..
OWNER-BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
103DO TORRE AVENUE -CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333- buildincQcuaerino.ora '
Dear Property Owner(s):
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at:
SITE ADDRESS APN BPS
OWNER NAME /7G ^TZ OWNER ADDRESS
i< g /�i7/ •� '�G�:r/iif7�[.oGr—L1/ caf'c�K�r�!G �y y-So yL
DESCRIPTION OF WORK:
We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of
your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We
will not issue a building permit until you have read, initialed your understanding of each provision, signed, and
returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless
you, the property owner, obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
(DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.)
rq1 ' 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-
Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material
personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by
an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not
provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my
insurance coverage for injuries to workers on my property.
1ek2. I understand building permits are not required.to be signed by property owners unless they are responsible for
the construction and are not hiring a licensed Contractor to assume this responsibility.
C3. I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may
protect myself from potential financial risk by hiring a licensed Contractor and having the permit riled in his or her
name instead of my own.
Rj�:z4. I understand Contractors are required by law to be licensed and bonded in California and to list their license
numbers on permits and contracts.
4&f -5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the
total value of my construction is at least five hundred dollars (S500), including labor and materials, I may be
considered an"employer" under state and federal law.
J, K:6. I understand if I am considered an "employer"under state and federal law, I must register with the state and
federal government, withhold payroll taxes, provide workers' compensation disability insurance,and contribute to
unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject
me to serious financial risk.
PL7. I understand under California Contractors' State License'Law, an Owner-Builder who builds single-family
residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by
licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work
its performed under contract with a licensed general building Contractor.
✓WB. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for
any financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction
defects in the workmanship or materials.
OwnerBuilduForm 2010.doc revised 04/14/10
4212 �3a � � �
GENERAL PERMIT APPLICATION M E P
Ell COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 M ' /�
CUPERTINO (408)777-3228 • FAX(408)777-3333• buildina(cDcuoerbro.om v\
❑PLIIIr-®--xo ❑MECRANICAL ❑n ELECTRICALCr,inJ❑NfISa=.AN/EE0Uh5 J
FRC1ECr ADDRESS
(J �JJ GS gAFNI t `��j /•� V "ted /
OWNERNAME ,+(J
ST'REEI'ADDRESS - Cf-Y, STATE,ISP PH
FAX
6 f l/�ih�+.��-t I�r.. cwPc�c�/Yo csI- 9Sai4-I
CONTACT NAME /2G,n «TZ_ PHONE9G84-3P/�S.5! E -rv)plpG '
SFRJ=ADDRFss �'7 ! CnY.STATE, LT �/ FAX
�� /-7�.5�/7L/ ZiG��IL+++
111`��WNER ❑ O ❑ OWNER AGENT ❑ CON Ri ACtOR ❑CONTRACTOR AGENT ❑ ARamF1.T ❑E.ccvEER ❑ nEVEI.OPR ❑ ;tT',1N;
CONTRACTORNAME �V$T/� /'N�/YS LICENSE NUMBER LICENSE TYPE SUS LICp
T7T lL*-�- 9�1+c r />/ '1—
CONB'ANY TAME E-MAIL
19e:L T?;L- //ICG"i% /ice fZ 9Ycir�R/1i94aDc-r/WAC-e c,,,
sTRErnnnREss I Y3-5
ARCrUTECTIENQ NEER NAME LICENSE NUMBER BUSY.LIC
COWANY NAME E-MAB. FAX
S771...'TTADDRESS CITY,STATE,IIP PHONE
USE OF 9?=m DUPLEX ❑ NULTI-F&NCLY I PROIECI N Wn.InwNO ❑ YES I PROJECT,IN ❑YES ISTIVIB AN ❑YES
BUILDING: M.MMC(
COL URBAN ENTERFAC�E AREA D
NO FLOOD ZONE ®No �I E4IL�- HOME/ ®NO
DESCRIPTION OF WORK 7-0 15:;0�1-50/1
TOTAL VALUATION: RECEIVED BY:
By my signature below,I certify to each of the fallowing: Inn the propery Dauer or autharixd agent m act oa the property owner's behalf. I have read this
application and die in`ormatim I have provided is cont]have read the Description of Work and verify it is acute. I agu m conmly vit a!]applicable local
ordinances and sem.,laws relating to building con� camf,I anLhon=representatives oECupertino m ceter the above-i
d
entified property for inspection pull)Wes.
Sigaann'e of App6amdAgenu �/`� L4C /v�� Data:
SLiPPL.El,=AL CIF011:4ATION REQU OFFICE USE ONLY
y ❑ OVER-THE-COUNTER
c
❑ EXPRESS
Y
U
❑ mvDARD
' V
< ❑ LkRGE
❑ NWOR
N1EPAfucdpp_2011.dac revised 06/21/11