13020121 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19421 PHIL'LN CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 13020121
. . CONDITIONING
OWNEWSNAME: ALLAJERDES 1712 STONE AVE DATE ISSUED:02212013..
OWNER'S PHONE: 4082532634 SAN JOSE,CA 95125 PHONE NO:(408)293.4717
❑ LICENCED CONTRACTOWS DECLARATION JOB DESCRIPTION: RESIDENTIAL EJ OMMERCIAL _
License ClassC a 6-0 Lie.# 7N 0 7 REMOVE AND REPLACE FURNACE IN SAME LOCATION
Contractor, � /yu6Ge - Date a r
I hereby affirm that 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 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:52200
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:37505034.00 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 WITHIN 80 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 18)DA FROM LAST CALLED INSPE TION:
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 source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature rk Date-2- 2r 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 amexempt 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 properly,or my employees'with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.9044,
Business&Professions Code) - .
I,as owner of the property,am exclusively,cdntracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
concoct the project(Sec.7044,Business&Professions Code). 1 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(x)should 1 store or handle hazardous
Ihave 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&Safety Code,Sectio r 25505,2553 „and 25534.
Section 3700 of the Labor Code,for the performance of the work for which Nis2-at`3
permit is issued. Owner or authorized agent: � Date:
I certify that in the performance of the work for which this permit is issued,I shall
not employ any person in my 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
becomesubjectto the Worker's Compensation provisions of the Labor Code,I most I hereby affirm that there is a construction lending agency for the performanceof
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 CERTMCATION - Lender's Address
I certify that I have read this application and state that the above infornation 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
GENERAL PERMIT APPLICATION ?\ MEP
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION ��\ 1�
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (` A /� ' �1 �1
CURa,ERTINO (408) 777-3228 - FAX(408)777-3333 -buildingupertino.org \/J�,} m s !c
PLUNMING t+MCHANICAI ELECTRICAL \\MISCELLANEOUS
(�'
1 PROJECT ADDRESS I 1111 11141 tom APN 4 �S 1)150_341
OIVNER NAME lkAA1` PHONE/Tr�, 29O3-202A ENWIl,
M—MADUMS '% 1 '�f lJ �Y•J'f' FA%
J CONTACT NAAm PHONE ` Ir� E M II
rMEETADORESS. MY,STATE. ZIP FAX
' ❑ OWNER ❑ OWNER-BUILOER ❑ OWNERAORT XCONTMCTOR ❑CON CTORAOENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER 11 TFNAKT
CONTTWCTOR NAME VU�nM. LIC�1 U E BUS.LIC/q(DGD
COMPANY NAME Aff �,�1/I A�!`NDN
8-MAILFFA�X
ST LM ADDRESS ' Y 1�Q,v.
ARCHITECT/ENMMER NAME -�1�G LICENSE NOh®ER BUS.uC 1 V
COMPANYNAME E-MAIL TnX
STREET ADDRESS CITY,SPATE,ZIP PH.W[
USE OF ly6FD or Duplex ❑ Multi•Faznily PROJECT W WB,DLAND FRO/ER IN
rmumvu: Cl Commercial URBAN mnFRFAce AAFA O Ya �No L00D ZONE O Ya No
DESOUMON OF WORK and 0101cej 415sbnq wall rlavvlj/
TOTAL VALUATION:
By my signaNrt below,7 eerdty to�,pj'ldl
the toll 'ng I am the property owner or authorized agent to ac[on the property owner's behalf I have read this
applicad9n and the information t he dad c rte . 'I have read the Description of Work and verify it is aCCUM . I agree to compty with all applicable loaf
ordinances and save lawn relating to g co c' n. I authorize representatives of Cupertino w enter the ab o -i cli property for impaction prapozca
Signature of ApplicanVAgent: Date a{/ 3
SUPE ME INFORMATION REQUIRED
&fEPMLrcRpp_1011.doe mired 03/16/71
CITY OF CUPERTINO t ` 2 l
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: I DATE: REVIEWED BY: mendez
APN: BP#: 'VALUATION: $2,200
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration Repair
PRIMARY PENTAMATION
USE: SFD or Duplex . ' PERMIT TYPE: FURN/AC
WORK remove and replace furnace in same location
SCOPE.
a
irt �.� tW
Meeh.Plan Check 0.0 hrs $0.00 Plumb.Plan Check Elec.Plan Check
Meeh.Permit Fee: IMPERMIT I Plumb. Pe,"u Fee' Ele.c. Permit Fee:
Other Mech.Insp. 0.0 hrs $45.00 01her Plumb Insp. Li Other Elm Insp.
