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12040053. CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 6359 MYRTLEWOOD DR OW'NER'S NAh1E: ULICKI ROBERT L AND PATRICIA K CONTRACTOR: SUPREME AIR SYSTEMS I PERMIT NO: 12040053 80 GILMAN AVE STE I DATE ISSUED: 04/102012 OWNER'S PHONE: 4084463718 I CAMPBELL, CA 95008 I PI IONF. NO: (408)376-0706 I ❑ IL%IICCENSED CONTRACTOR'S DECLARATION License Classss.li�t.-�>y'�1�p�� LLiiccpf-��yg,�pWYM Contractor J,/►q(�1"IG ADate 1 hereby affirm that I am licensed under the provisions of Chapter (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. 1 hereby affirm under penally 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 permit is issued. II r, APPLICANT CERTIFICATION - r(�!t/ - 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 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. Signature ❑ OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: 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) L as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penally 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. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of Labor Code, for the performance of the work for which this permit is issued. I certify that in the performance of the work forwhich 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 Workers 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 stale that the above information is correct. 1 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 hmmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this pemit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r MECH r RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: REMOVE AND REPLACE TME FURNACE(AMERICAN STANDARD) Sq. FI Floor Area: I Valuation: &1133 APN Number: 36917001.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAS/TT CALLED INSPECTION. Issued by:Se � grll 2/ Date: y•/o•/ RF. -ROOFS: All roofs shall be inspected prior to any roofing material berg installed. If a roof is installed withoat first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(x) should 1 store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Ouality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code. Sections 25505, 25533, and 25534. Owner or authorized agent: Dale -.400 17 CONSTRUCTION [.ENDING AGF,NCV 1 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 I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION APPLIANCE/EQUIP TYPE ADDRESS: 6359 Myrtlewood Drive DATE: 04110/2012 REVIEWED BY: Sean UNITS APN: I BP#: 'VALUATION: $4,133 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: p $130 PENTAMATION FURN/AC PERMIT TYPE: At WORK Remove and replace the furnace American Standard). SCOPE APPLIANCE/EQUIP TYPE FEE ID Plmnh. Pion Clrrclr I QTY UNITS BP FEES lilec. Perniir Fee: Furnace, Forced -Air 1MFR=<100 tiler. Inq!. 1 # $130 Pe.) Ina Fec: Supp/.lisp Fee PME Unit Fee: $130.00 PME Permit Fee: $44.00 C'ousn union Tax. Administrative Fee: (ADMIN $41.00 Work Without Permit? O Yes 0 No $0.00 TOTALS: A Travel Documentation Fee: ITRA VDOC $130.00 Strong+, Motion Fee: IBSEISMICR NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District etc These ees are based on the Prelimina information available and are on!v an estimate Contact the De ! or addn7 info. FEE ITEMS (Fee Resolution 11-053 E(l 711111) Mech. Plan Check 0.0 hrs $0.00 Plmnh. Pion Clrrclr I IJec. flan Cherk Mech. Permit Fee: I MPERMIT Plumb. I'crrnir Ne lilec. Perniir Fee: Other Mech. Insp. 0.0 hrs $44.00 Other Plump Imp.(!dn•r tiler. Inq!. .11,(h. In./,. ter: Plumb. Irnp. ree: /iter. /nap. Fee: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District etc These ees are based on the Prelimina information available and are on!v an estimate Contact the De ! or addn7 info. FEE ITEMS (Fee Resolution 11-053 E(l 711111) FEE QTY/FEE MISC ITEMS Plan C:herk Fee: .Supp/. PC Fee PME Plan Check: $0.00 Pe.) Ina Fec: Supp/.lisp Fee PME Unit Fee: $130.00 PME Permit Fee: $44.00 C'ousn union Tax. Administrative Fee: (ADMIN $41.00 Work Without Permit? O Yes 0 No $0.00 Advanced 1'141mring Fees: A Travel Documentation Fee: ITRA VDOC $44.00 Strong+, Motion Fee: IBSEISMICR $0.50 Select an Administrative Item 131de Sids Commission Fee: IBCBSC $1.00 SUBTOTALS: $260.50 $0.00 TOTAL FEE: $260.50 Revised: 04/01/2012 Sim plified Prescriptive Certificate of Compliance: 200S Residential HVACAlterations CF -IR -ALT -HVAC Climate Zones 1 and 3 - 7 Sile Address: Enforcement Agenry: Dale., Permit 4: / / Conditioned Duct insulation E ui ment Type' List Minimum Efficiency ' Floor Area requirement Thermostat Packaged Unit urnace 1 U AEER COP BHSPF Served by system Over 40 ft of ducts added or replaced in —/ `Lrl Setback ® Indoor Coil Condensing Unit • ❑SEER ❑ EER— ❑ Resistance sf unc nditioned space ace 6; (lfnotalreadypresent, must be inset/l ed) ❑ Other 6 (CZ 1. 