13100098 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 814 S BLANEY AVE CONTRACTOR:ABC COOLING& PERMIT NO: 13100098
HEATING
OWNER'S NAME: KAWAGUCHI MARY P ET AL. 3266 INVESTMENT BLVD DATE ISSUED:10/16/2013
OWNER'S PHONE: 4084462717 HAYWARD,CA 94545 PHONE NO:(510)471-8181
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL U COMMERCIAL11
License Class L o�0n Lie.+#' -_-i�� 3$3 REPLACE(E)FURNACE,SAME LOCATION
Contractor
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
erformance of the work for which this permit 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 foi.which this APN Number:36927012.00 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 F ED 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 Q ��
granting of this permit. Additionally,the applicant understands and will comply a e:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
���-t3 RE-ROOFS:
Signature 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
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)
1,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 maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(x)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,Sectio 550`5,255533,/and 25534.,
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agentiy/ei G/d� ate:�d—f(�7
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 �$M E P
13 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION O�
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 \0
MISCCUPERTINO (408)777-3228•FAX(408)777-3333•building(a-)gupertino.org
PLUMBING
[j]MECHANICAL EIELEcrRicm, ❑MISCELLANEOUS
PROJECTADDRESS814 SOUTH BLANEY AVE APN#
OWNER NAME KAWAG U CH I, MARY PHONE 408 446 2717 E-MAIL
STREET ADDRESS 814 SOUTH B LAN EY CITY,STATE,ZIP C U P E RT I N O FAx
CONTACT NAME MAGGIE MENDOZA PHONE510471 8181 E-MAILMAGGIEM@ABCCOOLING.COM
STREETADDRESS3266 INVESTMENT BLVD CIrY,STATE,ZIP HAYWARD CA 94545 F'"`510 471 8368
❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT liil] CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME SCOTT LUN DAY LICENSE NUMBER 382383 LICENSE TYPE C20 BUS.LIC#
COMPANY NAME ABC COOLING & HEATING E-MALMAGGIEM@ABCCOOLING.COM PAx510 471 8368
STREETADDRESS3266 INVESTMENT BLVD CITY,STATE,ZIP HAYWARD CA 94545 PHONE 510 471 8181
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ MULTI-FAMB,Y PROJECT IN WHDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK
REPLACE FURNACE WITH 70BTU Sp->r+wC Loop-notJ
TOTAL VALUATION: QO
F
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 correct. 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 contra tion. I ut rizp representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent + Date:
SUPPLEMENTAL INFORMATION REQUIRED
I.
Y,.
MEPMiscApp 2011.doc revised 06121111
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-HVAC
Climate Zones 1,3-7
Site Address: Enforcement Agency: Date: 7p;(
rmit#:
814 SOUTH BLANEY AVE Cupertino, CA 95014 City of Cupertino Oct 14, 2013 0 43 053
Duct insulation Conditioned Floor
Equipment Type1 List Minimum Efficiency2 requirement Area Thermostat
❑Package Unit
H Furnace ®AFUE 80% ❑COP ®Setback
E3 Indoor Coil [3 SEER [3HSPF [3 R 6 2( 1, , 7) Served by system If not already present, must be
[3 Condensing Unit [3EER 13 Resistance [3 R 4.2(CZ 6, 7) 1584 sf installed)
❑Other
1.Equipment Type:Choose the equipment being installed;if more than one system,use another CF-IR-ALT-HVAC for each system.
2.Minimum Equipment Efficiencles:13 SEER, 7801.AFUE, 7.7HSPF for typical residential systems.
Contractor(Documentation Author's/Responsible Designer's Declaration Statement)
•I certify that this Certificate of Compliance documentation 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.
•I 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 1 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: Scott Lundy Signature: Scott Lundy
Company: ABC COOLING &HEATING SERVICES INC Date: Oct 14, 2013
Address: 3266 INVESTMENT BLVD License: 382383
City/State/Zip: HAYWARD/CA/94545 Phone: (510) 471-8181
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Reg: 213-AO07805OA-000000000-0000 Registration Date/Time: 2013/10/14 19:39:16 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms July 2010