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12080268 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRFSS: 22415 PALM AVE CONTRACTOR:COLD CRAFT INC PERMIT NO: 12080268 OWNER'S NAME: LIGGETT CHARLES F AND KATIiLEEN 181 LOST LAKE LN ' DATE ISSUED:08272012 OWNER'S PHONE: 4083916259 CAMPBELL,CA 95008 PHONE NO:(408)374-7292 ❑ LICENSED CONTRACT'OR'S DECLARA'T'ION r r r: - I BUILDING PERDIIT INFO: BLDG — ELECT PLUMB License Class3-SLic:q r r IJ Cr � I � /� �7 MECI1' _ RESIDENTIAL COMMERCIAL Contractorc-1)l d 1.1�rM 4- Date D hereby affirm that 1 am licensed under the provisions of Chapter 9 306 DESCRIPTION:REMOVE AND REPLACE FURNACE IN SAME LOCATION (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 cenificate of consent to self-insure for Workcr'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:52778 I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for dhe performance of the work for which this permit is issued. APN Number:35703029.00 Occupancy Type: APPLICANT CERTIFICATION 1 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 Imus relating PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter - upontheabovementionedpropertyforinspectionpurposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnifyand keep harmless the City of Cupertino against liabilities,judgments, r costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulationsGthupertino Municipal Code,Section Issued by: ✓�i�/✓ ���G�! Date: 9.18. Signature. )ate / RE-ROOFS: ❑ - OWNER-BUILDER DECLARATION 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 hereby affirm that I 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 as their sole compensation, Signature of Applicant: Date: 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 ALL ROOF COVERINGS'TO BE CLASS"A"OR BE fITR construct the project(Sec.7044,Business&Professions Code). 1 hereby affirm under penalty of perjury one of the following three HAZARDOUS 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 Ilealth&Safety Code,Sections 25505,25533,and 2.5.534. I 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 Ilealth& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation insurance,as provided for by Additionally,should 1 use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for die performance of the work for which this contaminants as defined by the Bay Aren,Air Quality Management District 1 will maintain compliance with'the Cupertino Nfunicipal Code,Chapter 9.12 and the permit is issued. Health&Safety Code.Sections 25505,25533,and 25534. I certify that in the performance of the work for which this permit is issued,I shall not employ anyperson in any manner so as to become subject to the Worker's Os izI a eat v - Compensation Imes of California. If,after making this certificate of exemption,I )ale: 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 I 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 cored.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 harmless the City of Cupertino against liabilities,judgments, ARCI I ITECT'S DECLARATION 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 100S Hesidenrir+l Compliance Fnrnrs.doc revised 04110112 I IZ (D9 Ilau -2-- (-'-D GENERAL PERMIT APPLICATION mEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 ■ 3 I c CUPERTINO (4-08) 7T-3228 • FAX(408)T7-7-3333• SuildinckDruoercino.oro ❑PL.L�flLNC, !ECI-KCAL. ❑E!