12060122 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7557 NEWCASTLE DR CONTRACTOR:ATLAS-TRILLO HVAC PERMIT NO: 12060122
OWNER'S NAME: JOHNSON JUDY M AND LARS E TRUSTEE 1%5 KYLE PARK CT DATE ISSUED:06202012
OWNER'S PHONE: 4082529047 SAN JOSE,CA 95125 PHONE NO:1408)286-8931
LICENSED CONTRACTOR'S DECLARATION
J BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
Li
�,.s Class L i..0 Lic.k -10�O.T-1�--�_ r r r
7 MECH RESIDENTIAL COMMERCIAL
Contractor A_Q 1 .- r,Mn Dale
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REPLACE FURNACE AND ADD A/C UNIT
(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-insurc 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: Valualion:$8000
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
permit is issued. APN Number:36617073.00 Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
cored.I agree to comply with all city and county ordinances and stale 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 this permit. Additionally,the applicant understands and will comply /
with hh all non-point source regulations per the Cupertino Municipal Code,Section Issued by: z Date:(y!�'j1
Signature �'\ Date_"'
RE-ROOFS:
❑ OWNER-RUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed withoat first obtaining an inspection,I agree to remove all new materials for
1 hereby affirm that I am exempt from the Contractor's License Law for one of inspection.
the following two reasons:
1,as owner of the property,or my employees with wages as 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)
I,as owner of the property,am exclusively contracting with licensed contractors to ALI,ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby alarm under penalty of perjury one of the following three HAZARDOUS NIATERIAI S 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. Safety Code,Section 25532(x)should 1 store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as piovided for by Additionally,should 1 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 Our lity Management District 1 will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Health&Safety Code,Sections 25505,25533,and 25534.
1 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 O e ooze genf� S
Compensation laws of Califamia. If,after making this certificate of exemption,I Date: •( 1fj \
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY
hereby affirm 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 state 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 harnless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S ITECT'S DECLARATION
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 Pm%crtptnT Certificate of Compliance. 2008 Residential HVAC A tearooms CI'-I R-AI:f-VAC
Climate Zones 1 and 3-7 -
Manufactuter. Model Number.
Site Address: Enforcement Agency: Date: Permit No.
EcpiipmentType list Minimum= Conditioned Duct Insulation p1wrin stat
Efficiency floor Area requirement
o Packaged Unit, ' oAFU13 oCOP_ Served by Over 40 ft of ducts o Setback
Xvmace WSEER 'oHSPF system Added or replaced (if not already,
o Indoor Cod DEER oResistance sf in Unconditioned present,must
El Condensing Unit22 space be installed)
o Other 131 o R G(C'/_ 1,3-5)
I. Equipment Type:,Choose the equipment installed,if more than one system,use another CF-1 R-AI.T-
I I VAC for each system.
2. Minimirn Equipment Efficiencies: 13 SEER,78%AFUE,7.7 I ISPF for typical resitkntial systems.
Contractor(Documentation Authors/Responstble Designees Declatation Statement)
• 1 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 cemfy,that the eneigy,features and perfimnance specifications for the design identified on this
Certificate of Comjtlance confirm to the requirements of Title 24,Parts I and G of the California
Code of Regulations
• The design features identified on this Certificate of Ctrgiliance are consistent with the information
documented on other applicable compliance fortes,worksheets,calculations,plans and specifications
submitted to the ennforcemet agency for approval with the permit application.
Name: - - Signature:
Company. n, Date:
Address: license No.:
City/State/zip:' . - Phone No.:
Planning Approval Setback from property:
V
,t
JUN �0 2012
VI- -
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 7557 new castle dr. DATE: 06/20/2012 REVIEWED BY: bobs.
