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12050225 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10746 LINDA VISTA DR CONTRACTOR:CALVEY IIEATING&AIR PERMIT NO: 12050225 OWNER'S NAME: HARRIS KENT S 126 SAN ANTONIO CIR UNIT 9A DATE ISSUED:05/31R012 OWNER'S PHONE: 4089961294 MOUNTAIN VIEW,CA 94040 PHONE NO:(650)669-3320 ❑ LICENSED CONTRACTOR'S DECLARATION r r r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class C20 Lic.N �'I 3Z ('39 ,.r MECH r RESIDENTIAL r COMMERCIAL r Contractor U Date. -CIC I :�III Z 1 hereby affirm that 1 am licensed under a provisions of Chapter 99 JOB DESCRIPTION:ADDING A/C TO AN EXISTING SYSTEM (commencing with Section 7000)of Division 3 of the Business&Professions Code and(hat 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. Sq.Ft Fluor Area: Valualion:54000 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:35608017.00 Occupancy Type: 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 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[his permit ddilionally,the applicant understands and will comply 7 with all non-point soy191regulations per the Cupertino Municipal Code,Section Issued by: � � �ew Date: 1•/�'�� 9.18. C f / Signature Date . 0 -3 `. I RE-ROOFS: ❑ OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material bcug installed.Ira roof is installed without first obtaining an inspection,I agree to remove all new materials for 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of inspection. the following two reasons: I,as owner of the property or my employees with wages m their sole compensation. Signature of Applicant: Dale: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) 1,as owner of the properly am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). 1 hereby affirm under penalty of perjury one of the following three IIAZARDOIIS 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. Safely Code,Section 25532(a)should 1 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 I will pcmil is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Healll Safety Code,Sections 25505,25533,and 2553.1. not employ any person in any manner so as to become subject to the Worker's- . Own .(.jrized agent: Compensation Imes of California. If,after making this certificate of exemption;I Dale: if ��• become subject to the Worker's Compensation provisions of the Labor Code,l must forthwith comply with such provisions or this permit shall he deemed revoked. CONSTRUCTION LENDING AGENCY I hereby ammo that there is a construction lending agency for the performance of work'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 slate laws relating to building construction,and hereby authorize representatives of this city to enter Lender's.Address upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against Iiabil ifies,judgments, ARCHITECT'S DECLARATION RATION costs,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 Simplified Prescriptive Certificate of Compliance:2008 ResidentW HVACAIteratfons CF-IR-ALT-HVAC Climate Zona I and 3-7 Site Address: / t EnforcemenrAgeacy: Date: Pamft N: o Conditioned Duct insulation EgMgent Type' List Minimum EfficiencY2 _ Floor Area —requirement Thermostat LI Packaged Unit r, ©Furnace Q AFUE COP Over 40 R of duds LL!pdour Coil [f]gEER ASPF - 'Served bY mrat em added or replaced [I Sok Condensing Unit EER_- 13 Resistwo: L�-+aL.sf wcooditionad space i CQ�'P" .°1m be Other [3 R 6 (CZ 1,3-3) 1.Equipment Type:Choose the equipment being installed;if mote than one system,use another CF-I R-ALT-HVAC for=b system. 2.Minimum Equipment Efficieacim 13 SEER 73%AFUE,7.711SPF for typical residential systems. Contractor(Documentation Autbor's/Responsible Designer's Declaration Statement) • I certify that this Certificate of Compliance documentation is accurate and complete. • 1 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 w this Certificate of Compliance conform to the requirements of Title 24,Pmts 1 and 6 of the California Code of R e lations. • The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms, vorksheet%calculations,plans and specifications submitted to the= cut agency for approval with the permit licat on. Namc Signature: company: k. Date 0� 3I7L Address: License: n o City/StanelLip: :- Phone: 2008 Residential Compliance Forms.doc revised 04110/12 CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35608017. 