13020069 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10050 FIRWOOD DR CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 13020069 .
CONDITIONING
OWNER'S NAME: NINA ROSENBLADT 1112 STONE AVE DATE ISSUED:02/132013 -
OWNER'S PHONE: 6506196130. SAN JOSE,CA 95125 PHONE NO:(408)293A717
T" LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL U COMMERCIAL
License Class(-?cG C- 1/3Lic o 7 S&S -// REMOVE AND REPLACE FURNACE IN SAME LOCATION
Contractor Rd Rgot f e,7— Date -7-13-13
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 thatmy 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:$3500
1 have and will maintain Worker's Compensation Insurance,w provided for by
Section 3700 of the Labor Code,for the perlbrairce of the work for which this
APN Number:34233046.00 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 WITIIIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned propertyfor inspection purposes. (We)agree to save 180 DAYS LAST CALLED INSPECTI N.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accme against said City in consequence of the
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.
22 RE-ROOFS:
Signature Date_2 -/.7 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-BUILDEWDECLARATION
I hereby affirm that I am exempt from the Contractor's License Lew for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
L 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,.BusicessA Professions Code). I have read the hazardous materials requirements under Chapter 6.95of the.
. . California Health&Safety Code,Sections 25505,25533,and 25534. 1 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 1 store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 use equipment or devices which emit hazardous
Compensation,w 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,w provided for by the Health&Safety Code,Sectio s 25505,2553 and 25534. -1,-4,Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: ' Date: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 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.)
Leader'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 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
GENERAL PERMIT APPLICATION M E P
COMMUNITY DEVELOPMENT DEPARTMENT•`BUILDING DIVISION ��
10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 h M I
sc
CVRERTINO (408)7773 (&
228 • FAX(408)777-3333•buildinG -cupertino.orD 1�V
PLUWMINGmE_NICAL FIELFCMCAL ❑MISCn-LLANEOUS
PROJECT ADDRESS IOC�O •I V-NC /•���� ,{,^� (rAP/Nry9 ,/� �y-��J.. 2 2 bq,^
OWNERNAME ����v , 1 \`J`�'✓4�� U11 P '�//I"I•W ISI./ g-Jh1AEJ l.J-I lY
STREET ADDRE99 'I"^ ,_`�y� C 1 FAX
CONTACT NAM •�' `Iv�•(� PHONE V UVJ EE-MAd.
SrREEI'ADDRESS a CrtY,STATE• ZIP FAX
• ❑ OWNER ❑ OWNBR•BUILDER ❑ OWNBRAGENP -L.t CONTRACTOR ❑CONTRACTOR ACtM ❑ ARCHnYCr ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACrOR NAMI g Y 1v f10 UCENSE NUMBER�( I�.CYI I u tv BUS.WC I
COMPANYNAMEAAA YI/TAY 1/1j y�/•`/ EMAIL �w t l.• FAX �1N.
• STREET ADDRESS I�I1n W �IV1�.1/ `/r 1 C r� , IV/I -` I,J•`•T r I
A1tf3nrECT/ENOINIUMNAME LICENSE NUMEER bBUS.LICI
COMPANYNAME EMAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD or Duplex ❑ Multi-Family PROJECT IN WTLDLAND PROJECT IN
STRUCTURE: ❑ COTDDIEICl81 URBAN DiTERFACEAREA ❑ Yes TLOODZONE ❑ Ya 0
DESCRIPTION OF WORK ^y) A lT,ce exi.s-b - mare
TOTAL VALUATION: N
By my signature below,T certify toe of the fol �' g: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I h ve pro de s co et. I have read the Description of Work and verify it is ac cu c. I agree to comply with all applicable local
ordinances and Hue laws relating pro owtru on. I authorize representatives of Cupertino to enter the egOI Iden ed property for inspecdon purposes.
