13010052 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10486 SAN FERNANDO AVE CONTRACTOR:CALIFORNIA DELTA PERMIT NO: 13010052
MECHANICAL INC
OWNER'S NAME: ANAND KHARE 6056 E BASELINE RD STE 155 DATE ISSUED:01/09/2013
OWNER'S PHONE: 4082056569 MESA,AZ 85206 PHONE NO:(866)692-5273
dZI LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL
` REPLACE E
License Class Z O Lic.# 2//// / ( )FUNACES,ONE IN GARAGE&ONE IN
ATTIC
Contractor Date /` 9 AREA(BOTH UNITS,LIKE FOR LIKE)
I hereby affirm 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.
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. Sq.Ft Floor Area: Valuation:$3800
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:35712056.00 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 OF 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 FROM 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
1 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
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)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. 1 will
I 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
1 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 agen Date:
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 M E P
//
10
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION VI
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 �0
CUPERTfMO (408)777-3228• FAX(408)777-3333• buildincIOCUDertino.org � M 'SC
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❑PLUMBING �i MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROTECT ADDRESS APN R
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OWNER NhM- PHONE E-MAIL
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STREFf ADDRESS CITY, STATE,ZIP I FAX
CONTACT NAME PHONE E-MAIL
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STR.EET ADDRESS /� CITY,STATE, ZIP FAX
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❑ OwNER ❑ OwNER-BuI DER ❑ OWNER AGENT Iff CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑.ENGINEER ❑ DEVELOPER ❑TENANT
CO CTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC
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STREET ADDRESSCITY,STATE,ZIP PHONE
ARCHTTECTIENGII,=NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME' E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD.DUPLEX ❑ MULTI-FAMTLY PROJECT IN WILDLAND ❑ 1iS PROJECT IN ❑YFS IS THE BLDG AN ❑ YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WO
lc' kL, n / C0 7';,-
TOTAL
';-TOTAL VALUATION: ? Poo U RECEI
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 be)(.1f a 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 co with all applicable local
ordinances and state laws relating to bu'Idi construction. I authorize representatives of Cupertino to enter the above-identifiieedprope-ry for inspection purposes.
Signature of Applicant/Agent: Date: / / 7
S LEMENTAL INFOPUN ATION REQUIRED OFFICE USE ONLY
❑ OVER-THE-COUNTTR
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E' ❑ EXPRESS
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❑ L1,RCE
❑ MAJOR
MEPMisc Opp 2011.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10486 SAN FERNANDO AVE DATE: 01/09/2013 REVIEWED BY: MELISSA
AN: 357-12-056 BP#: *VALUATION: 1$3,800 Lj
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION
FURN/AC
USE: PERMIT TYPE:
i
WORK REPLACE E FUNACES ONE IN GARAGE & ONE IN ATTIC AREA BOTH UNITS LIKE FOR LIKE
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced-Air 1MFR=<100 2 # $266
TOTALS: $266.00
Mech.Plan Check TO.0hrs $0.00 ilhiiiib. Plan Chez i, 1., k
Mech.Permit Fee: IMPERMIT —h. Pcrm rat
Other Mech.Insp. 0.0 hrs $45.00 0(lierLi I Otluli. It ;:
' cp. Peep 1';rnub. Ta; p. T� ° Glec. Insp. I:e-
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These ees are based on the relimina information available and are only an estimate. Contact the De t or addn'l info,
FEE ITEMS (Fee Resolution 11-053 E f TT"I2) FEE QTY/FEE MISC ITEMS
Plein Check Fee:
SuppL PC Fee A
PME Plan Check: $0.00
Permit.Fee:
Suppl Insp Fee
PME Unit Fee: $266.00
PME Permit Fee: $45.00
Conswuction Tar:
Administrative Fee: IADAffN $42.00
Work Without Permit? 0 Yes (E) No $0.00
ldvanced Planning F',
Travel Documentation Fee: ITRAVDOC $45.00
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $399.501 $0.00 TOTAL FEE: $399.50
Revised: 10/01/2012
J r•eseri Live Certificate of'Complialice: ItesiclentialC]' 11.t_ ,_
ALT
Residential/Alterations
Project fvamcc I Climate Zone 0 2 #of Stories
HVAC SYSTEMS- HEATING
Minimum Duct or Piping Configuration
1-leating Equipment Efficiency Disu-ibutiou Insulation 'rhermostal (Central;Split;
l'y e and Capacit-N (AFUE or I-ISPF) Type and Location` R-ValueTvo; Snaee. i'acicage or Hvdronic)
r-
1,Indicate Heating 7)rpe(Central Fzunuce, !1 itll Furnace,Hectt prop.Boiler,Electric Resistance, etc.)