Adech.Insp.Flee: Plumb.Insp.Fee: - Elee.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(Le-Planning,Public Works,Fire,Sanitary Sewer District,School
District etc). These fees are based on the Prefindn information available and are only an estimate Contact the Dept for addn'1 info.
FEE ITEMS(Fee:Resolution II-053 E .. 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 1 # Mechanical
Suppl.PC Fee Q Reg. OT0.0 Ins $0.00 $133.00 IMFR=U00 Furnace,Forced-Air
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl.Insp. Fee-.0 Reg. 0 OT 0,0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $45.00
Consinlction Tar
Administrative Fee: IADMIN $42.00 O
Work Without Permit? 0 Yes Q No $0.00 0
Advanced Planning Fee: $0.00 Select a Non-Residential G
Travel Documentation Fee: ITRA VDOC $45.00 Building or Structure
i
Strong Motion Fee. IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
v,n
$133.50 $133.00 .. ;01y1L�FEEy $266.50
Revised: 01/01/2013
u n P tLr I IQ [_J p7 o -Z l
Prescriptive Certificate of Compliance: Residential CF-IR-ALT
Pa ell of 5)
Residential Alterations
- Climate Zone# #of Stories
Project Name:
PO4j
AC SYSTEMS-HEATING Configuration
Minimum Duct or Piping B
Efficiency Distribution Insulation Thermostat (Central,Split,
�FUE or HSPF) T e andLocationR-Value T e S ace,Packa a or H dronic)GlL �' I
dicate Heatig pe( t:•al Furnace,Nall Furnace. Hem pump, Boiler. Electric Resistance, ere.)
?.Electric resistance heating is allowed only in Component Package C. or except where electric heating is supplemental(i.e.. if total capacity
< i 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-IR-ALT Form for additional requirements and check applicable boxes.
4. Indicate Type or Location(Ducts. Hydronic in Floor, Radiators,etc.)
HVAC SYSTEMS-COOLING
Minimum Configuration
Efficiency r tPin g
Cooling Equipmen (SEER/EER or Di n Insulation Thermostat (Central,Split,
Type and Ca I a and Location[ R-Value T e Space,Package or H dronic)
1. me oolingTvpe(A/C, Heat pump, Evap. Cooling, etc) -
3. Refer to the HERS Verification section on Page 4 of the CF-I R-ALT Form jar additional requirements
applicable bases.
3. Indicate Type or Location(Ducts, H dronic in Floor,Radiators, etc.)
WATER HEATING
Lis pater heaters and boilers for both domestic hat water(DHW)heaters and hydrant pace heating. Individual dwelling DH W heaters must be
gas or pr tied,and may not exceed 50 gallons. Hot water pipe insulation fro the DHW heater to the kitchen(s)and on all underground
hot water,pipes is fired in all cont onent acka es in all climate zones. External Tank
Water Heater Type/Fuel istributionType mberIn Tank Energy Factor or Insulation
T e' (Standar , cula[i S stem Ca aci ( al) Thermal Efficiency R-Value
1. Indicate Tvpe(Storage Gas, t Pump, Instantaneous, etc.
2. Recirculating systems s Ing multiple dwelling units shall meet the recirculation regw emen 150(n). The Prescriptive requirements do
not allow the installation ofa recirculating water heating system jar single dwelling units.
3. The external water heatin tank and pipes shall be insulated to meet the re III emeIII I
SPECIAL FEATURES The enforcement agency shouldpay special attention to the Special Features specified in this checklist below.
These items may re wirejustification
written and documentation ands ectal vert(cation.
. NEW ROOF ASSEMBLY-Radiant Barrier
The radiant barrier re uirement of§151( 2 does no apply to roof alterations.
Slab Edge(Perimeter)Insulation 0 YES 0 NO
YES: In Climate Zone 16 in Component Packages D,R-7 insulation is required.
Heated Slab Insulation 0 YES 0 NO
YES:Slab edge insulation required for all heated slabs in all Climate Zones. See details in Table 1 I8-A of the standards.
Raised Slab Insulation 0 YES 0 NO
YES: In Climate Zones I,2, 11, 13, 14& 16,R-8 insulation is required; in Climate Zones 12& 15, R-4 is required under component Package D.
Thermal Mass
To obtain Com liance Credit for the installation of thermal mass,use the Performance Approach.
Registration Date/Time: HERS Provider:
Registration Number: August 200
2008 Residential Compliance Forms