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13090199 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10554 ORANGE TREE LN CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 13090199 CONDITIONING OWNER'S NAME: PRAGNA BIPINKUMAR 1712 STONE AVE DATE ISSUED:09/25/2013 OWNER'S PHONE: 4082197664 SAN JOSE,CA 95125 PHONE NO:(408)293-4717 ❑ LICENSED CONTRACTOR'S DECLARATION `r �60 12)s--+( ��( BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class �l 0 Lie.# �-A �} �J r NAIL � t6/1-3MECH r RESIDENTIAr—L COMMERCIAL� Contractor 1 Date I hereby affirm that I am licensed under.the provisions of Chapter 9 JOB DESCRIPTION:REMOVE AND REPLACE FURNACE AND A/C (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 Terformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$4423 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 permit is issued. APN Number:31634017.00 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Issued by:^� /V Date: �'�fj l 9.18. ignature ate 2� RE-ROOFS: ❑ OWNER-BUILDER DECLARATION 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 I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: 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 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 read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit 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. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&Safety 6de,Sections 25505,25533,and 25534. 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 Owner or.u ent Compensation laws of California. If,after making this certificate of exemption,I _ Date: ( G J become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) 1 certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,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 I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date GENERAL PERMIT`APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 MISC CUPERTINO (408)777-3228•FAX(40 (a� 8)777-3333•buildingcupertino.org []PLUMBING MECHANICAL LECTRICAL sss777 ❑MIS//SCELLANEOUS ,,,��/// PROJECT ADDRESS 1035 4 oro � , K C/ � /�� APN# 1 (to— � y ` ' / OWNERNAME �)' rv� Al� / 1 1 1 WP1 r -I E-MAIL r STREET ADDRESS 1 (J �V VII /^V V FAX CONTACT NAME "( PHONE " E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Y1/� q�i y O LICENSE NUMBER—jU(��`( 1 LICENS BUS.LIC# (� ;RC1 COMPANY NAME �v 4[�1 ` (AGV E-MAIL "11 STREET ADDRESS 1'/) C >n t� rM ►A�VI �/�.`{ .4-1 ARCHITECT/ENGINEER NAME v LICENSE NUMBER BUS.LIC#` Iv COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF .211'D or DUPLEX ❑ MULTI-FAMQ.Y PROJECT IN=AND ❑ YES 7R,0,1ECTIN ❑YES IS THE BLDG AN [3YES BUILDING: ElCOMMERCIAL URBAN INTERFACE AREA I-] NO ZONE ❑NO AEIICHLERHOME? ❑NO DESCRIPTION OF WORK AD Q TOTAL VALUATION: L3 , By my signature below,I certify to each of the following: 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 have provided is rrect. I 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 ilding con ction. I authorize representatives of Cupertino to enter the above ntifie -property for inspection purposes. Signature of Applicant/Agent: Date: J SUP MENTAL INFORMATION REQUIRED MEPMisr-App_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION VADDRESS: 10554 Orange Tree Lane DATE: 09/25/2013 REVIEWED BY: Sean BP#: a "'VALUATION: $4,423 *PERMechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: Lp PERMIT TYPE: WORK Remove and Replace Furnace and A/C. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $139 A/C Units (<=10K cfm) 1BREMAIR 1 # $70 TOTALS: $209 00 � - W" (y(�� alk � '& l 4 i,all Mech.Plan Check 0.0 hrs $0.00 Plumb. Plan Check Elec.Plan Check Mech.Permit Fee: IMPERMIT Plumb.I'trrmit Pee: 1i:Cc:c. Permit Fee: F01,her Mech.Insp. 0.0 ;-s $47.00 lJr{ter Plumb Insp. Other I lee.Insp, In.sp. I''eze. 177unab. Insp,Fee: Elec.Insp.f''cee: 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 pregUmina information available and are only an estimate- Contact the De t or addn'l info. FEE ITEMS(Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS Pl art Check Fee: SuppI. .PC:'Fee PME Plan Check: $0.00 Permit Fee: Suppl. Insp F'ee PME Unit Fee: $209.00 PME Permit Fee: $47.00 t:."onswuction Tax. Administrative Fee: IADAEN $44.00 Work Without Permit? 