13010140 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19880 PORTALPL CONTRACTOR:SUPREME AIR SYSTEMS PERMIT NO:13010140
OWNER'SNAME: MARTHALANDIS 80 GILMAN AVE STE 1 DATE ISSUED:01/28/2013
OWNER'S PHONE:: 6503037111 CAMPBELL,CA 95008 PHONE NO:(408)376-0406
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL U COMMERCIAL
LicenseClass
(^�LD . . Liic,k_•- / - INSTALL NEW DUCTLESS HEAT PUMP SYSTEM
D .
Contractor �t� Yci✓I
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C D 1uC �te
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I hereby affirm that I am licensed under the por visioI4 of Cl4pter 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:$16753
I have and will maintain Worker's Compensation Insurance;as provided for by
Section 3700 of the Labor Code,for the perf irmance of the work for which this APN Number:36946014.00 Occupancy
nPe•
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 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 DAY RO1V 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 L
granting of this permit. Additionallyijieapplicant understands and will comply Issued by: Date: /^
with:7�W7
o Municipal Code,Section
9.18
RE-ROOFS:
Si Date �� 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=BUILDERMECLARATTON
Signature of Applicant: Date:
I hereby arcrm that I am exempt from the Contractor's License Law 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 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
constrict the project(Scc.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&SafetyCode,Sections 6 533 and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorize rt• Dater
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 sous 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 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 regulationsper the Cupertino;Municipal Code,Section Licensed Professional
9.18.
Signature; Date
GENERAL PERMIT APPLICATION O\�� M E P
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 �\ M '
sc
CUPERTINO (408)777-3228•FAX(408)777-3333•buildinot7a.cupertino.org M
❑PLUMBING '(((��� MECHANICAL ELECTRICAL []MISCELLANEOUS
PROTECT ADDRESS / Q&) /JJDr Q APN# / 146
10A 1
Oro
C-,-3 O/
OWNERNAME r i S P — I� IO E-MAII.
STREET ADDRESS V 0 1
yrlI C Pk ZS CIN,S ATE,ZIP- u ✓�O 5 0/ FAX
CONTACT NAME
PHONE//��' E-
a Lc ZT 7���30 6
STREET ADDRESS I jr CITY,STATE FAX
V 00 8 0 .376-oro
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGEJEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME O �Pr LICENSE NUMB, -7 LICENSE'To
BUS.LIC#
COMPANY NAME Q EMAIL v L F 6
STREET ADDRESS CTN,STA PHONE
& G,/ Soot og-37G - 0VO4
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# .
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFDor DUPLEX ❑ MULTI-FAMILY PROJECT IN WIDI.AND ❑ YES PROTECT IN ❑YES ISTHEBLDGAN ❑YES
BUILDING: ❑COMNIERCW. URBAN INTERFACE AREA NO FLDO.ZONE
NO EICHLERHOME? NO
DESCRIPTION OF WORK _y— )/S
b h c
v S
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 the property owner's behalf. I have read this
application and the information I have provided is com ec I have read the Description of Work and verify it is accurate. I agree to comply withal]applicable local
ordinances and state laws relating to b ' . I thorize representatives of Cupertino to enter the above'demi dproperty for inspection purposes.
Signature ofApplicanr/Ag . Date:
SUPPLEMENTAL.INFORMATION REQUIRED FFICE USE ONLY
y OVER-THECOUNTER
❑ EXPRESS
Y
u
❑ STANDARD
u
< ❑ LARGE
❑ MAJOR
I
MEPMucApp_2011.doc revised 06/21/11 -
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 19880 PORTAL PLZ DATE: 01/28/2013 REVIEWED BY: MELISSA
APN: 369 46 014 BP#: 'VALUATION: $16,753
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION FURN/AC
USE: I I PERMIT TYPE:
WORK INSTALL NEW DUCTLESS HEAT PUMP SYSTEM
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Heat Pump (<=10K cfm) 113REMAiR 1 # $67
TOTALS yy ,.' +,' $67.00 4-,,.t
alt . l ! { g :.`_'F�
Mech.Plan Check 0.0 hrs $0.00 Plumb.Plan Cheek Elec.Plan Check
Mech.Permit Fee: 1MPERMIT Plumb,Permit Fee: Elec. Permit Fee.