APN: BP#: 'VALUATION: $8,000
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Duplex PENTAMATION FURN/A
USE: pPERMIT TYPE:
WORK re lace furnace and add a/c/unit.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
A/C Units (<=10K cfm) 1BREMAIR 1 # $65
Furnace, Forced-Air 1MFR=<100 1 # $130
TOTALS: $195.00
Mech. Plan Check0.0 hrs $0.00 PLm,b. plan Chc,6 h• . Ma,, Ch,',A
Mech. Permit Fee: IMPERMIT Pbm,h. Pc,',oa 1, lil..r. 1 l
Other Mech. Insp. 0.0 hrs $44.00 oaw, ivumi,insp. Lj U,brr/i/rr. /rop.
h,11.Lay' /-,r' Plumb. lmpm Fed: I'&r. /n,/,J,,C.
NOTE: This estimate does not include fees due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School
District,etc.). Thesefees are based on fire prelimina information available and are only an estimate Contact die De r or uddn7 info.
FEE ITEMS (F�e Resolution /1-053 Efl. 7111111 FEE QTY/FEE MISC ITEMS
Pian ( hc(k 1rr:
Suppl, PC 1 i•C
PME Plan Check: $0.00
l4'ttnit l4rr:
Supp/. Insp h'r•e
PME Unit Fee: $195.00
PME Permit Fee: $44.00
C'un.rnvavirnr 7u.c:
Administrative Fee: ]ADMIN $41.00
Work Without Permit? O Yes (F) No $0.00
Adl"Jih rd Plmmfn�tf I''CC.r:
Travel Documentation Fee: ITRA VDOC $44.00
A
Strong Motion I cc: IBSEISMICR $0.80 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $325.80 $0.00 TOTAL FEE: 1 $325.80
Revised: 06/30/2012
j -2-
GENERAL PERMIT APPLICATION P
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 I
SC
CUPERTINO (408)777-3228• FAX(408)777-3333• buildino(d)cu0ertino-oro
MB1NG CHANICAL ^ ELECTRICAL MISCELLANEOUS /1
PROIERADDRESS I
�1/r/W X577 A /n',1 AP\e /� IS
OWNERNAME 1 V'//N(n/V✓ t- /f(il' i</ jl — V E-MAIL
STREET ADDRESS Y ,, SSTATE,ZIP I FAX
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE.ZIP FAX
❑OWNER ❑ OUTER-BUILDER ❑ OwNER AGENT XCINTRACTOR CONTRACTOR AGENT nRCHITECT ❑ENGINEER ❑ DEN ELOPER ❑TEC.4\'T
CONTRACTOR NAME A /A � /( LICE\SE NUMBEIy 8 /3 LICENSL�:P6 J. BUS,LIC>
COMPANY NAME /X�(( f-I E-MAIL Jj /(� � �� FA\
STREET ADDRESS CITY.STATE,ZIP 1 L /�` PI .�39-Gsl
ARCHITECT/ENGINEER NAME (/7 LICENSE NUMBER ` / / r/ US LI[d
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD or DUPLEX ❑ MULTI-FAMILY PROJECT B:WIIDIANTI ❑ 1ES PROJECT IN ❑\"ES IS THE BLDG AN ❑ 1'ES
BUILDING, COMMERCIAL URBAN INTERFACE AREA NO FLOOD ZONY ❑NO EICHLERHOME? ❑NO
DESCRIPTION OF WORK /9 l-
,4d�
TOTAL VALUATIO. t RECEIVED Bl':
By my signature below,1 certify to each of the following: 1 am the property owner or authorized agent to act on the property mvner's behalf. I have read this
application and the information I have provided mect. I have read the Description of Work and verify it is accurate. I agree io comply wi[h all applicable local
ordinances and state law's relating to bu u rcpresenlalives of Cupertino to enter the above-id tified p perry for inspec[ion puiposes.
Signarurc of Applicant/Agent: Date:
SUPPLEMENTAL MFORMA REQUIRED ,y OFFICE USE ONLY
LJ O\'ER-TIIE-COUNTER
❑ EXPRESS
1
J
❑ STANDARD
U
i
< ❑ LARGE
❑ MAJOR
AIEPAfiscApp_2011_doc revised 06/21/11