0 Yes (E) No $0.00 Advcanced Planning b'ces': Travel Documentation Fee: 1TRAVDOC $47.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 ' $348.50 $0.00 $348.50 Revised: 08/01/2013 s Simplified Prescriptive Certificate of Compliance:2OO Resufendal kVACAIieraitons CF-IR-ALT-IWAG C#uirata Zona 1 and 3-7 Address Enlorce»renf.4gerscy: _ 'ermit# 4 OY Tr(O VAV\U Conditioned Duct insolation _ aFP l e mostat, , eat T Iast'lua Packaged Unci .: CDP s j�i,. ' {)i+er 4tJ 8 rif duds` 13 Furnace ®AiJE � iSPI: Served_by-system aided areglacxd.inEI.S P+ Cod QSF sf uncondttionad cel.-. ot serg must be spa Condensing Unit ®EER !Rssistaaae ®R 6 (CZ 13 3) Other !.Equipment Type:Choose the equipment beiug'iustalled;if more than one_system,use another CF 1R-ALT HVAC.for each system. 2.Afinimum Equipment E#Sciwcies:13 SEER,78%AFiJE,7.7HSPF for typical residentialsystems. Contrsctor(Documentation Amthar's/Responsible Designer's Declaration Statement) • I certify that this Certificate of Compliance documentation is acauare and' 3etc • 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. • I certify that the energy featurm and performance specifications for the designidentified on this Certificate of Compliance conform to the rsxjoirements of Title 24,Parts I and 6 of the California Code of Regulations. • The desiga.feati res identified on oris Certificate'.of Compliance are consistent with the information documented on other applicable compliance forms,worksheets,calculations,plans and specifications submitted t enformppt agency for approval,with the pemut iicafioa. Name:\ IM V1dlo signaYruc: Company (veyA a Date 13 Ltceshse CfUcG11 Adam: Irl Vj� S - � City/state/Zip: Phone: (/' [ . ._.. �.b Nom. . .. .... a . . .... p. - ' '" 2008 Residential Compliance Forms.doc revised 04/10/12 INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Condi.tioning Systems,Ducts and Fans (Page 1 of 2 Site Address: Enforcement Agency: Permit Number: Space Conditioning Systems Heating Equipment Duct Efficiency Location Equip (AFUE, (attic, Type ARI #of etc.)1,3 crawl- Heating Heating (package- CEC Certified Mfr.Name Reference Identical (zCF-1R space, Duct Load Capacity heat um and Model Number Numbers Systems value a etc.) R-value Btu/hr Btu/hr Cooling Equipment Efficiency Duct Equip (SEER Location Type and EER) (attic, (package #of ''3 crawl- Cooling Cooling heat CEC Certified Mfr.Name ARI Reference Identical (>_CF-1R space, Duct Load Capacity um and Model Number Number 2 Systems value)4 etc. R-value (Btu/hr) (Btu/hr 1.If project is nein construction, see Footnotes to Standards Table 151-B and Table 151-C for duct ceiling alternative compliance. 2.ARI Reference Number can be found by entering the equipment model number at http://www.aridirectory.org/ari/ac.php# 3.Listed efficiency on this page must be greater than or equal(>_)to the value shown on the CF-1 R form. 4. When CF-IR is reference it is also applicable to the CF-1R,CF-IR-AA or CF-IR-ALT ALL BOXES MUST BE CHECKED TO BE A VALID FORM ❑ §110-§113:HVAC equipment is certified by the California Energy Commission. ❑ §150(h):Heating and/or cooling loads calculated in accordance with ASHRAE,SMACNA,or ACCA. ❑ §150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of§I12(c). ❑ §1500)2:Pipe insulation for cooling system refrigerant suction,chilled water and brine lines meets minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entirely in conditioned space. 2008 Residential Compliance Forms August 2009 � 0 � or� � � � L � PrAqtj AA (-MAC r rN