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14040169CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10146 ALPINE DR CONTRACTOR: AVRAM MEYERS AND PERMIT NO: 14040169 GALE MEYERS OWNER'S NAME: AVRAM MEYERS AND GALE MEYERS 10146 ALPINE DR UNIT 1 DATE ISSUED: 04/24/2014 OWNER'S PHONE: 4155156644 CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL REPLACE & RELOCATE FURNACE TO ATTIC AREA, License Class Lic. # REPLACE (E) A/C UNIT, SAME LOCATION Contractor Date 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 Sq. Ft Floor Area: Valuation: $5000 performance of the work for which this permit is issued. 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: 32615105 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 PE 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 180 DAYS + 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 granting of this permit. Additionally, the applicant understands and will co ssued by: with all non -point source regulations per the Cupertino Municipal Code, ection 9 18. 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) 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, Secti s 5505, ,and 25 34. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: erm it is issued. ertify 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 -poi ource regul24ons per the Cupertino Municipal Code, Section Licensed Professional 9 18. Date t /! Signature A o GENERAL PERMIT APPLICATION ��► MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 - FAX (408) 777 -3333 - building(a1cuoertino.org MISC GUpERTINO MnTTr,mn - MPT.FrTRIrAI. nMISCELLANEOUS MEPMiscApp_2011.doc revised 06121111 PROTECT ADDRESS f `� ��,� /� �/ p�1 /� /i' APN # - f 'S OS OWNERNAME l` PHO /L —�(i'�� v Y—, E��l ..Q•< -E3 STREET ADDRESS /� CITY, STATE, ZIP. / /:� / i /jv FAX �- CONTACT NAME �L' PHONE (= E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX OWNER OWNER - BUILDER ❑ OWWNERAGENT ❑ CONTRACTOR ❑ CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHTTECT/ENGINEER NAME LICENSE NUMBER. BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX TI- FAMILY PROJECT IN WBALAND ❑ YES PROJECT IN ❑,, YESS IS THE BLDG AN ❑ YES BUILDING: ❑ COMMERCIAL URBAN INTERFACE AREA g?dl- FLOOD ZONE L`7'PO EICHLER HOME? 0-4< DESCRIPTION OF WORK i L 7 <f,�P l tt mow. Q_ o I Q o'er 1S TOTAL VALUATION: O 5' By my signature below, I certify to each of the following: I am the property own he owne ' ehalf. I have read this application and the information I have provide is correct. I h e ead the Descri i or an verify it' ate. h all applicable local ordinances and state laws relating to build' ns ruction. It s of Cupertino t e ab tifred prop rty for inspe i ses. 2 f Signature of Applicant/Agent: D SUPPLEMENTAL O REQUIRED Q ON RE =� OEFTCETTSEAI�bY ` _ " �-�� .� OVER;TH>•<COL3aTER .�`� �;"� mow � 110 OEM, WE IN STAND -aPR _�s: OWEN -10 IMF S - Y -J kW MEPMiscApp_2011.doc revised 06121111 CITY OF CUPERTINO FFF, ESTIMATOR — BUILDING DIVISION APPLIANCE / EQUIP TYPE 10146 alpine dr unit 1 QTY /FEE DATE: 04/24/2014 REVIEWED BY: melissa JimADDRESS: APN: 32615105 BP #: EVALUATION: 1$5,000 *PERMIT TYPE: Mechanical Permit 1 PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: PENTAMATION FURN /A PERMIT TYPE: WORK & relocate 1 [Ta!qge SCOPE $139 APPLIANCE / EQUIP TYPE FEE ID QTY /FEE QTY UNITS BP FEES A/C Units ( < =10K cfm) 1BREMAIR 1 # $70 Furnace, Forced -Air 1MFR = <100 slipl'-4, ?rate 1 `"'C 1 # $139 PME Unit Fee: $209.00 PME Permit Fee: $47.00 // Administrative Fee: 1ADMIN $44.00 Work Without Permit? ® Yes 0 No $0.00 TOTALS: A Travel Documentation Fee: ITRAVDOC $209.00 Strong Motion Fee: IBSEISMICR NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public works, tire, sanita/y sewer District, scnoo/ !'ontnrt tho nont for nddn'l info_ FEE ITEMS (Fee Resolution 11 -053 Eff. 7/1/131 FEE QTY /FEE MISC ITEMS Plan C.1ae'c l; 1 "'(!e: SZ1/: pl. PC Fce PME Plan Check: $0.00 I'er ^rnit l� {>c:: slipl'-4, ?rate 1 `"'C PME Unit Fee: $209.00 PME Permit Fee: $47.00 // Administrative Fee: 1ADMIN $44.00 Work Without Permit? ® Yes 0 No $0.00 rl C,/L`Cl,`ZC`c.'C/ �tt Plt3111'14,! I't'e:S`: A Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg- Stds Commission Fee: 1BCBSC 1 $1.00 y' g� BT®T _' $348.50 TOTAL FEE:: $0.00 $ 348.50 Revised: 04/01/2014 CUPERTINO O NER- BUILDER DISCLOSURE FORM COENiiJUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 85014 -3255 (408) 777 -3228 • FAX (408) 777 -3333. • buildlno(5-cuDeri1no.oro Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SIT ADDRESS AP i B? d 1 Lm 01'dNER NAfJE OWNER ADDRESS S�g� -167 DESCRIPTION OF WORK: - : L-It C 5- S %�C- OCGa�iL �tJYy(,Q1�,� G bG We are providing you with an Owner - Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner- Builder. VVe will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our ofricial address indicated. An agent of the owner cannot execute this notice unless You, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKIIOWLEDGiItENTAND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verry this information.) 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner- Builder, may be held liable and subject to serious inancial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner- Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. 9thLeconstruction I understand building permits are not required to be signed by proper y.owners unless they are responsible for and are not hiring a licensed Contractor to assume this responsibility. Gl' I understand as an "Owner- Builder" I am the responsible party of record on the permit. i understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit iled in his or her name instead of my own. . I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. . Lunderstand if i employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least dive hundred dollars ($500), including labor and materials, i may be considered an "employer" under state and federal law. 6. I understand if I am considered an "employer' under state and federal law, I must register with the state and rederal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." i also understand my failure to abide by these laws may subject m��e,to serious financial risk. ( t1 7. I understand under California Contractors' State License Law, an Owner - Builder who builds single - family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. G_ M 1. I understand as an Owner- Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. O ,,,rier�idlderrorna 2010.a:oc revised 01'/1-:'!10 E e,€ I understand I may o.btain.more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1 -800- 321 -CSLB (2752) or %1,1vw.cslb.ca.gov for more information about licensed contractors. 0. 1 am aware of and consent to an Owner - Builder building permit applied for in my name, and understand that I am 'the parry legally and financially responsible for proposed construction activity at the site address listed above. 6k,11 1. l agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Ovvner- Builders as well as employer. Q W. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of tha information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner- Builder and wish to hire Contractors, you urill be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, I orm notarization, or other verification acceptable to the ci` ay be required to be presented when the permit is issued to verify the property owner's siqnature. / I Property Owner's Signature: KZf_ � / r— / Date: - - --------------------------------------------------------------------------------- - - - - -- ---------------------------------------------------- (NOTE: The folloia ,,ing Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner - Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner - Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copyofthe property owner's D'river's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the propery owner's signature. Property Owner's Signature: Date: OY'7ierBuilde7"Fo77,i 2010.doc revised 04-114,110 CUPERTINO HVAC ALTERATIONS ENERGY COMPLIANCE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building acuoertino.oro WHEN IS A PERMIT REQUIRED A construction permit shall be obtained from the enforcement agency prior to the erection, construction, reconstruction, installation, relocation, or alteration of any mechanical system, except as permitted in Chapter 1, Section 112.2 of the 2010 California Mechanical