13030107 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7649 ERIN WAY CONTRACTOR:ONE HOUR HEATING PERMIT NO:13030107
AND AIR
OWNER'S NAME: BABB HAROLD D AND CHERYL L 1400 PETALUMA HILL RD DATE ISSUED:03/20/2013
OWNER'S PHONE: 4085294561 SANTA ROSA,CA 95404 PHONE NO:(707)545-1800
13 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11COMMERCIAL 11
Gl Uj G 1- L`13 Lic.# � )
LicenseClass �31TREPLACE E A/C UNIT IN REAR YARD&REPLACE
.. ,Ft 7���-�� (E)
FURNACE IN GARAGE
Contractor PIfVL&jxVAyA. Date 3-/!J: L3
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:$11877
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 35920022.00 Occupancy Type:
permit is issued.
APPLICANTCERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WIT
180 +RMIT 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 D + AST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which ma me against said City in consequence of the sued b
granting of this perm' ion a plicant understands and will compl
with all non-poi ource guI ns a 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-BU DER 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
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). , I have read the hazardous materials requirements under Chapter'6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I 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(x)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 Areva Qualijf Management District I
performance of the work for which this permit is issued. will maintain compliance with the rt' rid I Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sec' s 33,a 5534. ��/g,
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized ager 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 \OMEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION I I-P
.10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 O
CUPERTINO (408)777-3228• FAX(408)777-3333• buildingacuDerino.org � MISC
[:]PLUMBING �CHANICAL ❑ELECTRICAL ❑MISCELL-ANTEOUS
PROJECT ADDRESS L_\q ` �• \ APN# 3�Q rJ Q O�f `L
OV'NERNAMECNA L 3 o, r3 PHONE LIS l/ E MAII'
STREET ADDRESS CITY, STATE,ZIP �� FAX
C3Ni✓NDvR-
0013TACT NAME 21G
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❑ OWNER ❑ ci wxER-BUILDER ❑ WhINER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑EN NEER ❑ DEVELOPER ❑TETANY
CONTRACTOR NAME.,
QA V i' ��� LICENSE NUMBER LICENSE TYPE BUS.LIC#
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COMPANY NAME E-MAIL pevL N tai/ FAX
STREET ADDRESS C STATE,ZIP n n � PHONE
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ARCHITECT/ENGINEER NAME LICENSE NTUMBER BUS.LIC#
COMPANY NAME' E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN NVII.DLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN El YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FFLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK
TOTALVALUATION:
By my signature below,I certify to each of the follo the p erty er or authorized agent to act on operty oNvmer's beh have read this
application and the information I have pro�� Is correct hav d the scription of Work and verify it is accurate. I agree to co with all applicable local
ordinances and state laws relating to b mg co s on. I a orize r esentatives of Cupertino to enter the above-identified propel for inspection purposes.
Signature of Appl icant/Agent: Date: �—
PI AL ON REQUIRED OFFICE USE ONLY
,'ER-THE-COUNTER
❑ EXPRESS
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u ❑ STANDARD
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❑ LARGE
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❑ MAJOR
A�EPAfiscApp_2011.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 7649 ERIN WAY DATE: 03/20/2013 REVIEWED BY: MELISSA
APN: 359 2.0.022 BP#: VALUATION: 1$11,877
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION FURN/AC
USE: PERMIT TYPE:
WORK REPLACE E A/C UNIT IN REAR YARD & REPLACE E FURNACE IN GARAGE
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced-Air 1MFR=<100 1 # $133
A/C Units (<=10K cfm) 113REMAIR 1 # $67
TOTALS: $200.00 '
Mech.Plan Check 0.0 hrs $0.00 Plumb.Plan Check Elec.Plan Check
Mech.Permit Fee: 1MPERMIT Plumb.Permit ree: Elec.Permit['ee:
Other Mech.Insp. -0.0 hrs $45.00 Other Plumb Insp. Lj Other Elec.Insp.
.laech.Insp.F'ee: Plumb. Insp.Fee: Elec.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,Sehool
District,etc.). Thesefees are based on the preffinWha information available and are only an estimate Contact the Dept for addn'l info,
FEE ITEMS(Fee Resolution 11-053 E . 7/U12) FEE QTY/FEE MISC ITEMS
Ilan Check h'ee:
Suppl. PC Fee
PME Plan Check: $0.00
Permit Fee:
Suhpl. Inst)Fee
PME Unit Fee:. $200.00:
PME Permit Fee: 771 $45.00
Construction Tax:
Administrative Fee: 1ADMIN $42.00
Work Without Permit? ® Yes 0 No $0.00
,ldvanced Planning Dees:
Travel Documentation Fee: 1TRAVDOC $45.00
Strong Motion Fee: 1BSEISMICR $1.19 Select an Administrative Item
Blda Stds Commission.Fee: 1BCBSC $1.00
ME
$334.19 $0.00 1� O A $334.19
` \ Revised: 01/01/2013
Simplified Prescriptive Certificate of Compliance:2008 Residential HVA C Alterations CF-IR-ALT-HVAC
Climate Zones 1 and 3-7
Site Address: Enforcement Agency: Date: Permit#:
3-►�- 3
Conditioned Duct insulation
Equipment T el List Minimum EfficienCY2 Floor Area requirement Thermostat
Packaged Unit
Furnace ®COP Over 40 ft of ducts
Served by system added or replaced in ®Setback
Indoor Coil SEER_ HSPF_ (If not already present,must be
Condensing Unit ®EER ®Resistance /�!0 U sf unconditioned space installed)
Other
® ®R 6 (CZ 1,3-S)
I.Equipment Type:Choose the equipment being installed;if more than one system,use another CF-1R-ALT-HVAC for each system.
2.Minimum Equipment Efficiencies:13 SEER,78%AFUE,7.7HSPF for typical residential systems.
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 en cern ency for approval with the permit
application.
Name: I C N ,,J 1 n. V--% Signature:
Comp7y: JzylU[�12 7- I A% � Date: -3 _
Address: f)IDS ��� L v //lam p License: 7L v 7
City/State//Zip: y�T,s q 3— �7 9 11I t� Phone: b 7
r
2008 Residential Compliance Forms March 2010
1
Zv o ZZ
CUPERTINO 71
Building Department
MAR 2 0 200
REVIEW FOR CODE COMPLIANCE
Revie ed By:
COMMUNITY DEVELOPMENT DEPARTMENT !
BUILDING DIVISION-CUPERTINO
APPROVED
This set of plans and specifications MUST be kept at the
job slie during construction. It is unlawful to make any t
charges or alterations on same,or to deviate r '
thcrc{rcrn,without approval from the Building Official
Tran Stu' roping of this plan and specifications SHALL NOT
an approval of the violation
y dinance or State Law.
BY j
DATE Zv 13 I
PERWT NO.
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