13040002CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21676 OLIVE AVE
CONTRACTOR: ONE HOUR HEATING
PERMIT NO: 13040002
will do the work, and the structure is not intended or offered for sale (Sec.7044,
AND AIR
Business & Professions Code)
OWNER'S NAME: NORMAN SUSAN D
1400 PETALUMA HILL RD
DATE ISSUED: 04/01/2013
O R'S PHONE: 4088286072
SANTA ROSA, CA 95404
PHONE NO: (707) 545 -1800
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL L1 COMMERCIALE]
License ClassC ?A1 G 13� Lic. # 7 -ve �7 2 9
REMOVE AND REPLACE FURNACE IN SAME LOCATION
Contractor nl,-
Compensation, as provided for by Section 3700 of the Labor Code, for the
I hereby affirm that I am licensed under, the provisions of Chapter 9
performance of the work for which this permit is issued.
(commencing with Section 7000) of Division 3 of the Business & Professions
I have and will maintain Worker's Compensation Insurance, as provided for by
Code and that my license is in full force and effect.
Section 3700 of the Labor Code, for the performance of the work for which this
I hereby affirm under penalty of perjury one of the following two declarations:
permit is issued.
I have and will maintain a certificate of consent to self - insure for Worker's
I certify that in the performance of the work for which this permit is issued, I shall
Compensation, as provided for by Section 3700 of the Labor Code, for the
not employ any person in any manner so as,to become subject to the Worker's
Sq. Ft Floor Area:
Valuation: $4400
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation, Insurance, as provided for by
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.
Section 3700 of the Labor Code, for the performance of the work for which this
Lender's Name
permit is issued.
APN Number: 35721013.00
Occupancy Type:
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
to building construction, and hereby authorize representatives of this city to enter
WITHIN 80 DAYS OF PERMIT ISSUANCE OR
upon the above mentioned property for inspection purposes. (We) agree to save
180 DA OM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may ac againstsaid City in consequence of the
granting of this permit. Ad ' lly, , he applicant understands and will comply
Issued by: Date:
with all non -point so regu ions er Cupertino Municipal Code, Section
9.18.
IN
RE-ROOFS:
All Date 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.
I hereby affirm that I am exempt from the Contractor's License Law for one of
Signature of Applicant: Date:
the following two reasons:
I, as owner of the property, or my employees with wages as their sole compensation,
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
I, 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
I hereby affirm under penalty 'of perjury one of the following three
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
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 equipm nt or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Ba rea it Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the uper ' r ipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Se ' ns 3, d 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Owner or authorized age t: Date
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
CONSTRU TION 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
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.
Date
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CUPERTINO
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014 -3255
(408) 777 -3228 - FAX (408) 777 -3333 - bui1dlnq QQCUDertho.orq
M PLUMBING -PII�ECHANICAI
❑ELECTRICAL ❑MISCELLANEOUS
M E r
MIS*
PROJECT ADDRESS Z 16 7 �� U r /)� TA—?N
G f��
#
OWNER NAME
J4• �
454
PHONTB U� g
E-MAIL
STREET ADDRESS � �
CITY, STATE: ZIP / f� ti �
G
FAX
CONTACT NAME
PHONE
E -MAIL
STREETADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT
❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME M
jI
LICENSE NUMBER
LICENSE TYPE
BUS. LIC # 3
COMPANY NAME rte/
MAIL
FAX
STREET ADDRESS
,
CITY, STATE, ZIP
PHONE
ARCHITECT/ENGLNTEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME '
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD ., DUPLEX ❑ MULTI - FAMILY
BUILDING: ❑ COMMERCIAL
PROJECT IN WILDLAN'D ❑ YES
URBAN INTERFACE AREA NO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOM,E7 ❑ NO
DESCRIPTION OF WORK
J
TOTAL VALUATION: �S
RECEIVED BY:
By my signature below, I certify to each of the followin I am the property owner or authorized agent to act on the pr rty owmer's behalf. I have read this
application and the information I have pmvi t. d the Description of Work and verify it is accura I agree to comply with all applicable local
ordinances and state laws relating to bu' ng o au .ze representatives of Cupertino to enter the ab1oved- Identiled prope4 for inspection pu3poses.
