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11060145 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10940 SANTA TERESA DR CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 11060145 CONDITIONING OWNER'S NAME: NORBERG JAMES C AND REGINA A 1712 STONE AVE DATE ISSUED:06/17/2011 I R'S PHONE: 4082533539 SAN JOSE,CA 95125 PHONE NO:(408)293-4717 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB 7� � License Class C Zu Lic.# -7//'� MECH RESIDENTIAL COMMERCIAL �Contractor-A I;/ Vit rW?CE' Date �� 7 _ �� I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE&REPLACE EXISTING FURNACE (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 declat' 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:$3900 1 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 permit is issued. APN Number:35613005.00 Occupancy Type: 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 upon the above mentioned propeqy for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless e City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses wll ch y�fccrue against said City in consequence of the granting of this pe it. i rally,the applicant understands and will comply with all - of sour a ulations per the Cupertino Municipal Code,Section Issued b Date G 9.18.' Y�_ • Signature Date RE-ROOFS: L 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) 1,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 1 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 255 (a)should I store or handle hazardous material. 1 have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I s equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants of a by the Bay Area Air Quality Management District I will permit is issued. maintain c pli ith the Cupertino Municipal Code,Chapter 9.12 and the p a & afety de,Sections 25505,25533,and 25534. 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 O mer rized a ent: 6 -12-11 Compensation laws of California. If,after making this certificate of exemption,I Date: 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. O ST 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 mnify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 5 ITEMS OF 18 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 35613005 . 00 DATE ISSUED. . . . . . . : 06/17/2011 RECEIPT #. . . . . . . . . BS000013800 REFERENCE ID # . . . : 11060145 SITE ADDRESS . . . . . : 10940 SANTA TERESA DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER NORBERG JAMES C AND REGINA A ADDRESS 10940 SANTA TERESA DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4768 RECEIVED FROM . . . . : AAA FURNACE & AIR C 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 ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 3, 900 . 00 1. 00 0 . 00 1. 00 0. 00 1BSEISMICR VALUATION 3, 900 .00 0.50 0. 00 0 .50 0.00 1MFR=<100 UNITS 1 .00 126.00 0. 00 126 .00 0. 00 1MPERMITFE FLAT RATE 1. 00 42 . 00 0. 00 42 . 00 0. 00 1TRAVDOC FLAT RATE 1. 00 42 . 00 0 . 00 42 .00 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 211.50 0. 00 211.50 0. 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10940 santa theresa dr. DATE: 06/17/2011 REVIEWED BY: bobs. APN: BP#: I VALUATION: 1$3,900-� 'PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION USE: p PERMIT TYPE: woRK Replace furnace. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Select a Mech Item Furnace, Forced-Air 1MFR=<100 1 # $126 TOTALS: $126.00 Mech.Plan Check 0.0 hrs $0.00 Mech.Permit Fee: 1MPERMIT Other Mech.Insp. 0.0 hrs $42.00 NOTE: These ees are based on the prelitninary information available and are only an estimate. Contact the De t or addn7 in o. FEE ITEMS (1,' e Resolution 09-051 1. 1. 10) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $126.00 PME Permit Fee: $42.00 Work Without Permit? 0 Yes (D No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 A Strom Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $211.50 $0.00 TOTAL FEE: $211.50 Revised: 04/29/2011 (�LA t�;Lt)AJ u Prescriptive Certificate of Compliance: Residential CF-IR-ALT Residential Alterations Page 4 of 5) Project Name: Climate Zone# #of Stories N 0-f 1�-e HVAC SYSTEMS-HEATING Minimum Duct or Piping Configuration Heating Equipment Efficiency Distribution Insulation Thermostat (Central,Split, Type and Capacity"2.3 (AFUE or HSPF) Type and Location' R-Value Type Space,Package or H dronic) —'U r 1.10l CSL on,4Q Tbn icy 9v6->= _S 1.Indicate Heating Type(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 7,000 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-1 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 Duct or Piping Configuration Cooling Equipment (SEER/EER or Distribution Insulation Thermostat (Central,Split, Type and Capacity 1,2 COP) Type and Location R-Value Tye S ace,Packa e or H dronic) 1. Indicate Cooling Type(A/C,Heat pump, Evap. Cooling, etc) 2. Refer to the HERS Verification section on Page 4 of the CF-1 R-ALT Form for additional requirements and check applicable boxes. 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 hydropic 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 vvater pipes is required in all com onent packages in all climate zones. External Tank Water Heater Type/Fuel Distribution Type Number In Tank Energy Factor or Insulation Type (Standard,Recirculating)' System Capacity(gal) Thermal Efficiency R-Value3 1. Indicate Type(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 i es shall be insulated to meet the requirements o 150 ). SPECIAL FEATURES The enforcement agency should pay special attention to the Special Features specified in this checklist below. These items may require written 'usti►cation 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 118-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: HERS Provider: 2008 Residential Compliance Forms August 2009 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: [(�)q U nJrC, —FereSc� PERMIT# OWNER'S NAME: -JQ No-t Pr- PHONE# 68 -j-SS GENERAL CONTRACTOR: A A a CSL- BUSINESS LICENSE# ADDRESS: 1-7 CITY/ZIPCODE-&n I a3C S-I Z S" *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: V 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 wner/Cont r or Signature Date CITY OF CUPERTINO FURNACE/AC CUPEkTINO PERMIT APPLICATION FORM APN # Date: 4 -1 -11 Building Address: 1 q4o q- >anA-C,, Te res ci, b-k- Owner's Name: Phone #: 3aw\e N d,rher 6ff - aS3 - 3s'39 Contractor: A-A A F-LtrN Q CA Phone #: Fax #:4-b F� -6t 173--& 7 7 / Contractor License #: -7 (p "-7 1 Cupertino Business License #: Contact: Dn(-\. G-lar-V Q `I Phone #: c 3--q W 7 Fax #: -93 —4�77 `7J Building Permit Info: Elect Plumb ❑/ Mech Residential Commercial Job Description: ;R e YYlo oe. N- P-e-P I G C 5 �C S n� F Ct r'A.1U C Q- For Residential Installations: Attic ❑ 1 S` floor []" 2°d floor ❑ Adhere to minimum setback requirement For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: 3 leo Type of Construction (Usage Class): Strapped On Platform Bonded New Location Replacement Project Size: ExpressEJ ExpressStandard Large Major Valuation: 3`30z.ov Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Revised 01/07/09