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11120112 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20665 GARDENSIDE CIR CONTRACTOR:KEEP IT FLOWING PERMIT NO: 11120112 MECHANICAL OWNER'S NAME: MAKARAND CHITALE 4940 MARY JANE WAY DATE ISSUED: 12/21/2011 NNER'S PHONE: 4083071997 SAN JOSE, CA 95124 PHONE NO:(408)821-9813 ❑ LICENSED CONTRACTOR'S DECLARATION ``�� BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class V Lic.# ac F- _ �� r MECH RESIDENTIAL COMMERCIAL Contractor (fit-Uellt Date JOB DESCRIPTION: REPLACE FURNACE IN SAME LOCATION 80%9000B"1'[I I hereby affirm t at I am licensed under he provisions o Cha er 9 (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:$1200 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 APN Number:36232022.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above inf ation is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS/ LAST CALLED INSPECTN. 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 Issued by: �'/ Date: with all non-poisource regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. L] OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sec ' ns 255 ,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Dater 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,1 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 ARCHITECT'S DECLARATION lemnify and keep harmless the City of Cupertino against liabilities,judgments, ,sts,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN 36232022 . 00 DATE ISSUED. . . . . . . : 12/21/2011 RECEIPT # . . . . . . . . . BS000015614 REFERENCE ID # . . . : 11120112 SITE ADDRESS . . . . . : 20665 GARDENSIDE CIR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER MAKARAND CHITALE ADDRESS 20665 GARDENSIDE CIR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : JESSE BOCANEGRA CONTRACTOR . . . . . . . : JESSE BOCANEGRA LIC # 33192 COMPANY KEEP IT FLOWING MECHANICAL ADDRESS 4940 MARY JANE WAY CITY/STATE/ZIP . . . : SAN JOSE, CA 95124 TELEPHONE . . . . . . . . : (408) 821-9813 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 1, 200 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 1, 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 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CASH 260 . 50 cash --------------- TOTAL RECEIPT 260 . 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL Sim lifted Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-HVAC Climate Zones 8 Site Address: 7 r 77° Enforcement Agency: Date: Permit#: U w C,(-th C� L f Equipment T List Minimum Efficiency' Conditioned Floor Area Thermostat Packaged Unit ; Furnace AFUF,�ec COP Served by system ®Setback Indoor Coil SEER ®HSPF sf (lfnot already present,must be installed) Condensing Unit EER Resistance Other 1.Equipment Type:Choose the equipment being installed if more than one system use another CF-IR-ALT-HVAC for each system. 2.Minimum Equipment Efficiencies: 13 SEER,78%AFUE,7.7I-iSPF for typical residential systems. HERS VERIFICATION SUMMARY Listed below are three HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted.A copy of the forms shall be left on site for final inspection and a copy given to the homeowner. At final,the inspector verifies that the work listed on this form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF-6R and registered CF4R forms(no hand filled CF-4Rs allowed)are filled out and signed. Beginning October 1,2010,a registered copy of the CF-111 and CF-611 shall also be on site for final ins tion. 1.HVAC Changeout Required Forms: • All HVAC Equipment CF-6R forms: MECH-04,MECH-25-HERS replaced CF-4R forms: MECH-25 • Condenser Coil and/or CF-6R forms: MECH-25-HERS • Indoor Coil and/or CF-4R forms: MECH-25 • Furnace For Split Systems: RC,CCA_>300 CFM/ton,TMAH For Packaged Units: No testing required 2.New HVAC System Required Forms: • Cut in or Changeout with CF-6R forms: MECH-04,MECH-25-HERS new ducts:(all new ducting CF-4R forms: MECH-25 and all new a ui ment For Split Systems:RC,CCA>300 CFM/ton,TMAH. For Packaged Units:No testing required 3.New Ducts with Replacement Required Forms: • Includes replacing or installing all new CF-6R forms: MECH-25-HERS ducting and/or outdoor condensing unit CF-4R forms: MECH-25 and/or indoor coil and/or f imace. Not all e ui ment changed. For Split Systems: RC,CCA>_300 CFM/ton,TMAH For Packaged Units:No testing required 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 responsibility for the design identified on this Certificate of Compliance. • 1 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 I 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 forms,worksheets,calculations,plans and specifications submitted to the enforcement agency for approval with the permit application,, Name: -T 'G� Signature: "Y u� J // Company: Date:6�n IC I y Address: �, �+ License: T MG�r -Tc �� 2 City/State/Zip: �� CA Phone: - 3 2008 Residential Compliance Forms March 2010 GENERAL PERMIT APPLICATION MEP fCOMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333• building(acupertino.org MISC CUPERTINO ❑PLUMBING / MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS �,s� ��_.G,yn -I�� L�(� � APN# �//)Z �./�� OWNER NAME iJ /� l`✓•- v d Vf ��,�/ MA 1<6Cr0/1Ck C4)/ 7 Al e PHONE �G�t,_4}`? _ E-MAIL STREET ADDRESS ? q' CITY, STATE,ZIP/?.CU 1 (1 �? FAX CONTACT NAME J eS '>Lr 6�n`� �e� PHONE ; i1k a 98 E-MAIL STREET ADDRESS , / o L All r�.--�� CITY,STATE, ZIP G -{,�� /^ c/Z� FAX `T �Gv �J (-1�-{- ❑OWNER ❑ OWNER-BUIIdDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR N LICENSE NUMBERC LICENSE TYPE C BUS.LIC# eSS� ail l COMPANY NAMEE-MAIL FAX - F-lvwl', �c, STREET ADDRESS f CITY,STATE ZIP A PHONE �Ur f � S _JL /,t ARCHTTECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME' E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX MULTI-FAMMY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA NO FLOOD ZONE B NO EICHLER HOME? NO DESCRIPTION OF WORK ►C42c�- )u cJe-J `;"A c c ®000 h 0II h TOTAL VALUATION: RECEIVED BY: 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 information I have 'ded 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 b i] ng cons 'on.I authorize representatives of Cupertino to enter the above-i entifie property for inspection pu(poses. Signature of Applicant/Agent: A Date: SU?16LEMENTAL INFORMATION REQUIRED OFFICE USE ONLY ❑ OVER-THE-COUNTER a ❑ EXPRESS Y U w ❑ STANDARD S U ❑ LARGE e, ❑ MAJOR MEPMIscApp_2011.doc revised 06/21/11