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13040138
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10495 MERRIIvLkN RD CONTRACTOR:PELLE HEATING&AC PERMIT NO:13040138 INC OWNER'S NAME: BETTY TOPP _ 3751 D CHARTER PARK DR DATE ISSUED:04/18/2013 OWNERS PHONE: 4084464240 SAN JOSE,CA 95136 PHONE NO:(408)978-7060 [3 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL L1 COMMERCIAL1 License Class_ Lic.# �O O 0 ADD A/C TO REAR OF SFDWL 30 TON,13 SEER Contract ore /^' Date d I hereby a firm that I am licensed under the provisions.of hapter 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:$3741 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:34229057.10495 Occupancy Type: permit is issued: APPLICANT CERTIFICATION I certify that I have read this application and state.thatthe above information is PERMIT XPIRES IF WORK IS NOT STARTED correct.1 agree to comply with all city and county ordinances and state laws relating WIT 80 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 DAV F M LAST CALLED INSPE T ON. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.1%. RE-ROOFS: Signa] ate l� 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. ❑ OWNEWBU1110kRDECLARATION' Signature of Applicant: Date: I hereby affirm that I am exempt fr m the Contractor's 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 in compliance with the Cupertino Municipal Code,Chapter 9.12 andthe 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 performance of the work 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,Sections255 ,25533,and 34. Section 3700 of the Labor Code,for the performance of the work for which this permit isC r� 'issued.,: Owner or authorized agent . / Date: 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. If,after:making this certificate of exemption,I CONSTRUCTION LENDING 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 forthwithcomply with such provisioi s of: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'l have readthis 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 I I I CONSTRUCTION PERMIT APPLICATION ` COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINC3 (408)777-3228•FAX(408)777-3333•buildingCcDcupertino.orq ❑NEW CONSTRUCTION .,❑ ADDITION ❑ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS APN# - j I n a'� Q �t�[' --Dm5 ka I �.,�� OWNER NAME XP 1� PHONE Y!_��+�"� 4" E`MMAIIL_l (J J ,.f! STREET ADDRESS ® STAT ,ZIP FAX CONTACT NAME �Yr` PHONE MAIL aU.CtO STREET ADDRESS _ C ,STATE,ZIP F X �1 ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LI NSE NUMBER LI ENSE YPE BUS.LIC# 2.n 1 COMPANY NAME E-MAIL FAX ( 14+ STREET ADDRESS CI Y,STATE,ZIP 13 P ONE 60 ARCHITECT/ENGINEER NAME LICENSE NUMBER 7 BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK ' s EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKMORCH AREA I GARAGE AREA: UDFTACH []ATTACH #DWELLING UNITS: IS A SECOND UNIT []YES :SECONDSTORY ❑YES BEING ADDED? ❑NO ADDITION? []NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN YES PLANNING APPL 0 NO PLANNING APPROVAL LETTER EICHLERROME? ❑NO �� vI TOTAVALUATTTIIOOON: 'k 1:5 J By my signature below,I certify to each of the following: I am the property owner or authorized, t to act on the property owner's behalf. I have read this application and the information I have rovided is correct. I have read the Description of Work an erify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to b din construction horize representatives of Cupertino to enter the above-idcntified property for inspection purposes. Signature of Applicant/Agent: w Date: /I SUPPLEMENTAL INFORMATIO REQUIRED rrwn TS'1 _New SFD or Multifamily dwellings: Apply for demolition permit for o existing building(s). Demolition permit is required prior to issuance of builddgTOR, © n ' P AN ItEty permit for new building. t, ❑ exAAI`IrItI� AIw,, _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. C� �AxGE © rip .° _Copy of Planning Approval Letter or Meeting with Planning prior to 14sA5tli- ©, we submittal i22T1 submittal of Building Permit application. B1dgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10495 MERRIMAN RD DATE: 04/18/2013 REVIEWED BY: MENDEZ APN: BP#: `'VALUATION: 1$3,741 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: FURN/A WORK ADD A/C.TO REAR'OF SFDWL 30 TON 13 SEER SCOPE. Mech.Plan Check 0.0 hrs $0.00 Plumb.Plan Check T Elec.Plan Check Mech.Permit Fee: IA PERMIT Plumb.Permit Fee: Elec.Permit Fee: Other Mech.Insp. 0.0 hrs $45.00 Other Plumb Insp. L] Other Elee.Insp. .Dlech.Insp.Fee: Plurnb. Insp.Fee: Elec.Insp.Fee: NOTE.This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). Theseees are based on the prefindna information available and are on an estimate. Contact the Dept for addn'1 info. FEE ITEMS.(Fee Resolution 11-053 E . 7111121 FEE QTY/FEE MISC ITEMS Plan Check Fee $0.00F_1 # Mechanical Suppl.PC Feer (E) Reg,. ® OT 0.0 hrs $0.00 $67.00 IBREMAIR A/C Units(<=10K cfm) PME Plan Cheek: $0.00 Permit Fee: $0.00 Suppl'. Insp.Feeig Reg. Q OT 57lns $0.00 PME Unit Fee: $0.00 PNM Permit;Fee: $45.00 Cemso-tict on Taal Administrative Fee: IADMIN $42.00 . Work Without Permit? 0 Yes (E) No $0:00 E) Advanced Planning Feer $0.00 Select a Non-Residential G Travel Documentation Fee: ITRAVDOC $45.00 Building or Structure i Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Blda Stds'Commission Fee:, 1BCBSC $1.00 $133.50 $67.00 $200.50 Revised: 04/01/2013 Simplified Prescriptive Certificate of Compliance:2008 Residential HVA CAlterations CF-IR-ALT-HVAC Climate Zones I and 3-7 SiteAd&ess: s EnforcementAgency: Date: permit#: tip 4015- eALUM&:1 RAM& Conditioned Duct insulation Equipment Type List Minimum Efffciency2Floor Area requirement Thermostat Packaged Unit of duc Over 40 Furnace E3 AFUE COI' ft ducts Furnace Setback Indoor Coil Served by system added or replaced in Condensing U EIrR ®Resistance sf unconditioned space installed) ready present,must be Conden ' Unit ®li 6 (CZ 1,3-5) Cather 1.Equipment Type:Choose the equipment being installed;ifmore than one system,use another CF-IR-ALT-RVAC for each system. 2.hfinimum Equipment Efficiencies:13 SEER,•78%AFUE,7.7118PF for typical residential systems. Contractor(Documentation Author's./Responsible Deftier's Veclaratibn Statement) • I certify that this Certificate of Compliance doou nentation 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. • t 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 I 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: 4Y1 Signature: Company: - - Date'Q- 4(p-�' Kpe.-4 jAj(L-. : / 3 Address: Licens City"ate/Zip. Phone: 0 2008 Residential Compliance Forms March 2010 I-4 1 1 BUILDING DIV ISIO 1' R, CLJPE INC 1 1 V APPCED of r1ans and spevificMiOn MLJSTtekEpta Tne .1. 0; i f t�j Mns fte,Q.1. nv w aiteratio 19 o i saine,or to Jevi to tj vc)rn, WRrIOUE 3ppr)val From Illy im , -SH WL-40T r.ojpq of this pla T and spe, -nit nr to.1je.am am irov4i of he viblatpri . aiwic jisic ns of an),City Or Ina nceorSt aL,,w ,V, r-r-"rTVF I DATE i—PERMI) NO. J jI I—j- 4 , raw III 4-k' r -5 11 AFN NU F W:t I�A ' 4 r-5 I i 01 im -------------- ...... ........