13020012 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10500 STOKES AVE CONTRACTOR:VALLEY HEATING& PERMIT NO: 13020012
COOLING
OWNER'S NAME: PRIYA SRINATH 1171 N 4TH ST DATE ISSUED:02/05/2013
OWNER'S PHONE: 4088739833 SAN JOSE,CA 95112 PHONE NO:(408)294-6290
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL U COMMERCIAL
License Class C 12d Lia H 256'5 O REMOVE AND REPLACE FURNACE IN SAME LOCATION,
11
Contractor ✓o!/�y flea Date 2251/ DUCTS AND ADD A/C
1 hereby affirm that I am licensed tinder the 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.
1 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:$11145
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 APN Number:32648001.00 Occupancy Type:
permit is issued. -
APPLICANT CERTIFICATION
I certify that I have read this application and state 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 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 M 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 /3
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature( Dated 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
inspection.
❑ OWNER-BUILDER DECLARATION
I hereby affirm that I am 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)
1,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(a)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,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the perfornance of the work for which this
Owner or authorized agent:
permit is issued /,�itccwc i/ �ate:
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 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�RTIFICATTON Lender's Address
I 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 laws relating
to building construction,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,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
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-HVAC
Climate Zones I and 3-7
Site Address: Enforcement Agency: Date: Permit#:
65d0 Stokes2/5/,
Conditioned Duct insulation
Equipment T ' List Minimum Efficienc x Floor Area requirement Thermostat
Packaged Unit Over 40 ft of ducts
El Furnace AFUE9�i/eCOP_ I�qq Setback
® Served by system added it replaced in Vy
rl Indoor Coil SEER /3 HSPF_ lllnat already present,must be
Condensing Unit I EER_ ❑Resistance sf unconditioned space Installed)
Other R 6 (CZ 1,3-5)
/. Equipment Type:Choose the equipment being installed;if more than one system,use another CF-IR-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.
• 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.
• I 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 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
application.
Name: Bf a c Signature f ^�
Company: Date:
P y ✓l� Weg f,
Address: License:
/17/ ff1i S�• 2585�{d
City/State/Zip: Phone:
2008 Residential Compliance Forms March 2010
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
FZADDRESS: 10500 stokes ave DATE: 02/05/2013 REVIEWED BY: Mendez
APN: BP#: VALUATION: $11,145
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Duplex PENTAMATION FURN/AC
USE: PERMIT TYPE:
WORK
SCOPE move arend replace furnace in same location 11 ducts and add a/c
nl.
Mech.Plan Check 0.0 IVs $0.00 Plumb.Plan Check Elec.Plan Check
Mech.Permit Fee: IMPERMIT Plumb. Permit Fee: Elec. Permit Fee:
Other Mech.Insp. 0.0 hrs $45.00 Oder Plumb Insp. ET
Other Flee,Insp.
Mech.Insp. Pima Plumb. Lisp.Fee: Elec.Insp. Fee:
NOTE:This estimate does not include fees due to other Deparitnents(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District etc). These ftes are based on the prelintina in ormation available and are only an estimate. Contact the Dept for addn l info.
FEE ITEMS (Fee Resolution 11-053 E . 711/12) FEE QTY/FEE I MISC ITEMS
Plan Check Fee: $0.00 L-1-1 # Mechanical
Suppl. PC Fee: 0 Reg. 0 OT FO.OThrs $0.00 $133.00IMFR=1100 Furnace,Forced-Air
PME Plan Check: $0.00 F-1-1 # Mechanical
Permit Fee: $0.00 $67.00IBREM,9IR A/C Units(<--I OK cfm)
Suppl. Insp. Fee:Q Reg. 0 OT 0.0 1 hrs $0.00 1 # Mechanical
PME Unit Fee: $0.00 $67.00IBAPPLOT Other Appliance/Equip
PME Permit Fee: $45.00
Consowetion Tax:
Administrative Fee: IADMIN $42.00 0
Work Without Permit? 0 Yes Q No $0.00 0
Advanced Plannine Fee: $0.00 Select a Non-Residential 0
Travel Documentation Fee: 1TRAVDOc $45.00 Building or Structure 0
i
Strong Motion Fee: IBSEISMICR $1.11 Select an Administrative Item
Blde Stds Commission Fee: IBCBSC $1.00
$134.11 $267.001 TT FEE, $401.11
Revised: 01/01/2013
GENERAL PERMIT APPLICATION M E P
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION KU\
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 UU M I
CUPERTINO (408)777-3228• FAX(408)777-3333• buildina(a)cupertino.ora I
sc
❑PLUMBING MECHANICAL EJELECTRICAL [—]MISCELLANEOUS
PROJECT ADDRESS (6500Slates ✓e APNH
OWNERNAME� J/ nPHONE O(,ll' E-MAIL i1
Ufa 3-9s
STREET ADDRESS CITY, STATE,ZIP FAX
�e C
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE, ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSENUMBER LICENSE TYPE BUS.LICk
COMPANY NAME 11 (/ E-MAIL FAX,
STREET ADDRESS /17/
1 CITY,STATE,ZIP /
NA PHONE g'Z 2QO
At, 4RAARCHITECTIENGINEERI LICENSE BUS.LIC4
COMPAN E E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD.1DUPLEX [3 MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROTECT IN EI YES IS THE BLDG AN ❑ YES
BUILDING: COMMERCIAL URBAN INTERFACE AREA NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK ` // u C
TOTAL VALUATION: _ RECEIVED
By my signature below,I certi6 to each of the following: I am the property owner or authorized agent to acto the perty owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it i accu . I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the abo iidentified property for inspection purposes.
Signature of Applicant/Agent Date: :7 /5//3
SUPPLEMENTAL INFORMATION REQUIRED OFFICE PSE ONLY
to OVER-THE•COUNTER
❑ EXPRESS
Y
V
❑ STANDARD
V
❑ LARGE
6
❑ MAJOR
MEPMiscApp_2011.doc revised 06/21/11