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12120060CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10418 MIRA VISTA AVE CONTRACTOR: A & H HEATING PERMIT NO: 12120060 OWNER'S NAME: SUMAL NAVKIRAN S AND JASPAL K 770 CHESTNUT ST DATE ISSUED: 12/12/2012 OWNER'S PHONE: 4083980432 SAN JOSE, CA 95110 PHONE NO: (408)279 -0722 ❑ LICENSED CONTRACTOR'S DECLARATION F BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class T /Lic. # Contractor d * F4.— Date Z r Z G- I hereby affirm AM 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. 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. 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 permit is issued. APPLICANT CERTIFICATION 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature �v +� k ►'� �Q -Date 2--12 ❑ OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 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 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date MECH r— RESIDENTIAL f— COMMERCIAL I— JOB DESCRIPTION: FURNACE AND A/C CHANGE OUT Sq. Ft Floor Area: I Valuation: $7000 APN Number: 35702015.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: ate: ,/"�,2 —le RE- ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Ownk or authorized( /% ate• CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of Mrk's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional '2 l 2.0 0 (n c3 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 CUPEEtT[NO (408) 777 -3228 • FAX (408) 777 -3333 • building (d)..cuDeriino.org MISC MWTTk=T'uJn F1xrp - T- T ATITCAT_ nELECTRICAL nMISCELLANEOUS PROJECT ADDRESS i ( IZA t V Imo' I `.PN # 357- O 2 – d t 5— OWNER NAME N PH! C6 e+ E-MAIL STR.BI7TADDRESS CITY, STA'T'E, ZIP 9vt q I FAX 5- CONTACT NAME F, r S POE 2- M r 4P STREET ADDRESS C (�v� t �) �❑ C1lY, STATE )r /'1 (❑/ F ❑ O ' ❑ OWNER - BUILDER OA?NER AGENT CONTRACTOR ❑ CONTRACTOR AGENT. ❑ ARCi -=.CT! ENGINEER 13 DEVELOPER ❑ TENANT CONTRACTOR NAME d > >. LICENSE NUMBER � LICENSE rff - ?c> � BUS. LIC ,°. •� O COMPANY NAME � �/�_ � t� � � G�1 � L -�� DL • FAX STREET ADDRESS ` i D /P t ( fr I L.0 CITY, STA E ZIP Y `•l V f ✓ j t W Z ! G ARCHITECTIENGIIvZE t NAME LICENSE NUMBER BUS. LIC'# COMPANY NAME ' E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF SFD . DUPLEX ❑ MULTI -FAI MY BUILDING: ❑ COMTgRCIAL PROJ'EC'T IN WII DLAND ❑ YFs I URBAN INTERFACE AREA ❑ NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO ( IS THE BLDG AN ❑ YS EICHLER HOME? ❑ NO DESCRIPTION OF ORK TOTA.LVALUATION: ?�(j�© r_ I 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 correct. I have read the Description of Work and verify it is accurate. I agree to comply vrith all applicable local ordinances and sate laws relating to building construction. I authorize representatives of Cupertino to enter the above- identinedprope„y for inspection pu;�)eses. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQ=D OFFIC&EE ONLY E OVER- THE - COUNTER ❑ EXPRESS U U ❑ STANDARD ❑ L .RGE ❑ MAJOR 11=Muc.,4pp- 201 1.doc revised 06121111 i I 17 CITY OF CUPERTINO ICI FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10418 mira vista ave. FEE ID DATE: 12/12/2012 REVIEWED BY: bobs. APN: BP #: 'VALUATION: 1$7,000 'PERMIT TYPE: Mechanical Permit 1sREMAiR PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: # PENTAMATION FURN /AC PERMIT TYPE: WORK furnace and ac change out 1MFR = <100 SCOPE 1 # APPLIANCE / EQUIP TYPE FEE ID QTY /FEE QTY UNITS BP FEES A/C Units ( < =10K cfm) 1sREMAiR 1 # $67 Furnace, Forced -Air 1MFR = <100 1 # $133 PME Unit Fee: $200.00 PME Permit Fee: $45.00 Administrative Fee: JADMIN $42.00 Work Without Permit? ® Yes (!) No $0.00 TOTALS: Travel Documentation Fee: ITRAVDOC 1 $200.00 Strong Motion Fee: 1BSEISMICR NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the nreliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11 -053 j " .7j/12) Mech. Plan Check " 00 $0.00 Mech. Permit Fee: 1MPERMIT Other Mech. Insp. 0.0 hrs $45.00 QTY /FEE Lj NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the nreliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11 -053 j " .7j/12) FEE QTY /FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $200.00 PME Permit Fee: $45.00 Administrative Fee: JADMIN $42.00 Work Without Permit? ® Yes (!) No $0.00 Travel Documentation Fee: ITRAVDOC $45.00 Strong Motion Fee: 1BSEISMICR $0.70 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $333.70 $0.00 TOTAL FEE: $333.70 Revised: 10/01/2012 DEC 11 2012 ]BY:- Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-1R-ALT-VAC Climate Zones 1 and 3 -7 Manufacturer: T a-A lA E- Model Number: -"r u o Z- L3 d SD A- WW A .4T-15C SD q 7- 0,100O& Site Address: Enforcement Age cy: Date: Permit No. DL( [ $ lit. t (Zv4 V( t) TA Ct ry 6 I 0-kni DD 'p tcv Q�i�L<< N Y2-1911Z Equipment Type' List Minimum 2 Conditioned Duct Insulation Thermostat Efficiency Floor Area requirement ❑ Packaged Unit WAFUE ❑COP 190 Served by Over 40 ft of ducts etback ef�imace WEER ❑HSPF system Added or replaced (if not already ❑ Indoor Coil ❑EER ❑Resistance 1,100 sf in Unconditioned present, must V<ondensing Unit space be installed) ❑ Other ❑ R 6 (CZ 1, 3 -5) 1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -1 R -ALT- HVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7 HSPF 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 submitted to the enforcement agency for approval with the permit application. Name: L, L - Signature: Company: A- . Date: a- - L Address: III C lr T License No.: 8 Ci /State /Zi : j ( Phone No.: C40 V 2 2Tjz 07 Z Z Planning ApprovaL• Setback from property: