13030135 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7424 RAINBOW DR CONTRACTOR:AIR MAZE SERVICES PERMIT NO:13030135
INC
OWNER'S NAME: CAMBRIDGE MANAGEMENT 933 KIFER RD STE A DATE ISSUED:03/25/2013
OWNER'S PHONE: 4087273021 SUNNYVALE,CA 94086 PHONE NO:(408)738-0333
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALS
License Class �20 Lich# �3 Z �� REPLACE(E)FURNACE,SAME LOCATION
Contractor SI��Z. v 2—.5 1 c.vJ Date
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:$2375
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:36619016.00 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 WITFUN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereb : orize representatives of this city to enter
upon the above mentioned pi for.ins tion purposes. (We)agree to save 180 ED INSPECTION.
indemnify and keep harmless the ity of Cupe ino against liabilities,judgments,
costs,and expenses which may ac a ag ' st s 'd City in consequence of the Date: "3 !
granting of this pe it. Ad' ' ' e plic t understands and will comp Y'70
with all non-points xegu o er ertino Municipal Code,Section
9.18. .
RE-ROOFS:
Signature Date dei 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
Signature of Applicant:. Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
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)
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. 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( §hould ore or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I u e e uipme tor' ces which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by t a it Qua Management District I
performance of the work for which this permit is'issued. will maintain compliance with t up lino icip Code,Chapter 9.12 and
I have;and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,S 2 5 25 33,3 25534.
Section 3700 of the Labor Code,for the performance of the work for which this 3
Owner or authorized agent: Dater
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.. It after making this certificate of exemption,I CONSTRUCTION ING 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 thatI 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
L PERMIT APPLICATION ��
GENERAL � MER
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 Q
E (408)777-3228• FAX(408)777-3333• building aOCuoertino.org AlMmisc
CLIP R INO
❑PLUMBING MECHANICA []ELECTRICAL ❑MISCELLANE/OU/S
PROJECT ADDRESS�� •,/� ' j 'PN^ 3 6 l 9 4 l
OWNER NAI— �� A/ s�� /� / C IX19
i.! ( � C.?Zs E-MAIL
STREET ADDRESS V ✓ 7 r CITY, STATE,ZIP FAX
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CONTACT J.AME 72
E-MAIL
STREETADDRESS 6 !`•, CITY,STATE,ZIP FAX
❑ OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
COCi'� +'l ` v LICENSENUMBER�•�AC ('p BUS.LIC
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COMANY3AME E-MAIL FAX
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pHOI.E 4146,737,` n
ARCHITECT/ENGLNrEER NAME LICENSE NUNMER BUS.LIC II
COMPANY NAME' E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK eg Fwmk4A
TOTAL VALUATION: 2'9 7 . RECEIVED BY
By my signature below,I certify to each of the follo 'n I pro ONm or auth rized aeent to act on the property m mer' ehal£ I bave read this
application and the information I hav ided is c t. I ave rea es 'pti n of ork and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to ildi cons tru I tho' rep f Cupertino to enter the above-id
�ent/ified ropef y for inspection pu€poses.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATIO RE UIRED OFFICE USE ONLY
OVER-THE-COUNTER
❑ EXPRESS
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u ❑ STANDARD
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❑ LARGE
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❑ TAAJOR
MEPAIiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 7424 RAINBOW DR#4 DATE: 03/25/2013 REVIEWED BY: MELISSA .
APN: 366 19 016 BP#: "VALUATION: 1$2,375
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Du lex PENTAMATION FURN/AC
USE: p PERMIT TYPE:
WORK REPLACE E FURNACE SAME LOCATION
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced-Air 1MFR=<100 1 # $133
TOTALS: " $133.00
Mech.Plan Check 0.0 hrs $0.00 Plumb.Plan Check F_.lec.Plan Check
Mech.Permit Fee: IMPERMIT Plumb.Permit Pee: Elec. Permit Fee:
Other Mech.Insp. 0.0 his $45.00 Other Plumb Insp. Li Ocher Elee.Insp.
tilech.Insp.Fee: Plumb. Insp. Fee: I:lee.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments('tie.Planning,Public Works,Fire,Sanitary Sewer District,School
District etc.). These fees are based on the prelimina information available and are only an estimate. Contact the Dept for addn7 info.
FEE ITEMS (Fee Resolution 11-053 E . 7111121 FEE QTY/FEE MISC ITEMS
Plan Check Fee.:
Suppl. PC:Fee
PME Plan Check: $0.00
Permit Fee:
.S"uppl. lisp Fee
PME Unit Feer $133.00
PME Permit Fee: $45.00
Consiruction Tax:
Administrative.Fee: IADMIN $42.00
Work.Without Permit? 0 Yes. No $0.00
Advanced Planning Fees: .
Travel Documentation Fee: ITRAVDOC $45.00 i
Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item
Bldy Stds Commission Fee: 1BCBSC $1.00.
$266.50 $0.00 �T $266.50
,
�' Revised: 01/01/2013
Simplified Prescriptive Certificate of Compliance:2008 Residential HVA C Alterations CF-IR-ALT-HVAC
Climate Zones 1 and 3-7
SiteA res: EnforcementAaency: Date: Permit#:
�� t '
Conditioned Duct insulation
Equipment T e' List Minimum Efficieney2Floor Area requirement Thermostat
JZ Packaged Unit Over 40 ft of ducts
MLFurnaceAFUE ®COP Served by system added or replaced in ®Setback
®Indoor Coil SEER HSPF_ afnot already present,must be
®Condensing Unit ®EER ®Resistance sf unconditioned space installed)
®Other ®R 6 (CZ 1,3-5)
1.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. , f
• The design features identified on this Certificate of Compliance are consistent wi the; formation documented on other plicable
compliance forms,worksheets,calculations,plans and specifications submitted to �nforeement ' encyTor approval v tth.the permit
application.
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Name•
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City/State/Zip: w hr A No w Phone
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2008 Residential Compliance Forms March 2010