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13010094 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22483 MC CLELLAN RD CONTRACTOR:AAA FURNACE&AIR PERMIT NO:13010094 CONDITIONING OWNER'S NAME: GOLDSTEIN ROBERT H ET AL 1712 STONE AVE DATE ISSUED:01117/2013 OWNER'S PHONE: 4082534489 SAN JOSE,CA 95125 PHONE NO:(408)293-0717 t3 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL . License Clasf-20 C-.q3. Lie.# 7ff6 7I REMOVE AND REPLACE FURNACE IN EXISTING Contractor —--L//bULOCATION & 6 I hereby affirm that I am licensed under the provisions of Chapter 9 (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-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:$2950 _ 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 APN Number:35705050.00 Occupancy Type: permit is issued. APPLICANT CERTM—CATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.l 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 DAYS LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue Against said City in consequence of the Issued by: Date: granting of this permit..Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature .Date — 6' All roofs shall be inspected prior many roofing material being installed.if a roof is 6 % installed without first obtaining an inspection,I agree to remove all new materials for inspection. _ ❑ OWNER-BUILDER DECLARATION I her affirm that I em exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER _ 1,as owner of the property,or my employees with wages as their sole compensation, 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 HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,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. I will I 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(x)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-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 Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sec ons 25505,25533, d 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or euthoriud agent: " Date:Nd permit is issued. I certify that in the performance of the work for which this permit is issued,l shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY 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(Sec.3097,Civ C.) Lender's Name - APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is - corect.I agree to comply with all cityand county ordinances and state laws relating to building concoction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,andexpenses whichmay 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 regulationsper the Cupertino Municipal Code,Section Licensed Professional 9.18: Signature Date - - 11/91/FOPannar 00P'I IOC ddyvn.{Nd�'J (IgMb N NOUVMOjM(TV.LN37a dns :a1H 1L< au22vALmmiddV jO adnlHu9lg -naodmd uopaa&m Jo)AU dwd pa}p pl•>A H alp J>1u>m ouw>dno;o mAµWu2mdaJ azuoymH] •u a =0 9u I!nq o1 pe]aJ rMel a1H¢pa nawulpJo moi a]geallddH Ipl gym.SIdWoa m aadla I ':awnoop H111 4p2A PuH)JOMJO aapdMMC[alp PHOJ DA 14]. 7 0o cl ap]A 2Ae uopeuuo;ul ayl pun uouoa]Idda nlp P=HAsy 131Hgaq 9,10"0 AL>doJd alp uo lae m Jua9H pazuoyln Jo jo"o Aluadad a p u,I :9uw, lo;atp;o yaea m L;Wao 1�MDlaq�3aHH916 AW/.8 •lYw Rouyn-NA•rv.LoJ. `Z'"Yq— �" In'Oov rV' 'O'•� ;IUOM dO N011dIL'J53a OIZ,Q sah p alloz 000v oN�`. sa ❑ ren aovd mim NYMM rol=urmo0 ❑ 7&=nws " "h w.uarow OAYnovMw1.03101dq 41!=.4-Pfnpq p xaldnQioCLi�< do asn aNOHd di2'aIYJS•AM HH3Hacry 183W XYd MYW-3 3WY11ANvdW00 IOn'Hna �xami NHHN3JP1 3WYNll3•DWN3/JJ3dJHOlrY �'"�• �'-^'• OHd alic�/IJ V I 3.IV 11J � '� � 21u HSa3aaY 133llIS ILLS £bZ'�}7xra ryry�� nvwa /O�7�� MWXN Nvmvo0 ��II rOn sne a �rLa1n OMIA��-�vnxasN3:Jn 1111 VNm dOzyuLxOO JNrN3t❑ Hadoianaa [3 Ha Dw 0 .u3 vv [:) J Dv�o)� HOJOvawo J Ov naN o p 3a07NH•HHNMO C] H3NM0 ILIA Qb2 � 2naL (1oSdu atvJs Aua I� '� /�S �lU as3Haav IaNIC 3Y„.3 L)Lr ribZ'� �73Nau xa-MI9 POO 3WYN J7Y W00 Xvdb(�} . �fd(aj,, Yu•A,1� �� w ZZsmaava,za3.]s •uvW-a �JJ�Y• ��ul}r 3NOHd �7VN L3NM0 6150 So L-S #x-Y pJ Ublr-� 30W ObhZZ ssaaaav doarow sn63Nv7ms]wFI TdJRi.LO3g3LJ 7VOINVKO31NE DPaamid 0 S W ^ Joroulpa no ulplmq• CCCC-LLL(80b)XVd • BZZC-LLL(804) \)\`I v oNa�.aaan� Y Y S5Z£-v 6046 VO 'ONIla3dno , 3(1N3AV 2NWOl OOCOL �a� \ NOISIAIO ONlall(t8:•1NIU1 WdSC IN3WdOl3A301.11N im6o d3_w NOIlb�I'Iddb lIW2i3d "Ib213.N�© CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 22483 McClellan rd DATE: 01/1712013 REVIEWED BY: mendez -APN: BP#: 'VALUATION: 1$2,950 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: P PERMIT TYPE: woRK remove and replace furnace in existing location SCOPE p.r s Mech.Plan Check 0:0 hrs $0.00 Phunb.Plan