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11010100 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22265 CANYON VIEW CIR CONTRACTOR:CHOICE MECHANICAL PERMIT NO: 11010100 OWNER'S NAME: MANOJ GHANDI 4720 FALSTAFF AVE DATE ISSUED:01/18/2011 OWNER'S PHONE: 6508611530 FREMONT,CA 94555 PHONE NO:(510)797-1289 r.. LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r L�zpCf� 9�Z z7 License Class Lic.# _ /� MECH RESIDENTIAL COMMERCIAL Contractor /�j `�� rz- Date l � l Z I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:CHANGE OLTP HEAT PUMP PACKAGE UNIT REAR OF (commencing with Section 7000)of Division 3 of the Business&Professions DWELLING 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. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$5000 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:36641007.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. 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. Issued ba✓ ? Date//`� Signature <V /�--. Date 7 OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Date: Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. 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 Owner or authorized agent: / become subject to the Worker's Compensation provisions of the Labor Code,I must Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments, r--*s,and expenses which may accrue against said City in consequence of the , ing of this permit.Additionally,the applicant understands and will comply ARCHITECT S DECLARATION ::...,all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date 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 F 01 JOB ADDRESS: Z-Z Z(oS- C -+.1 o 4 1/ PERMIT# l OWNER'S NAME: PHONE# V77i Sof GENERAL CONTRACTOR: C BUSINESS LICENSE# ADDRESS: ?Z r �Z. 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: 01 / Sig ture Date Please check applicable subcontractors and complete the following information: V 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 Signirture Date CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 2 of 3) CF-1R Project Title Q Date HVAC SYSTEMS Note:Input hydronic or combined hydronic data under Water Heating Systems,except Design Heating Load. Distribution Heating Equipment Minimum Type and Duct or Heat Pump Type(furnace,heat Efficiency Location Piping Thermostat Configuration �pump, etc.) (AFUE or HSPF) (ducts,attic,etc.) R-Value Type (split or package) Cooling Equipment Minimum Duct Heat Pump Type(air conditioner, Efficiency Location Duct Thermostat Configuration heat pump evap.cooling) (SEER) (attic,etc.) R-Value Type (split or package) t/f4-�-et)1t4-19 1 l� Cts L !�z n,e2,e 06 �f} LIGA¢�G t1.�Ll f" 90Z- SEALED DUCTS and TXVs (or Alternative Measures) Sealed Ducts(all climate zones) (In'staller testing and certification and HERS rater field verification required) �TXVs,readily accessible(climate zones 2 and 8-15 only) (Installer testing and certification and HERS Rater or field verification required) Refrigerant Charge/Air Flow(climate zones 2 and 8-15 only) (Installer testing and certification and HERS Rater or field verification required) OR 0 Alternative to Sealed Ducts and TXVs(see Package C or D Alternative Package Features for Project Climate Zone) Climate Zone Window SHGC Window U-Factor SEER Heating WATER HEATING SYSTEMS Energy' External Rated' Tank Factor or Tank Water Heater Distribution Number Input(kw Capacity Recovery Standby' Insulation Type Type in System or Btu/hr) (gallons) Efficiency Loss(%) R-Value 1. For small gas storage water heaters(rated inputs of less than or equal to 75,000 Btu/hr),electric resistance,and heat pump water heaters,list Energy Factor. For large gas storage water heaters(rated input of greater than 75,000 Btu/hr),list Rated Input,Recovery Efficiency and Standby Loss. For instantaneous gas water heaters,list rated input and recovery efficiencies. SPECIAL FEATURES (add extra sheets if necessary). Package C and D: TXVs,Sealed Ducts,Radiant Barriers(see installation requirements for radiant barriers in Section 8.13 of the 200lResidential Manual). Package C: thermal mass(thermal mass type,covering,thickness,and description). r Compliance Forms August 2001 A-3 CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36641007 . 