13030023 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10881 MAXINE AVE CONTRACTOR:VALLEY HEATING& PERMIT NO: 13030023
COOLING
OWNER'S NAME: ENRIQUE TAN 1171 N 4TH ST DATE ISSUED:03/05/2013
OWNER'S PHONE: 9098959643 SAN JOSE,CA 95112 PHONE NO:(408)294-6290
X
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL IJ COMMERCIAL
LI
License'C1ass -�'D Lic.tl 2SS8 REMOVE WALL HEATER& INSTALL(Ni FORCED AIR
FURNACE 1N ATTIC AREA. INSTALL(N)AC UNIT AT
Contractor Reci t'nc Date 3%5 REAR
hereby affirm that 1 am licensed un er the provisions of Chapter 9 OF BUILDING.
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
1 hereby effrm 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:$9170
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:32602014.00 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 j180
ITM 180 DAYS OF RNIIT 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 DAYS F ALLED INSPECTION.
indemnify and keep harmless the City ofCupertino against liabilities,judgments,costs,and expenses which may accrue against said City in consequence of the 3
granting of this permit. Additionally,the applicant understands and will comply 1y: a e:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
s1 d 3/� any
r ROOFS:
Signature � ,t--,� � Date All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,1 agree to remove all new materials for
inspection.
❑ . OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
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. 1 will
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 andwill maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 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
performance of the work-for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
have and wi11 maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this g
ent:
permit is issued. Owner 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
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
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
hereby authorize representatives of this city to enter
to building construction,and y p tY
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 1 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
r� V�
GENERAL PERMIT APPLICATION �v
MEP
is COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255CUPERTINO 1
(408)777-3228•FAX(408)777-3333•building(cDcupertino.org MISC
❑PLUMBING MECHANICAL ❑ELECTRICAL ,� /❑MISCELLANEOUS
' �� //
PROJECT ADDRESS t0 ' C ) APN# 3 / L.. D 2 �- V / y
OWNER NAME ���� a PHONE
!�`� E-MAIL
e T 4oq-895_2 13
STREET ADDRESS/b CITY, STATE,ZIP lC 501 FAX
a '
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE, ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR 1,0rCONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBERLICENSE TYPE BUS.LIC#
V6 Ile.f' 5l`f.5116
COMPANY NAME t E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
r k s C A �si�z ybs Zgcf-Gz4b
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF 19SFD or DUPLEX ❑ MULTI-FAMn.Y PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME?? ❑NO
DESCRIPTION OF WORK � /
UJ4/1 r ! c e ct.� egf, i
TOTAL VALUATION: q RECEIVEI)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 be . 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 com y with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: C!)31OV2o13
SUPPLEMENTAL IN ORMATION REQUIRED o CE USE 0A'y S
w "qOv -THE-CouN CEIi
EXPRESS `,.
� ❑ �YDARb ��r r
x.AT2GE r e
0,MAJOR a.
MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
{ ADDRESS: 10881 MAXINE AVE DATE: 03/05/2013 REVIEWED BY: MELISSA
APN: 326 02 01.4 BP#: "VALUATION: 1$9,170
*PERMIT TYPE: . Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: FURN/A
WORK REMOVE WALL HEATER& INSTALL N FORCED AIR FURNACE IN ATTIC AREA. INSTALL N AC
SCOPE UNIT AT REAR OF BUILDING.
APPLIANCE/EQUIP TYPE . FEE ID QTY UNITS BP FEES
A/C Units (<=10K cfm) 1BREMAIR 1 # $67
Furnace, Forced-Air 1MFR=<100 1 # $133
TOTALS:
� $200.00
Mech.Plan Check 0.0 hrs $0.00 Phunb. Plan Check Elec. Plan Check
Mech.Permit Fee:.IWERMITPlumb.Permit Fee: Elec•.Permit Fee:
FOther Mech.Insp. Rolhrs $45.00 Other Plumb Insp. F-1 Other Elec.Insp.
Insp.1, - Plumb. Insp.Tec;: 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 . These fees are based on the prefindna information available and are only an estimate- Contact the Dept for addn I info.
FEE ITEMS (Fee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Supp1. PC Fee
PME Plan Check: $0.00
Permit
Suppl. Insp Fee
PME Unit Fee: $200.00
PME Permit Fee: .T7 $45.00
C;onslruction:Tar:
Administrative Fee: IADMIN $42.00
Work Without Permit? ®Yes (j) No $0.00
Advanced Planning fees:
Travel Documentation Fee: 1TRAVDOC $45.00
Strong Motion Fee: 1BSE1SMfCR $0.92 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
$333.921 $0.00 - $333.92
y Revised: 01/01/2013
Y_
Simplified Prescriptive Certificate of Compliance:2008 Residential HVACAlterations CF-IR-ALT-HVAC
Climate Zones 1 and 3-7
Site Address: Enforcement Agency: Date: Permit#:
t5 La « ✓e 3/5
Conditioned Duct insulation
Equipment T el List Minimum Efficiency' Floor Area requirement Thermostat
Packaged Unit
Furnace ®AFUE D ®COP Over 40 8 of ducts
Indoor Coil SEER HSPF_ Served by system added or replaced in Setback
�- sf unconditioned space (I not already present,must be
Condensing Unit ®EER ®Resistance installed)
Other MTrR 6 (CZ 1,3-5)
1.Equipment Type:Choose the equipment being installed;if more than one system,use another CF-1R-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 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: C�R S Signature:
r
Company:,/ ' C Date: 3/ I
3
Address: License:
City/State/Zip: J�4� — QSI/2 Phone:
2008 Residential Compliance Forms March 2010
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