10080114 CITY OF CUPERTINO BUILDING PERMIT
WILDING ADDRESS: 827 SEPTEMBER CT CONTRACTOR:VALLEY HEATING& PERMIT NO: 10080114
COOLING
1'NER'S NAME: KATHLEEN ALLEY 1171 N 4TH ST DATE ISSUED:08/17/2010
_PER'S PHONE: 4082578809 SAN JOSE,CA 95112 PHONE NO:(408)294-6290
LICENSED
2 ED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB
License Class�y Lic.# J F> 7 4 G MECH r RESIDENTIAL F COMMERCIAL
--ontractor Ug, Y CT241> Date 7�r 20iO
[herebyaffirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:FURNACE REPLACEMENT(SAME LOCATION);ADD AJC;
200AMP PANEL CHANGE
(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.
I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft FI)or Area: Valuation:$8195
Section 3700 of the Labor Code,for the performance of the work for whichthis
permit is issued. 1 j /'
APN Nu nber:36212005.00 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, W[THIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 181) 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 l �
9.18. f Issued ltd` Date:
Signature
❑ OWNER-BUILDER DECLARATION RE-ROOFS:
All roof, 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, Signatui a of Applicant: Date:
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 and will maintain a Certificate of Consent to self-insure for Worker's I have r ead the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the Califor ria Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
performance of the work for which this permit is issued. compli.nce 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.
Additionally,should I use equipment or devices which endt 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
permit is issued. mainta n 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 OV5pr or Author a e�nt• �7Xrc1(1
become subject to the Worker's Compensation provisions of the Labor Code,I must'%4 / i���'��I!/!' Date: ( ' 7 `tet
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereb;1 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 whish 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
--n the above mentioned property for inspection purposes.(We)agree to save Lender's Address
unify and keep harmless the City of Cupertino against liabilities,judgments,
and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I under stand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
-�► CITY OF CUPERTINO
�C FURNACWAC
CUP OF PERMIT APPLICATION FORM
Date:
Building ddress: �� e r
Phone#:
Owner's Name:A
1 [ Phone
Contractor: 7
�'te,vHe ��� � � �a4 �� Fax#:
�{o� 2i�F -Ff
2 i
��
Cupertino Business License#:
Contractor License#:
540
Phone#: e(d$'-24 4- 67 0
Contact:
Fax#:
Building Permit Info:
ElectZ Plumb Meeh
Residential Commercial
Job Descrition: it) ` �C 26M,, Pnpref
Furnace Ke 14e4j eSerr.-ie toe
For Residential Installations: l floor ( 2nd floor []
Attic ❑
Adhere to minimum setback requirement
4.
For Commercial Installations:
Additional weight(structural calcs) ❑
Replacement same weight ❑
Structural Calculations required for new installation []
New installation Planning Approval Requirede❑of Construction(Usage Class):
Cost of Proje t: '
i 1(�
Stra ped On Platform Bonded New Location Replacement
P j Ak\
Valuation: �/1 G 5 —
Green Building: Must attach Green Building Check list to this application
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: VALUATION: $8,195
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
PRIMARY OVER THE APPLICATION
USE: ___TSFD or Duplex COUNTER? Yes No TYPE•
WORK
SCOPE L_
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.f.
R-3 (Custom) II-B,111-B,IV,V-B 0 $0.00 $0.00
TOTALS: 0 $0.00 $0.00
MECHANICAL ®,.Yes G No PLUMBING I:) Yes O No ELECTRICAL 0Yes (D No
)hol(.h7 cA 'lf'L'. Iaitdt? {ti'Cbf
F'ervnu T°ce
L-i
-I--
0117"'r 1"I Imp,
NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info,
FEE ITEMS (Fee Resolution 09-051 Ef. /i1:-10) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 1 # Mechanical
Suppl.PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 $126.00 IMFR=<100 Furnace,Forced-Air
PME Plan Check: $0.00 E= Mechanical
Permit Fee: $0.00 $63.00 1BREMAIR A/C Units(<=I OK cfm)
Suppl. Insp. Fee0 Reg. 0 OT 0.0 hrs $0.00 1?00 amps Electrical
PME Unit Fee: $0.00 $42.00 IERT<200 Temporary Power
PME Permit Fee: $0.00
tt171PfYK'It=':t7 i"J,I
Acoustical Fee: 0 Yes 0 No $0.00 0
Work Without Permit? 0 Yes E) No $0.00 0
Planning Fee: $0.00 Select a Non-Residential 0
Building or Structure 0
Travel Documentation Fee: ITRA VDOC $42.00 A
Strong,Motion Fee: 1BSEISMICR $0.82 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $43.82 $231.00 TOTAL FEE: $274.82
Revised: 8/12/2010
v
