13020120 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10195 VICEROY CT CONTRACTOR:AAA FURNACE&AIR PERMIT NO:13020120
CONDITIONING
OWNER'S NAME: ROBERT ITEM - 1712 STONE AVE DATE ISSUED:0221!2013
OWNER'S PHONE: 4085696223 - SAN JOSE,CA 95125 PHONE NO:(408)293-4717
❑
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License ClasS�// ��DC� Lic.9 76 17SD6;>/ UNIT k 3-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 andeffect.
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:$2500
1 have and will maintain Worker's Compensation Insurancq as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this APN Number:32615117.00 Occupancy Type:
permit is issued. .-
- APPLICANT CERTIFICATION
I certify that I have read this application and state thatthe above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and aisle laws relating WITFIIN 10 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 OM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ke-la-1
/
costs,and expenses which may accme against said City in consequence of the Issued by: Date:
granting of this permit. Additionally,the applicant understands and will cemply
with all non-point source regulationsper the Cupertino Municipal Code,Section
9.18.
� Y RE-ROOFS:
Signature `` All roofs shall be inspected prior to any roofing material being installed.If a roof is
;Zt
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ - OWNER-BUILDER DECLAR'ATION
Signature of Applicant: Date:
I hereby affirm 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)
L as owner of the property,'arn 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 tabor Code,for the air contaminants as defined by the Bay Area Air Quality Management District 1
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&Safety Code,Sectio 25505,2553 f and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent:
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 tq 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 permitshali 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 1 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 accme 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 0 ME p
COMMUNITY DEVELOPMENT DEPARTMENT v8'UILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255L ^
CURER71N0 (408)777.3228 • FAX(408)7773 (G� /v
333 •buildina
cuoertino.orD nU�/
PLUMBING FMECHAMCA.L ELECTRICAL MISCELLANEOUS
PROTECT ADDRESS IU1G�' �A CA .-*Z APNM �'^ 1� ]I�.
OWNERNAta v'/(��,�-F I`/Itft v PHO t(»(X-�rjl EMAfLI -
STREET ADDRESSID' 16 VI It
V W, 0 C^Y, STALE.ZIP �/�LJ6 FAX
CONTACT NAME 11 PHONE E MAI
STREET ADDRESS. CRY,STATE, ZIP PAX
• ❑ OWNER ❑ OWNBR•BUILDER ❑ OWNERAowr -4 CONTRAROR ❑CONTRACATTORAAOBNr Cl ARcmr ECT ❑ ENoRmER Cl oevELOPFA ❑ TENANT
CONrRACrORNAMB, f.IM Pando LICENSENUlaERj'/y/a„ 'I u ^u BUS.UC IQ=
DGMPANY NAME A A r.�'P� 0im Bim. I�IjP/'�t(J(VJ �{ (.(J Y�l��� �I
SIREETADDRESS(ia11 ��I��V1W � CrrY.STATE,1 ` man w cit q013
ARCICTEC IENGUMBR NAhM LICENSE NU&MER BUS.LIC P
COMPANYNAME E.MAB- FAX
STREET ADDRESS CrrY,STATE,ZIP PHONE
USE OF SFD or Duplex ❑ Multi.Family PROTECT IN WB.DLAND PROTECT IN
7muc ugz: ❑ Commercial URBAN
,INMFACE AREA
t��� 0 Yes No FLOOD ZONE O Yell �NO
DESCR7PRON I L/I OF WORX of ai /l M (act V/..I SI` -AIR ca
TOTAL VALUATION: lf%x (o
8y niy signature below,l eerttfy to each of rollo"ng: I am the property owner or authorized agent to act on the property owner's behalf. t have mad this
application and the information i have pr Ide 1 is et. 'I have read the Description of Work and verify it is accurate. I agree to cornply with all applicable loaf
ordinances and state lawa relating to bui ing o c n. I authorize repmaentadycs orcupertino to enter the aabbo -ird^e�n and property For inspection pwpoam.
Signatureor ApplianVAgent: Date: LIT!
STJPPLENJTN7AL INFORMATION REQUIRED
MEPMucqpv_201l.doe revved 03116/11
CITY OF CUPERTINO p
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY: mendez
APN: BP#: 'VALUATION: $2,500
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Duplex PENTAMATION FURN/AC
USE: p PERMIT TYPE:
wORK remove and replace furnace in same location
SCOPE
es we
Meeh.Plan Check 0.0 his $0.00 Plumb. Plan Check Elec.Plan Check
Mech.Permit Fee: 1MPERMLT Plumb.Permit Fee flee. Permit Fee:
Other Meeh.Insp. 0.0 his $45.00 Other Plumb 7nsp. El
Other Elec.Insp.
