14050083 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11698 OLIVE SPRING CT CONTRACTOR:CALIFORNIA HEATING PERMIT NO: 14050083
&COOLING
OWNER'S NAME: KRISHNA GUPTA TRUSTEE 5143 BROOKFIELD CT DATE ISSUED:05/13/2014
OWNER'S PHONE: 9257560700 ANTIOCH,CA 94531 PHONE NO:(925)756-0700
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL ❑
�q �s t� REMOVE&REPLACE(E)FURNACE AND A/C UNITS,
License Class C,1-0Lic.# ( ��v ( / SAME
Contractor GA
Ui'pR.N (A 1 eA-riN-C Date 05/1 3 L LOCATIONS
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
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$7000
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:36654101 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 110 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 FROM 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 � '' Date 13'✓
granting of this permit. Additionally,the applicant understands and will comply Issued by: ;"
with all non-point source regulations per the Cupertino Municipal Code,Section i
9 18. Ll
12 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)
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 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,Sections 2yy5��505,25533/3,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Kl � 1 �1�G Z Date: O� �VIM
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
05/13/2014 08:37AM 9257558079 PAGE 02/03
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildinaftSUpertino.Om
CUPERTINO
❑NEW CONSTRUCTION ❑ ADDTI'ION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT t#
FRADDDRESS 11698 Olive Spring Ct. APN h 3 6 — •�
t.>E Krishna Gupta PHONE408-446-1270 F-MA
—T
DRESS 11698 011ve Spring CL QTX.STATE zIP Cupertlno CA 85014 k'
NAmE haul Oalvez PHS 400.446-1270 E MAn
DRESS 11698 Olive Spring W. crry STATE,zip Cupertino,CA 85014 FAX
D owNER-auEDER0 OwNMAGMT ® CONTRACTOR OCOMACTORAGeNT O ARCIt WT 0 ENOMER 1] DEMOPER O-WN-'NT
TORNAItE California Hsating and Cooling LICENssNLn•IDs R 890699 LICENSETxiz6 C20 NAME California Heating and Cooling E-MAIL
FAX
STREE717 ADDRESS 5143 Brookfield Ct. CrIY;STATE„ZTP Antioch,CA 94531 PHONE 825-x'56.0700
ARcHrrEcrm;GmFR,NANM LICENSE NUMEER aUS.LIC
COMPANY NA14 E-MAIL FAX
STKFzr ADDRESS CITY,STATE.ZIP PHONE
FEMSTINOUSS
ORK Furnace and NG Replacement Same Location
Furnace 80%AFU6 A1C 5 Tons 13 SEER
PROPOSED USE CONSTX TYPE MSTORM USE TYPE OCC. SQ_FT. VALUATION(S)
NEwFLOOKDEMO TOTAr
ARpA AREA NrTAREA
KITCHEN OTHER
REMODMAREA REMODELAREA•
PORCH AREA DECKAREA TOTALDECWPORCHAREA G.1RAOriAREA: CH
❑ATTACH
y Dw�t.LV4G UNM; ISA SECOND UNrf YES 5ETA
F.COND STORY YES
PYMGADDED? L)NO ADDITION? QN0
PRE APPLICATION ❑XE8 D?Y63.PROv�DE COPY OF 1S TM BLDG AN ❑YES o t S ,i� ,'. S I TOTAL VALUATION.
PL.ANNn4GAPPLW []NO PLANNING APPROVALI.ETTER LT4r+Le1tHOMIS! ONO R, 7 000.00
ACJ:•, rn
By> Y signatlud below,[certify t0 Bach of the folio I am the property owner o o' t to act on operty o half. 1 have reed this
application and the information I have is t I b ad the Descc' on of Work and v it is accura ee to complywit all applicable local
ordinances and state laws relating uil p. a representatives of Cupett uao to en a eve-identified potty for i Spection purposes.
