13040121 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:,.19147 COZETTE IN . CONTRACTOR:AAA FURNACE&AIR PERMIT NO:13040121
CONDITIONING
OWNER'S NAME:jI KARL'ICADIE 1712 STONE AVE DATE ISSUED:04/16/2013
OWNER'S PHONE: 4083662561 .: SAN JOSE,CA 95125 PHONE NO:(408)293-4717
.LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
REMOVE&REPLACE(E)FURNACE,SAME LOCATION
License ClassC Lrc
Contractor UNNI�UM/ Date `l
77
I her affirm that't 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 wilt 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 thistpermit'is issued. Sq.Ft Floor Area: Valuation:$4000
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:37507020.00 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'coupty,ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,acid her iiiilhorize representatives of this city to enter
upon the above.meutioned property for'inspection purposes. (We).agree to save 180 DAYS O ALLED INSPECT 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 ]S Date:
granting of this permit; Additionally,the applicant understands and will comply
with all no. point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signatur Date 7 / 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-BUH DERDECLARATION
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
1,as owner of the property,or my,employees with wages as their sole compensation,
will do lthe work>!an¢the 19tnicture is'nof intended`or offered for sale(Sec.7044,
Business&Profession's 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 6.95of 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,auilthe
declarations :' I Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and:will maintain a Certif tate 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:
permit;is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and.
performance of the,work ror,which this
I the Health&Safety Code,Sec ons 25505 5533,and 25534.
Nil I and will maintain YVorker s Compensation Insurance,as provided for by
Secti
oode,forthe performance of the work for which this
n 3700 of tlie!Labor COwner or authorized agent Date:
permit is issued.
that in the perfor}nance of the,work for which this permit is issued,I shall
I certify
not employ any person in any manner so as to become subject to the,Worker's CONSTRUCTION LENDING AGENCY
Compensation laws of California. If,aftermaking this certificate of exemption,I
become subject to'the Workers Compensation,provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
"I work's for which this permit is issued(Sec.3097;Civ C.)
to,
ith,comply with isucli provisions or this permit shall be deemed revoked.
I, Lender's Name
I „ I APPLICANT CERTIFICATION Lender's Address
I certifx that I have read this applicat on and state that;the above information is
correct.,I agree to;com�ly 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',peml Additionally,;the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
I ,
Date
Signature
GENERAL PERMIT APPLICATION 454
COMMUNITY DEVELOPMENT DEPARTMENT- 8'UILDING DIVISION
10300 TORRE AVENUE , CUPERTINO, CA 95014-3255
URE>aT1N0 (408)777-3228 - FAX(408)777.3333 ,building(a cupertino.org I MISC
PLUMBING �54CHAMCAL ❑ELECTRICAL ❑MISCELLANEOU5
PROJECT ADDRESS AP 4 3 rO / V ZO
OWNER NAME ��[p
F?X rADORM t `v4FQ, e/ fr�siCff J�W FAX
CONTACT NAME ON 1 1 V IV �0 V �J�I V
STREET ADDRESS. CM,STATE, ZIP FAX
i.
0 OWNER E7 OWNEMUILDER CJ OWNER AGENT CONTRACTOR O CONTRACTOR AGENT C❑ ARCHITECT CI ENGINEER C1 OEvELOFER ❑Te4AKT
CONTRACTOR NAMELICENSE MAA rpt I U E � ) 8U3.UC
COMPANY NAME 1 \v , 3-MAD.
STREETADDRESS I n ,C�II�O/ , I CrrY,SfMT (�A
AR0iJTZCTlBNOD=R N NMl
AM 1\J1 LICENSE aER�� ` \J i 1 J 31J3.UC 0 I
COMPANY NAME EMAIL FAX
S•IRE$r ADORBS3 CITY,STATE.ZIP ?HONE
usE of /:rSFDorDuplex 0 Multi-Family mOJECTINWILDLAND FROJECr
mucmw: Cl Commercial URBAN MWACE AREA O Yes o FLOOD ZONE O Yes 21No
DEscRlirnoN of woRic F A1C
TOTAL VALUATION:
By my signature below,I certify to each of th oll wing: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I h e p vi ed is orrect. 4 hays read the Description of Work and verify it is accu te. I grce to comply with all applicable IocaJ
ordinances and state laws reladn to buil i co ction. I authorize representatives of Cupertino to enter the e-ide ietl propCTty for inspection purposes.