00 DATE ISSUED. . . . . . . : 05/31/2012 RECEIPT #. . . . . . . . . : BS000016958 REFERENCE ID # . . . : 12050225 SITE ADDRESS . . . . . : 10746 LINDA VISTA DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : HARRIS KENT S ADDRESS . . . . . . . . . . : 10746 LINDA VISTA DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4020 RECEIVED FROM . . . . : JOSEPH E CALVEY CONTRACTOR . . . . . . . : JOE CALVEY LIC # 32390 COMPANY . . . . . . . . . . : CALVEY HEATING & AIR ADDRESS . . . . . . . . . . : 126 SAN ANTONIO CIR UNIT 9A CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 94040 TELEPHONE . . . . . . . . : (650) 669-3320 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, 000 .00 1 . 00 0. 00 1 .00 0.00 1BREMAIRHA NO.UNITS 1 .00 65. 00 0. 00 65 .00 0. 00 1BSEISMICR VALUATION 4, 000 .00 0.50 0. 00 0 .50 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 195. 50 0 . 00 195 .50 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ---------- ------- --------------- -------------------- CREDIT CARD 195.50 MC --------------- TOTAL RECEIPT 195.50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 -------- ----' - 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 10746 Linda Vista Dr DATE: 05/31/2012 REVIEWED BY: Sean APN: BP#: 'VALUATION: 1$4,000 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: PERMIT TYPE: WORK Addin A/C to an existing system. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES A/C Units (<=10K cfm) 1BREMAIR 1 # $65 TOTALS: $65.00 Mech. Plan Check 0.0 hrs $0.00 Phunh. Plnn Check Elee. Plan Check Mech. Permit Fee: IMPERMIT Plumb.Permit F,rc: Elet. I'wmir Fee: Other Mech. Insp. 1 0.0 hrs L $44.00 Other Plumb Insp. Ocher/ilrr.Insp. Li I J1,CA hap. Fcc. !'lrunb. htrp. ree: lilcr.Grip.Fce: NOTE: This estimate does not includejees due to other Departments(i.e. Planning,Public Works, Fire,Sanitary Sewer District,School District,etc). Thesefees are based on the prelimina information available and are only an estimate Contact the Dept for addn 7 info. FEE ITEMS (Fee Resolution I/-,053 F/! 7/1/11) FEE QTY/FEE MISC ITEMS Plan Chuck Feu:. Ruppl. PC Fee PME Plan Check: $0.00 Perini//.-Ce: Rupp/. lusp [ea •. PME Unit Fee: $65.00 PME Permit Fee: $44.00 C'onsnvciton 7iix Administrative Fee: (ADMIN $41.00 Work Without Permit? 0 Yes (E) No $0.00 Adveinced Pluundng Fees: Travel Documentation Fee: 1TRAVDOC $44.00 A Strong,Motion Fee: IBSEISMICR $0.50 Select an Administrative Item 131dg Stds Commission Fee: IBCBSC $1.00 IP SUBTOTALS: 1 $195.50 $0.00 TOTAL FEE, $195.50 Revised: 05/01/2012 l Zo 5 J zZ� GENERAL?ERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 M ' SC CUPERTINO (408)777-3228 •FAX(408)T77-3333•buildina(a),cuoertino.ora X ❑P( ❑EL LUM13ING MECHA ICAL ECTRICAL ❑MISCELLANEOUS V PROJECT ADDRESS . t( (_ `�� �^ ( � — c � C) r OWNER NAME ,n �IS .PHONE /��� ( E-MAD. ,y STREETADDRESS nPr�`/ - / l V( CITY TE l.. STAZIP � t44�i, O (gSTI FAX CONTACT NAME li s PHONE E-MAIL STREET ADDRESS CRY,STATE, zip FAX Td OWNFJt ❑ OWNER-BUDDER ❑ OWNFAAGENT ❑ CONTRACTOR ❑CONIRACIORAGENT ❑ Aitt:K ECr ❑ENGD ER ❑ DEVELOPER ❑ TEHANr CONTRACT RNAMECC1` Q LICENSENUMBER LICENSE TZ2 BUS.LICK COMPANY NAME ( E-MAIL FAX STREET ADDRESS 1 p �y L (br C� CITY,STATE,ZIP ^,n ''q0v PHONE ^ 33 a ARCNRECT/ENGMER NAME �(� LI fO(\ LICENSE NUMBER `/T BUS.LIC p `–( COMPANY NAME " E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF FIDm0.1 IGY ❑ Nut. PANTRY PROIECf IN WD.DLWO ❑ YES PROIECrIN ❑ YES ISTHEBLDGAN ❑ YES BUILDING; ❑COM1At£RCLLL URBAN INTERFACE AREA NO FLOOD]ANE NO ElCH1.FR HOME' 0 DESCRIPTION OF WORK � S TOTAL VALUATION: 4000 , RECEIVED BY: By my signature below,I certify to each of the llowing:-I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the infonnanon I have provi i ednecL 1 have read the Description of Work and verify it is accurate. 1 agree m co ly with all applicable local ordinances and state laws relating to buildi It ction. 1 authorize representatives of Cupertino to enter the above-id PrrrOpe. `or inspection pui�oses. Signature of ApplicanVAgene Date: 0J 7( ('2— suppLEmEwAll.rNitRMATION REQUIRED OFFICE USE ONLY N OVER-THE-COUNTER ❑ ECPRESS 1 U ❑ STANDARD U L ❑ LARGE E ❑ MAJOR A-(EPMucApp_2011.doc revised 06/11/11