.Heck Insp:Fee: Plumb. Insp.Fee: B(ee.Insp. Fee:
NOTE:This estimate does not includejees due to other Departments(Le.Planning,Public Warks,Fire,Sanitary Sewer District,School
District etc). These fees are based on thereUmin ix ormadon available and are only an estirmue. Contact the Dept for addn7 info.
FEE ITEMS (Fee Resolution 11-053 E . 711/121 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 1 # Mechanical
Suppl.PC Fee: 0 Reg. 0 OT 0.0 his $0.00 $133.00 /MFR=1100 Furnace,Forced-Air
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee-.0 Reg. 0 OT 0.0 his $0.00
PME Unit Fee: $0.00
PME Permit Fee: $45.00
Construction Tint.
Administrative Fee: 1ADMIN $42.00 O
Work Without Permit? O Yes 0 No $0.00 0
Advanced Planning Fee: $0.00 Select a Non-Residential 0
Travel Documentation Feer ITRA VDOC $45.00 Building or Structure 0
Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
$133.50 $133.00h TOALtFEEl $266.50
Revised: 01/01/2013
C:u�eKt,, � u 3O 2.01 ZO
CF-IR-ALT
Prescriptive Certificate of Compliance: Residential pa e 4 of 5)
Residential Alterations Climate Zone# #of Stories
Project Name:
HVAC SYSTEMS- HEATING Duct or Piping Configuration
Minimum Central,Split.
Heating Equipment Efficiency Distribution Insulation Thermostat S ace,Packa a or H dronic)
Type and Ca aci 1•x'3 ( '.FUE or HSPF) T e and Location R-Value
PA 00o v 0
1.Indicate Heating Type(Cervi.-TI Furnace,Poll Furnace. Hear pump. Boiler. Electric Resistance, etc.)
2.Electric resistance heating is allowed only in Component Package C. or except where electric heating is supplemental(i.e., if total capacity
< 2 KW or 7,000 Btu/hr electric Heating is controlled by a time-limiting device not exceeding 30 minutes). See§151(b)3 exception.
3.Refer to the HERS Verification section on Page 4 of the CF-I R-ALT Form jbr additional requirements and check applicable boxes.
4. Indicate Type or Location(Ducts. Hydronic in Floor, Radiators,etc.)
HVAC SYSTEMS-COOLING
Minimum r ,piing— -- - - - Configuration
iciency,
CoolingE (SEER/ ution Insulation Thermostat (Central,Split,
Equip P men[ n T e an ' r R-Value T e S ace,Package or H dronic
Type and Ca acit �'
I. Indicate ing Type(A/C. Heat pump. Evap. Cooling, etc)
2 to the HERS Verification section on Page 4 of the CF-I R-ALT Form jot additional requirements and check ap b(e boxes.
`3. Indicate Type or Location (Ducts, H dronic in Floor, Radiators,ere.)
WATER HEATING
List ware,heaters and boilers jor both domestic hat water(DHat
W)heers and hydromc space heating. Individual dwelling DHW hearers must b,
gas or propane fired,and may not exceed 50 gallons. Hot water pipe insulation from the DHW hearer to the kirchen(s)and on all underground
hot water pipes is required in all cont anent acko es in all climate zones. External Tank
Water Heater Type/Fuel Distribution Type Number In Tank Energy Factor or Insulation
Typel (Standard, Reeirculatin )'' S stem Ca aci ( al) Thermal Efficient R-Value3
1. Indicate Tvpe(Storage Gas, Heat Pump, Instantaneous, etc.)
2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of§150(n). The Prescriptive requirenrentr do
not allow the installation of a recirculating water heating system for single dwelling units.
3. The external water Hearin tank and pipes shall be insulated to meet the reiruirements of§150
SPECIAL FEATURES The enforcement agency should pay special attention to the Special Features specified in this checklist below.
These items may re uire written 'ustt,cation and documentation ands ecia(veri ication.
. NEW.ROOF ASSEMBLY-Radiant Barrier
The radiant barrier re. uirement of 15 1( 2 does nota I 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 OYES ❑ NO
YES:Slab ed a insulation re uired for all heated slabs in all Climate Zones. See details "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;uired; in Climate Zones 12 & 15,R-4 is required under cont onent Pa
' Thermal Mass
To obtain Com liance Credit for the installation of thermal mass,use the Performance A roach.
Registration Date?ime: HERS Provider:
Registration Number: August 20
2008 Residential Compliance Forms