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11080022 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19732 DRAKE CT CONTRACTOR:VALLEY HEATING& PERMIT NO: 11080022 COOLING OWNER'S NAME: JANSSON ROSE 1171 N 4 TH ST DATE ISSUED:08/02/2011 ER'S PHONE: 4089739926 SAN JOSE,CA 95112 PHONE NO:(408)294-6290 ❑ LICENSED CONTRACTOR'S DECLARATIONtf- BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class C�_/2c Lic # /n MECH RESIDENTIAL COMMERCIAL Contractor Vd f>r "r Date ( ! I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE&REPLACE FURNACE&ADD A/C;REPLACE (commencing with Section 7000)of Division 3 of the Business&Professions DUCTS. Code and that my license is in full force and effect. ADHERES TO 5'SETBACK / I hereby affirm under penalty of perjury one of the following two decla 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. 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 Sq.Ft Floor Area: Valuation:$8800 permit is issued. APPLICANT CERTIFICATION APN Number:31632017.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. `7> Issued b � �-- Date: Signature � ' JPTate LJ OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. 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 Ow.ge�f t riz d agent �y forthwith comply with such provisions or this permit shall be deemed revoked. .9 . V APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save -mify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address and expenses which may accrue against said City in consequence of the ;,,..iting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 8 ITEMS OF 16 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31632017. 00 DATE ISSUED. . . . . . . : 08/02/2011 RECEIPT #. . . . . . . . . : BS000014283 REFERENCE ID # . . . : 11080022 SITE ADDRESS . . . . . : 19732 DRAKE CT SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . . JANSSON ROSE ADDRESS . . . . . . . . . . : 19732 DRAKE CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2432 RECEIVED FROM . . . . : VALLEY HEATING & CO CONTRACTOR . . . . . . . : ATKINSON, THOMAS LIC # 141 COMPANY . . . . . . . . . . : VALLEY HEATING & COOLING ADDRESS . . . . . . . . . . : 1171 N 4 TH ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95112 TELEPHONE . . . . . . . . : (408) 294-6290 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 1 .00 41. 00 0. 00 41 .00 0. 00 1BAPPLOTHE NO OF APPLIAN 1. 00 65. 00 0. 00 65 .00 0. 00 1BCBSC VALUATION 8, 800 . 00 1. 00 0. 00 1. 00 0. 00 1BREMAIRHA NO.UNITS 1. 00 65. 00 0 . 00 65 . 00 0 . 00 1BSEISMICR VALUATION 8, 800 . 00 0 .88 0 . 00 0 .88 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 390. 88 0. 00 390 .88 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 782. 07 #22375 --------------- TOTAL RECEIPT 782 . 07 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL / 0 E 0 (-) z2-- GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228• FAX(408)777-3333•buildinga-cupertino.org MISC CUPERTINO ❑PLUMBING MEC14ANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS ;� 7 7)2 lrq e (f-f - APN# (� 2 J , ^ �/� f OWNER NAME (, K PHONE l <'I/1��!E-MAIL STREET ADDRESS ^� CITY, STATE,ZIP /1 � FAX 7Z 1')r� ke' C-f �u- T_ CONTACT NAME `�I/l v�(4.� r PHONE,- � ��`r E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAMELICENSE MB LICENSE TYPE BUS.LIC# "S5 COMPANY NAME V E-MAIL FAX STREET ADDRESS CITY,S TE,ZIP v PHONE 44 2YCY ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF SFD or 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 J� Y-� �4 i ` ,( (r X/ z K f tG'r9 ,!� C l�el;> e (� t h-C/ C TOTAL VALUATION: RECEIVED BY: r By my signature below,1 certify to each of the following: I am the property owner or authorized agent to act on the prope 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 building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: �-":ct_- Date: ��<�zC�f/ SUPPLEMENTAL INFORMATION REQUIRED OFTICE USE ONLY ❑ OVER-THE-COUNTER F ❑ EXPRESS x ❑ STANDARD U Z ❑ LARGE w , ❑ MAJOR MEPMiscApp_201 1.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION F121 ADDRESS: 19732 drake ct. DATE: 08/02/2011 REVIEWED BY: bobs. APN: I BP#: "VALUATION: 1$8,800 -PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: p PERMIT TYPE: WORK re lace furnace add A/C unit re-duct. 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 Other Appliance/Equip � � O��e, 1 # $65 TOTALS: $260.00 Mech.Plan Check0.0 hrs $0.00 Mech.Permit Fee: 1 MPERMIT Other Mech.Insp. 0.0 hrs L$44.00 LLJ Lj - NOTE. These fees are based on the preliminary information available and are only an estimate. Contact the Dept-for addh 7 info. FEE ITEMS (Fee Resolution 11-05;Fff FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $260.00 PME Permit Fee: $44.00 Work Without Permit? 0 Yes E) No $0.00 Travel Documentation Fee: ITRA VDOC $44.00 Strom Motion Fee: IBSEISMICR $0.88 0.5 hrs Admin./Clerical Fee Bldg Stds Commission Fee: IBCBSC $1.00 $41.00 ]ADMIN SUBTOTALS: $349.88 $41.00 TOTAL FEE: $390.88 Revised: 07/04/2011 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-HVAC Climate Zones I and 3-7 Site Address: Enforcement Agency: Date: Permit#: Conditioned Duct insulation Equipment T e' List Minimum Efficienc z Floor Area requirement Thermostat Packaged Unit Over 40 ft of ducts Furnace tNAFUE ).%l nCOP Served by system added or replaced in �Setback Indoor Coil SEER HSPF sf unconditioned space (Ynot already present,must be Condensing Unit BEER— Resistance R 6 (CZ 1,Spa installed) Other 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. • 1 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: Signature: Company: Date: Address: License: City/State/Zip: �' —� f, -� Phone: , _ zy 'tee 2008 Residential Compliance Forms March 2010 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C O P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIS JOB ADDRESS: Iq3; brakeCf PERMIT# OWNER'S NAME: d ';� 50- PHONE# GENERAL CONTRACTOR: V, jje ' eu 6-, BUSINESS LICENSE # !� ADDRESS: j ( �(� ' ' CITY/ZIPCODE: 542 ., *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 Owner/Contractor Signature Date