11010036 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10885 DRYDEN AVE CONTRACTOR:COLD CRAFT INC PERMIT NO: 11010036
OWNER'S NAME: MAC NAUGHTON ROBERT G AND MARG 181 LOST LAKE LN DATE ISSUED:01/06/2011
(""NER'S PHONE: 4087798672 CAMPBELL,CA 95008 PHONE NO:(408)374-7292
CV LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r- ELECT r PLUMB r
r1 T
License Classy:/D,'261AVARic.# 1 MECH RESIDENTIAL COMMERCIAL r
Contractor ��O - C Q.X 1A,G. Date l
JOB DESCRIPTION:REMOVE&REPLACE FURNACE
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:$2990
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
permit is issued. l APN Number:35614015.00 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 PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter WITHIN 18O DAYS OF PERMIT ISSUANCE OR
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION.
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Issued by _ Date
9.18.
Date l �,
SignaCurc---�'
RE-ROOFS:
OWNER-BUILDER DECLARATION 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
I hereby affirm that I am exempt from the Contractor's License Law for one of inspection.
the following two reasons:
I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date:
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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three
HAZARDOUS MATERIALS DISCLOSURE
declarations: I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued. Health&Safety Code,Sections 25505,25533,and 25534.
1 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 Owner or authorized agent:
Compensation laws of California. If,after making this certificate of exemption,I Dater
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and state that the above information is Lender's Name
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 Lender's Address
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
-ts,and expenses which may accrue against said City in consequence of the
►ting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Licensed Professional
Signature Date
CITY OF CUPERTINO
5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35614015 . 00
DATE ISSUED. . . . . . . : 01/06/2011
RECEIPT #. . . . . . . . . BS000012412
REFERENCE ID # . . . : 11010036
SITE ADDRESS . . . . . : 10885 DRYDEN AVE
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MAC NAUGHTON ROBERT G AND MARG
ADDRESS : 10885 DRYDEN
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM COLD CRAFT, INC
CONTRACTOR PENNING, KENT LIC # 18644
COMPANY . . . . . . . . . . : COLD CRAFT INC
ADDRESS . 181 LOST LAKE LN
CITY/STATE/ZIP CAMPBELL, CA 95008
TELEPHONE (408) 374-7292
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
____ ------------- ----------
---------- ---------- -
1BCBSC VALUATION 2, 990 . 00 1 .00 0 .00 1. 00 0 .00
1BSEISMICR VALUATION 2, 990 . 00 0 .50 0 .00 0 .50 0 .00
1MFR=<100 UNITS 1. 00 126 .00 0 .00 126 .00 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 211.50 0 .00 211.50 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- -
CHECK 211 .50 #003906
---------------
TOTAL RECEIPT 211 .50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10885 dryden ave DATE: 01/06/2011 REVIEWED BY: bobs.
APN: BP#: "VALUATION: $2,990
PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition / Repair
PRIMARY PENTAMATION FURN/AC
USE: SFD or Duplex PERMIT TYPE:
WORK re lace furnace at closet location
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced-Air
1MFR=<100 1 # $126
TOTALS: $126.00
T
('Pck
Mech.Plan Check 0.0 hrs $0.00 a
Mech.Permit Fee: IMPERMIT
�I r�'t', f'c 'rz7r1 Ir,z,- I'ersariT i:cf.
Other Mech.Insp. 0.0 hrs $42.00 0he it T"afnh h ,3
;1Icet'la.Rash. t`ae�
NOTE: These fees are based on the prelintinairTv in ormation available and are only an estimate. Contact the Dept for addn 7 info.
FFEEITEMS (Fee Resolution 09-051 Eff. 7/1/101 FEE QTY/FEEMISC ITEMS
e'e':
e
PME Plan Check: $0.00
Permit Fee:
,Su/lpl. Ir.7s,p Fee
PME Unit Fee: $126.00
PME Permit Fee: $42.00
C.`onslruction Tax
A(.ouslicol 1?CVi('1V
Work Without Permit? 0 Yes (E) No $0.00
I'lczrzrtin,�7 1�'e�e°,>:
Travel Documentation Fee: ITRA VDOC $42.00
Strong Motion Fee:
:IBSEISAffCR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $211.50 $0.00 TOTAL FEE: $211.50
Revised: 12/07/2010
Prescri tNe Certificate of Compliance: Residential CF-IR-ALT
Residential Alterations age 4 of 5
Project Name:i n /j Climate Zone# I #of Stories
HVAC SYSTEMS-HEATING
Minimum Duct or Piping Configuration
Heating Equipment Efficiency Distribution Insulation Thermostat (Central,Split,
Type and Capacity 1,2,3 AFUE or HSPF Type and Location4 R-Value Type Space,Package or H dronic
1.Indicate Heating Type(Central Furnace, Wall Furnace,Heat pump,Boiler,Electric Resistance, etc.)
