12110056 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10179 BYERLY CT CONI'RACFOR:ONE HOUR HEATING PERMIT NO: 12110056
AND AIR
OWNER'S NAME: SUM JOYCE C AND CHARLES P 1400 PETALUNIA HILL RD DATE ISSUED: 11/092012
OWNER'S PHONE: 4082577381 SANTA ROSA,CA 95404 PHONE NO:(707)545-1800
ILICFNSF,D CONTRACFOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL .
License Class Geo Li,A ��{ 09 9 �9 REPLACE FURNACE IN SAME LOCATION
contractor 0- 12- Ffti/-1 Q r-fh Z Date I,
I hereby affirm that 1 am licensed under the provisionsof Chapter')
(commencing with Section 7000)of Division 3 of the Business S Professions
Code and that my license is in full force and effect.
hereby affirm under penalty of perjury one of the following two 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 Cade,for the
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$7308
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
\PN Number.34212084.00 OccupancyType:
permit is issue].
APPLICANTCERTIFIC\TION
I certify that I have read this application and stale that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAY OM ,AST CALLED INSP CTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accme against said City in consequence of the I�
m
granting of this permit. Additionally,the applicant undes and will comply Issued by: Dale: 66 1
with all mm-point source regulations per the Cu unicipal Code,Section -
9.18.
RE-ROOFS:
Signatui Date Z All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,1 agree to remove all new materials for
inspection
❑ OWNE - MILDER DECLARATION
Signature of Applicmu: Date:
1 ltZ'.ffi—rm that I am exempt from the Contractor's License Law for one of -
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BF;ITER
1,as owner bf the property,or my employees with wages as their sole compensation,
will do the work,and die structure is not intended or offered for sale(Sce.7044,
Business&Professions Code)
I,as owner of the property,run exclusively contracting with licensed contractors to IIA7,ARDOIIS NIATERIALS DISCLOSURE
construct the project(Sec,1044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code.Sections 25505,25533,and 25534. 1 will
1 hereby affirm under penalty of perjury'one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to sell-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Jlunicipal Coder 9.12 and
I hmro and will maintain Worker's Compensation Insurance,as provided for by the I Iealth&Safety Code,Sections 255115,25533,and 25 .
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent: Uatc ! /S /2,
permit is issued.
I 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
Compensation law's of California. If,after making this certificate of exemption,I CONST ON LF\DING AGF,NCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(See.3097,Civ C.)
Lender's Name
APPLICANT'CERTIFICATION Lender's Address
I certify mat 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,mid hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save ARCIII"fFCF'S DECLARATION
and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10179 BYERLY CT DATE: 11/09/2012 REVIEWED BY: SYLVIA
'A PN: BP#: 'VALUATION: $7;308
*PERI111T TN'PEi Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair '
PRIMARY SFD or Duplex PENTADIATION FURN/AC
USE: PERMIT TYPE:
WORK REPLACE FURNACE IN SAME LOCATION
SCOPE
APPLIANCE'/EQUIP TYPE FEE ID QTl' UNITS BP FEES
Furnace, Forced-Air 1MFR=<100 1 # $133
TOTA LS: F $133.00
Mech.Plan Check 0.0 1 hrs $0.00 Plutab.Plan Cheek Elec.Plan Check
Mech..Permit Fee: ImPERAIIT Plumb. Permit Fee: File. Permit Fee:
Other Mech. Insp.- 0.0 hrs $45.00 Other Plumb Imp. El
Other face. htsp. El
,Mech.bap.Fee., ' ' Plumb. lase.Fee: Elec.htsp.Fee:
NOTE: This ectintate does not includejees due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School
District,etc). These eev are baser/nn the prelintinan information available and are adt•an estimate. Contact the De t or adtbt't in o. '
FEE ITEMS (Fee Resohtliint 11-053 lilt' 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
S11/)PL PC Fee
PME Plan Check: $0.00
Permit Fee:
Seipw Ins/ Fee
PME Unit Fee: $133.00
PME Permit Fee: $45.00
Consliwetion Tat-:
Administrative Fee: 1ADMIN $42.00
Work Without Permit? C) Yes Q) No $0.00
Advanced Planning Fees:
Travel Documentation Fee: ITRA VDOC $45.00
i
Shona Motion Fec: 1BS£ISAHCR $0.73 Select an Administrative Item
Blda Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: 1 $266.731 $0.001 TOTAL FEE: $266.73
Revised: 1 0/0 112 01 2
�tf
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-HVAC
Climate Zones I and 3-7
Sue Address: Enforcement Agency: Dare: Permit N:
GtJ'c27 t.J0 li /d�Iz
Conditioned Duct insulation
Equipment T t List Minimum Efficiency 2 Floor Area requirement Thermostat
Packaged Unit Over 40 ft of ducts
Furnace AFU 6 COP Served by system added or replaced in Setback
door Coil SEER_ ®HSPF_ (1 of already presew,must be
Condensing Unit EER_ ❑Resistance sf unconditioned space installed)
Other R 6 (CZ 1.3-5)
1. Equipment Type:Choose the equipment being installed;if more than one.system,use another CF-1 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)
• I 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 specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24,Parts 1 and 6 of the California Code of Regulations.
