12100178 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7851 CREEKLINE DR CO\IRACI'OR:AAA FURNACE&AIR PERMIT NO: 12100178
CONDITIONING
OWNER'S NAME: ROSENTHAL JANE L AND JACK A 1712 STONE AVE DA'Z'E ISSUED: IOP_42012
OWNER'S PHONE: 4082028176 SAN.IOSE,CA 95125 1111ONE NO:(408)293-4717
❑ LICENSED CON"FRACf"'O�R'SS DECLARATION BUILDING PERMIT INFO: BLDG r. ELECT0 PLUMB
License Class l_ ON Lic,q _2 V D 7 I r [I r
(� �` n/ 7 AIECII RESIDENTIAL COMMERCIAL
Contractor Am F011-a e- Dale �O _pt —/2-
1
/2-
1 hereby a(fnn that I am licensed under the provisions of Chapter 9 •JOB DESCRIPTION:REMOVEAND REPLACE EXISTING FURNACE
(commencing with Section 4000)of Division 3 of the Business S Professions '
Code and that my license is in full force and effect.
hereby affirm under penally of perjury one of the following rvo 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 Floor Area: Valuation:$3500
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:3621704400 Occupancy Type:
%PPI.ICANI'CER'1'IFICA'1'ION
I certify that I have read this application and state that the above information is
correct.l agree to comply with all city and county ordinances and slate 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 ofCupertino 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 all non-point source regulations per the Cupertino Municipal Code,Section Issued by: !G Date: `0•ate/ /
9.18.
Signature ' '✓ Date/0
REI-ROOFS:
❑ OWNER-BUILDER DECLARATION All roofs shall be inspected prior to my rooting material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
I hereby affirm that I am exempt from the Contractor's License Law for one of inspection.
the following lvn 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 1 FIVER
construct the project(Sec.7044,Business&Professions Code).
hereby affirm under penally of perjury one of the fallowing three IIA%ARDOUS MATERIALS DISCLOSURE
declarations: I have read the hazardous materials requirements under Chapter 6.95 of the
1 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. Safery Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Workers 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 1 mill
maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the
permit is issued Ileallh&Safer 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 any person in my manner so as to become subject to the Worker's Ow r or aWhoritti ertt� //
Compensation laws of California. If,after making this certificate of exemption,1 ,,((�/ffjj�fjj Irate: /0"9Yr/!/'7,
become subject to the Worker's Compensation provisions of the Labor Code,1 must /
forthwith comply with such provisions or this permit shall be deemed revoked. CONS9RUC7ION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
APPLICAYf CERTI FICATION for which this permit is issued(Sec.3097,Cir C.)
I certify that I have read this application and slate that the above information is Lender's Name
correct.1 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,
costs,and expenses which may accrue against said City in consequence of ARCHITE I"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
: iz I ► �
GENERAL PERMIT APPLICATION
. COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION MP 1 • 1 1
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 ' ^ A
CURERTINO (408) 777-3228 • FAX(408) 777-3333 • buildinc6cu°ertino.°ra J (v_
-7❑PLUNSING V NMCHANICAL ❑ELE=TCAL ❑MISCELLANEOUS
PaoJEcrnnoaEss' 1G17� 1m1MuC �nJe IAaGA' Lf 9
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OWTNAME, GN. �V%nfi/ at'
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SrREETADDRESS—A(;j C1 `V,/r , �, nA C1�4 q03\4 FAX
CONTACT NICE (��"'(())77 !�`.�K-1A,✓
u�/� '11. �yv/✓� (A�� rL� PHDNE N3-410 E-MAd.
STREET ADORPSS I,Irl SA he- TC(
vivi d1'} �}J "1�
• ❑OWNER ❑ o"EP.a WLOM ❑ OWNERAGENT CONTRACTOR ❑COM. CCTORACENT ❑ ARL MR ❑ ENGINEER ❑ DEVELOPER ❑TENAM
CONTaACTOR NAME\ m V4/mctl L:CE.N' Ea 11 I LIlENSE TC E BUS.LIC/
COWANYNAhIE , (��AI v, 1��1 M EMEI ( FAX te�Inr` { f/) •24 - b534
STREET ADDRESS ' ,{� {Rv`• .k` ( `.�'VI Te 1� �1i'!S P
V C/ '7Li3 rl
A1!=CT/ENGDMER NAh1E LICENSE N"ER BUS.LIC I
MWANY NAME E-MAR FAX
STP-M ADDRESS CITY,STATE,ZIP PHONE
USE OF t;or DuplcX ❑ Multi-Family PROJECT INWRDLA.NO PROJECT IN
STRUCTUTLE: ❑ 'COrriatercial URBANINIF FAC•EAREA ❑ Yes Q No TLOoD iOmE ❑ Ya No
DESCRIPTION OF WORK /l ya'1 I/r(`O, - "CACe-'-
�� . VI'r(JI VIIV
TOTAL VALUATION: .71_��•� Milos,
" �y w -�...,
IIJJ�r II ffiti^ � •u. . 7
By my signanue below,I certi •o each f the Collo 'ng: (am Lhe property owner or authorized agent to act an Lite property owner'i behalf. t have read this
application and the infortnad I have pr vided'Is a rrece. 'f have read the Description of Work and verify it is accurate I agree to comply with all applicable IoW
ordinances and=to laws ry acing to buil ing co cdon. I authorize representatives oCCupertino to enter the above-'dentifie property rar.inspection purposo.