00 DATE ISSUED. . . . . . . : 01/18/2011 RECEIPT #. . . . . . . . . : BS000012508 REFERENCE ID # . . . : 11010100 SITE ADDRESS . . . . . : 22265 CANYON VIEW CIR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . . MANOJ GHANDI ADDRESS . . . . . . . . . . : 22265 CANYON VW CL CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : CHOICE MECHANICAL CONTRACTOR . . . . . . . : DOUGLAS CROWE LIC # 31924 COMPANY . . . . . . . . . . : CHOICE MECHANICAL ADDRESS . . . . . . . . . . : 4720 FALSTAFF AVE CITY/STATE/ZIP . . . : FREMONT, CA 94555 TELEPHONE . . . . . . . . : (510) 797-1289 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 5, 000 . 00 1. 00 0 . 00 1. 00 0 .00 1BREMAIRHA NO.UNITS 1. 00 63 . 00 0 . 00 63 . 00 0 .00 1BSEISMICR VALUATION 5, 000 . 00 0 . 50 0 . 00 0.50 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 148 .50 0.00 148. 50 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 148 .50 #6685 --------------- TOTAL RECEIPT 148 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 22265 canyon view cr. DATE: 01/18/2011 REVIEWED BY: bobs. APN: BP#: *VALUATION: 1$5,000 PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: FURN/AC WORK replace heat pump less that 10,000 cfm at rear yard. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Heat Pump (<=10K cfm) 1BREMAIR 1 # $63 TOTALS: F $63.00 Mech.Plan Check 0.0 hrs $0.00 Phon', 1'tctri ?FICA Mech.Permit Fee: IMPERMIT "lr;nah. f'c rn,ir I ire- lig"r-r P,rmit Vee FOther Mech.Insp. 0.0 hrs $42.00 C)r;';�, f'Iurtal5; >_ l ( ( r C1i t/I �r. Ir?sr. Ll NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn 7 info. FEE ITEMS (Fee Resolution 09-051 Elf. 7/1;10) FEE QTY/FEE MISC ITEMS PItm Check c~I I. .Supp/. Pt_'FCC, PME Plan Check: $0.00 Iac'rinit Fee: Suppl. Irtsp Fee PME Unit Fee: $63.00 PME Permit Fee: $42.00 Construction 1 LV "4couslical Reviell Vec. Work Without Permit? 0 Yes 0 No $0.00 Plarrnin�r/�'c�es: Travel Documentation Fee: ITRAVDOC $42.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $148.50 $0.00 TOTAL FEET $148.50 Revised: 01/03/2011 CITY OF l 10 1 �. l CITY OF CUPERTINO FURNACE/AC CUPERTINO PERMIT APPLICATION FORM APN# GGqI -7 Date: �i- Building Address: 2-Z,.L & -�- C Ob,PY m f� V- % 'e-e-D v- c 6L-Y-la 2) If residential, is house an Eichler? Yes ❑ No [ f yes, needs planning approval. Owner's Name: _ Phone #: JAA 4) Contractor: I Phone #:, S`t -gam S-DYs C f+zD t Z ,0- Fax#: �;-( 0 4 7 12- Contractor 2-Contractor License#: Cupertino Business License#: Contact: Phone#: bo-z"C, C v-ts Fax/e-mail: Building Permit Info: Elect Plumb �� Mech,. T Residential Commercial Job Description: For Residential Installations: Attic F-11 floor 0 2°d floor ❑ Adhere to minimum setback requirement 21 For Commercial Installations: Replacement same weight ❑ Additional weight(structural calcs) ❑ Structural Calculations required for new installation ❑ , New installation Planning Approval Re uired ❑ Cost of Project: Type of Construc ion(Usage Class): Strapped On Platform Bonded New Location ❑ Replacement Project Size: Counter ❑ Express ❑ Standard ❑ Large ❑ Major ❑ Valuation: �..� Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set& the sheet index. Revised 12/06/10