13060096 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1158 SCOTLAND DR CONTRACTOR:AAA FURNACE&AIR PERMIT NO:13060096
CONDITIONING
OWNER'S NAME: CINDEE CHRISTENSEN 1712 STONE AVE DATE ISSUED:06/12/2013
OWNER'S PHONE: 4089961969 SAN JOSE,CA 95125 PHONE NO:(408)2934717
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALE]
License Class A 2 Lic.# e4 ' �S 9 e+� REPLACE(E)A/C UNIT,SAME LOCATION
Contractor 04 A 11 Jd r c e . Date
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:$5450
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:36228008.00 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 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 DAYS T 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 Is ed Date: Z b
granting of this permit. Additionally,the applicant understands and will comply
with all - int source regulations per the Cupertino Municipal Code,Section
:Signature
.
<� t any
roofing
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
1,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
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�E t e,Sec �502 �an� 534.
Section 3700 of the Labor 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 with such 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 O ME P
COMMUNITY DEVELOPMENT DEPARTMENT 5UIl DING DIVISION X�
10300 TORRE AVENUE CUPERTINO; CA 95014-3255
(408) 777-3228 FAX (408) 777-3333 building cupertino.org
misc
CUREl:iT1N0
PLUMBING <cHANTCAL ZE:ELECTRICAL WSCELLANEOU5
PROIECT ADDRESS �CQA ,.q � ( APN 9 Z 2(I COY
OWNER NAMESw�1S Zn , `q Vol I e MAI
STREET ADDRESS 00 vOuo\ O I(j\ P/ �1 (fi
99)'LI FAX
CONTACT NAME
FHONE E-KAJL
STREET ADDRESS. a CrrY,STATE, ZIP FAX
• ❑ OWNER ❑ OWMIA-MLDaR ❑ OWNER AGENT ,,XONTPAcToR ❑CONTRACTOR Acerr ❑ ARCHITECT ❑ eNGINEER ❑ ouvELOPER ❑ rFNMR
CONTRACTOR NAME �{� �/�f��I C ej LICENSE411�W I BUS.WC I `Vcr,
COMPANY NAME
j► f'� 1�A F-uv \\'n1�VAc&
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STREET ADDRESS `�,�J �-�'1(�(], �• �1 C. TF�ZIA � � P .'��j� "L(-�`�
ARCFMCTIENGITIHER NAME` W LICENSE NUMBER{' 1 BITS.LIC i v
COMPANY NAME E-MAIL, FAX
STREET ADDRESS CTI-Y,STATE,ZTP PHW-
usE of ,2YSFD or Duplex ❑ Multi-Family PROTECT IN WILDLAND PROTECT T
mucrtm: ❑ Cotntnercial URBAN N ERPACB AREA ❑ Yes No FLOOD ZONE O Ya IN*
DESCRIPTION OF WORK �`. 3 -(�y(w
U '
TOTAL VALUATION: IN
A, -4000v
By my signature below,I certify toa ch o the folly n 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 pro idcd is eo Qt. I have read the Description of Work and verify it is accurate. I agree to comply with ail applicable low
ordinances and state laws relating o buil Ing coction, I authorize representatives of Cupertino to enter the ve i(d]ennttifi:fd property for inspection purpes
os
Signature of ApplicanVAgent: Date-
SUFPLETYEENTAL INFORMATION REQUUT ED
0
dgPhfucRpp_101I.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 1158 SCOTLAND DR DATE: 06/12/2013 REVIEWED BY: MELISSA
APN: 362 28 008 BP#: "VALUATION: 1$5,450
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION FURN/AC
USE: PERMIT TYPE:
WORK REPLACE E A/C UNIT SAME LOCATION
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
A/C Units (<=10K cfm) 1BREMAIR 1 # $67
TOTALS: $67 00
Mech.Plan Check 0.0 hrs $0.00 Plumb.Plan Check Elec.Plan t'heck
Mech.Permit Fee: IMPERMIT Plumb.Permit Fee: Elec. Permit Fee:
Other Mech.Insp. 0.0 hrs $45.00 Other Plumb Insp. Other Elec.Insr).