Check Elec.Plan Check Mech.Permit Feer IAPERMIT Plumi,.Permit Fee: H(ec.Permit Fee: Other Mech.Insp. 1 0.0 1 hrs $45.00 Other Plumb Insp. Other El,,.Insp. Adech.Insp.Fee: Plumb. Insp.Fee: Eli Insp.Pec.' NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District etc.). These ees are based on the prelitidna information available and are onl an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 711/12) FEE QTY/FEE MISC ITEMS Flan Check Fee: $0.00 r 1 # Mechanical Suppl.PC Feer Q Reg. Q OT 0.0 hrs $0.00 $133.00 1MFR=<100 I Furnace,Forced-Air PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee.e.Reg, 00 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $45.00 Construction Tars: Administrative Fee: JADMN $42.00 Work Without Permit? 0 Yes O No $0.00 O Advanced Planning Feer $0.00 Select a Non-Residential Q Travel Documentation Fee: ITRAVDOC $45.00 Building or Structure OA Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 rilkE4 "ijlp $133.50 $133.00 �4 _ T01�ALFF ( $266.50 Revised: 10/01/2012 " Prescriptive Certificate of Compliance: Residential CF-IR-ALT Residential Alterations Pa e 4 of 5) Project Name: O - Climate Zone# #of Stories C 6) HVAC SYSTEMS-HEATING Configuration Minimum Duct or Piping g Heating Equipment Efficiency Distribution Insulation Thermostat (Central,Split, Type and Ca aci l'Z's (LFUE or HSPF T e and Location' R-Value Type S ace,Packa a or H dronic) ►�rz- i 0 0 s t 1.Indicate Heating Type(Centra!Furnace,.Wall Furnace.Heat pump. Boiler. Electric Resistance. etc.) _'.Electric resistance heating is allowed only in Component Package C, or except where electric heating is supplemental(i.e., if total capacity < 2 KW or 7,000 Btu/hr electric heating is controlled by a time-timiting device not exceeding 30 minutes). See§151(6)3 exception. 3.Refer to the HERS Verification section on Page 4 of the CF-IR-ALT Form Jor additional requirements and check applicable boxes. 4. Indicate Type or Location(Duets.Hydronic in Floor, Radiators.etc.) HVAC SYSTEMS-COOLING Minimum Effic' Duct or Piping Configuration Cooling Equipment ER/EER or Distribution Insulation Thermostat (Central,Split, Type and Ca atop) Type and Location[ R-Value Type Space, Packs a or H dronic) [21�. . Indicate Cooling Type(A/C, Heat pump, Evap. Cooling, etc)Refer to the HERS Verification section on Page 4 of the CF-IR-ALT FormJor additional requirements and check applicable boxes. . Indicate T e or Location Ducts, H dronic in Floor,Radiators,etc.) WATER HEATING List�vater heaters and boilers for both domestic hot water(DHW)heaters and hydronic space heating. Individual dwelling DHW heaters must be gas a,-propane fired, and may not exceed 50 gallotis. Hot water pipe insulation from the DHW heater to the kitchen(s)and on ail underground hot water Dives is required in all com one acka es in all climate zones. External Tank Water Heater Type/Fue Distribution Type Number In Tank Energy Factor or Insulation Type' (Standard,Recirculatin )' System Capacity(gal) Thermal Efficient R-Value 1. Indicate Tvpe(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 not allow the installation ofa recirculating water heating system for single dwelling units. 3. The external water hearing tank and i es shall be insulated to meet the requirements of§1500,). SPECIAL FEATURES The enforcement agencv shouldpgv special attention to the Special Features specified in this checklist below. These items may require written 'usg tcation and documentation ands ecial verification. NEW.ROOF ASSEMBLY-Radiant Barrier The radiant barrier requirement of 151( 2 does nota I to roof alterations. Slab Edge(Perimeter)Insulation ❑YES [3NO YES: In Climate Zone 16 in Component Packages D,R-7 insulation is required. Heated Slab Insulation ❑ YES ❑NO 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 ❑YES ❑ 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 Pac a D. ' Thermal Mass To obtain Compliance Credit for theinstallation of thermal mass,use the Performance A roach. Registration Number: Registration Date/Time: HERS Provider: 2008 Residential Compliance Forms August 200 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 CU P ERTI NO Fax: 408-777-3333 CONTRACTOR/SUBCONTRACTOR LIST JOB ADDRESS: F3 , PERMIT# OWNER'S NAME: PHONE# GENERAL CONTRACTOR: Un) C— BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: *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 SUBCONTRAC ORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signatur Date Please check applicable subcontractors and complete the following 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