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11090063 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10450 N PORTAL AVE CONTRACTOR:A&H HEATING PERMIT NO: 11090063 OWNER'S NAME: KLEIN PETER A AND WOON SANDRA 770 CHESTNUT ST DATE ISSUED:09/09/2011 ''YNER' HONE: 4084109332 SAN JOSE,CA 95110 PHONE NO:(408)279-0722 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r— ELECT T_ PLUMB License Class ca Lic.# �bt-1 cer2_, MECH RESIDENTIAL COMMERCIAL Contractor Date \ ^_—t f JOB DESCRIPTION:SFWL,REPLACE FURNACE AND A/C UNIT 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 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:$5000 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 Occupancy T e permit is issued. APN Number:31629014.00 P Y YP 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. 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 Issued Date: ,r.�l� 9.18. Signature Date RE-ROOFS: OWNER-BUILDER DECLARATION 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 I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Health&Safety Code,Sections 25505,25533,and 25534. 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 Ow Compensation laws of California. If,after making this certificate of exemption,I Date: J l become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION !z its,and expenses which may accrue against said City in consequence of the ting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. .a all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: TraciC COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 31629014 . 00 DATE ISSUED. . . . . . . : 09/09/2011 RECEIPT #. . . . . . . . . BS000014714 REFERENCE ID # . . . : 11090063 SITE ADDRESS . . . . . : 10450 N PORTAL AVE SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER KLEIN PETER A AND WOON SANDRA ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2325 RECEIVED FROM . . . . : A & H HEATING CONTRACTOR PHELPS, DALE LIC # 12079 COMPANY A & H HEATING ADDRESS 770 CHESTNUT ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95110 TELEPHONE . . . . . . . . : (408) 279-0722 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 1. 00 41 . 00 0 . 00 41 . 00 0 . 00 1BCBSC VALUATION 5, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BREMAIRHA NO.UNITS 1 . 00 65 . 00 0 .00 65. 00 0 . 00 1BSEISMICR VALUATION 5, 000 . 00 0 .50 0 . 00 0 . 50 0 . 00 1MFR=<100 UNITS 1 . 00 130 . 00 0 . 00 130 . 00 0 . 00 1MPERMITFE FLAT RATE 1. 00 44 . 00 0 .00 44 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 44 . 00 0 . 00 44 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 325 . 50 0 . 00 325.50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 325 .50 V 438925 --------------- TOTAL RECEIPT 325 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO V FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10450 n. portal ave. DATE: 09/09/2011 REVIEWED BY: bobs. APN: Q BP#: 'VALUATION: 1$5,000 "PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: p PERMIT TYPE: WORK replace furnace add a/c unit. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES A/C Units (<=10K cfm) 1BREMAIR 1 # $65 Furnace, Forced-Air 1MFR=<100 1 # $130 TOTALS: $195.00 Mech.Plan Check 0.0 I hrs $0.00 Mech.Permit Fee: 1MPERMIT Other Mech.Insp. 0.0 hrs $44.00 NOTE. This estimate does not include fees due to other Depts(i.e.Public Works,Sanitary Sewer District,School District,etc.). Thesefees are based on the preliminary in ormalion available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Res•olulion 11-053 Et f.' 7,1/111 FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $195.00 PME Permit Fee: $44.00 Administrative Fee: 1ADMIN $41.00 Work Without Permit? 0 Yes E) No $0.00 Travel Documentation Fee: ITRA VDOC $44.00 Strom Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bld�:t Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $325.50 $0.00 TOTAL FEE-T $325.50 Revised: 09/02/2011 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255IM (� (408)777-3228• FAX(408)777-3333•building(aD-cupertino.org MISC CUPERTIN O V PLUMBING OMECHANICAL ELECTRICAL S PROJECT ADDRESS T7/ t�/�� /I/e)y Pba. rj/� j /�, 4I APN# Q� 42p- 1 OWNER NAME t5,;r e t a e,a 6 ow P &lP E-MAIL STREETADDRESS �` , Rbz N CiTY�S�TFC J�� N ^,// r, FAX CONTACT NAME ;� I`4 � r 7 z E-MAIL STREET ADDRESS ❑OWNER ❑ OWNER-BUILD(ER ❑ OWNER AGENTI CONTRACTOR ❑CONTRACTOR AGENT ElARCHITECT ❑ENGINEER 13DEVELOPER 13TEN CANT CONTRACTOR NAME CENSE NUMB7� LICENSE TYP�_ v BUS.LIC# ) c).` COMPANY NAME —�' ,� �/ E-MAIL / .i• F /�(��7CG 17 STREET ADDRESS "J`�� CITY,STATE IP (� p� PHO `� `� [[ ` G ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OFor DUPLEX ❑ MULTI-FAMILY 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 n �� ss� Lff,21a2AL AIC TOTAL VALUATION: RECEIVED 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 behalf. 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 comply with all applicable local ordinances and state laws relating to b ' ing tru ' n. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED OFF CE USE ONLY OVER-THE COUNTER ❑ EXPRESS ❑ STANDARD Z ❑ LARGE a ❑ MAJOR MEPMiscApp_201 Ldoc revised 06121111 ,✓ V x. Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-1R-ALT-VAC Climate Zones 1 and 3-7 Manufacturer 7—P,49 E Model Number. 7—It D Z 13000"3r Z19 At1TR303"1L96r,?A Site Address: Enforcement Agaff.. Date: Permit No. 1 o 4 SG i'�l o. Poir k L � 6-1 Ty C� 111 Ott fir.,-m- ! og o crLt(.;vz-zrT Nb Equipment Type' List Minimum 2 Conditioned Duct Insulation Thermostat Efficiency Floor Area requirement ❑Packaged Unit >V&UE ❑COP Served by Over 40 ft of ducts Setback �KFumace t6EER ❑HSPF system Added or replaced (if not already ❑Indoor Coil ❑EER ❑Resistance %y V0 sf in Unconditioned present,must XCondensing Unit space be installed) ❑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 F-1R ALTHVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEER,78%AFUE,7.7 HSPF 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. 0 The design features identified on this C.ettificate 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: V1rLci t;LPture Corn — — panT /gig Date: Address: O G n2( S License No.: O C{177 Ci /State/ S S Phone No.: 7 Plug Approva; Setback from property: Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: ( /yo 1Yu �cw/1g�L— �-�-- PERMIT# JU OWNER'S NAME: PHONE# GENERAL CONTRACTOR: ✓. k BUSINESS LICENSE# /20701 ADDRESS: 77C/ C 3> CITY/ZIPCODE: S-S 5371I5� *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. - I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/ Carpeting Linoleum /Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Date Owner/Contractor Signature