2.Llecn•ic resistance heating"is•cal/owes/only in Component Package C, or except where electric heating is supplenzen/a/(i.e., i/total copaeih,
Z K141or 7,(1(1(1 Btulhr e/ecu•ic•heating is conu•o//ed by a time-limiting device not exceeding 3(1 nnitnucs). See§15/(b)3 exceptiorn.
3.Refer to the HE/ZS'VeriJicatinn section an Page zl q1 the CF=1 R-�1LT Farm for additional requirements andcheck applicable boxes.
4. Indicate 7jrpe or Location(Ducts, Hvdronic in Floor,Radiators, etc.)
HVAC SYSTEMS- COOLING
Minimum �
Efficiency Duet or Piping Configuration
Cooling Equipment (SEEiUEER or Distribution lnsulation Thermostat (Central,Split.
Tv e and Ca acitv"2 COP) Type and Location' R-Value Tvne Space. 1'acl<age or Hvdronic i
1.Indicate Cooling Type WC.Heat pump.Evap. Cooling,etc)
2.Refer to the HERS Net•ifcation section on Page 4 of the CF-11,'-ALT Form.Jor additional requn•enzenis and check applicable boxes.
3.Indicate Tyve or Location Mucts. Hvdronic in Floor.Radiators, etc.)
WATER HEATING
List water heaters and boilers,for both domestic hot water(DHM4 i/Heaters and 17'vdronic space heating. Individual divellirtg DHi4'/Heaters must be
gas or propane Fred,and may not exceed 50 gallons. Hot water pipe insulation,(i•om tine, DH`W heater•to the kitchen(s)and on all underground
hot water piper is reauired in alt component lnackaRCS in all climate_zones.
Waier Heater Type/Fuel Distribution Type Number 11) External7s,nr
Energy 1 anl; Eney Factor oi- lnsulation
Type (Standard. Recirculating)' System Ca acity(gal) Thermal Efficiency P-\talue`
I
1.Indicate Type(Storage Gas, Heat Pump. hHsiantoneous,etc.)
2.Recirculating systems serving nzzdliple drvellhng zaniis shall meet llic recir•cztlaiion regztirennents•of¢15O(n). The Prescriptive regzaremenr.r dr.
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 reaztft•enHents of 6150(r.
Contractor(Documentatimt Author's/Responsible Designer's Decinration Statement)
• I cerrifl•that this Certificate of Compliance docs mentation is accurate and complete.
1 am eligible under Division 3 of the California Business and Professions Coale to accept responsibility for the design identified on this Certificate of
Compliance. -
• 1 certih,tbai[lie enerew features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24,Parts I and G of the California Code of Rc-ulations.
• Tht:desil-n features identified ou this Certificate of Compliance are consistent with the information documented on other applicable liame
pP e con r
forms.worksheets,calculations.nlans and snecificabons submitted Io the enforcemem agency for approval with flit,permit aonlication.
Name: Si�rnaune:
Collip Ity: Date:
dress: Livens:.•: 1�
� r OHC A-�.f
Cil.v/state/Zi Rhone:
n e o ZO � ��' P2P , o�ay
200S/residential Compliance Fonns Mcn•ch 2010
- -
i
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: 4 • PERMIT#
OWNER'S NAME: 4A1,14�e PHONE# AOY- —>Of'6 9
GENERAL CONTRACTOR: �ZW7t; c / BUSINESS LICENSE#
ADDRESS: _ ;� e CITY/ZIPCODE: �-
*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:
G/ 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
W er/ ractor Signatur Date