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12060084 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10>45 MIRA VIS'T'A AVE CO.\I'RAC'fOR:SOLARCI'IY PE1011I NO: 12060084 ON'NER'SNAMIF,: MA'f'I'III:W&S'I'LIPIIANIEMII,I,I'R 3055 CLEARVIEWWAV DAIS ISSUED:06/142012 OWNER'S Pl IONE: 6,02049994 SAN MIA'TEO,CA 94402 11IIONE NO:((50)638-1028 ❑ LICENSED CONT RACfOR'S DECLARATION I— F F CIOCQO BUILDING PERMITINFO: BLDG ELECT PLUMB license Class CA F', Lic.k S%BI Oy r F r 4 N1EC11 RESIDENTIAL COMMERCIAL Contractor Due toI la' hereby alum that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REMOVE AND REPLACE FURNACE AND DUCE S.INSTALL (commencing with Section 7000)of Division 3 of the Business&Professions NC' Code and that nry license is in full force and effect. &ADD NEW,11"I'IC INSULA"PION I hereby affirm under penalty of perjury one of the following two declarations: I]live and will maintain a certificate of consent to self-insure for Worker's Co11npensmion,as provided liar 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 )]'the Labor Code,lin the perfonnancc of the work for which this Sq.FI Floor Area: Valualion:S19500 permit is issued. APPLICANT CERTIFICATION APN Number:35705002.00 Occuptmcy'1'rpe: I certif)'thin I have read Ellis application and slate that the above information is correct. I agree to comply with all city and county ordinances and state law's relating to building cunslructi al,laid hereby authorize representatives of this city EO enter upon d,e above mentioned property for inspection purposes. (We)agree it)save PERMIT EXPIRES IF WORK IS NOT STARTED indenmil) and keep harmless Lite City of Cupeninu against liabilities,judgments. 6815,anti CxPe11xS which may accrue against said City in consequence ofthe WITHIN 180 DAYS OF PERMIT ISSUANCE OR ,ranting of this Permit Additionally.the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all 11011-POinl Source regulations per the Cupertino Municipal Code,Section 9,IR Signal e �-C_nUZLILLb—n'� Date (0 14 �Z Issued by:�� /g� Date:Tri'/ ❑ OWNER-BUILDER DECLARATION RF:ROOF'S: I hereby affirm that 1 am exempt from the Contractor's Liccnsc Law for one of All roofs shall be inspected prior to any roofing material being installed. If a ruol'is the following two reasons: installed without first obtaining an inspection,I agree to remove all new analerials for I_as owner of Lite property,or Illy employees With wages as their sole compensation. inspection. will Jo the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature ol'Applicant: Date: Las owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044-I3euiness&Protcssions Code). :\1.1.ROOF COVERINGS"fO HE CLASS":\"OIt BE 1"1'4:12 hereby affirm under penalty of perjury one of the following three declarations: I bloc and will maintain a Certificate Of'Consent to self-insure for Worker's IIAZARDOVS)1:\'f F.RIALS DISCLOSURE Compensation,as provided for M'Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of tlue work for which this permit is issued. California lleallh&Safety Code.Sections 25505,25533,and 25934, 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino?Municipal Code,Chapter 9.12 and the lleallh& Section 3700 of the Labor Code.for the performance of the work for which this Safely Cade,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which trait hazardous air permit is issued contaminants as defined bs,the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Cade,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code.Sections 25505,25533,and 25534. Compensation hays of Califnntia. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the labor Code,I must Ow'ne�orr 1oulhorized ngtnt: lorlhw'ith comply with such provisions or this permit shall be deemed revoked. �-�-T `.