_ECZCkL ❑N csGLi>NcOUS /J` fltM i%F ? / lJ / OWNER NAME - / . .HONE E-MAM S7==ADDRESS C[1Y, STATE ZIP FAX I (A C014TAC1 NAME NONE E-MAL SSE-ADDRESS L,a_,STAT� Z3 FAX ❑OwNER ❑ 0wh'E:R-aM ❑ 0wNEa AGi..Nr mn-ru,eoR ❑wNrzA=R Acs.; ❑ AR C== ❑n+GYE ER ❑ o _oen ❑ -=yAN; CONTRACTORNAME - uCENSE NL'h1ER I GQISE TYPE 13lig._Cq UL/ COMPANY NAME I E.MAM „ �- ,tAX g - 6-7 4-13 3-3 r. sTxADDRESS ARCIa ECTIENGWrRNAMEJ ucENsE vuMaER I ays.uc a COMPANY NAME' I E-MAD. FAX STR.EEC ADDRESS Cir,1.STATE,T3 PHONE USE OF YES 9=D:G: YES �COWi tCAL ❑ MULTI-:M•LY I U1BANDITERFACc ARTA ❑ NO I PFLOOD ZONE ROUECT IN P-N❑ 0 I E1CiL=il OMc-1 NO DESCAPTON OF WORT: TOTAL VALUATION: / I RECEDED BY: 3y my sigratn.:below,I certify to each ti the fellowing: I ac the propc.f owner or anth=zed agent M act on the oropery owner's`lichal`. i bave read this application and;he inforataricci 14zwe oravded is coret III read the Desciption of Work and vcfy it is accnzcc. I agree to cotnpiy wish all applicable local mvnzTcs and sate laws mlats -.o' t+i''_ ons •coon. 1 3 r'zo M tescacves of Cnper,.=c ^ter L':e ehe ideti5e3. pe.—y.cr inspection otrpeses. sig:vatw-e of ApplicandAgenn Date: Zi SLP.PLEbLN 1. .t MgTiON REQUIRED OFFICE USE ONLY O 'ER-THE-COUNTER EXPRESS U STANDARD U Z ❑ LARCE 5 ❑ MAJOR MP?Mua4pp_2011.doc revised 0601/11 ' I CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 22415 Palm Ave DATE: 08/27/2012 REVIEWED BY: Sean ` APN: BP#: 'VALUATION: $2,778 *PERMIT TYPE: Mechanical Permit PLAN CIIECK TYPE: Alteration /Addition / Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMITTYPE: FURN/ACAt NVORK Remove and replace furnace in same location. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $133 TOTALS: $133.00 Meeh. Plan Check "00 $0.00 Plumb.Plot)Cheek Flea Plan Check Mech. Permit Fee: IMPERMIT Plumb.Permit Fee: Mee.Permit Fee: Other Mech. Insp. 0.0 hrs $45.00 Other Plumb In.sp. Other Flee.Insp. klech. limp. Pec: Plumb. /nap. Fee: Flec.hcsp.Fee: NOTE: This estimate does not include fees due to other Departments(i.e. Planning, Public 11'orks, Fire,Sanitary Sewer District,School District,etc. . These ees are based on the prefintinan information available and are onb,an estinmte. Contact the Dept for otldn'I info. FEE ITEMS (Fee Resohaion 11-053 E(L 7/I//l FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl. PC Fee PME Plan Check: $0.00 Permit Fee: Supp/. /nsp Fee PME Unit Fee: $133.00 PME Permit Fee: $45.00 Construction Tax: Administrative Fee: (ADMIN $42.00 Work Without Permit? O Yes Q No $0.00 I tivanced Planning Fees: Travel Documentation Fee: ITRdIDOC $45.00 Strove Motion Fee: IBSFISHICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $266.50 $0.001 TOTAL FEE: 7$266.50 Revised: 07/01/2012 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAlterations CF-IR-ALT-HVAC Climate Zona 1 and 3-7 SiteAddrz Enforceme tAgency: Date: Permit H: Conditioned Duct insulation Equipment T l List Minimum Efficiency Floor Area requirement Thermostat Fmnaced Unit /AFUE d Over 4 ft of s L"J - ®COP etbxk Smcd by system adtcrl o ad in ®Indoor Coil ❑SEER_ HS PF_ sf on mndspace p/as alreadvpresmt.mart be Condensing Unit EER_ ©Resistance 6 (CZ 1 3 3) iartalled) Other 1. Equipment Type:Choose the equipment being installed:if more than one system,use another CF-I R-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) • 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. • 1 certify that the energy features and performance specification¢for the design identified on this Certificate of Compliance conform to the requirements of Tide 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 appikcation. ' Name: Signalure: Compan : Address: License: Citylstale2ip: / -G�-q S20 Phone: _ 3 '7y -- 7.-2,22 2008 Residential Compliance Forna.doc revised 04110/13