Signature of Applicant/Aeent: Date: 7 "/
ORMATION REQUIRED
OFFICE USE ONLY
❑ OVER- THE - COUNTER
I•'
❑ EXPRESS
U
U
❑ STANDARD
❑ LARGE
L
❑ MAJOR
MBPA1iscApp_2011.doc revised 06121111
$133.50 $133.00KjjjjjNjjjjNM $266.50
Revised: 04/01/2013
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
Mech. Plan Check 0.0 1 hrs $0.00 Plumb. Plan Check Elec, Plan Check
Mech. Permit Fee: 1MPERMIT Plumb. Pcrmit Fee: Elec. Permit Fee:
Other Mech. Insp. 0.0 hrs $45.00 Other Plumb Ins). 01her Elec. Insp.
ltlech. Insp. Fee: Plumb. Insp. Fee: Elec. Insp, Fee:
1vnTF.r Thic e_ctimam does not include feet -due to other Departments (i.e. Plannine. Public Works. Fire. Sanitary Sewer District, School
District, etc.). Thesefees are.based on the prelindnary information available and are only an estimate Contact the Dept-for addh 1iaL
FEE ITEMS (Fee Resolution 11 -053 E�'
21.676 OLIVE AVE
DATE: 04/01/2013
REVIEWED BY: MENDEZ
JimADDRESS:
APN:
BP #:
*VALUATION:
1$4,400
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
Suppl. PC Fee: (E) Reg. 0 OT
PENTAMATION FURN /A
PERMIT TYPE:
WORK
REMOVE AND REPLACE FURNACE IN SAME LOCATION
SCOPE
1MFR = <100
Mech. Plan Check 0.0 1 hrs $0.00 Plumb. Plan Check Elec, Plan Check
Mech. Permit Fee: 1MPERMIT Plumb. Pcrmit Fee: Elec. Permit Fee:
Other Mech. Insp. 0.0 hrs $45.00 Other Plumb Ins). 01her Elec. Insp.
ltlech. Insp. Fee: Plumb. Insp. Fee: Elec. Insp, Fee:
1vnTF.r Thic e_ctimam does not include feet -due to other Departments (i.e. Plannine. Public Works. Fire. Sanitary Sewer District, School
District, etc.). Thesefees are.based on the prelindnary information available and are only an estimate Contact the Dept-for addh 1iaL
FEE ITEMS (Fee Resolution 11 -053 E�'
711112)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
0 #
Mechanical
Suppl. PC Fee: (E) Reg. 0 OT
0.0
1 hrs
$0.00
$133.00
1MFR = <100
Furnace, Forced -Air
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:a Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$45.00
Construction Tax:
Administrative Fee:
IADMIN
$42.00
Work Without Permit? 0 Yes
19 No
$0.00
G
Advanced Planning Fee:
$0.00
Select a Non - Residential
E)
Travel Documentation Fee: ITRAVDOC
$45.00
Building or Structure
i
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee:
IBCBSC
$1.00
$133.50
$133.00
�',
$266.50
Revised: 04/01/2013
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAlterations CF -IR- ALT-HVAC
Climate Zones 1 and 3 - 7
She Address: r
-7 (a 0 L1 NrAV L'
Enforcement Agency:
Date:
Permit #:
Conditioned
Duct insulation
Equipment T el
List Minimum Efficient
Floor Area
requirement
Thermostat
Packaged Unit
umace
AFUE�
® COP
Over 40 ft of ducts
� Setback
Indoor Coil
Condensing Unit
®SEER
®EER
HSPF
® Resistance
Served by system
sf
-added or replaced in
unconditioned space
Qfnot already present, must be
t„ stalled)
® Other
® R 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 enforceme a ency for approval with the permit
application.
Name:
Company: E 7- �-
Oft
ate:
Address:
d.4
License:
o
City /State/Zip:
j A S— D
.7
Phone: 7o % S` 9O0)
2008 Residential Compliance Forms March 2010