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12100119 CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: 10701CASTINE AVE CONTRACTOR:ATLAS-TRILLO IIVAC PLRMITNO: 12100119 OWNER'S NAME: SOMA EDUNURI 1965 KYLE PARK CI' DATE ISSUED: 10116/2012 OWNER'S PHONE: 4084214252 SAN JOSE,CA 95125 PHONE NO:(408)286-8931 ❑ LICENSED CON fRACI'OR'S DECLARATION r_ r IJ ��''a � BUILDING PERMITINFO: BLDG ELECT PPLUMBLicense Class�Z Lie.tl 3 r_ r r O ��� R1ECI1 RESIDENTIAL COMMERCIAL Contractor /-'1-/(�4'): J 1 !V UAJ Date hereby affirm that I am licensed tinder the provisions of Chapler') JOB DESCRIPTION: REMOVEAND REPLACE FURNACE SAME LOCATION, (commencing with Section 7000)of Dk ision 3 of the Business& Professions 1000 Code and that tiny license is in full force and effect. BTU,80% hereby affirm under penalty of perjury one of the following tiro 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 die work for which this Sq.Ft Floor Area: Valuation:$2000 permit is issued. APPLICANT CERTIFICATION APN Number:32643039.00 OrcupancyType: I certify that I have read this application mid 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 properly for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnifv and keep harmless the Cit, fCupcnino against liabilities,judgments, costs,ande pense idtich in enst said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of his per it. Add if alvthe m 'cant understands and will comply 18f) D S FROM L T CALLED INSPECTION. with all no -point re I rims p (e C ni enino Municipal Code,Section 9.18. 6 �� Signature Issued 1) a Date: ' Dam ❑ OWNER-RUILDER DECLARATION RF--ROOFS: 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(See.7044, Business&Professions Code) Signature of Applicant: Date: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(See.7044,Business&Professions Code). ALL ROOF COVERINGS TO RE CLASS"A"OR BETTER hereby affirm under penult).of perjury one of the following three declarations: I have and will maintain a Cenificate of Consent to self-insure for Worker's HAZARDOUS MATERIAI S DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the 1 have read the hazardous materials requirements under Chapter 6.9.5 of the performance of the work lot which this permit is issued. California Ilealth&Safery Code.Sections 25505.25533,and 25534. 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 Health& Section 3700 of the labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use-equipment or devices which emit hazardous air permit is issued. contaminants as de ted b))he Ba•Area Air ) Quality Jtanagement District 1 will I certify that in the performance of the work fn-which this permit is issued,I shall maintain complia cc with Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Ileo h& rt• 'oda 'r s 25505,25533,and 25534. Compensation Tars of California. If,after making this certificate of exemption,I / become subject to the Worker's Compensation provisions of the Labor Code,I must Ow er it �,'thy iz (: ("� m forthwith comply with such provisions or this permit shall be deenied revoked. ,01(late:—to AI'1'LICANI'CER'1'IFICAT'ION CONSI'RUC1'ION LENDING AGENCY I certify 1hatI have read this application and state that the above information is I hereby affirm tha there is a construction lending agency for the performance of work's correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ 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 indemnify 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 this permit.Additionally,the applicant understands and will comply ARCHITEICI"S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 10701 casting ave. DATE: 10/16/2012 REVIEWED BY: larrys APN: BP#: `VALUATION: $2,000 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY PENTAMATION USE: SFD Of Duplex PERMITTVPE: FURN/AC WORK remove and replace furnace same location 1000 btu 80% SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNI'T'S BP FEES Furnace, Forced-Air 1MFR=<100 1 # $133 "TOTALS: $133.00 Mech. Plan Check 0.0 hrs $0.00 Plmntb.Plan Check Elec. Plan Check Mech. Perini( Fee: 1,1-1PER41IT Plumh. Permit Fee: flec. Permit Fee: Other Mech. Insp. 1 0.0 hrs $45.00 Other Plumb Insp. El Other Elev.htsp. Hoch. hup. Fee: Plumb. hr.rp. Fee: Elev.Insp.Fee: NOTE: This estimate aloes not include fear due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School District,etc. . Thesefees are based on the preliminan information available and are onlf an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-0531-_L.' 7/1/121 FEE QTY/FEE MISC ITEMS Plan Chuck Fee: Supp(. PC Fee PME Plan Check: $0.00 Permit Fee: Supp(. btsp Fee PME Unit Fee: $133.00 PME Permit Fee: $45.00 Consultation Tax: Administrative Fee: 1ADMIN $42.00 Work Without Permit? I) Yes 0 No $0.00 dvenicecl Planting Fees: Travel Documentation Fee: /TRAPDOC $45.00 A Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $266.50 $0.001 TOTAL FEE: $266.50 Revised: 10/01/2012 GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 M I (408)777-3228• FAX(408)777-3333•building(DDcupertino.org CUPERTINO SIC "be❑PLUMBING ECUANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS Q I(nAPNM 2— OWNER NAME STREETADDRESS OI I T 1 C r CONTACT NAME PHONE E-MAIL STREEI'ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT >QNTRACTOR ❑CONDtACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT C rMELI �NS LIC BUS.LIC M RJ tio COMPANY NAMEAI F X YYI S DD 5 C' C Y S T P N. 0 �r��/�'v8 / Aff6r (�l.LLilJ A61FITCT/ENGINEERN IE LICENSENUMBER BUS.LIC0 COMPANYNAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF 04M.,DUPLEX ❑ MULTIFAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES BUILDING: ❑COMMERCIAL ` URBAN INTERFACE AREA ❑ NO FLOODZONE ❑NO EICHLER HOME? ❑ NO DESCRIPTION OF WORK N To 0011-01 k TOTAL VALUATION: '— RECEIVED BY:. By my signature below,I certify to each of -IDllowing: m the pr pe y owner or authorized agent to act on the property ow 's bchal f. I have read this application and the information I ha'e prov correct I haver Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating t build g con ctI nut ize prejenlatr�s of Cupertino to enter the above-identified p//rape for inspection purposes. Signature of Applicanl/Agent: / Date: /fJ � SUITLENIENTAL M- RMATION REQUIRED ovFlce rise oa'Li ❑ OYER-rH&COUNTER• } J ❑ CXI'R4S5 - L V J ❑ SrANDARD V' ❑ LARCe ❑ MAJOR' X1EP,WseApp_2011.doc revised 06121/11 Simplified Prescriptive Certificate of Compliance: 2008 Residential FIVAC Alterations CF-IR-ALT-VAC Climate Zones 1 and 3-7 Manufacturer. Model Number. LU Site Address: / Enforcement Agency: Date: - Permit No. 070 l C'A%11\1e Equipment Type' Listi\•futitnum2 Conditioned Duct Insulation Thermostat Efficiency Floor Area I requirement ❑Packaged Unit Y&IFUE ❑COP_ Served by Over 40 ft of ducts ❑Setback t—Vornate ❑SEER ❑HSPF_ system Added or replaced (if not already ❑ door Coil ❑EER ❑Resistance sf in Unconditioned present,must o Condensing Unit space be installed) ❑Other o R 6(CZ 1,3-5) 1. Equipment Type Choose the equipment being installed;if more than one systema,use another CF-IR-ALT- HVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEER,78%AFUE,7.7 HSPF 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. • 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 • 1 certify that the energy features and performance specifications for the design identified on this Cartificate of Compliance conform to the requirements of Tide 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 forms,worksheets,calculations,plan specifications submitted to the enforcement agency for approval with the permit. licati ' Name. I KJt1 Signature: Com . Date: / Address: License No.: Phone No.: Planning Approval: Setback from property: