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11070058CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10792 BROOKWELL DR CONTRACTOR: AAA FURNACE & AIR PERMIT NO: 11070058 CONDITIONING OWNER'S NAME: DAVIS PAUL H AND BARBARA D 1712 STONE AVE DATE ISSUED: 07/11/2011 ( R'S PHONE: 4082538015 SAN JOSE, CA 95125 PHONE NO: (408)293-4717 ❑ LICENSED CONTRACTOR'S DECLARATION r r— BUILDING PERMIT INFO: License Class Lic. # bs BLDG ELECT PLUMB r Contractor l� i. lf`N �j C:[ Date -- — / MECH RESIDENTIAL COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REMOVE FURNACE & CONDENSER & INSTALL NEW (commencing with Section 7000) of Division 3 of the Business & Professions FURNACE & Code and that my license is in full force and effect. CONDENSER IN SAME LOCATION 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 �(�1 Compensation, as provided for by Section 3700 of the Labor Code, for the .-.LUI.7T�� performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Sq. Ft Floor Area: Valuation: $5985 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION APN Number: 36921034.00 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 City of Cupertino against liabilities, judgments, costs, and expenses 'ch ccrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this pe it. tonally, the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-poin sourc gulations per the Cupertino Municipal Code, Section 9.18 Issued by: / Date: ? //-'" Signature Date f L 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: I, 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: I have and will maintain a Certificate of Consent to self -insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 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, shoul u e equipment or devices which emit hazardous air permit is issued. contaminants as fine 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 nee ith 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 Safe C e, 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 O ne norized agent: forthwith comply with such provisions or this permit shall be deemed revoked. Date: APPLICANT CERTIFICATION CONT UCTION 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.) Io 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 in-' -nify and keep harmless the City of Cupertino against liabilities, judgments, Lender's Address nd expenses which may accrue against said City in consequence of the ;rw..mg 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 ).18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36921034.00 DATE ISSUED.......: 07/11/2011 RECEIPT #.......... BS000014008 REFERENCE ID # ...: 11070058 SITE ADDRESS .....: 10792 BROOKWELL DR SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ...... OPERATOR: patg COPY # : 1 OWNER ............: DAVIS PAUL H AND BARBARA D ADDRESS ..........: 10792 BROOKWELL DR CITY/STATE/ZIP ...: CUPERTINO, CA 95014-4609 RECEIVED FROM ....: RANDO AAA HVAC,INC CONTRACTOR .......: RANDO, JIM LIC # 8050 COMPANY ..........: AAA FURNACE & AIR CONDITIONING ADDRESS ..........: 1712 STONE AVE CITY/STATE/ZIP ...: SAN JOSE, CA 95125 TELEPHONE ........: (408)293-4717 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 5,985.00 1.00 0.00 1.00 0.00 1BREMAIRHA NO.UNITS 1.00 65.00 0.00 65.00 0.00 1BSEISMICR VALUATION 5,985.00 0.60 0.00 0.60 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 ---------- 325.60 ---------- 0.00 ---------- 325.60 ---------- 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT AMOUNT --------------- 325.60 --------------- 325.60 VOICE ID DESCRIPTION -------- ---------------------------- 505 FINAL ELECTRICAL 508 FINAL MECHANICAL REFERENCE NUMBER -------------------- #38742 VOICE ID DESCRIPTION -------- ---------------------------- 507 FINAL PLUMBING CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building-8cupertino.org ❑ PLUMBING 5VIECHANICAL ❑ELECTRICAL ❑ MISCELLANEOUS MEP MISC PROJECT ADDRESSD I C1 Z_ � {`00 IC Vic 1 b� TAPNI OWNER NAME TaLL U \ _ f ,� 1 S NE � _,;IS_ �O lJ r EMAIL STREET ADDRESS l.J� Z'-Fj rock- Wd t I 1 . ST 'ZIP C.) wCkc U' FAX CONTACT NAME ' 1. C Q f_J O 3 ` I /'� . C �C STREETADDRESS ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT VcoNTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME ��4- Fit r LICENSE NUMBER e-9-7 LICENSE TYPE BUS. LIC 9 COMPANY NAME p Q j STREET ADORES L S CITY. STATE, s ✓� Pa, P 0 ARCHITECTIENGINEER NAME LICENSE NUMBER BUS. LIC I! COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE SE OF ❑ SFD or Duplex ❑ Multi -Family -MUCTUgE. ❑ Commercial PROJECT IN WILDLAND URBAN INTERFACE AREA Cl Yes ❑ NO PROJECT IN FLOOD ZONE ❑ Yes ❑ NO DESCRIPTION OF WORK P eryl u a P SJ --t PQ UAD 4qA, EX)a-4- cond P k, Pe f- (o[rr 0 -� TOTAL VALUATION: By my signature below, I certify to each of the fo g: I the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I h e rovide Is c 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 ons on. I authorize represe o Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: 7Aff Date: Q' 7 ' O - 1 MEPMucApp_2011. doc revised 03/16/11 CITY OF CUPERTINO FF,F ESTIMATOR — BUILDING DIVISION im,ADDRESS: 10792 brookwell dr. DATE: 07/11/2011 REVIEWED BY: bobs. UNITS APN: BP#: "VALUATION: 1$5,985 Y' PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: I PENTAMATION FURN/AC I PERMIT TYPE: WORK remove exisiting install new furnace install new a/c unit. SCOPE APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES A/C Units (<=10K cfm) 1BREMAIR 1 # $65 Furnace, Forced -Air 1MFR=<100 1 # $130 PME Unit Fee: $195.00 PME Permit Fee: $44.00 Work Without Permit? 0 Yes E) No $0.00 TOTALS: Travel Documentation Fee: ITRA VDOC 1 $195.00 Strong Motion Fee: 1BSEISMICR Mech. Plan Check 10.0 1 hrs $0.00 Mech. Permit Fee: IMPERMIT Other Mech. Insp. 1 0.0 1 hrs $44.001 Nn T!. • Thorn %oe nro hncad nn iho nrolissiinary i"Mrmatinn availahlo and nro anly an owimato_ Cnntart the Dent for addn'1 info. FEE ITEMS (P�e Resolution 11-053 fff. '-1.11) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $195.00 PME Permit Fee: $44.00 Work Without Permit? 0 Yes E) No $0.00 Travel Documentation Fee: ITRA VDOC $44.00 Strong Motion Fee: 1BSEISMICR $0.60 0.5 hrs Admin./Clerical Fee $41.00 (ADMIN Bld > S'tds Commission Fee: IBCBSC $1.00 SUBTOTALS: $284.60 $41.00 TOTAL FEE: $325.60 Revised: 07/04/2011 i✓ Lk I 2 le -t 1 i,j U Prescriptive Certificate of Compliance: Residential CF -IR -ALT Residential Alterations (Page 4 of 5) Proje t Name: Climate Zone # # of Stories �C1U.L HVAC SYSTEMS - HEATING List water heaters and boilers for both domestic hot water (DHW) heaters and hydronic space heating. Individual dwelling DHW heaters must be Heating Equipment 3 Minimum Efficiency Distribution Duct or Piping Insulation Thermostat Tank Configuration (Central, Split, Type and Capacity' (AFUE or HSPF) Type and Location' R -Value Type Space, Package or H dronic) R-Value3 43 XX) I. Indicate Keating Tvpe (Central Furnace, Wall Furnace. Heat pump, Boiler, Electric Resistance, etc.) _'. Electric resistance heating is allowed only in Component Package C, or except where electric heating is supplemental (i. e., if total capacity < 2 KW or %, 000 Btu/hr electric heating is controlled by a time -limiting device not exceeding 30 minutes). See §151(b)3 exception. 3. Refer to the HERS Verification section on Page 4 of the CF -I R -ALT Form for additional requirements and check applicable boxes. 4. Indicate Type or Location (Ducts, Hvdronic in Floor, Radiators, etc.) HVAC SYSTEMS - COOLING Minimum Efficiency Cooling Equipment (SEER/EER or Distribution Duct or Piping Insulation Thermostat Configuration (Central, Split, Type and Capacity COP) Type and Location} -R-Value Type Space, Package or H dronic S fCT►,�{ fi G 1. Indicate Cooling Tvpe (A/C, Heat pump, Evap. Cooling etc) 2. Refer to the HERS Verification section on Page 4 of the CF-1R-,4LT Form for additional requirements and check applicable bores. 3. Indicate Type or Location (Ducts, Hydronic in Floor, Radiators, etc.) WATER HEATING List water heaters and boilers for both domestic hot water (DHW) heaters and hydronic space heating. Individual dwelling DHW heaters must be gas or propane fired, and may not exceed 50 gallons. Hot water pipe insulation from the DHW heater to the kitchen(s) and on all underground hot water pipes is required in all component packages in all climate zones. Water Heater Type/Fuel Distribution Type Number In Tank Energy Factor or External Tank Insulation Type (Standard, Recirculating)' System Capacity (gal) Thermal Efficiency R-Value3 1. Indicate Tvpe (Storage Gas, Heat Pump, Instantaneous, etc.) 2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of §150(n). The Prescriptive,requirements do not allow the installation of a recirculating water heating system for single dwelling units. 3. The external water heating tank and pipes shall be insulated to meet the requirements o §1506). SPECIAL FEATURES The enforcement agency should pay special attention to the Special Features specified in this checklist below. These items may require written justfication and documentation and special verification. NEW -ROOF ASSEMBLY - Radiant Barrier The radiant barrier requirement of § 151(f)2 does not apply to roof alterations. Slab Edge (Perimeter) Insulation ❑ YES ❑ NO YES: In Climate Zone 16 in Component Packages D, R-7 insulation is required. Heated Slab Insulation ❑ YES ❑ NO YES: Slab edge insulation required for all heated slabs in all Climate Zones. See details in Table 1 18-A of the standards. Raised Slab Insulation ❑ YES ❑ NO YES: In Climate Zones 1, 2, 11, 13, 14 & 16, R-8 insulation is required; in Climate Zones 12 & 15, R-4 is required under component Package D. Thermal Mass To obtain Compliance Credit for the installation of thermal mass, use the Performance Approach. Registration Number. Registration Date/Time: 2008 Residential Compliance Forms HERS Provider: August 2009 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: 1 0-7 Z FOO lc tI PERMIT #1 1 0-7 U v OWNER'S NAME: uu-t S PHONE # $-eZC/ 3'4/7/ 7 GENERAL CONTRACTOR /IV,? O -Q, BUSINESS LICENSE # ADDRESS: Z CITY/ZIPCODE:R *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 Please check applicable subcontractors and complete the following information: Date Owner / Contra Signature '7-k -1 Date 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 Ro Tile Owner / Contra Signature '7-k -1 Date