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13040076
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10437 AVE NIDA LN CONTRACTOR:SANDIUM PERMIT NO: 13040076 OWNER'S NAME: PARPARITA ANN S AND MIHAI 4223 VERDIGRIS CIR DATE ISSUED:04/09/2013 OWNER'S PHONE: 6502834582 SAN JOSE,CA 95134 PHONE NO:(408)894-9072 LICENSED CONTRACTOR'S DECLARATION JOB DESCRH'TION:.RESIDENTIAL 11 COMMERCIAL U . License Class Cu Lic.# gB$I t ADD A/C TO REAR OF SFDWL Contractor 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:$5685 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:34245044.00 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 DA F M LAST 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 Issued b Date: granting of this permit. Additionally,the applicant understands and will comply Y' with all non-point source regulations per the Cupertino Municipal Code,Section Sign � RE-ROOFS: Signatu �_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 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. 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(a)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 Area Air Quality Management District I performnce oe.wo af thrk 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,Section 25505,25533 and 25534. Section 3700 of thetabor Code,for the performance of the work for which this Owner or authorized agent: 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 CONSTRUCTION LENDING AGENCY Compensation.laws of California. If,after making this certificate of exemption,I 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 withsuch 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 MEP . COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION�b 10300 TORRE AVENUE•CUPERTINO,CA 950143255 CLtPERT(FE© (408)777-3228• FAX(408)777-3333•building(aD-cuoertino.org MISC []PLUMBING ❑MECHANICAL [-]ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS 10,37 d,3 APN OWNERNAPM 1" ` ` .L-G PHONE V Zg3 4382 E-MAII. /�jJ STREET ADDRESS '/+ A Y t s v CITY, STATE,lZIP7FAX CONTACT NAME (•` PHONE I. Cf Ur � ! L E-MAIL STREET ADDRESS S w CITY,STATE,ZIP �t f�+` FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENTCOT.'TRACTOR El CONTRACTOR AGENT 11 ARCHITECT ElENGIJ.°EER ❑ DEVELOPER 13TENANT CONTRACTOR NAME /�` G.b1 LICENSE I�MB1 LICENSE TYPE/ BUS.LIC n ko- COMPANY NAME ,IS w ,' `u`A E-MAIL l• FAX STREET ADDRESS /�1;2eC2 Av�r�,* %4 CC✓`, CITY,STATE,ZIP JPHONE QOARCHITECT/ENGLNtEER NAME ! LICENSE NUMBER BUS.LIC# C COMPANY NAME' E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ❑ MULTI-FAMII.Y PROJECT IN W ILDLAND El PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: Q COMMERCIAL - URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO USE OF )K�FD.DUPLEX DESCRIPTION OF WORK TOTAL VALUATION: S RECEIVED B101 By my signature belo-w,I certify to each of the following: I am the property owner or authorized agent to act on tf e p perry owner's behalf. I have read this application and the information I have provi d is correct. I have read the Description of Work and verify it is accura I agree to comply With all applicable local ordinances and state laves relating to bu' consttuctio . I authorize representatives of Cupertino to enter the abo -iden�t;fi�propef[y for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY VER-THE-COUNTER ❑ EXPRESS v U ❑ STANDARD U ❑ LARGE ❑ MAJOR AgPWiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10437 AVENIDA LN DATE: 04/09/2013 REVIEWED BY: MENDEZ APN: BP#: "VALUATION: 1$5,685 %PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION FURN/A USE: pPERMIT TYPE: WORK ADD A/C IN BACKYARD SCOPE Mech.Plan Check 0.0 Ill's $0.00 Plumb.Plan Check Elec.Plan Check Mech.Permit Fee: IMPERMIT Plumb.Permit Fee: I ec. Permit Fee: Other Mech.Insp. F-01hrs $45.00 Other Plumb Insp. Li Other Elec.Insp, Afech..Imp.Fee: Plumb. hrsp.Fee: Elec.Insp Fee: NOTE:This estimate does not include fees due to other Departments(L a Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These fees are based on the prelfinina information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS(Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Mechanical Suppl.PC Fee: Q Reg. 0 OT0.0 hrs $0.00 $67.00 IBREMAIR A/C Units(<=10K cfm) PME Plan Check: $0.00 Permit Fee: $0.00 Suppl.Insp.Feer Reg. ®OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $45.00 C'onstt-tiction :Tax: Administrative Fee:. 1ADMIN $42.00 Work Without Permit?. ®Yes (E) No $0.00 E) Advanced Planning Feer $0.00 Select a Non-Residential Travel Documentation Fee: _ ITRAVDOC $45.00 Building or Structure 0 i Strom Motion Fee: 1BSEISMICR $0.57 Select an Administrative Item Bldg-Stds Commission Fee: IBCBSC $1.00 $133.57 $67.00 $200.57 Revised: 04/01/2013 Simplified Prescriptive Certificate of Compliance:2008 Residential HVACAlterations CF-IR-ALT-HVAC Climate Zones 1 and 3-7 Site Address: Enforcement Agency: Date: 7rmit#: Conditioned Duct insulation Equipment T el List Minimum Efficiency' Floor Area requirement Thermostat Packaged Unit ®Fumace ®AFUE COP Over 40 ft of ducts Served by system added or replaced in M Setback t2. door Coil aSEER HSPF_ (If not already present,must be ondensing Unit ®EER ®Resistance sf unconditioned space installed) ther ®R 6 (CZ 1,3-5) quipment Type:Choose the equipment being installed;if more than one system,use another CF-1R-ALT-HVAC for each system. inimum 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 enforcement agency for approval with-the permit application. Name: Signature: Company: ' t J Date: Q Address: 422Zo . License: City/StateMp: Phone: 4 .� 2008 Residential Compliance Forms March 2010 j lt_ cor�r.nI ulWIrfG be ' Th c^ ,,r r 1 t 71 cc jc!L� J1 _ _. f �� a��j��'i��L�n J� • - I 1{�v �:�<4 �' r i �� i Ui l� I i ! 1;Y� �- .._1 _ _.. _ -.... 'Y I ,Y APR U g 2013 6i DN'17 a .,t 'fr' J;. a �• 3'� 'iO'` AAr7 IANC ��i. ' _l_i _ - - 04 Ad r�evd r , I , a + : I I I I � I r 11 { i ' I i � I I I I -P .