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14060113CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1105 MILKY WAY CONTRACTOR: AAA FURNACE & AIR PERMIT NO: 14060113 CONDITIONING OWNER'S NAME: VAN ZOEREN HAROLD R AND JANET 1712 STONE AVE DATE ISSUED: 06/17/2014 OWNER'S PHONE: 4084461701 SAN JOSE, CA 95125 PHONE NO: (408)293-4717 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL zZ 3 �O �Q r License Class Lic. # y 1 REMOVE AND REPLACE (E) FURNACE/ AND DUCTS �j /� Contractor /1 A A E N 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: $7536 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: 36219010 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 WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 AYS OF P IT 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 OM LAST CAELED INSPEC ION. 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: grantin rmit. Additionally, the applicant understands and will comply Issued by: i a I non -point urce reg at' s per the Cupertino Municipal C de, Section with 18. r.. l 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 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 compliance vdthAhe Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by e, Section 550 , 3 , nd 25534. the Health &=orized Section 3700 of the Labor Code, for the performance of the work for which this Owner or annt: Date: 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 918. Signature Date GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 VQ (408) 777-3228 - FAX (408) 777-3333 - building(d-)cuoertino.org �c LJ PLUMBING MfiCHANICAL LJ 15L1 4 I KIC AL LJ IVLLJI-Zj- K Lv V J PROJECT 7771 ADDRESS I I ,�Y �n j{� 1.. 1 A� I APN # 2j /) 2 � � O I� ^ �U OWNERNAME vAa Non STREET ADDRESS FAX CONTACT NAME ; PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER-BUWML ❑ O'%`NMAGEh'TCONTRACTOR ❑ CONrRACTORAGEN'T ❑ ARCHITECT ❑ ENCM,7EEet ❑ DEVELOPER ❑ TENANT CONTRACTORNAME LICENSE NUMBER j_t LI E BUS. LIC COMPANY NAME Pft VikY ' ^ n O A 1f lid/ E-MAIL STREET ADDRESS -1 t( Cm C114— M ARCHITECT/ENGINEERNAME LICENSE NUMBER I BUS.LIC# COMPANY NAME E-MAIL. FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF or DUPLEX ❑ MALTI-FAMILY PROJECT IN WMI)LAND ❑ YES PR07ECT IN ❑ YES BUILDING: ❑ COMMERCIAL URBAN INTERFACE AREA --Er2d0 I FLOOD ZONE it IS TIM BLDG AN ❑ YFS EICBL.ER HOIAF? DESCRIPTION OF WORK n S�ln a ce 6A �u TOTAL VALUATION: --6, 'w�F D' . - By my signature below, I certify to eac the following: am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I hav pro 'ded is correc . I ave read the Description of Work and verity it is accurate. I agree to comply with all applicable local ordinances and state laws relating to uildi c nsttuc ' uthor' representatives of Cupertino to enter thea ove-ide tifie props for inspection purposes. S i mature of Applicant/Agent: Date: 7 SUPPLtffiNTAL INFORMATION REQUIRED ll a. . vt - �� MEN �r - S MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO .:�... FF.F ESTIMATOR — 1111TILDING DIVISION ADDRESS: 1105 milky way DATE: 06/17/2014 REVIEWED BY: Mendez APN: BP#: `VALUATION: 1$7,536 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: Mechanical 1MFR=1100Furnace, Forced -Air PENTAMATION FURN/A PERMIT TYPE: l WORK remove and replace a furnace and ducts SCOPE $0.00 YME Mech. Plan Check 0.0 hrs $0.00 Plumb. ]'.!an (:-Ixxk %r`ec_ P,«y. Check Mech. Permit Fee: 1MPERMIT 1'Itdmb. Permit 1,ee, f;11 ( Perim;, Other Mech. Insp. 0.0 hrs $47.00 Clrtsr, Plumb Inst). lfrs,, Pinar=t7.�, hisZz Fee. I:icc. L� �,�. i�°��: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, tire, unitary Sewer District, School otn 1 Th— foot aro h—d nn tho nroliminan) infnrmadnn availahlo and aro inik an octimate_ Cnntaet the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 711/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 # $139.00 Mechanical 1MFR=1100Furnace, Forced -Air Suppl. PC Fee: (j) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. 0 OT 0,0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 C o' .s,rtiction TUX., Administrative Fee: ]ADMIN $44.00 0 E) Work Without Permit? ® Yes (F) No $0.00 Advanced Plannig Fee: $0.00 Select a Non -Residential Building or Structure E) i Travel Documentation Fee: ITRAVDOC $47.00 Strom Motion Fee: 1BSEISMICR $0.75 Select an Administrative Item Bldg Stds Commission .Fee: IBCBSC $1.00 M >_ $139.75 $139.00 TOTAL FEE: $278.75 Revised: 04/01/2014 ., ._ a ., •.✓ ..L �'� ,.. 'fr'b i r r s' -, , a :.i `. - —' t i�� q .r<' IR -ALT -AY rebetiptive Certifcste of ComPliaacs 2008 Resrrleitt iri JT'A�Alferatinns CF C ; k iand3-7 EnforconewAjency: S�te•Addreu n` V J U Coaffiigucd Duct to Mahon •• j Yi iiICa le �1IIiOStBt eIIt Ut 5 r g., Over 4tJ S of ducts S CCPerv� by. systea+ added orrcpi ced-.in ' b�utcral pre. CottISP S,. s unconditioned spar, u�rsr be densing Unit EER Itisistancx ®R 6 (CZ 1,'3 -SJ • ent 'being'- if more than one system. use another CF -I It -AI T-HitAC for each system ipnieIIt Type: Ciioase the egciipm 7,7HSEF for typical residerdal mIst$ms. 2. buDImurn 9quiptriynt) #bcieacies 13 SEBR 78% AFM Contractor {Iiocuraeatatioa Aathor s /Responsible Destds er`s Declarafiou Statement) • I =tify that this Cerdfitate of Compliance docuutentadon is acctuale and c6ihpicte and Professions Codr- to accept resp°nsibili?Y for.ihc design identified on rias I am eligible under Division 3 of the Califortria Business Certificate of Compliance. I ecctify that the energy feahues and perfoimanee speati'c4ons for the design identified on this CwUcate Of Compliance conform to the requirements of Titin 24, Parts I and 6 of the California Code of Regulations. • The design.fcatuvs identified on this Cerd f=at of Compliance are'eonsismat with theme iota . eat app voloth' alp a mt . compliance forms, worlcsbeets, calculation$, plans and speoifica#ons. submir4isd tion. Sim - Name: Date ' Company: Z. t1 License Address. , 2 j,�` v►�"/ t Ae. lAr-Im.,C Rhone: �i't`' 2008 Residential Compliance Fo"s.doc revised 04/10/12 Al