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13110086CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20776 HANFORD DR CONTRACTOR: AAA FURNACE & AIR PERMIT NO: 13110086 CONDITIONING OWNER'S NAME: PETER & TINA WANG 1712 STONE AVE DATE ISSUED: 11/13/2013 OWNER'S PHONE: 4082182183 SAN JOSE, CA 95125 PHONE NO: (408)2934717 E❑ LICENSED CONTRACTOR 'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL 1 : ZZ `� Lic. # �� T Ch License C/^ REMOVE AND REPLACE FURNACE n Contractor AAA eV f'^✓A< f Date I,I I hereby affirm that I am licensed under the provisions o Chapler 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. 1 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 Sq. Ft Floor Area: Valuation: $5800 performance of the work for which this permit is issued. 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: 32630066.00 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 IM 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 DAY R M LAST 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 Issued by: Date: granting of this permit. Additionally, the applicant understands and will comply ourc re ations per the Cupertino Municipal Code, Section Fithall / � � X* RE -ROOFS: Signature Date [ t 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. 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(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 compliant pertin M nicipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health &Safe ode, Sections 2 505, ,and 25534. Section 3700 of the Labor Code, for the performance of the work for which this � Owner or thorized agent: Date: � 3 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 Compensationprovisions 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 CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building aC-cupertino.org 11 MEP MISC PROJECT ADDRESS ((JW I APN # � t _ 614 / „ OWNER NAME V� �A!29 1 PHONE ..2AC0 ° v1C� EMAIL STREET ADDRESS2:51-1 nY/ `f�,a FAX CONTACT NAME C ►�r, u 1� YCi PHTM -2 2 E-MAIL 4-1 Ll STREETADDRESS n (2- S1plyz C CR 'qS12S F Zrs.� - ❑ OWNER ❑ OwNER-BUIL-DER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT El ARCHITECT 11 ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME^ V ,�O LICENSE NUMBER•jU[„(�%j LIC q E BUS. COMPANY NAME tL EAU, M� `1i L I F �7 %34 STREET ADDRESS qjAA C ySr 251R ARCHITECT/ENGINEER. LICENSE NUMBER BUS. LIC -# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑ YES IS THE BLDG AN ❑ YES BUILDING: ❑ COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO EICHLER HOME? ❑ NO DESCRIPTION OF WORK i i n rJ y I i TOTAL VALUATION: `mueW,W By my signature below, I certify tch of the following: I am the property owner or authorized agent to act on jllie�roperty owner's behalf. I have read this application and the information I ave rovided is orrect. I have read the Description of Work and verify it is acc ate. I agree to comply with all applicable local ordinances and state laws relatin to bu ding co t ction. I authorize representatives of Cupertino to enter the above-identifie property for inspection purposes. Signature of ApplicanUAgent: Dater i 13 INFORMATION MEPMiscApp_2011.doc revised 06/21/11 ,��,��, � � CITY OF CUPERTINO II!a" 1 1 1W F.CT><MATnR — RITTI DING DIVISION Mech. Plan Check 10.0 I hrs $0.001 Plumb. Plan Check I I I Elec. Plan Check Mech. Permit Fee: 1MPERMIT Plumb. Permit Fee: IElec. Permit Fee: Ll I Other Mech. Insp. 0.0 hrs $47.00 C)iher:Plumb Insp. Other Elec. Insp. 9le.,ch. Insp. Fete: Plumnb. hap. Fee: Elec. Insp. Fee: NOTE. This estimate does not include_jees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School .. t--- Contact the Dent for aaan'I Into. FEE ITEMS (Fee Resolution 11-053 E f 7/1/13) ADDRESS: 20776 hanford dr DATE: 11/13/2013 REVIEWED BY: Mendez APN: BP#: *VALUATION: 1$5,800 *PERMIT TYPE:. Building' Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or DuR lex hrs PENTAMATION FURN/AC USE: PERMIT TYPE: WORK remove and replace furnace Permit Fee: $0.00 SCOPE Mech. Plan Check 10.0 I hrs $0.001 Plumb. Plan Check I I I Elec. Plan Check Mech. Permit Fee: 1MPERMIT Plumb. Permit Fee: IElec. Permit Fee: Ll I Other Mech. Insp. 0.0 hrs $47.00 C)iher:Plumb Insp. Other Elec. Insp. 9le.,ch. Insp. Fete: Plumnb. hap. Fee: Elec. Insp. Fee: NOTE. This estimate does not include_jees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School .. t--- Contact the Dent for aaan'I Into. FEE ITEMS (Fee Resolution 11-053 E f 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 # Mechanical $139.00 1WR=<100 Furnace, Forced -Air Suppl. PC Fee: (E) Reg. ® OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -,0 Reg. Q OT'Fo7o hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 Construction Tax. Administrative Fee: IADMMIIN $44.00 E) Work Without Permit? ® Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion. Fee: IBSEISMICR $0.58 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 gAIF 4- $139.581 $139.00 $278.58 Revised: 10/01/2013 t,. S- nplifled Prescriptive Certificate of Compliance: 2008 Resislenf d HVACAlteratrons.' CF -1R-/ Chraste Zones 1 and 3 - 7 Me Address � � -11„ Vl'�l —J , W � I wl EnforceJnerrt Agettry: Dom` 'erinit.#. , ConMoned Duct insulation Equipmcnt T ' :nisi 1vaniiiaffeDJ .}oor,ni.-rmosrai .:.3 13 Packaged Ufut C. - " COP y r, Srsv� by'ri;Actn Aver 46:a of dudsi aiided orrtpiacxd :: Setback Twnac* door Cort PI! _ .iii Cady presort, mvx be Unit FFR Res>stx►ce sf cued tt ,.not u c onditt spaondensing ® R 6 (CZ 4 3-5) it Ocher 1. Equipment Type: Choose the equipment being installed, if mole than one _system, use another CF -JR -ALT -HVACfor each system. 2. Minimum Equipment E-Mciencim 13 SEER, 78%AFUE, 7.7i3SPF for typical residential:systems. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) • I certify that this Certificate of Compliance documentation is aecuaate 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 features and performance s'pbcifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts I and 6 of the California Code of Regulations. • The design.feahurs identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms, worksbeets, calculations, pians and specifications. submitted t th en t agency for approval,with the permit. application. Name: Sim Company: Date: Address: Lnceuse: Icily'slalelzip- Q . _ 1S Phone: 4-7 t� - "" 2008 Residential Compliance Forms.doc revised 04/10/12