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11060146
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10380 SCENIC BLVD CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 11060146 CONDITIONING OWNER'S NAME: TOM TARSHIS 1712 STONE AVE DATE ISSUED:06/17/2011 i ER'S PHONE: 4084972249 SAN JOSE,CA 95125 PHONE NO:(408)293-4717 ❑ LICENSED CONTRACTOR'S DECLARATIONI— BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Al Lic.# �7 14 7 t r MECH RESIDENTIAL COMMERCIAL ContractoDate I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE&REPLACE EXISTING FURNACE&ADD A/C (commencing with Section 7000)of Division 3 of the Business&Professions UNITS(220UNIT) Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declaration 1 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 Sq.Ft Floor Area: Valuation:$11833 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:35708005.00 Occupancy Type: APPLICANT CERTIFICATION 1 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned prop5py,for inspection purposes. (We)agree to save indemnify and keep harmless e eity of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and eVt a ccrue against said City inconsequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of ionally,the applicant understands and will comply with gulations per the Cupertino Municipal Code,Section / 9.18. Issued by: e__ >— Date:C� Signature Date !� L OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Date: Business&Professions Code) 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 HAZARDOUS MATERIALS DISCLOSURE declarations: 1 have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the C tino Municipal Code,Chapter 9.12 and the Health& 1 have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 53'2(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,shout a equipment or devices which emit hazardous air contamina d mfd by the Bay Area Air Quality Management District I will permit is issued. maintaZco ith the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Healt Sections 25505,25533,and 25534. 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 O n gent: become subject to the Worker's Compensation provisions of the Labor Code,I must Date: (!� forthwith comply with such provisions or this permit shall be deemed revoked. 4NSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's 1 certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address -unify 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 with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 6 ITEMS OF 18 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 35708005. 00 DATE ISSUED. . . . . . . : 06/17/2011 RECEIPT #. . . . . . . . . BS000013800 REFERENCE ID # . . . : 11060146 SITE ADDRESS . . . . . : 10380 SCENIC BLVD SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER TOM TARSHIS ADDRESS 10380 SCENIC BLVD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 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 11, 833 . 00 1. 00 0 . 00 1 .00 0. 00 1BSEISMICR VALUATION 11, 833 .00 1. 18 0. 00 1.18 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 1MRRAA UNITS 1 .00 63 . 00 0. 00 63 .00 0. 00 1TRAVDOC FLAT RATE 1.00 42. 00 0. 00 42 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 275. 18 0. 00 275 .18 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 824 . 65 #38633 --------------- TOTAL RECEIPT 824 .65 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION MDDRESS: 10380 scenic blvd. DATE: 06/17/2011 REVIEWED BY: bobs. PN: BP#: "VALUATION: 1$11,833 'PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Du lex PENTAMATION FURN/AC USE: p PERMIT TYPE: WORK a lace furnace add A/C units SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES A/C Units (<=10K cfm) 1BREMAIR 1 # $63 Furnace, Forced-Air 1MFR=<100 1 # $126 TOTALS: T $189.00 Mech.Plan Check 0.0 hrs $0.00 Mech.Permit Fee: 1 MPERMIT - Other Mech.Insp. 0.0 hrs "00 NOTE: These ees are based on the preliminary in ormation available and are onlV an estimate. Contact the Dept fir addn'l info. FEE ITEMS (F'ee Resolution O9-OSI I ffj' -1,%102 FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $189.00 PME Permit Fee: $42.00 Work Without Permit? 0 Yes No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 Strony, Motion Fee: 1BSEISMICR $1.18 Select an Administrative Item Bld,Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $275.18 $0.00 TOTAL FEE: $275.18 Revised: 04/29/2011 (�U L"1Lt 1 J\J U Prescriptive Certificate of Compliance: Residential CF-IR-ALT Residential Alterations Page 4 of 5) Project Name: Climate Zone# #of Stories HVAC SYSTEMS-HEATING Minimum Duct or Piping Configuration Heating Equipment Efficiency Distribution Insulation Thermostat (Central,Split, Type and Capacityl,2,3 (AFUE or HSPF) Type and Location' R-Value Type Space,Package or H dronic) 1.Indicate Heating Type(Central Furnace, Wall Furnace, Heat pump, Boiler. Electric Resistance, etc.) 2.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 12 COP) Type and Location R-Value Type S ace,Package or H dronic TP 1.Indicate Cooling Type(A/C Heat pump, Evap. Cooling, etc) _ 2. Refer to the HERS Verification section on Page 4 of the CF-IR-ALT Form for additional requirements and check applicable boxes. 3. Indicate 7:ype 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 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 pipes shall be insulated to meet the requirements of§150y). SPECIAL FEATURES The enforcement agency should pay special attention to the Special Features specified in this checklist below. These items may require written justification 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(Perifiieter)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 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: er) > e Bloc\ PERMIT# y OWNER'S NAME: vrv, g r PHONE# y�l LZYS GENERAL CONTRACTOR: 6- o BUSINESS LICENSE# ADDRESS:1, i-L_ S&ClyCITY/ZIPCODE: Y2 16,�e *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/Contracto nature Date CITY OF CUPERTINO FURNACE/AC CUPEkTINO PERMIT APPLICATION FORM APN '- _-7 _ R Date: Building Address: ()3�-o sc,encq- Iod Owner's Name: Ph1��ne #: Contractor: n Phone #:468 Z9 3 Fax #: <'f6g g —;�-q 3 4 7 `7 / Contractor License #: ..7 Cupertino Business License #: Contact: Phone #4oj 1l Fax #: -71 Building Permit Info: Elect 9 Plumb Mech Residential Commercial Job Description: '12,fW Doe ��! u�5��n� 14 rNa Ce Gt Jcl Cid PK�eA .4- H--oo�c v,p For Residential Installations: Attic ❑ 1st 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 3 U Type of Construction (Usage Class): Strapped On Platform Bonded New Location Replacement Project Size: Express EJ Standard EJ Large Major Valuation: 1t , $33 .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