2.Electric resistance heating is allowed only in Component Package C,or except where electric heating is supplemental(i.e., if total capacity
<2 K W or 7,000 Btu/hr electric heating is controlled by a time-limiting device not exceeding 30 minutes). See§151(b)3 exception.
3.Refer to the HERS Verification section on Page 4 of the CF-IR-ALT Form for additional requirements and check applicable boxes.
4. Indicate Type or Location(Ducts,Hydronic in Floor,Radiators,etc.)
HVAC SYSTEMS-COOLING
Minimum
Efficiency Duct or Piping Configuration
Cooling Equipment (SEER/EER or Distribution Insulation Thermostat (Central,Split,
Type and Capacity'2 COP) Type and Location3 R-Value Type Space,Package or H dronic
1.Indicate Cooling Type(A/C,Heat pump,Evap. Cooling, etc)
2.Refer to the HERS Verification section on Page 4 of the CF-IR-ALT Form for additional requirements and check applicable boxes.
3.Indicate Type or Location(Ducts,H dronic in Floor,Radiators, etc.
WATER HEATING
List water heaters and boilers for both domestic hot water(DHW)heaters and hydronic space heating. Individual dwelling DHW heaters must be
gas or propane fired,and may not exceed 50 gallons. Hot water pipe insulation from the DHW heater to the kitchen(s)and on all underground
hot water pipes is required in all com onent packages in all climate zones.
External Tank
Water Heater Type/Fuel Distribution Type Number In Tank Energy Factor or Insulation
Type' (Standard,Recirculating)2 System Capacity(gal) Thermal Efficiency R-Value3
1.Indicate Type(Storage Gas,Heat Pump,Instantaneous, etc.)
2.Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of§150(n). The Prescriptive requirements do
not allow the installation of a recirculating water heating system for single dwelling units.
3. The external water heating tank and i es shall be insulated to meet the requirements o 150 '.
SPECIAL FEATURES The enforcement agency should pay special attention to the Special Features specified in this checklist below.
These items may require written 'usti ication and documentation and special verification.
NEW ROOF ASSEMBLY-Radiant Barrier
The radiant barrier requirement of§151 2 does not apply to roof alterations.
Slab Edge(Perimeter)Insulation ❑YES ❑NO
YES:In Climate Zone 16 in Component Packages D,R-7 insulation is required.
Heated Slab Insulation ❑YES ❑NO
YES: Slab edge insulation required for all heated slabs in all Climate Zones. See details in Table 118-A of the standards.
Raised Slab Insulation ❑YES ❑NO
YES:In Climate Zones 1,2, 11, 13, 14& 16,R-8 insulation is required;in Climate Zones 12& 15,R-4 is required under component Package D.
Thermal Mass
To obtain Compliance Credit for the installation of thermal mass,use the Performance Approach.
Registration Number: Registration Date/Time: HERS Provider:
2008 Residential Compliance Forms August 2009
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: j O�'$5 0 rPERMIT#
OWNER'S NAME: PHONE#
GENERAL CONTRACTOR: BUSINESS LICENSE# ">( 3
ADDRESS: IF'/ Lam,;j L_G:.l+ < 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. <�_, //� / if
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
CITY OF
CITY OF CUPERTINO
a] FURNACE/AC
CUPERTINO PERMIT APPLICATION FORM
APN# LLI 0 Date: I/ 6
Building Address:
If residential, is house an Eichler? Yes ❑ No ❑ If yes, needs planning approval.
Owner's Name Phone#:
N'
� >
,
Contractor: Phone #.
Fax#:
Contractor License #: Cupertino Business License#:
17
Contact: Phone#:
Fax/e-mail:
Building Permit Info:
Elect 9' Plumb Mech
Residential LJ Commercial
Job Description:
R e m.wt?
For Residential Installations:
Attic ❑ 1St floor ® 2"d floor ❑
Adhere to minimum setback re uirement ❑
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: Type of Construction sage Class):
Strapped On Platform ❑ Bonded New Location Replacement x
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