Other Meeh.Insp. 0.0 hrs 1 $45.00 Other Plumb Insp. Other Elec.Insp.
itdech. hap. Fee Plumb. 1,18.7). 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.). Thesefees are based on the prelfinWna inorn a"on available and are on ly an esdm ate. Contact the Dept for addn'1 in fo.
FEE ITEMS LFee Resolution 11-053 Eff LLL121 FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
PME Plan Check: $0.00
Permit Fee:
Suppl. Insp Fee
PME Unit Fee: $67.00
PME Permit Fee: $45.00
Constriction Tarr.
Administrative Fee:. IADMIN $42.00
Work Without Permit? O Yes Q No $0.00
Advanced Planning Fees:
Travel Documentation Fee: 1TRAVDOC $45.00
Strong Motion Fee: IBSEISMICR $1.68 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
fid' t $201.68 $0.00 , TOTAL' E. $201.68
Revised: 10/01/2012 -
Building Department
City Of Cupertino
10300 Tone Avenue
2 Cupertino, CA 9JU14--5137
Telephone: 408-777-3228
C U P E RTI NO Fax: 408-777-3333
CONTRACTOR/SUBCONTRACTOR LIST
JOB ADDRESS: 19tr,o,-:Ay4-q1 PERMIT# I Tato fSi a
OWNER'S NAME: PHONE# 1*- –D D
GENERAL CONTRACTORS BUSINESS LICENSE# >V0416
ADDRESS: p A 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 SUBCONjR4GT,0RS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
gignafiire Ilate
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
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COMPAnSLEIM)OORUNFMANDASSOCU=FdNMCOMTVMLLERS
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PORTAL PLAZA HOMEOWNERSASSOCIATION
APPLICATION TO MODIFY PROPERTY EXTERIOR OR
COMMON ELEMENTS WITHIN OR SERVING UNIT
Please describe all changes you propose to make to your home or on your lot. Include a scale
drawing with top and side views (plan and elevation) as necessary to clearly establish locations
and elevations of any structures. Include dimensions and description of materials, and specify
color(s) if appropriate. Your drawing should include existing structures and boundaries where
necessary to Indicate relative location. Photographs may be acceptable for some application.
Contractors must be licensed and may be asked to provide acceptable evidence of Insurance.
Permits and compliance with building and safety codes are the responsibility of the owner and
may be required. To avoid delay of approval please Include all the Information that the
Architectural Committee will need to make a decision. Attach additional pages if needed.
Your application must be signed and doted below and on the attached Acknowledgment of
Responsibility. Professional review and/or extensive scrutiny of contracts and plans may be
required for significant or structural modifications.
You may deliver this completed form along with drawings to M & C Association Management,
4305 Hacienda Drive, Suite 180,Pleasanton, CA 94588; or FAX (408) 241-0093. A copy of the
form will be returned to you shortly with the bottom portion completed as your receipt.
Owners: Martha Kiernan
Address: 19880 Portal Plaza Cupertino,CA 95014
Daytime Number. 650-303-7111 Evening Number.
Description of Proposed Modification: Per Ass. Board requirements, the leader piping and
electrical will go to Inside walls below the fence line to
avoid view from outside private yard.
The Mitsubishi VRF system being installed is a climate&air quality controlled ductless HVAC
System chosen for the ultra high efficiency and quiet effective operation.
Signature: Raymond Scott(Contractor) Date: 01-16-13
Print Name: Martha Kiernan Unit#: 19880
Attachment(s):
❑ Contract ❑ Plan/Elevation
xProduct Information ❑ Detail/Dimension
❑ Certificate of Insurance
❑ Acknowledgement of Responsibility ❑ Other
The CCLR's of your Anoctation contain this Information for architectural control.Please read them carefully
and rotor to fMm when applying for any architectural modification.
The Board of Directors has reviewed the proposed exterior changes to your unit as
outlined above, and grants approval for you to proceed with the work, subject to the
plans that were submitted, use of a licensed and Insured contractor, and the
AMRF-Page 1,
I
acceptance of the owner's liability for maintenance and extraordinary expenses to the
Association, with Owner assuming full responsibility for Its satisfactory and timely
completion.
❑ Your application has been denied.
Reason:
❑ Your application Is being returned for additional Information.
Forms Needed:
Signed Py; Title:
Dated:
Affach all applicable above-referenced documents.See alfached Instruction for additional Information.
"'If applicable plows remember to allach gle signed and dated Satellite Dish lnsfallallon Guidellnes or
Window Reoiaaemerd aulde&nes.
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ANW-Page 2