Signature of AppllcanVAgent; Date:
Supplm!�T;tINFORMATION REQUIRED
IIJ�
M1ffFAfucApp_2011.dod revved 03/76/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10050 FIRWOOD DR DATE: 02/13/2013 REVIEWED BY: MENDEZ
APN: I BP#: 'VALUATION: $3,500
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair
PRIMARY PENTAMATION
USE: SFD Or DUpleX PERMIT TYPE: FURN/AC
WORK REMOVE AND REPLACE:FURNACE IN SAME LOCATION
SCOPE
7t Y t
ala
Meeh.Plan Check 0.0 his $0.00 Plumb.Plan Check Dec. Plena Check
Mech.Permit Fee: IAPERMT Plumb, Permit Pee: Glee.Permit Fee:
Other Mech.Insp. 0.0 his $45.00 Other Plumb Insp. Other Etc(.Insp. Li I
A•lech:Insp. Fee, Plumb. htsp. Fee: Elec.Insp. Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District etc). These fees are based on the prefintin in ormation available and are only an estimate Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution I1-053 E . 7( /1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 F 1 # Mechanical
Suppl.PC Fee: Q Reg:,Q OT 0.0 hrs $0.00 $133.00 IAIF'R=1100 I Furnace,Forced-Au
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee-.0 Reg. Q OT 0.0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $45.00
Consmtction Tax.
Administrative Fee: IADAHN $42.00
Work Without Permit? O Yes Q No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential
Travel Documentation Fee: ITRAVDOC $45.00 Building or Structure
Strong Motion Fee: IBSEISAt1CR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
Ali r,i fir s �, $133.50 $133.00 hctc4 aaTOTALFEEi: $266.50
Revised: 01/01/2013
C%uP2W-1rhiu
Prescriptive Certificate of Com liance: Residential CF-IR-ALT
Residential Alterations
Mize 4 of 5
Project Name:
Climate Zone# #of Stories
HVAC SYSTEMS-HEATING Configuration
Minimum Duct or Piping g
Heating Equipment Efficiency Distribution Insulation Thermostat (Central,Split,
T e and C act ''r'3 (sFUE or HSPF T e and Location' R-Value Type space,Packa a or H dronic)
1.Indicate Hearing Type(Central Furnace.Wall Furnace. Heat pump. Boiler. Electric Resistance, etc.)
7.Electric resistance heating is allowed only in Component Package C. or except where electric heating is supplemental(i.e.. if total capacity
<?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(Ducts. Hvdronic in Floor, Radiators.etc.)
HVAC SYSTEMS-COOLING
Minimum
Efficiency Duct or Piping Configuration
Colling Equipment (SEER/EER or Distribution Insulation Thermostat (Central,Split,
Ty;
" } R-Value Type Space,Package or H
dronic
andCa Capacity
SOP Type and Location
1. Indicate Cooling Type(A/C, Heat pump, Evap. Cooling, etc) -
2. Refer to the HERS Verification section on Page 4 of the CF-IR-ALT Form Jor additional requirements and check applicable boxes.
3. Indicate Type or Location(Ducts,H dronic in Floor. Radiators,etc.)
WATER HEATING
List waren hearers and boilers jar both domestic hat water(DHW)heaters and hydronic space heating. Individual dwelling DHW heaters must be
gas or propane fired, and may not exceed 50 gallons. Hot water pipe insulation from the DHW heater to the kiichen(s)and on all underground
hot water pipes is required in all com anent packages in all climate zones. External Tank
Water Heater Type/Fuel Distribution Type Number In Tank Energy Factor or Insulation
Type' (Standard,Recirculating)' System Capacity( al) Thermal Efficient R-Value3
L Indicate Tvpe(Storage Gas,Heat Pump. Instantaneous, etc.)
2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of§1 50(n). The Prescriptive requirements do
not allow the installation ofa recirculating water heating system for single dwelling units.
3. The external water heating tank and i es shall be insulated to meet the requirements o 150 '.
SPECIAL FEATURES The enforcement agency should pay special attention to the Special Features specified in this checklist below.
These items may require written justification and documentation and s ecial veri ication.
NEW.ROOF ASSEMBLY-Radiant Barrier
The radiant barrier requirement of§151( 2 does not apely to roof alterations.
Slab Edge(Perimeter)Insulation ❑YES ❑NO
YES: In Climate Zone 16 in Component Packages D,R-7 insulation is required.
Heated Slab Insulation O YES ❑NO
YES:Slab ed a 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 Package D.
' Thermal Mass
To obtain Compliance Credit for the installation of thermal mass,use the Performance Approach.
Registration Number: Registration Date/Time: HERS Provider:
2008 Residential Compliance Forms August 200