• The design features identified on this Certificate of Compliance arc consistent with the information documented on other applicable
compliance forms,worksheets,calculations,plans and specifications submitted to the enforcement agency for approval with the rmit
application.T
Name: J t Signature:
Company: / ^ Date. w f r_
t'�n�E f-EUt,IL !� '%T'fr � ✓, /'ll2 , (
Address: �.f&t> E..•��t/v'L4 f /,Z.J. C iccnLf qcy
se: 7 Q / / 9
City/Statelzip:5A,)q+ iZ-0,4 GA lul Phone: '70 7 . S q S• I C)-O
2005 Residential Compliance Forms.doc revised 0!/10/1?
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: 10 17 '1 5 L—P—I G7. PERMIT#
OWNER'S NAME: :�O 4Z7, .5 X-', PHONE # '-f'O • 2-5,7. 7 3,91
GENERAL CONTRACT R: OiJC HoLrjZ. o l r i BUSINESS LICENSE #
ADDRESS: IqCV ?6-7,4 L4) ILL CITY/7_IPCODE: 5/ wi+ lzo5,4 qgol
*Our municipal code requires all businesses working in the city to have a City of Cupertino business he
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL 'rIIE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE O i'vfTT�CITY OF CUPERTINO
BUSINESS LICENSE.
7 am not using any subcontractors:
igna ore Date
Please check applicable subcontractor,, d com the following information:
t/ 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
GENERAL PERMIT APPLICATION �CJ� M E P
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 \ \\ MIA
CUPERTINO (408)777-3228 • FAX(408)777-3333• buildinOOncuoertino.oro J
❑PLUMBING MECHANICAL ELECTRICAL /// ❑NIISCELLANEOUS
PROJECTADDRESS I O I ^ I ^—-7APN0 L[2 i2 D
OWNERNAME (,l U C(�G� e-5.
` CPt10I I 6MAIt.
of G- NEO ,^L
STREET ADDRESS ( � G CITY,STATE,ZIP FA\
O
I elz/ 7. C-Upo -7"W0 eA . 9 Sol
CO\TACT NAME KIM LAPORTA PHONE707-545-1800 E-.NAIL
STREETADDRESS 1400 PETALUMA HILL RDyy,, CITY.STATE.ZIP SANTA ROSA,CA 95404 FAN
1-1 OWNER 11OWNFILBUIIDER ❑ OWNERAGENT 6 CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER 0 TENANT
6N9 H0'J'A'EATING AND AIR LICENSENUMBER 740999 LICENSETYPE C20 BUS.LIC.
COMPANY NAME ONE HOUR HEATING AND AIR E-,NAIL FAN 707-523-1803
STREET ADDRESS 1400 PETALUMA HIULL ROAD CITY.STATE ZIP SANTA ROSA, CA 95404 PHONr:707-545-1800
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC P
COMPANYNAME EMAIL FAN
STREET ADDRESS CITY.STATE,ZIP PHONE
USE OF %SFDaDUPLEX ❑ NIULTI-FAMILY PROJECT IN WIIDIAND ❑ YES PROJECTIN Cl Ps IS INE BLDG AN ❑ YES
BUILDING C]CO>LNERCIAL URBAN INTERFACE AREA NO FLOOD ZONE ❑NO EICHLER HOME:' ❑ NO
DESCRIPTION OF WORK �[j�
1- `- f�011ZnJ/i-GL- /t — Obi/k l l
�O K 96 `Io 4 f-OF .
TOTAL VALUATION: -7.3 0(2 RECEIVEDBY:
By my signature below,I certify to each of the folio,ing: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application andthe information 1 have provided is correct. Ihave read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and stale laws relating to building comtruction. I rize representat enter the above-identified propeny for inspection purposes.
Signature of Applicant/AgenC Date:
SUPPLER AL MATION REQUIRED OFFICE USE nsI.Y
❑ OVER-TBC-COUN I ER
r
❑ ExPRE.ss
❑ STANDARD
L
❑ LARGE,
L
❑ MAJOR
,t✓rMtfiscApp 201 Ldoc revised 06121/11