13080053 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10831 NORTHFORDE DR CONTRACTOR:AAA FURNACE&AIR PERMIT NO:13080053
CONDITIONING
OWNER'S NAME: RICH MARGARET C 1712 STONE AVE DATE ISSUED:08/07/2013
OWNER'S PHONE: 4082589346 SAN JOSE,CA 95125 PHONE NO:(408)293-4717
Er LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALE]
License Class C d3 �2 r Lic.# 7 6'o a 7/ REPLACE(E)FURNACE&A/C UNIT,SAME LOCATIONS
Contractor AAA A ✓tiz cam- Date
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 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:$7312
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:31637053.00 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 DAYS CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ��D costs,and expenses which may accrue against said City in consequence of thesued at . SW12e
granting of this permit. Additionally,the applicant understands and will comply
with all non-point sourc r gulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date 7" 3 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
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, 'ona2550 533,a d 5534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized ager. Dater
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 inconsequence 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
tEN_ERAL PERMIT APPLICATION h % ME p
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION '$ 0
i 103'00 TORRE AVENUE - CUPERTINO, CA 95014-3255
CUPE1 71'1`" .. sl (408)777-3228 ' FAX(408)777-3333 'buildingecupertino.om
MISC
PL"1NG bCECHAMCAL CMCAL ❑WSCELLANEOUS
PROJECT ADDRESS I O��1 .i v ids r' APN I 3 ' 6 3 O
OWNER NAME n A/J C4Wr 1•"�` 1 PH
ST
REET'ADDRESS 1�/V✓� .�d �•V Crry j V1(, c j CK-Z)+ FAX
CONTACT NAME Ga 1 0 L1 PHO 7MAIL
VT=ADDRESS 1 VII - 1 CITY.S('KOB/XIP SCP I�j�Cj(�/� FAX
• 1 �(/1 1 � �l/U V t/1 �
Cl OWNER Cl OWNER-BUILDER ❑ OWNER AGENTCONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ oEvELOPER ❑TENANT
CONTRACTOR NAME LICENSE I LlCBRf j�P /'n n BUS.L1C I
COMPANY NAME 1 1/l(n/I1 8-MAIL
u (/ALJ VLl/ FAX
STPEETADDRESS��� � `��rY�•/••AvI 'Y` ' r C TDX C v"
ARCHTTECTJENOIIMRNANM ` LICENSE NUMBER BUS.LIC I
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF �FYSFD or Duplex El Multi-Family PROJECT IN WE.DLAND PROJECT IN
mucnw: ❑ Commercial URBAN INTERFACE AREA 0 Yes ❑ No `FLOOD ZONE Cl Yes O No
DESCR7PTi0NOFWORJC (gyp /�
GCe aY jl 4TCC
TOTAL YALUA TION:
13y my signature below,l certify to eac a followi 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 hav prov' ed is co t. 4 have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating t uildi cons I authorize representatives of Cupertino to enter the e-id ntified property for inspection purposes.
Signature ofApplicwt/AgM Date; 5
SUPP EIVIE AL INFORMATION REQU ED
O'
T � G
baFWwcApp 2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
{' ADDRESS: 10831 NORTHFORDE DR DATE: 08/07/2013 REVIEWED BY: MELISSA
APN: 316.37 053 BP#: "VALUATION: $7,312
*PERMIT TYPE: Mechanical Per PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY PENTAMATION FURN/AC
USE: SFD or Duplex PERMIT TYPE: A
WORK REPLACE E FURNACE&A/C UNIT SAME LOCATIONS
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
A/C Units (<=10K cfm) 1BREMAIR 1 # $70
Furnace, Forced-Air 1MFR=<100 1 # $139
TOTALS: $209 00 °_
m
Mech.Plan Check 0.0 7Fee:
7Plurnb.
Plumb.Plan('heck Elec. Plan{'heck
Mech.Permit Plumb.Permit Fee: Elec. Permit Fee:
Other Mech.Insp. 0.0 Other Plumb Insp. (Other Elec.Insp,
Ifech.Insp. Fee: hap.Fee. glee.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These ees are based on the prelimina information available and are only an estimate Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E f 711112) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
buppl. PC.`Fee
PME Plan Check: $0.00
Permit Fee:
Suppl. .Insp Fee
PME Unit Fee: $209.00
PME Permit Fee: $47.00
Consir action Tax:
Administrative Fee: IADMIN $44.00
Work Without Permit? ®Yes (E) No $0.00
Aclvanced Planning Fees:
Travel Documentation Fee: ITRAVDOC $47.00 A
Strong Motion Fee: 1BSEISMICR $0.73 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
$348.731 $0.00 $348.73
` , Revised: 07/0.1/2013
K L_LA t+�e_1)"iL)
CF-IR-ALT
Prescri tive Certificate of-C.om liance: Residential Page 4 0 5)
Residential Alterations Climate Zone# #of Stories
Project Name:
r
HVAC SYSTEMS--HEA ING Configuration
Minimum Quct�or�Piping
Distribution Insulation Thermostat (Central,Split,
Heating Equipment Efficiency Type S ace,Packa a or H dronic)
T e and ( \FUE or HSPF T e and Location R-Value L {u�
1.Indicate Heating Type(Central 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-l R-AL T Form Jor additional requirements and check applicable boxes.
4. Indicate Type or Location(Ducts, Hlydronic in Floor, Radiators.etc.)
HVAC SYSTEMS-COOLING
Minimum Configuration
Efficiency Duct or Piping
insulation Thermostat (Central,Split,
Cooling Equipment (SEER/EER or Distribution T e Space,Package or H dronic
T e and_Ca aeit '" COP) Type and Location' R-Value
1. Indicate Cooling Tvpe(ASC. Heat pump, Evap. Cooling, etc)
2. Refer to the HERS Verification section on Page 4 of the CF-IR-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 dwelling DHW heaters must b
gas or propane fired, and may not exceed 50 gallons. Hot water pipe insulation from the DHW heater to the kitchens)and on all underground
hot water i es is required in all component packages in all climate zones. External Tank
Water Heater Type/Fuel Distribution Type Number in Tank Energy Factor or Insulation
T el (Standard, Recirculatin )' S stem Ca aciry( al) Thermal Efficient R-Value
1. indicate Type(Storage Ca.r, Heat Pump, instantaneous. etc.)
2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of§150(n). The Prescriptive requirements do
not allow the installation of a recirculating water heating system Jor single dwelling units.
3. The external water heating tank and pipes shall be insulated to meet the requirements o 150 ' .
SPECIAL FEATURES The enforcement agenev should pay special attention to the Special Features specified in this checklist below.
These items may re uire written justification and documentation and ecial yeti tcation.
NEW.ROOF ASS FWi 0i,Y-R'adiant Barrier
The radiant barrier requirement of L1151( 2 does not apeI to roof alterations.
Slab Edge(Perimeter) Insulation C3 YES 0 NO
YES: in Climate Zone 16 in Component Packages D,R-7 insulation is required.
Heated Slab Insulation C3 YES 0 NO
YES:Slab edge insulation re uired for all heated.slabs in all Climate Zones. See details in Table 118-A of the standards.
Raised Slab Insulation C7 YES O NO
YES:In Climate Zones 1,2; 1 I, 13, 14& 16,R-8 insulation is re_uired; in Climate Zocomponent nes i2,& iS,:R 4.is re uired:under
Thermal Mass
To obtain Compliance Credit.for the installation of thermal mass,iist.the:Performance Approach.
Registration DatelTime: HERS Provider:
Registration Number: August 20
2008 Residential Compliance Forms