( `LLQ-ULA n Date:—41 H, — APPLIC\NT CERTIFICATION CONS'IRUC'['ION LENDING ACF.NC1' 1 certil'y that I have read this application and slate that the above information is I hereby afiirin that there is a construction lending agency lir the peronhnance of evork's correct. I agree to comply with all city and county ordinances and stat law's relating for which this permit is issued(Sec.3097,Co. C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes,(We)agree to save Indenmi R'and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address costs,and expenses which may accrue against said City in consequence of the granting of Ellis permit.Additionally,the applicant understands and will comply ARCI I I I'EC I'S DECL%R%I ION with all non-point source regulations per the Cupertino Municipal Code.Section 9 1, 1 understand any plans shall be used as public:records. Signamrc Date Licensed Professional CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35705002 . 00 DATE ISSUED. . . . . . . : 06/14/2012 RECEIPT #. . . . . . . . . : BS000017069. REFERENCE ID # . . . : 12060084 SITE ADDRESS . . . . . : 10545 MIRA VISTA AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : MATTHEW & STEPHANIE MILLER ADDRESS . . . . . . . . . . : 10545 MIRA VISTA AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : SOLARCITY CONTRACTOR. . . . . . . . : LYNDON RIVE LIC # 28844 COMPANY . . . ... . . . . . : SOLARCITY ADDRESS 3055 CLEARVIEW WAY CITY/STATE/ZIP . . . : SAN MATEO, CA 94402 TELEPHONE . . . . . . . . : (650) 638-1028 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 19, 500 . 00 1 . 00 0 .00 1 . 00 0 . 00 1BREMAIRHA NO.UNITS 1 . 00 65 . 00 0 . 00 65 . 00 0 . 00 1BSEISMICR VALUATION 19, 500 .00 1 . 95 0 . 00 1 . 95 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 326 . 95 0 . 00 326 . 95 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 326. 95 12295 --------------- TOTAL RECEIPT 326 . 95 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ---- ---------------------- ---- --- ---- 505 FINAL ELECTRICAL '507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO 'FEE ESTIMATOR - BUILDING DIVISION its ADDRESS: Mira Vista Road DATE: 06/14/2012 REVIEWED BY: Sean APN: BP#: 'VALUATION: $19,500 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY SFD or Duplex PENTANIATION FURN/AC USE: PERMIT TYPE: WORK Remove and replace furnace and ducts install A/C install new attic insulation. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES A/C Units (<=10K c1m) 1BREMAIR 1 # $65 Furnace, Forced-Air 1MFR=<100 1 # $130 TOTALS: $195.00 Mech.Plan Check 0.0 hrs $0.00 P6u„h p&,,,ci„,k 17r;_ PI,,n 07-A Mech. Permit Fee: IMPERMIT I'Iu,rrh. F; libr. Other Mech. Insp. 1 0.0 hrs $44.00 oduvr PG,mh ln.,7,, n,der l:I<,. 1,,..p. .IJ,�rh. D,y.. h�r1'lumh. Gey,, pi•c lite. imp. F,'r: NOTE. This estimate does not include fees due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School District, etc. . These fees are based on the prelimina information available and are and an estimate. Contact the Dept for arddn7 info. FEE ITEMS (Fce Resolution If- Et' Z/l/I l/ FEE QTY/FEE MISC ITEMS I'lun C.'h,rch I C,•: Sup/l_ PCI f'., PME Plan Check: $0.00 P, o1 it I.,fc. supe/ hup Ie'! PME Unit Fee: $195.00 PME Permit Fee: $44.00 C',ntao III I n l'n Administrative Fee: InDMIN $41.00 Work Without Permit? O Yes 0 No $0.00 ,I,Irru,asl l'1,u1)1mg lees: Travel Documentation Fee: ITRAVDOC $44.00 Stronk Motion Fee: IBSEISMICR $1.95 Select an Administrative Item Illda Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $326.95 $0.00 TOTAL FEE: $326.95 Revised: 0610512012 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 CUPEkTINO Building Department JOB ADDRESS: PERMIT # �0 IC5y5 mir: UlstQ (Zd X (aDO OWNER'S NAME: o')ni+ mi .ii r PHONE # be-L3F5-1 O:D- 8 GENERAL CONTRACTOR Sov-Cxtu FAX # 650 - 2) 2- I I 