13010053 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10478 BONNY DR CONTRACTOR:CALIFORNIA DELTA PERMIT NO:13010053
MECHANICAL INC
OWNER'S NAME: BOYLE ETHEL S TRUSTEE&ET AL 6056 E BASELINE RD STE 155 DATE ISSUED:01/09/2013
OWNER'S PHONE: 4084060308 MESA,AZ 85206 PHONE NO:(866)692-5273
1q LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
11
License Class Lic.# t'g /// </ REPLACE(E)FLOOR FUNACE IN HALLWAY
Contractor Date l"
1 hereby arrm that I am licensed 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.
1 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. Sq.Ft Floor Area: Valuation:$2863
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 APN Number:35914035.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS F PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS F CALLED INSPECTION.
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 Issue Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date 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.
❑ OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,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 HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). t have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agentDate:
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 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
GENERAL PERMIT APPLICATION �j M E p
10 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION tj /
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 11 00
CUPERT{NO (408) 777-3228• FAX(408)777-3333• building guoertino.org �Q` misc
PLUMBING MECHANICAL ❑ELECTRICAL []MISCELLANEOUS
PROTECTADDRESS -D �/ 7d7 /7 AYNn S "-� ._ I LC G S
OWNER NAME �� fE-MAIL
STREET ADDRESS L2TA TE, FAX
CONTACT NAME �C 2C0/ PHONE
C OTD E-MAIL
S 4DDRES�, STATE
ZIP
FAX
!J .ti r if ' C D d
❑ OWNER ❑ OWNER-BLIUMER ❑ O'AW R AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
ECCO CtOR NAME / LICENSE NUMBER LICENSE TYPE BUS.LIC#
O NAME // E-MAIL FAX
-
ADD SSS CITY,STATE,ZIP PHONE
l
ARCHITECTIENGINMNAME LICENSE NUMBER BUS.LIC
COMPANY NAME' E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑sFD m DUPLEX ❑ MULTI.FAMILY PROJECT INWILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLERHOME? ❑NO
DESCRIPTION OF WORK
TOTAL VALUATION:
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 build* nstruction. I authorize representatives of Cupertino to enter the above-identifieeddproperty for inspection puc�oses.
Signature ofApplicant>Agent: Date: �` 7
U PLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
t�
❑ OVER-THE-COUNTER
c i
❑ EXPRESS
U I
=� ❑ STANDARD
U
❑ LARGE
❑ MAJOR
MEPMiscAPP_2011.doc revised 06/21111
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10478 BONNY DR DATE: 01/09/2013 REVIEWED BY: MELISSA
APN: 359-14-035 BP#: 'VALUATION: 1$2,863
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: FURN/A
WORK [REPLACE E FLOOR FUNACE IN HALLWAY
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Floor 1MFLRFURN 1 # $67
TOTALS: $67.00
Mech.Plan Check 10.01hrs $0.00 Plumb. Plan Check Elec.Plan Check
Mech.Permit Fee: 1MPERMIT Plunah. r c: LYcc. Permir Fee:
Other Mech.Insp. 0.0 hrs $45.00 Other Plumb InspLl I Other Elee.Insp. EIF
'h ch. ln.p.Fee: Plumb. Insp. Fee: Elee.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Thesefees are based on the prelimina information available and are only an estimate Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Fes
PME Plan Check: $0.00
Permit Fee:
';Uppl. hrs p Fee
PME Unit Fee: $67.00
PME Permit Fee: $45.00
Conswuction Tux: T-T
Administrative Fee: IADMIN $42.00
Work Without Permit? 0 Yes 0 No $0.00
�1'dvuneed Planning Fces.
Travel Documentation Fee: ITRA VDOC $45.00
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $200.501 $0.00 TOTAL FEE: $200.50
Revised: 10/01/2012
Prescriptive Certificate of Com lianee: Residential CF-11R-ALT
tPro
irlentialAllerationc
ieel Name: ` Climate Zone# 2 #of Stories
HVAC SYSTEMS-HEATING
MinimumDuct or Piping Configuration
Heating Equipment Efficiency Distribution Insulation Thermostat (Central;Split:
Type and Capacit��t•'-' (AFUE or HSPF) Type and Location° R-Value Type Space. Package or Hvdronic)
1.Indicate Hecrunc I)pc(Central Furnace, !Nall Furnace,Heat pump,Boiler,Elecu-ic Resistance, etc;)
2.Eleco-ic resistance heating is allowed only in Component Package C or except where electric heating is supplemental(i.e., iftotcrl capacit
<2 Y•19'or 7,000 Btu/Iv electric heating is co)7u•olled by a time-limiting device not exceeding 30 minutes). See§1_51(b)3 exception
3.Refer to the HERS'Nerif cation section on Page 4 of the CF-1R f1LT Fortn.for additional requirements anti check applicable boxes.
4. Indicate Tppe or Location(Dints,Hvdronic in Floor,Radiators, etc.)
HVAC SYSTEMS-COOLING
Minimum
Efficiency Duct or Piping Configuration
Cooling Equipment (SEEPUBER or Distribution lnsulation Thermostat (Central; Split,
Type and Capacin",2 COP) Type and Location' R-Value Tye Space. Package or Hvdronic)
1.Indicate Cooling T),pe(A/C,Heat pzanp,Evctp. Cooling,etc)
2.Refer to the HERS Nerrif cation section on Page 4 of the CF-/R ALTForm,for additional requirements and check applicable boxes.
3.Indicate Tuve or Location(Ducts. Hvdronic in Floor.Radiators, etc.)
WATER HEATING
List water heaters and boilers,for boll?donestic hot Nater(DH11j heaters and hvdrornic space heating. Individual dwelling DHTI'i7eaters n7ust be
gas or propanc.ired,and n7av not exceed 50 gallons. Hot water pipe insulation fr•on?the DRW heater to the kitchen(s)and on all umderg-ouund
hot water pines is reauired in all component pacl(aQer in all climate zones.
External Tank
Water Heater Type/Fuel Distribution Type Number In Tank Energ% Factor or Insulation
Type' (Standard.Recirculatina)'' System Capacity(gal) Thermal Efficiency R-Value'
1.Indicate T)pe(Storage Gas, Heat Pump.Instantaneous, etc.) I
2.Recirculating systems serving multiple chwelling units shall meet the recirculation requirements of§150(n). The Prescriptive requirements do
not allow the installation of a rech•cutlating water heating system for•single dwelling units. I
3. The external water heating tank and noes shall be insulated to meet the -equirenients Of§150(j)-
Contractor(Documentation Author's/Responsible Designer's Declaration Statement)
I cerrifi,that this Certificate of Compliance documentation is accurate and complete.
1 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.nlans and specifications submitted to the enforcement agency for awroval with the permit apnlication.
Name: C 4 v0 Signature:
C�Qmpgn'*:
Date: -
f ddress: Licen
C"'State/Zip: � p� I Phone:
2008 Residential Compliance Fortns Allarch 2010
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: lD Y7? a :� t" .� PERMIT#
OWNER'S NAME: /E'o PHONE# / OX
GENERAL CONTRACTOR: BUSINESS LICENSE#
ADDRESS: dZa CITY/ZIPCODE: a
*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. L <� ---
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 -