Signamreor Applic"LlAg I f. I Date:
SUPPLEiv AL WFORMA't-ION REQULRED —
REPhftscApp 1011.doc revised 03%16/11
Prescriptive Certificate of Compliance: Residential CF-IR-ALT
Residential Alterations (Page 4 of 5)
Project Name:
Climate Zone 4 P at stories
HVAC SYSTEMS - HEATING
Minimum Duct or Piping Configuration
etg Equipment Effciency Distribution Inulation Thermostat (Central,Split,
Hain dCapacity,''r -Value Type Space,Package or H
dronic
Type nAFUEorHSPF) _Type andLocation' R
i
I.Indicate Henning Type(Central Furnace. Wall Furnace. Hear pump. Boiler. Electric Resistance. etc)
2.Electric resistance heating is allowed only in Component Package C.or except where electric heating is supplemental(i.e.. ito[al capociry
< 2 KW or 7.000 Bndhr electric heating is controlled by a rime-limiting device not exceeding 30 minutes). See§!3)(b)3 exception.
3.Refer to the HERS Verification section on Page 4 of the CF-I R-ALT Form for additional requirements and check applicable boxes.
4. Indicate Type or Location (Ducts. Hvdronic in Floor, Radiators.etc.)
HVAC SYSTEMS-COOLING
Minimum
Efficiency Duct or Piping Configuration
Cooling Equipment (SEER/EER or Distribution Insulation Thermostat (Central,Split,
T e and Ca stir '�'- SDP) T e and Locations R-Value Type Space, Package or H dronic
1. Indicate Cooling Type(A/C. Heat pump. Evap. Cooling, etc) -
2. Refer to the HERS Verification section ort Page 4 of the CF-1 R-.4LT Form for additional requirements and check applicable bores.
3. Indicate Type or Location(Ducts, H dronic in Floor. Radiarors,etc.)
NATER HEATING
List water heaters and boilers for both domestic hot venter(DHIV)heaters and hydronic space heating. Individual dwelling DHW heaters mutt b
gas or propane fired, and may not exceed SO gallons. Hot water pipe insulation from the DMV hearer to the kiichen(s)and on all underground
hon roarer pipes is required in all tom onent acka es in all clinmte zones.
External Tank
Water Heater Type/Fuel Distribution Type Number In Tank Energy Factor or Insulation
Type' (Standard, Recirculatin )' System Capacity(gal) Thermal Efficiency R-Valuer
1. Indicate Type(Storage Gas. Heat Pump, Instantaneous.etc.)
2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of§/50(n). The Prescriptive requirements do
non allow the installation of a recirculating water hearing system for single dwelling units.
3. The external water heating tank and pipes shall be insulated to meet the requirements of f SD(i)r
SPECIAL FEATURES The enforcement ogencv should pr v special attention to the Special Features specified in this checklist below.
These items may req uire written justification and documentation ands ecial veri rcalion.
NEN'.ROOF ASSEMBLY-Radiant Barrier
The radiant barrier requirement of§15 1(02 does not apply to roof alterations.
Slab Edge(Perimeter) insulation D YES D NO
YES: In Climate Zone 16 in Component Packages D, R-7 insulation is required.
Heated Slab Insulation D YES D NV
YES:Slab edge insulation required for all heated slabs in all Climate Zones. See details in Table 118-A of.the standards.
Raised Slab Insulation D YES D No
YES: In Climate Zones I,2, 11, 13, 14& 16,R-8 insulation is required; in Climate Zones 12 & 15, R-4 is-required under component Package D.
Thermal Mass
To obtain Compliance Credit for the installation of thermal mass,use the Performance ADDroach.
Registration Number: Registration Date/Time: HERS Provider:
2008 Residential Compliance Forms August 201
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 7851 creekline dr. DATE: 1 0/2 412 01 2 REVIEWED Bl': bobs.
APN: BP#: 'VALUATION: $3,500
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARYPENTAMATION
USE: SFD Or Duplex PERMITTYPE: FURN/A i
WORK remove and replace existing furnace.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced-Air 1MFR=<100 1 # $133
TOTALS: $133.00
Mech.Plan Check 0.0 1 hrs - $0.00 Phunb. Plan Check Flee. Plan Check
Mech. Permit Fee: IMPERMIT Plumb. Permir Fec: Floc.Permit Fee:
Other Mech. Insp. 0.0 hr§ $45.00 Odaa Plumb Imp. El
Oilier Eler.Insp.
Mech.hap.Fee: Plumb. bisp. Fee: Elec.Imp. Fee:
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 baser)on the prelindnto3 information available and are only an estimate Contact lite Dept for alldn'l info.
FEE ITEMS(Fee Resolution 11-053 Ef/ 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
5'uppl. PC Fee
PME Plan Check: $0.00
Permir Fee:
Supp). Insp Fee
PME Unit Fee: $133.00
PME Permit Fee: $45.00
Constnvrction Tax
Administrative Fee: IADAON $42.00
Work Without.Permit? O Yes (j) No $0.00
Advanced Planning Fces:
Travel Documentation Fee: )TRMIDOC $45.00
Strong, Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
131de Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $266.50 $0.00 TOTAL FEE: $266.50
Revised: 10/01/2012
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: PERMIT# O4/7
OWNER'S NAME: 1Ae, p ei 4-hAl PHONE# � ' —q7/
GENERAL CONTRACTOR: 14AA 1A14i-P , BUSINESS LICENSE # 7
ADDRESS: 17 Z S CITY/ZIPCODE: o e C /,
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACT RS HAVE OBTAINED A CITY .OF CUPERTINO
BUSINESS LICENSE.
1 am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the ollowing information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/ Carpeting
Linoleum /.Wood
Glass/Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date