„ p tis �„ 5 k - �•- =_ 4 c o a
qy YAN I
4.Use Solid Wall Systems(Inciuges SIPS,ICF_,&Any Non-Stick Frame Assembl))
ED
:.Floors -
I I b,Wal!s C
I ❑ C.Roofs I I —.1
5.Reduce Pollution Entering the Home from the Garage
❑ a.Tightly Seal the Air Banter between GaraJe and Living Area
❑ b.Install Garage Exhaust-ran OR Build a Oe ached Garago 0 I t
❑ E.Deign Energy Heals on Trusses(75°6 of Attic Insulation Haight at Outside Edge of E tailor lM1'a')
❑ 7.Design Roof T ruse to Accommodate Ductwork
B.Use Recycled-Content Steel Studs for 90,>of interior Wall Framing I 0
R.Thermal Mass Wails:5!B-inch Drywall on All Interior Walls or Wells Weighing more than 401b1cr.ft
10.install overhangs and Gutters p I - -
----
-__—. — - -❑ - a.lAinimum 16-InCh Overhangs and Gutters p I i --
❑ t Ninimum 24-Inch Overhangs and Gutior>
Tota!PoinE Ava able in StrdCVJ7al Building Frame and Envelope=3oI 0 I
Pointy Avail=bl-Per 1•he2sure
E.EXTERIOR FINISH I D I 2
1.Use Recycled-Content(No Virgin P)zstia)or FSC-Certified Wood 0.eking 0 I
❑ 2.Install s Rain Screen Wail System I p I 1
3.Use Durable and Noncombustible Siding Materials I D
❑ 4.Select Durable and Noncombustible Roofing Materials7—
Total Poiri s Available in Exterior Finish-71 D
Points AvaOabl_P-r M.,aSur�
F.Ih'STJL.4TION ( I
1.Install Insulation with 75%Recycled Content
❑ a.Walls and/or Floor
—❑ b-Ceilings I I
2 install Insulation trial is Low-Emitting(Certified Section 01350) 0
❑ a.Walls and/or Floors p 1
❑ b.Ceilings 0
1
❑ 3.inspect Quality of Insulation installation before Applying Drywall Total Points Available in insulation=51 0
Points Available Per Measure j
G PL1JIurSING I
1.Distribute Domestic Hot Water Efficiently(Maximum 7 Points). 0
❑ a.insulae Hot Water Pipes from Water Heater to Kitchen 0 1
❑ b.Insulate WI Hot Water Pipes 0 I i
e.Use Engineered Parallel Piping p 1
❑ d.Use Enoinaered Parallel Piping with Demand Controlled Circulation Loop 0 — y 2
❑ a.use Structured Plumbing with Demand Controlled Circulation Loop 0 1 1 2
❑ f.use Central Go Plumbing I p I I
❑ 2.Install Only High Efficiency Toilets(Dual-Flush or 5128 gpf) Total Points Available in Plumbing=Total 12I 0
Points Available_Per Measure 1
r3.
ENTILATION&9IR CONDITIONING I D 4
and Install HVAC System to ACCA Manual J,D,esled Combustion UnitsacasZ
r Heaters I 0oned,Hydronic Radiant Heating with Slab Edge Insulation p 1
4.install High Efficiency Air Conditioning with Environmentally Responsible Refrigarants
5.Design and Install Effective Ductwork, I 0 I _g I I
❑ a.Install HVAC Unit and Ductwork within Conditioned Space —p I- T-1
❑ b.Use Duct Mastic on All Duct Joints and Seams 0
D❑
—=J —
c.Install Ductwork under At,insulation(Buried Ducts) i 1
❑ d.Pressure Balance the Ductwork System p �— i
❑ e.Protect Ducts during Construction and Clean All Ducts before Occupancy I 0 1 i I
❑ 6.install High Efficiency HVAC Filter(MERV 6+) ------------
❑ 7.Don't Install Fireplace or install Sealed Gas Fireplaces with Efficiency Rating Not Les That 60% p ;
using CSA Standards
B.Install Effective Exhaust Systems in Bathrooms and ritchens 0
❑ a.Install ENERGY STAR Bathroom Fans Vented to the Outside I 1
❑ b.All Bathroom Fans Are on Timar or Humidistat D 1
❑ c.Install Kitchan Range Hood Vented to the Outside
9.Install Mechanical Ventilation System for Cooling(Maximum 4 Points) D I ! 1
❑ a.Install ENERGY STAR Coiling Fans 8 Light Kits in Living Areas&Bedrooms
b,install Whole House Fan with Variable Speeds -
❑ c.Automatically Controlled Integrated System
❑ d.Automatically Controlled Integrated System with Variable Speed Control
i D,Install Mechanical Fresh Air Ventilation System(Maximum 3 Points) 0 I I 2 '
❑ e.Any Whole House Ventilation System That Meets ASHRAE 62.2i —j- I
p --...
❑ b.install Air-tD-Air Heat Exchanger that meets ASHRAE 62.2 I 0-7-
11,
I 11.install Carbon Monoxide Alarm(s)
Total Point Available in Heating,Ventilation and/,it Gongmomnc=30I D j
ppm_P n`d
Cinnln F=nil,:r,ronnG�,int('.he-l•IiM Pri`17\rercinn
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
91 Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: S,Z SC�mFe, e� C PERMIT# pal
OWNER'S NAME: -x-12 n �� PHONE# �
GENERAL CONTRACTOR: Vr,I 7�,` 6 1' BUSINESS LICENSE# JZS$ d ;ns�
ADDRESS: // 1 S CITY/ZIPCODE: S �-t
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY SUBCONTRACTOI;:S ION(S) WILL BE SCHEDULED
HAVE OBTAINED ACIY O
GUNTIL THE
ENERAL CONTRACTOR AND AL CUPERTINO
BUSINESS LICENSE. S ��-/"-,0
I am not using any subcontractors: Date
Signature
Please check applicable subcontractors and complete the Following information:
SUBCONTRACTOR BUSINESS NA?4E 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
Date
Owner/Contractor ature