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11050179
CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 20682 CHERYL DR I CONTRACTOR: VALLEY HEATING & I PERMIT NO: 11050179 I OLING OWNER'S NAME: QUERMANN GENE C I 1171N4THST DATE ISSUED: 05/23/2011 ER'S PHONE: 4085292153 1 SAN JOSE, CA 95112 l PHONE NO: (408)294-6290 I /LICENSED CONTRACTOR'S DECLARATION License Class O - Lic. # J 0 "[ Contractor Date 1-3 _33 I hereby affirm that Ajeensed 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. 9,11 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 permit is issued. 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 to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, 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 9.18. Signature Date L OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). 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 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 permit is issued. 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 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 forthwith comply with such provisions or this permit shall be deemed revoked. 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 to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save -unify and keep harmless the City of Cupertino against liabilities, judgments, 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 9.18. Signature Date BUILDING PERMIT INFO: BLDG r— ELECT PLUMB r- MECH f— RESIDENTIAL COMMERCIAL F_ JOB DESCRIPTION: REMOVE & REPLACE 90K BTU FURANCE IN EXISTING UTILITY ROOM Floor Area: I Valuation: $4092 APN Number: 35916018.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: _57Z_3 -"ce RE -ROOFS: 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 inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air 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 Health & Safety Code, Sections 25505, 25533, and 25534. Owner or — agent: Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of Hork's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO 5 ITEMS OF 10 PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 35916018.00 DATE ISSUED.......: 05/23/2011 RECEIPT #.........: BS000013527 REFERENCE ID # ...: 11050179 SITE ADDRESS .....: 20682 CHERYL DR SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ...... OPERATOR: patg COPY # : 1 OWNER ............: QUERMANN GENE C ADDRESS ..........: 20682 CHERYL DR CITY/STATE/ZIP ...: CUPERTINO, CA 95014-2910 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 ---------- 1BCBSC ------------- VALUATION ---------- 4,092.00 ---------- 1.00 ---------- 0.00 ---------- 1.00 ---------- 0.00 1BSEISMICR VALUATION 4,092.00 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 -------- ---------------------------- 505 FINAL ELECTRICAL 508 FINAL MECHANICAL VOICE ID DESCRIPTION -------- ---------------------------- 507 FINAL PLUMBING CUPERTIINO GENERAL PERMIT APPLICATION fr COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building( cupertino.or PLUMBING MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS MEP MISC PROJECT ADDRESS(qou � ^ C, 1 tl ( APN # G� ej Jk. OWNER NAME C- V' 1e �1�-(a1 O o - � , `�� Mot E-MAIL STREET ADDRESS` 1p�a , CITY,. 71 n o Clc\�, Lk FAX CONTACT NAME � 1 t „ � ^ ' I t e- I / „ � ` l �( PH oICA4 I U a -n & E-MAIL , \ q -k _ jS J STREET ADDRESS L c) CITY, ST,q X S 4 q S1 ( a FAX 11 OWNER 1:1 OWNER -BUILDER ❑OOWNER AGENT CONTRACTOR XONTPACTOR AGENT ❑ ARCHITECT ❑ ENGINEER Cl DEVELOPER ❑ TENANT CONTRACTOR NAME V o� l I l.&t, r, "$ C06 I I LICENSE NUMBER 0 i5a L,; t t O LICENSE TYPE /+ - `Q BUS. LIC # COMPANY NAME / , �' ^ an Q) � C V) 1 K`r K• J EMAIL FAX STREET ADDRESS n(� I III I '+ . �� l� CITY, STATE, ZIP �y�� ` /°� �y �' l tom l �U�i C' t PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE SE OF XSFD or Duplex Cl Multi -Family STRUCTURE: ❑ Commercial PROJECT IN WILDLAND URBAN INTERFACE AREA ❑ Yes Cl No PROJECT IN FLOOD ZONE ❑ Yes ❑ No DESCRIPITON OF WORK moi-- n ©Y l``1"`i ✓� 1`�v Lk r—Lt,� n � ! ` 1S�Tt n � 1' rt V� 1 l � dR TOTAL VALUATION: Lj oej Lq 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 building on. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: 1J _ �C( — , SUPPLEMEtTgAYINFORMATIONREQUIRED� H�ern t 1 MEPMisc,4pp 2011.doc revised 03116111 0 � CITY OF CUPERTINO 111 FEE ESTIMATOR -BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 20682 cheryl dr DATE: 05/23/2011 REVIEWED BY: bobs. UNITS APN: BP#: "'VALUATION: 1$4,092 r PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: # PENTAMATION FURN/AC PERMIT TYPE: WORK sfd replace existing furnace at utility closet location SCOPE APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES Furnace, Forced -Air 1MFR=<100 1 # $126 PME Unit Fee: $126.00 PME Permit Fee: $42.00 Work Without Permit? 0 Yes E) No $0.00 TOTALS: Travel Documentation Fee: ITRA VDOC 1 $126.00 Strong Motion Fee: IBSEISMICR Mech. Plan Check 10.0 1 hrs $0.00 Mech. Permit Fee: IMPERMIT Other Mech.Insp. 1 0.0 1 hrs $42.00 NnTF• Thoco foot oro haeod an tho nroliminary infnrmatinn availahle and ore nnly an estimate_ Cnntart the Dent for addn'l info. FEE ITEMS (h'ee .Resolution 09-051j,,,&' 7" UIO) 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 E) No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bld,Stds Commission Fee: IBCBSC j $1.00 SUBTOTALS: 1 $211.50 $0.00 TOTAL FEE: $211.50 Revised: 04/29/2011 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVA C Alterations CF -IR -ALT -HVAC Climate Zones 8 Site Address: Enforcement Agency: Date: Permit #: d a _ Equipment T e List Minimum Efficiency2 Conditioned Floor Area Thermostat Packaged Unit Furnace ¢¢ J9AFUE O�% COP Served by system ,'Setback Indoor Coil Condensing Unit SEER EER HSPF ❑ Resistance s f (If not already present, must be 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. HERS VERIFICATION SUMMARY Listed below are three HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF -6R and registered CF -4R forms (no hand filled CF-4Rs allowed) are filled out and signed. Beginning October 1, 2010, a registered copy of the CF -IR and CF -6R shall alsoon site for final inspection. ,be 1. HVAC Changeout Required Forms: • All HVAC Equipment CF -6R forms: MECH-04, MECH- 25 -HERS replaced CF -4R forms: MECH-25 • Condenser Coil and/or CF -6R forms: MECH- 25 -HERS • Indoor Coil and /or CF -4R forms: MECH-25 • Furnace For Split Systems: RC, CCA > 300 CFM/ton, TMAH For Packaged Units: No testing required 2. New HVAC System Required Forms: • Cut in or Changeout with CF -6R forms: MECH-04, MECH- 25 -HERS new ducts: (all new ducting CF -4R forms: MECH-25 and all new a ui ment) For Split Systems: RC, CCA >_ 300 CFM/ton, TMAH. For Packaged Units: No testing required ® 3. New Ducts with Replacement Required Forms. • Includes replacing or installing all new CF -6R forms: MECH-25-HERS ducting and/or outdoor condensing unit CF -4R forms: MECH-25 and/or indoor coil and/or furnace. Not all equipment chaned. For Split Systems: RC, CCA > 300 CFM/ton, TMAH For Packaged Units: No testing required 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. • 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 a lication. Name: LTJ Signature: j� Company: '� �1 � Date: Address:l ( b , ' l� C License: 6 —do {* a 5� S j� v [City/State/Zip: 6 s"r CA 9, Phone: L1u c-,-914 —U ,90 0 2008 Residential Compliance Forms March 2010 .UPERTINO 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: b(L . PERMIT # ��✓� OWNER'S NAME:uw-!)�nn PHONE # GENERAL CONTRACTOR: ! BUSINESS LICENSE # SSl� ADDRESS: j ( 1',S . -E' • CITY/ZIPCODE: Scx-1 c�sc CA *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. 1=j -0A2 � 1 I am not using any subcontractors: Sign tur Date Please check applicable subcontractors and complete the following information: Owner / Contractor Signature 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 Rock Tile Owner / Contractor Signature Date