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14020012 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10505 MILLER AVE CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 14020012 CONDITIONING OWNER'S NAME: FIRST BAPTIST CHURCH 1712 STONE AVE DATE ISSUED:02/04/2014 OWNER'S PHONE: 4082527191 SAN JOSE,CA 95125 PHONE NO:(408)293-4717 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION. RESIDENTIAL❑ COMMERCIALEI � License Class L 2 Lic.# REMOVE AND REPLACE FURNACE AND A/C Contractor t\ Z—V rNl�C2_Date Z �f 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:$9875 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:36916026.00 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 AYS OF P + T 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 1801 FRO ST CALLED INSPE TION. 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 b granting of this permit. Additionally,the applicant understands and will comply Y Date: with all nonjw4aUource regulation per the Cupertino Municipal Code,Section 91 Z 7 RE-ROOFS: Signature Date U 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 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 com th the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health afety Code,Sect] s 255 3,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner ora horized agent: Date:Z 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 Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY 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 GEN':ERAL PERMIT APPLICATION MEP COMMQNITY DEVELOPMENT DEPARTMENT I �#UILDING DIVISION„ �1/ +: 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 n (aos)777-3225 , FAX(408)777.3333 build!nGC-cupeftin0-0-C p�i MISC - CUI15RYrf4o S NICAL ELECMCA.L MISCELLA OUS PROJECT ADDRESS I�'�^ f�I`i�J� n APN sOWNERNA3vMf �1 ,1J'T�'1 Sj- �ttAPH m 2--��q ,j�' `�.� FAX STREET ADDRESS �f�rx UAL -� C � � CONTACT NAME PHONE B-MAIL CrrY,STATE, ZIP FAX S•T1tEF1•ADDRESS a- • 0 OWNER Q OWNBR•OUILOER C3 OWN AGENT �i�CONTRACrOR 0 CONTRACTOR AGENT ARCHrrECT ❑ENGtMEER OevELOPER 7'Ei+Alrr LICENSE NUNOER LICENSE E BUS.LIC I j) CONTRACTOR NAME �.I,.a_ �4h� Lj COMPANYNA)a E-MAIL FAX MEET ADDRESS X712 CIfte 'A57 AX'C, top, �� '�•2c1�-�4'I1'I BUS.LIC AR0411ECr/ENOMMIR NMM LICENSE Man FAX COMPANY NAME E MAI Srp=ADDRESS CITY,STATE,ZIP PHONE PROJECT PI USE OF Q $FD Or Duplex Q Multi-Faznily. PROJECT W WQ DLAND Yes �o FLOOD ZONE Q Yes Q HO STRUCTURE: orDmercial URBAN arIERFACE AJtEA Q DESCRDMONof Won gA5AtW TOTAL VALUATIOT`t: 13y my signaZ below,I eetfify to each of the following: I am the property owner or authorized agent to act on; property owner's behalf, 1 have read this application and the information I have ildin ided is correct. -1 hai�e read the Description of Work and verify it is accurate gree to i acomply with all applicable local ordinances and state lawn relating t uconstrue' I authorize representatives of Cupertino to enter rhe abov ,dfed property for inspection purposes- Signature ofApplicandAgent Date; f 71 i. SLTPPL IENTAL INFORMATION REQUIRED P df F ueApp_101 Ldoc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION JTADDRESS: 10505 miller ave DATE: REVIEWED BY:k[ PN: BP#: EVALUATION: 1$9,875 YPERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial BuildingPENTAMATION FURN/AC USE: PERMIT TYPE: WORK remove and replace furnace and a/c SCOPE . MEF Mech.Plan Check 0.0 hrs $0.00 Phi nb,I'icrr,C"hc;cA L cru. Plan(,`h=:rif Mech.Permit Fee: 1MPERMIT Plwnh.Po-mil 1°"ee Other Mech.Insp. 0.0 �hrs $47.00 011,wr Nlim�h Trf s,> C�rrr r tFie�. '•`y NOTE This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These fees 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�711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.001� # Mechanical Suppl.PC Fee: Q) Reg. 0 OT 0.0 hr's $0.00 $139.00 1MFR=<100 I Furnace,Forced-Air PME Plan Check: $0.00 1 # Mechanical Permit Fee: $0.00 $139.00IBCAIRHA A/C Units(<=1 OK cfm) Suppl. Insp.Feet Reg. 0 OT Q,Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 Administrative Fee: IADMIN $44.00 0 Work Without Permit? ® Yes (E) No $0.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential E) Travel Documentation Fee: 1TRAVDOC $47.00 Building or Structure , Strong Motion Fee: 1BSEISMIC0. $2.07 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 OR331, � L $141.07 $278.00 TOTAL FEE $419.07 _ - . Revised: 01/15/2014 INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning 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 Number 2 systems value a etc.) R-value (Btu/1.) Btu/1. Cooling Equipment Efficiency Duct Equip (SEER Location Type and EER) (attic, (package #of 1,3 crawl- Cooling Cooling heat CEC Certified Mfr.Name ARI Reference Identical (ZCF-1R space, Duct Load Capacity PUMP and Model Number Number 2 Systems value)' etc.) R-value (Btu/hr) (Btu/hr 1.If project is nein construction, see Footnotes to Standards Table 151-B and Table 1 SI-C for duct ceiling alternative compliance. 2.ARI Reference Number can be found by entering the equipment model number at http:/Avwiv.aridirectory.org/arilac.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-IR, CF-IR-AA or CF-IR-ALT ALL BOXES MIDST 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§112(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