Code. Projects requiring permits include, but are not limited to: • New HVAC installation • HVAC Changeout • Replacement of furnace, coil, FAU or condenser • Relocation of an existing HVAC unit • Adding or replacing more than 40ft ducting in unconditioned space BUSINESS AND PROFESSIONS CODE, SECTION 7110 Willful or deliberate disregard and violation of the building laws, including the California Building Code, and local permit requirements constitutes a cause for disciplinary action from the Contractors State License Board working in conjunction with the local building department. This action may consist of fines up to $5,000 per violation or suspension/revocation of a contractor's license. 2008 BUILDING ENERGY EFFICIENCY STANDARDS (Title 24, Part 6) REQUIREMENTS INCLUDE: 1. Heating equipment must have a minimum 78% AFUE (Exception: Wall & floor furnaces; room heaters). 2. Central air conditioners & heat pumps less than 65,000 Btu/hr must have a minimum 13 SEER. 3. Newly installed or replaced ducts must have a minimum insulation value of R -4.2. 4. A setback type thermostat (24 hr clock with four set points) is required for all alterations. 5. New or replacement ducts must meet the mandatory requirement of Section 150(m). • All joints and openings in the HVAC system must be sealed. • Only UL 181, UL 181A, or UL 181B approved tapes or mastic shall be used to seal duct openings. • Connections of metal ducts and the inner core of flex ducts shall. be mechanically fastened. Flex ducts must be connected using a metal sleeve /coupling. • Flex ducts that are suspended must be supported every 4 ft. max for horizontal runs with no more than 2" of sag between supports and 6 ft. max for vertical runs. 6. The CF- 6R- MECH -04 must be completed and signed by the installing contractor. The Inspector will collect this form and verify that the model numbers are the same as the installed equipment. 2008 Residential Compliance Forms.doc revised 04110112 A c0-6 R�SldeWW A CA Simplified Prescriptive Certificate of Compliance: 8 -hry I eiaqvfts. R-ALT Crh a Zones I aad 3 - 7 SY4! Address MWc- ph ceP�7 101YL, d C/ 14 e Conlitioned Duct insulation ent'rypel qr AFJE - COP 8 Sery system ov 8 f ddds added &f6pli . in Owoorca . . ��k TIT 0 —, k9spit— -If unconditioned spac;... - 'T'Ifor rT� preSM4 ml�v be Otondensing Unit 13 EER — E3 Fisistartce E3 R 6 (CZ JJ-S) - • 0 Other' ., 1. Equipment Type; Choose the equipment being installed, if more than one_*Vzn, use another CF-IR-ALT HVAC for each system 2. Afiahnum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems. Contractor(Docuinentatio4 Author's /Responsible Designer's DerIaration Stateixient) • I certify that this Certificate of Compliance documentation is accurate and comblete.: • 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 performancespHkifications for the design ide&ffied on this Certificate of Compliance conform to the requirements of Title 24, Parts I 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 agen for approval. .with the permit application. Name: Signature: I&,-- Company Address License: City/StatwZ ip- C a,) e, p. f Phone: 1¢/ S= j s.. I 2008 Residential Compliance Forms.doc revised 04110112 6- f cos y- .57 6-13-- 57C C � F wok ptc 0 cads a D./Y fr CUPERTINO /34 Building Department V REVIEWED FOR CODE COMPLIANCE Reviewed By L MFNT EPARTMENT -DING DiViSION - CUPERTINO ARF"FlOVED e. -.d specifications MUST be kept at the nml -truction. It is unlawful to make any ; iteratiorz on same, or to deviate L approval from the Building Official. is plan and specifications SHALL NOT F o or rova'ofthe violation r roval of the violation c or S 0 Law. ,sofa nance or State Law. F? ,I- If C S- C 7'0 At t A Zakol 7 /0 A/ 111.10G. DEPT. PLOT PLANS rV CHECKED BY tf C ANNING DEPT. 111.10G. DEPT. Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014 -3255 Telephone: 408 - 777 -3228 C U P E RT 1 N O Fax: 408 - 777 -3333 CONTRACTOR / SUBCONTRACTOR LIST. JOB ADDRESS: 1A / G ` l.A'l' PERMIT # ._ OWNER'S NAME: r// ,� �— OT.5 PHONE # ( '-V fo GENERAL CONTRACTOR: BUSINESS LICENSE'# ADDRESS: CITY /ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: s/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile /)49, tractor Signature Date