Signature of Appl icanVAgent: Date:
SUP LE AL INFORMATION MQU RED
I �
lrffPhftscApp_101I.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 19147 COZETTE Df;(LA/ DATE: 04/16/2013 REVIEWED BY: MELISSA
APN: 375 07 020 : BP#: "'VALUATION: $4,000 .
xPERMIT TYPE: . Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Du lex PENTAMATION FURN/AC
USE: p PERMIT TYPE:
WORK REMOVE& REPLACE E FURNACE SAME LOCATION
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace; Forced-Air 1MFR=<100 1 # $133
r ' $133.00
TOTALS:
Meeh.Plan Check 0.0 hrs $0.00 Plumb.Plan Check Elec.Plan(.'heck
Mech.PermitFee: 1WERMIT Plumb.Permit Fee: Elec.Permit Fee.,
Other Mech.Insp. 0.0 hr§ $45.00 �)N Plumb Insp. Other Elec.Insp.
R ech Insp.Fee: Plumb. Insp.Fee:: Elee.Insp.Fee:
NOTE:This estimate does not include fees,due to other Departments(Le Planning,Public Works,Fire,Sanitary Sewer District,School
'District,eta). Tbese fees-are based on the prelintina information available and are only an estimate. Contact the Dept for addn'1 in o:
FEE.ITEMS(Fee Resolution 11-053 E . 7ff 11112) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl.PC.Fee
PME Plan Check: $0.00
Permit.Fet
,Supp 1. Insp Fee
PME Unit Fee: $133.00
PMS Permit Fee: $45.00
Constr-ztction :Tay.
Administrative Fee: 1ADMIN $42.00
Work Without Permit? ® Yes G) No $0.00
Advanced Planning Fees:
Travel Documentation Fee: 1TRAVDOC $45.00 i
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
r
$266.501 $0.00 ` $266,50
Revised: 04/01/2013
L;uPa�-ttr� u
CF-1R-ALT
Prescriptive Certificate of Compliance: Residential pa le e 4 of 5)L
Residential Alterations #of Stories
Project Name: Climate Zone#
HVAC SYSTEMS-HEATING Configuration
Minimum Duct or Piping
Heating Equipment Efficiency Distribution Insulation Thermostat (Central,Split,
Type and Ca aci 1''-') ( �FUE or HSPF) T e and Location R-Value T e S ace,Packa e or H dronic)
0 a
1.Indicate Heating Type(Cent.-a1 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 KW 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-1 R-,4LT Form for additional requirements and check applicable boxes.
4. Indicate Type or Location(Duets. Hydronic in Floor, Radiators.etc.)
HVAC SYSTEMS-COOLING
Minimum Configuration
Efficiency Duct or Piping g
Cooling Equipment WE or Distribution Insulation Thermostat S ace,Pack(Cenaae orpHt dronic
Type and Ca acit l'' C UPj'-- T e and Location R-Value e
1. Indicate Cooling Type WC, Heat r , yap. Cooling, etc)
2. Refer to the HERS Ve ' on section on Page 4 of the CF-1 R-,4LT Form for additional requirements and check applicable bores.
3. In ' or Location(Ducts, H dronic in Floor, Radiators, etc.)
WATER HEATING
W)heaters and hydropic space heating. Individual dwelling DHW heaters must b
List water heaters and boilers for both domestic hot water(DH
gas or•propane nd 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 require1 com onent packages in all climate zones. External Tank
Water Heater Type/Fuel Dts on Type umber in Tank Energy Factor or Insulation
Ty et (Standar et S stem Ca acity( al) Thermal Efficienc R-Value
1. Indicate e(Storage Gas, Heat Pump, instantaneous, etc.)
?. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements'af§I SO(n). The Prescriptive requirenru cfo
not allow the installation of a recirculating water heating system for single dwelling units.
3. The external water heating tank and pipes shall be insulated to meet the requirements of§1506,)._
SPECIAL FEATURES The enforcement agency should pav special attention to the Special Features specified in this checklist below.
These items may re afire written justification and documentation andspecial verification.
NEW ROOF ASSEMBLY-Radiant Barrier
The radiant barrier requirement of; 151(f)2 does not a2ply to roof alterations.
Slab Edge(Perimeter)Insulation O YES O NO
YES: in Climate Zone 16 in Component Packages D, R-7 insulation is required.
Heated Slab Insulation El YES 0 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 O YES O NO
YES: In Climate Zones I,2, 11, 13, 14& 16,R-8 insulation is required; in Climate Zones 42.& 15,:R-4 is required under component Pa !Q
Thermal Mass
To obtain Compliance Credit for the installation of thermal mass,;use.the.Performance A roach.
Registration DatelTime: HERS Provider:
Registration Number: August IO
2008 Residential Compliance Forms