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13020031 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10194 BEARDON DR CONTRACTOR:R&B HEATING AND A/C PERMIT NO: 13020031 OWNER'S NAME: CHD 12610 FOOTHILL AVE DATE ISSUED:02/07/2013 OWNER'S PHONE: 4082797657 SAN MARTIN,CA 95046 PHONE NO:(408)977-1401 Z9 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL U COMMERCIAL License Class e—Z 0 Lie,4 ?D 9I e 7- REMOVE AND REPLACE FURNACE IN SAME LOCATION ��e4/� ,�ii,�o qry 4�Date Z - 7-/� !. 2 Contractor y,�_"�,�oT c I hereby affirm that 1 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:$1200 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:32632022.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that 1 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 1 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 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 issued by: Date: granting of this permit Additionally,the applicant understands and will comply with all non point ce regulations per the Cupertino Municipal Code,Section 9'18. r RE-ROOFS: Signature ZaLDate Z' 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 Signature of Applicant Date: 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of 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,aexclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE m 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. 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 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 CqWfino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio 05,25533, d 25534. s - 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certificate of exemption,I 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 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 HPACAlterations CF-IR-ALT-HVAC Climate Zones I and 3-7 SiteAddress: Z EnjorcementAgency: Date: Permit k: y �J9.ttb� '2- Conditioned Duct insulation E ui ment T et List Minimum Efficient 2 Floor Area requirement Thermostat Packaged Unit Over 40 ft of ducts ©Furnace ®AFUE ®COP 'Setback ® erve Sd by system aor replaced added ld in Indoor Coil SEER_ HSPF a7readypresent,must be Condensing Unit ❑ ❑ wtall Resistance EER Resistasf unconditioned space installed) BOther ❑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 1 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 fors,worksheets,calculations,plans and specifications submitted to the enforcement agency for approval with the permit application. /19 - Name: lJ -� Signature: Company:" Date: 7 >�.q /ice G^e �112Cm r d 2— ,7-- /-3 Address: License: City/State/Zip: - 1 c-4 �12 t� Phone: y�._7 2008 Residential Compliance Forms March 2010 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION Icl ADDRESS: DATE: REVIEWED BY: APN: BP#: `VALUATION: $1,200 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Du lex PENTAMATION FURN/AC USE: p PERMIT TYPE: WORK REMOVE AND REPLACE FURNACE SCOPE Mech.Plan Check 0.0 1 Ins $0.00 PRurrh P/�;" Cdr-<� - rGir ctnk Mech.Permit Fee: IMPERMIT lY;:n;n. Permit F,<. Elr<-P...... Other Mech.Insp. 0.0 hrs $45.00 Odr,"r Plzr.n h Insp uiht-, fSh'c. Insp. 1f,11 1,,,y) P,<< Phuuh. Ia.��. 4�-... /:kr Irnl,.l',a- NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,eta). These fees are based on the prelimina in ormation available and are only an estimate. Contact the Dept for addu7 info. FEE ITEMS (Fee Resolution ll-053 E . 7/1/1_22 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 # Mechanical Suppl. PC Fee: Q Reg. Q OT 0.0 Ins $0.00 $133.00 ]MFR=<100 Fumace,Forced-Air PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-.0 Reg. Q OT 0,0 Ins $0.00 PME Unit Fee: $0.00 PME Permit Fee: $45.00 Consnncriu�: Ta.c: Administrative Fee: IADMIN $42.00 Work Without Permit? © Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select Non-Residential 0 Building or Structure O Travel Documentation Fee: ]TRAVDOC $45.00 i Strong Motion Fee: ]BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: ]BCBSC $1.00 SIUBTOTALS: j $133.501 $133.00 TOTALFEE: $266.50 Revised: 01/01/2013 GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 n M ' sc CUPERTtNO (408)777-3228 • FAX(408)777-3333• building0cuoertino.org PLUMBING MECHANICAL FIFLECTPJCAL ❑MISCELLANEOUS PROJECTADDRES(, /y _ �`Z ^°N= �,a-c� 32 c�a OWNERNAME�,� / PHONE E-MA)L STREZ ADDRESS �� / C�/u CITY, STATE,ZIP FAX CONTACT NAME fQ.,/_ `5 PHOh�E E-MAIL STREETADDRESS CITY,STATE, ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT W CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME 0 1 LICENSE NUMBER cg LICENSETYPE BUS.❑C;' COMPANY NAME E-MAIL - FAX STREET ADDRESS CITY,STATE,ZIP PHONE Lli ,v �t zt Q" -�zg v S G r 4 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC% COMPANY NAME- E-MAIL. FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF [ISMDUPLEX ❑ MUL.TI-FAMILY PRODS TINWILDLAND ❑ YES PROJECT IN YES; IS THE BLDG AN ❑ YES BUILDING: [3ODJ ERCIAL URBAN INTERFACE AREA E3 NO FLOOD ZAN'E 0N EICHLER HOME? (3 NO DESC]UPTIONOFWORK 7� �I TOTAL VALUATION: RECEIVED BY: By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on thyrop owner's behalf. I have read this application and the information I have ded is correct. 1 have read the Description of Work and verify it is accurate. gree to comply with all applicable local ordinances and state laws relatin dine construction. Iy nze representatives of Cupenino to enter the above-identified propetty for inspection purposes. Signature of Applicant/Agen Date: SUPPLEMENTAL INFO ION REQUIRFE OFFICE USE ONLY OVER-THE-COUNTER ❑ EXPRESS 1 U � ❑ STANDARD U ❑ LARGE ❑ MAJOR 1EPMiscApp_201 Ldoc revised 06/21/11 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 C U P E RTI N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: v l Y � ti N PERMIT# OWNER'S NAME: PHONE# GENERAL CONTRACTOR: cy ( USINESS LICENSE # a 2Z e, ADDRESS: y� 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 SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. _ i«9� �-' I am not using any subcontractors: — Signature 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/ tractor 91gnature Date