Signature of ApplicandAge0 _ Date: �•
SUPPLEMENTAL 114FORMATION REQUIRED
New SFA or Multifamily dwellings:-:Apply for demolition permit for
IpCommercial
xisting building(s). Demolition permit is required prior to issuance ofbuilding
emait for new building.
._ Bldgs; Provide a completed Hazardous Materials Disclosure "i' S
form if any Hazardous Materials are being used as part of 9iis project. l �,
—Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
Bldg4ppp 2011.doc revised 06/2111
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 11698 OLIVE SPRING CT DATE: 05/13/2014 REVIEWED BY: MELISSA
APN: 366 54 101 BP#: *VALUATION: 1$7,000
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION FURN/AC
USE: PERMIT TYPE:
WORK REMOVE & REPLACE E FURNACE AND A/C UNITS, SAME LOCATIONS
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
A/C Units (<=10K cfm) 1BREMAIR 1 # $70
Furnace, Forced-Air 1MFR=<100 1 # $139
TOTALS: $209 00
> ,
Mech.Plan Check0.0 hrs $0.00 Plue b,Plivi C7mck c.i';"cr=:-t:'i, c:
Mech.Permit Fee: IMPERMIT I'?rtzr,,.F'e�,rti Fee ;>i£rc. l'er;ait F"c:
Other Mech.Insp. 0.0 hrs $47.00 t:)tr`1e?".17,•'rarh lyase. ter%as>r °:;r,:°,Irs�:. E3
tl£ch, fnsj!,Ft-e: '311tay,•13-11" 1.1.1ce: ElecC .l wjv. Fee:
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 prelimina information available and are onl an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution I1-053 E . 7/1113) FEE QTY/FEE MISC ITEMS
Man Check T ee:
SfeppL PC'Feu
PME Plan Check: $0.00
Permit 1:'e
PME Unit Fee: $209.00
PME Permit Fee: $47.00
Administrative Fee: IADMIN $44.00
Work Without Permit? 0 Yes 0 No $0.00
Travel Documentation Fee: 1TRAVDOC $47.00
Strong Motion Fee: 1BSEISMICR $0.70 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
� Y�'; $348.70 $0.00 .. TOTAL"FEE•' $348.70
Revised: 04/01/2014
05/13/2014 08:37AM 9257558079 PAGE 03/03
Simplified Prescriptive Certfflcate of Compliance:2008,Residential,F,[VACAlterations CF-IRALT-$VAC
Climate Zone 3
Site Address: Enforcemei(agency: Aate: Permit tk
11696 Olive Spring Ct.Cupertino,CA 95014 City of Cupertino 05/13/2014
Conditioned Duct insulation
E4 ui ment et ListivlinimumBffi,cienc F1oor,A.rea requirement Thermostat
Packaged Unit Over 40 ft of ducts
Furnace AFUE soy Cop Served by system added or replaced iu ®Setback
El Indoor Cott
" SI
is HSPF zsoy sf unconditioned space (Ifnor already present,must be
J CondensingUnit Resistance insrallea9
Q R 6 (CZ 1,3-3)
Other
I.Equipment Type:Choose the equipment being installed;if more than one system,use another CF-IR-ALT-IiVAC for each system.
2,Minimum]Equipment Efficiencies:13 S)EER,78%ARM,7.7HSPP for typical residential systems.
Contractor(Documentation Author's/Responsible Designer's Declaratiou Statement)
• I certify that this Certificate of Compliance documentation is accurate and complete.
• I am eligible under Division 3 of the Califom�ia Business and professions Code to accept respoa bility for the design identified on this
Certifteate 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 a fo t or ap oval with the permit
application.
Name:Raul Galvez Signature:
cornpany. a 05/13/2014
California Heating and Cooling
,Address`5143 Brookfield Ct. Lrcetase:890699
City/State/Zip:Antioch,CA 94531 Phone:925-756-0700
,ll
2008,Residential Compliance,Forms p.5 2010