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13010147 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7515 MOLTZEN bR CONTRACTOR:RELIABLE AIR PERMIT NO: 13010147 . MECHANICAL OWNER'S NAME: WILLIAM WOO 3670 D CHARTER PARK DR DATE ISSUED:01/29/2013 OWNER'S PHONE: 4085159666 SAN JOSE,CA 95136 PHONE NO:(408)266-7267 ❑ LICENSED CONTRA&02'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class �`�-o Lic.0 ts'tl L/bn REMOVE AND REPLACE FURNACE IN SAME LOCATION Contractor Date 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. 1 hereby affirm under penalty of perjuryone 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:$3000 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:36230034.00 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 1 0 D YS 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, 2 costs,and expenses which may accrue against said City in consequence of the Date: 14�6"t /?2 granting of this permit. Additionally,the applicant understands and will comply Issued by: with all regulationsper the Cupertino Municipal Code,Section 1 RE-ROOFS: Daliq 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: I hereby affirm that I am exempt from the Contractor's License Lew for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,as owner of the property,or my employees with wages as thew 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(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 Ba Area Air Quality Management District 1 performance of the work for which this permit is issued. will maintain compliat t e rtino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&S Code,Sections 05, 3 and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorize Date: 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.) 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 abovementioned 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 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 7515 MOLTZEN DR DATE: 01/29/2013 REVIEWED BY: Mendez APN: BP#: *VALUATION: $3,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair PRIMARYor Duplex PENTAMATION *URN/AC USE: SFD PERMIT TYPE: WORK REMOVE AND REPLACE FURNACE IN SAME LOCATION SCOPE ds Mech.Plan Check 0.0 his $0.00 Plumb. Plan Check Flec.Plan Check Mech.Permit Fee: 1MPERMIT Plumb.Permit Fee: F,le.c. Perma Fee: Other Mech.Insp. 0.0 his $45.00 Odrer PIumG 1nrp. LLJ Other Elec.Insp. Li Mech.Insp.Fec, Plumb. Lisp. Fee: Ekc.Insp.fee: NOTE:This estimate does not include fees due to other Departments(Le,Planning,Public Works,Fire,Sanitary Sewer District,School District eta). These&es are based on therelimina in ormation available and are only an estimate Contact the Det or addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff' 711/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 L 71 # Mechanical Suppl.PC Fee: 0 Reg. Q OT] 0.0 hrs $0.00 $133.00 1MFR= 100 Furnace,Forced-Air PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-.0 Reg. O OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $45.00 Construction Tax: - T-1— Administrative Fee: /ADMIN $42.00 O Work Without Permit? O Yes 0 No $0.00 T 771 G Advanced Planning Fee: $0.00 Select a Non-Residential 0 Travel Documentation Fee: ITRA VDOC $45.00 Building or Structure A Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 $133.50 $133.0011 TbTAY FEE�i $266.50 Revised: 10/01/2012 Simplified Prescriptive Certificate of Compliance:2008 Residential FIVACAlterations CF-IR-ALT-HVAC Climate Zones I and 3-7 site Address: M 6 1 � EajorcewmAgency: Dae: Permit#: JJ J Conditioned Duct insulation E ui ment T t List Minimum Efficiency' Floor Area reuirement Thermostat Packaged Unit G Over 40 ft of ducts umor AFUE O COP_ Served by system added or replaced in 0 t4 ®Indoor Coil SEER ®HSPF 1 Z..,n�If unconditioned space Ofnot alreadypresent,must be Condensing Unit ®EER_ ®Resistance -1-id� ®R 6 (CZ 1,3-5) installed) Other 1.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 forms,worksheets,calculations,plans and specifications submenforcement agency for approval with the permit arnilication. Name: .,II 2K Signa Company: v,6 2 , A Q Date: f Address: b _r r `nn License: IC, � C/cl b6 City/State/Zip: ��J Phone: /05- 2 _ 2008 Residential Compliance Forms March 2010 GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION a \ 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333• buildina(d),cuoerthO.OrG d\ M 'S C El PLUMBING CHANICAL FJFLECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS -75 S M01 4. �z� APN s /a/ C-)3� 1 OWNER NAME • -L Lt rs" Vs/OO P� !�'q� tp C/ E-MAILE STREET ADDRESS CITY,STATE,ZIP FAX CONTACT NAME �l r-e PHONE SS" S 41-1-)b STREEFADDRESS/� Oa� CITY.STATE,"PE, cc,,-c ��/��/aYL/1- FAX -(/� �r't ❑OWNER 11 OWNER-BUDDER ❑ OWNER/AGENT ( CONTRACTOR ❑CONTRACTORAGENT ❑ ARCMTECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME ✓✓ LICENSE TYP ^ BUS.LIC N Yt4D_ ypJ COMANYNM � �)61Le EMAIL �SW FAX STREET ADDRESSJ 6 i V Gp I (/, CITY,STAg,ZIP G ? PHONE S J ARCHITECT/ENGINEER NAME L SE NUMBER BUS.LICK COMPANY NAME E-MAIL FAX STREETADDRESS CITY,STATE,ZIP PHONE USE OF ❑STD or DUPLEX ❑ MULTI-FAMILY PRO]ECTW WDDLAND ❑ YES PROTECT IN ❑YES IS THE BLDG AN ❑ YES BUILDING: COMMERCIAL MAN INTERFACE AREA 1 NO FLOODZONE EJ NO EICHLER HOME? ❑NO DESCRIPTION OF WORK TOTALVALUATION: 000 D' RECEIVED BY: By my signature below,I certify to ea V ollowing: I am the property owner or authorized agent to act on the prope o er's behalf. I have read this application and the infonnatio ave provid is corzect. I ve read rhe Description of Work and verify it is accost . I a ee to comply withal]applicable local ordinances and state laws aling buildin nstruc' n, a on. repfrgsentatives of Cupertino to enter the above denI fled p peny for inspection pu(poses. Signature ofApplicant/Age . Date: SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY OVER-THE-COUNTER 6 t' ❑ EXPRESS Y U W ❑ STANDARD �V ❑ LARGE ❑ MAJOR MEPMiscApp_2011.doc revised 06121111