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 Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date Simplified Prescriptive Certificate of Compliance:2008 Residential HVA CAlterations CF-IR-ALT-HVAC Crumte Zoom I and 3-7 SdeAddr� I QC5L45M%Y lS1-a KCl EgfMwn",4gatry. Date Penny 0: 0 ler I Z. Conifiiticued Duct insulation eat Type' List Nfmimum ElfieianFloor Am requimment Thermostat tP7admp Unit Over 40 ft of ducts COP_ Served by systrm added orreplaced m ❑Setback ot? SEER ®HSPF _ (((nmelreadyprison,manbs Unit ❑EER_ - ❑Resistancesf vaeonditiooed spaher /.Equipment Type:Choose the equipment tieing msmned;if mote tato owsystem,use another CF-I -ALT- AC for each system. 2.N w m us Equipment Efficiencies:13 SEER,73%AFUE,7.70PF for typical residential systems. Contractor(Documentation Author's/Responsible Designer's Declaration Statement) • I oatify 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 Por the design identified on this Certificate of Compliance. • I octify that the energy featmss and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Tide 24,Paris,I and 6 of the'California Code of Regulations. • The design features identified on this Certificate of Compliance are consistent wits the information docemented on other applicable compliance forms,swrksaeets,calculations.plans and speeificatious submitted to the eofort>rment agency for approval with the permit implication. Name: Q{ {�v�{ n S gemtme. kn U Company. G -a r" Cov-p Date: (.P I Li �Z Address C rLccnsc Ulm 104 City/staterzip:pari Mcg CI 4 G2 I 2008 Residential Compliance Forms.doc revised 04/10/11 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO. CA 95014-3255 :B (408)777-3228^FAX(408)777-3333• building(Dcupertino.oro CUPERTINO ❑NEV CONSTRUCTION ❑ ADDITION _ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERNUT M PROIECTADDRESS APNI 357-of - X20 a L OWNER NAME PHONE E-MAIL STREET ADDRESS STATE ZI FAX CONTACT NAME ..U� n °"� E-M"'n- TREET ADDRESS =.STATE IIP FAX ❑OWNER ❑ OWNFJI-BUlDER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGMEER ❑ DEVELOPER ❑TENANT CONTRACTORNAME LICENSE ER LICENSE TYPE C:IO BUS.LICK uan c��l z (2 �g8y t:DMPANY NAM�I^rG1 E-"AIL C� molar -cam FAX Z' lc2g STREET ADDRESS l.V CITY,STATE ZIP PHONE 30 1 1P CA C1I q4 ) 6 b--106$-1029 ARCHTTECTIENGNEER NAME LICENSE NUMBER BUS.I1C R COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK ont'), a t r cork k ,r . n 'Do" 0 PROPOSED USE CON TYPE 0STORffS USE TYPE OCC. SQ.FI'. VALUATION(5) 7 ERLSTG NEWFLOOR DEMO TOTAL AREA AREA AREA NET AREA - BATHROOM RITCFO:N OTI nt PPMODELAREA RFMODELARFA REMODELAREA PORCHAAFA I DECKAREA TOTAL DECK/PORCH AREA GARAGE AREA DETACH LJ ATTACH p DWELLNG UNM; ISASECONDUNTT YES SECOND STORYYES I BEING ADDED? WO ADDITION! - KNO PRP-APPLICATION OYES IF YES,PROVIDE COPY OF LSTBEBLDGAN YES RECETyED Y: - TOTAL VALUATION: PLANNING A°PLMJ$]`Na PtANNNGAPPROVALLETER RTCBLER ROME? O By my signature below,I certify to each of the following•. I a o the property owner or authorized agent to act on the prpperty owner's behalf. 1 have read this application and the information I have pmvided 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 nlating ttoo building construction. I authorize representatives of Cupertino to enter die above-identified pmp�eTrty for inspection purposes. Siguatu a of Applicant/Agenc I�-�.A �W'u ' Date: U , I L. - SUPPLEMENTAL INFORMATIONREQUIRED PIAN CRECK TYPE RRRTT?�� RouriNG SLIP New SFD or Multifamily dwellings: Apply for demolition permit for ( OVT.R ER-TBE-COUNTyf BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure CI STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project ❑ LARGE ❑ FIRE DEPT' _Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. 1-1 MAJOR ElSANTTAAY SEWER DLSTRIR ❑ ENVIRONMENTAL HEALTS BldgApp-2011.doc revised 06/21/11