,Mech.InspFee: Plurrab. In"p.Fee: Elec.Insp..Pee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). These fees are based on the prelimina information available and are only an estimate. Contact the Dept-for addn'(info.
FEE ITEMS (Fee Resolution 11-053 E . 7f /f 1/12) FEE QTY/FEE MISC ITEMS
Plein Check Fee:
4Supp1. PC Fee
PME Plan Check: $0.00
Pennit.Fee:
,Suppl. Insp Fee
PME Unit Fee: $67.00
PME Permit Fee: $45.00
Construction Tax:
Administrative Fee: IADMIN $42.00
Work Without Permit? 0 Yes iq No $0.00
Advanced Planning Fees:
Travel Documentation Fee: 1TRAVDOC $45.00 i
Strons Motion Fee: 1BSEISMICR $0.55 Select an Administrative Item
B1d�Stds Commission Fee: IBCBSC $1.00
$200.55 $0.00 OVAL E $200.55
- Revised: 04/29/2013
L,u��ti�-trrvu
CF-1R-ALT
Prescriptive Certificate of Compliance: Residential
rage 4 of 5)
Residential Alterations Climate Zone# #of Stories
Project Name:
HVAC SYSTEMS-HEATING Duct or Piping Configuration
Minimum Thermostat (Central,Split,lit,
Heating Equipment Efficiency Distribution Insulation S ace,Package or H
donic)
Type and Capacity", ( .kFUE or HSPF) Type adLocation' R-Value Type
1.Indicate Heating Type(Cent.-al Furnace,.Wall Furnace. Heat pump, Boiler. Electric Resistance, etc.)
or except where electric heating is supplemental(i.e.,
Electric resistance treating is allowed only in Component Package Cif total capacity
< 2 KW or 7.000 Btu/hr electric heating is controlled by a time-limiting device not exceeding 30 minutes). See§1 51(b)3 exception.
I R-ALT Form Jor additional requirements and check applicable boxes.
3.Refer to the KERS Verification section on Page 4 of the CF
4. Indicate Type or Location (Duets. Hydronic in Floor, Radiators,etc.)
HVAC SYSTEMS-COOLING
Minimum Configuration
Efficiency Duct or Piping
Cooling Equipment (SEER/EER or Distribution Insulation Thermostat Space,Pack(Cenage Lr dronic
T e and Ca acit �'' SOP) T e and Location R Value Ctrl
apt �b ANY\ C t.3
I. lndicate Cooling Tvpe(AIC, Heat pump, Evap. Cooling, etc)
2. Refer to the HERS Verification section on Page 4 of the CF-I R-ALT Form Jor 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 hydropic space hearing. Individual nts)ung DNW heaters must b
gas a•propane fired, and may not exceed SO gallons. Hot water pipe insulation from the DHW heater to the kitchens)and on all underground
hot water pipes is required in all tom onent packages in all climate zones. External Tank
Tank Energy Factor or Insulation
Water Heater Type/Fuel Distribution Type
Number In
T (Standad, Recirculatin )' S stem Ca aciry( al) Thermal Efficient R-Value'
y el r
1. Indicate Type(Storage Gar, Heat Pump, Instantaneous, etc.)
2.Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of§I SO(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 pipes shall be insulated to meet the requirements o
SPECIAL FEATURES The enforcement agency should pay special attention to the Special Features specified in this checklist below
These items may re vire written 'usti:cation and documentation andspecial verification.
NEW ROOF ASSEMBLY-Radiant Barrier
The radiant barrier requirement of§151( 2 does nota I to roof alterations.
Slab Edge(Perimeter)Insulation O YES El NO
YES: In Climate Zone 16 in Component Packages D, R-7 insulation is required.
Heated Slab Insulation CI YES ❑ NO
s in all Climate Zones. See details in Table l 18-A of the standards.
YES:Slab edge insulation re uired for all heated slab
Raised Slab Insulation O YES El NO
n is required; in Climate Zones 12& 15,R-4 is required under tom open:Pa
YES: In Climate Zones 1,2, 11,13, 14& 161 R-8 insulatio
' Thermal Mass
To obtain Compliance Credit for the installation of thermal mass,use the Performance Approach.
Registration Date/Time: HERS Provider:
Registration Number: Registration 20
2008 Residential Compliance Forms