3-5) 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, 7.7HSPF for typical residential systems. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) • I cenify 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. • I 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 1 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 fomes, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit a ication. Name: Signature: Company: ,(�(^� 1 �` w^ �1^y-1 Date: O " Address: u Licenser C City/State/Zip: Phone:(AlWlb -W64, 2008 Residenliol Compliance Forms A4arch 2010 6 ITEMS OF 6 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36917001.00 DATE ISSUED.......: 04/10/2012 RECEIPT #.........: BS000016499 REFERENCE ID # ...: 12040053 SITE ADDRESS .....: 6359 MYRTLEWOOD DR SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OPERATOR: patg COPY # : 1 METHOD OF PAYMENT ---------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 260.50 --------------- 260.50 VOICE ID DESCRIPTION -------- ---------------------------- 505 FINAL ELECTRICAL 508 FINAL MECHANICAL REFERENCE NUMBER -------------------- #13867 VOICE ID DESCRIPTION -------- ---------------------------- 507 FINAL PLUMBING OWNER ............: ULICKI ROBERT L AND PATRICIA K ADDRESS ..........: 6359 MYRTLEWOOD DR CITY/STATE/ZIP ...: CUPERTINO, CA 95014-4624 RECEIVED FROM ....: SUPREME AIR SYSTEMS CONTRACTOR .......: ALLEN SENNERT LIC # 21614 COMPANY ..........: SUPREME AIR SYSTEMS ADDRESS ..........: 80 GILMAN AVE STE 1 CITY/STATE/ZIP ...: CAMPBELL, CA 95008 TELEPHONE ........: (408)376-0406 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 4,133.00 1.00 0.00 1.00 0.00 1BSEISMICR VALUATION 4,133.00 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 ---------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 260.50 --------------- 260.50 VOICE ID DESCRIPTION -------- ---------------------------- 505 FINAL ELECTRICAL 508 FINAL MECHANICAL REFERENCE NUMBER -------------------- #13867 VOICE ID DESCRIPTION -------- ---------------------------- 507 FINAL PLUMBING 2'� �� -S3 GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 950143255 M I CUPERTINO G ❑PLUMBING MMECHANICAL MELECTRICAL ❑MISCELLANEOUS (408) 777-3228 •FAX (408) 777-3333 • buildinDl�cuoertino.or PROJECT ADDRESS ` �J APN0 - ' D OWNE0. NAME ' Oba+ ^ W - (� Ct:j PHOS/ �J j I E-MAIL STREET ADDRESS�tM rN U IV_ CITY, STATE. ZI - FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CRY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHRECr ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME I n � �C•1 I L ,/Yp '�`� LICENSE NUMBER �Jn BUS LICM COMPANY NAMII .'µA'1I�.,�'nn� CLI�C�ENS{'EOTYPE /C� E -MA 1 lN., V`(J TF- \ ` IA iLVcV FA fq STREET ADDRESS A iWan `1 I CRY, STATE, ZIP I �]�ffv _1\,{/jJo PH N �T_l /_ /`I d /, IV �1`•1P ARCHITECTIENGINEER NAME LICENSE NUMBER BUS . LIC 9 COMPANY NAME EMAIL FAX STREET ADDRESS CRY, STATE, ZIP PHONE USE OF SFDor DUPLEX BUILDING COMMERCIAL ❑ MULTLFAMILY PROJECTINWILDLAND ❑YES URBAN INTERFACE AREA NO P0.0JER LY ❑YES FLOOD ZONE NO IS THE BLDG AN ❑YES EICHLER HOME? NO DESCRIPTION OF WORK rna 'e Gnat �a� TOTAL VALUATION: RECEIVEDBY: 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 provided is correct I 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 building construction. 1 authorize representatives of Cupertino to enter the abo a -id III d property for inspection purposes - Signature of Applicant/Agent: Dat e: SUPPLEMENTAL INFORMATION REQUIRED -� 1OFFICE USE ONLY . �j ,OVER-TRECOMMR'I' � ❑ EXPRESS _ �i ❑. STANDARD ._. Z ❑ LARGE d ❑ MAJOR MEPMiscApp_2011.doc revised 06121// l R