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13030024CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7612 RAINBOW DR - CONTRACTOR: REACO HEATING & AC, PERMIT NO: 13030024 INC OWNER'S NAME: HELEN LEWIS 16250 RAILROAD AVE DATE ISSUED: 03/05/2013 OWNER'S PHONE: 4082534443 MORGAN HILL, CA 95037 PHONE NO: (408)578-6145 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL U COMMERCIAL License Class C- Zt) Lic. 4 REMOVE AND REPLACE EXISTING FURNACE ( ate I SI is Contractor Q.,r � in I-IV A tr Date—.'Z SEE NOTES I hereby affirm that 1 am licensed under the provisions of hapter 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: $1990 I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 36611036.00 Occupancy Type: 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 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 180 DA LAST CALLED INSPECTION. upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, City in of the rOM .- costs, and expenses which may accrue against said consequence Issued by: granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section RE -ROOFS: 9.18. r -(% II rr�,,�� __ Signature 0�+ Dated All roofs sM1all be inspected poor to any roofing material being installed. If a roof is „,,JJJJ �+1+ 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 Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 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 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 Section 3700 of the Labor Code, for the performance of the work for which this the Health & Safety Code, Sections 25505, 25533, and 25534. Owner 7�s 11Lt--^ Date:' 3 ISJ13 permit is issued. or authorized agent: . 1 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 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 of 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 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 CUPERTINO GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 e v(408) 777-3228• FAX (408) 777-3333 • building0cuoertino.orG I—I PLUMBING MMECHANICAL F IELEcTRICAL nNBSCELLANEOUS PROJECT ADDRESS i oq ® \ �� (/(,j APN Nom% I n f o t 1 n `% CP `/lY l._Y�� (. �MAt OwNERNAME'Jderi ' � �r / C PHONE Ljo� . 11, STREET ADDRESS�W 4111^v^'., CITY, STATE, DP X CONTACT NAME PHONE E-MAIl. STREETADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNEI-BUBDER ❑ OWNER AGENT 9 CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSENUI.dBER r f "�, L7C SE TY7F�� I /� BUS. LICk COMPANY NAME E-MAIL 61 � � lc{r e L FAX STREET ADDRESS A / r VGC.L� CITY, STATE, ZIP �� C /NC�'(ONEYY.C7��/��-� ARCHITECT/ENGINEERNAME ZA LICENSENUMBER BUS. LIC4 COMPANYNAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF SFDor DUPLEX ❑ MULTI -FAMILY BUI.DMG: ❑COMMIERCIAL PROJECT IN WI.DLAND ❑YES URBAN INTERFACE AREA ❑ NO PROTECT IV ❑YES FLOOD ZONE ❑ NO IS THE HLDG nTI ❑YES EICHLERHOME9 ❑ NO DESCRIPTION OF WORK TOTALVALUATION: �J RECENEDBY: By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the pberty owner's behalf. I have read this application and the information 1 have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relatin s e representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED -om>�ICEusa ONLY W o" L� VER-THE-CGUMTER m ❑ EXPRESS ❑ STANDARD zm ❑.. LARGE. ❑ MAJOR MEPMiscApp_2011.doc revised 06/21/11 F�� CITY OF CUPERTINO M -1 FEE ESTIMATOR - BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 7612 RAINBOW DRIVE DATE: 03/04/2013 REVIEWED BY: UNITS APN: I BPH: 'VALUATION: $1,990 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARYSFD or Duplex USE: $133 PENTAMATION FURN/AC PERMIT TYPE: WORK REMOVE AND REPLACE FURNACE. SCOPE APPLIANCE / EQUIP TYPE FEE ID Mech. Plan Check 0.0 hrs $0.00 QTY UNITS BP FEES Y6unh. Pernr/r / Furnace, Forced -Air 1MFR=<100 Other Plumb brap. 1 # $133 ((Irc Mq,a Ier: /lei mi! I-ce: .Sapp/. /lisp Ice PME Unit Fee: $133.00 PME Permit Fee: $45.00 C 017sinic tion la.v. Administrative Fee: IADMIN $42.00 Work Without Permit? O Yes Q No $0.00 TOTALS: Travel Documentation Fee: ITRAVDOC $133.00 Strong Motion Fee: IBSEISMICR x �f FEE Mech. Plan Check 0.0 hrs $0.00 1'Lnnh. Man ('heck r (°/,,,, c h,•, k Mech. Permit Fee: ZA9ERA9T Y6unh. Pernr/r / mv!-:,, Other Mech. Insp. 0.0 hrs $45.00 Other Plumb brap. u,her lcicr. hoy,. :I k, h. hnp. /to: Pl,m1b. In.sp. Piz•: ((Irc Mq,a Ier: NOTE: This estimate does not inchtde fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School nkMW otr 1 Thncn foie aro hated an the nrnriminam information available and are only an estimate. Contact the Deot for addn'l info. FEE ITEMS (Pee Resolution 11-053 Eff. 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check 1'ee: Suppl. PC 1'ce PME Plan Check: $0.00 /lei mi! I-ce: .Sapp/. /lisp Ice PME Unit Fee: $133.00 PME Permit Fee: $45.00 C 017sinic tion la.v. Administrative Fee: IADMIN $42.00 Work Without Permit? O Yes Q No $0.00 :I ((uncal Plannin Ices: Travel Documentation Fee: ITRAVDOC $45.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 c' FOALS:°. $266.50 $0.001 TOTAL FEE: 1 $266.50 Revised: 10/01/2012 0 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAlterations CF -IR -ALT -HVAC Climate Zones 1 and 3 - 7 - SiteAddress:EnjorcenrentAgency: Date: Permit #: Conditioned Duct insulation Equipment T et List Minimum Efficiency2 Floor Area re uirement Thermostat Lj Packaged Unit N El Furnace O M AFUE COP Over 40 ft of ducts Indoor Coil ®SEER HSPF — ®Resistance Served by system �-�—� sf added or replaced in unconditioned space Setback (Ifnot alreadypresem, mist be Condensing Unit ® other ®EER _ ®R 6 (CZ 1, 3-5) installed) i 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 o 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 specificationssubmittedto the enforcement agency for approval with.the permit application. Name: Signa Company: - .. Date:—[ c z s t3 Address: License: tt, 7--Z6 A 1l. Z t L6 City/SlatefZip: tUAdAwk 141 L1,- Phone: -tuq- .M„ , — 2008 Residential Compliance Forms March 2010