14060203 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1202 BELKNAP CT CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 14060203
CONDITIONING
OWNER'S NAME: FROLICH GORDON W AND JANET S 1712 STONE AVE DATE ISSUED:06l30/2014
OWNER'S PHONE: 4085789519 SAN JOSE,CA 95125 PHONE NO:(408)293-4717
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL � COMMERCIAL �
1� _ „ ����� � REPLACE(E)FURNACE,SAME LOCATION
License Class� Lic.#
Contractor �,��Vh�llf��-- Date b��Q �C��
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 ceRificate 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:$2950
�` 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:36210028.00 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--�A'Y 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 A�S FRO AS CALLED INSP�CTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the '3�
granting of this permit. Additionally,the applicant understands and will co � ss Date:
with all non-poi t source regulations per the Cupertino Municipal Code,Section
9 18.
a� RE-ROOFS:
Signature Date��C� 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. 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 ns 25505,2 33,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: ^�� Date: v ^3��
permit is issued.
I certify[hat 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 ceRificate 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 �CHITECT'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
. _ GEE�IEF2f�L PEF�l�[T AFPL[CAT[C3[�1 � �
'''�` COMMUNITY DEVELOPMENT DEPARTt�iENT•BUILDWG DIVISION ((�O�
10300 TORRE AVEhUE•CUPERTINO,CA 95014-3255 b�l1
, ___ _ (408) 777-3228•FAX(408)777-3333•buiidina aC�.cuner�ino.ora � �
eUP�Ft`t`CE+IO �
❑PLUrBII�tG MECHATiICAL ❑ELECTRICAL ❑MISCELLAI�'EOUS
PROJECf ADDRESS ��V�/ lJ�i� r'`'�� —""v� I APN� ��A Z � r O i �2�
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CONTP.AGTOR NAN,ET�A ,"`/`��.� LiCEhSE NUMBER��L[ �C_ 1 L1 j BUS.LIC n (�v J`J
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COMP1ilQYN.ANaE A�IJ�IA, ��t1.A�L•V E'TvIAII' F '�L�. ��✓�
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STREET ADDRESS��i� liew n/� fM_.Q. � . � TA CO. V j' 1��� I p `�������
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ARCHIl�.CT/ENGINEERIiA1viE . � : LICEI�SE N[R�BER. I BUS.LIC R .
COMPANY NAl✓.E . ' • E'1,�fA,II, FAX
STREEf ADDRESS CITY,STATE,ZIP � PHOA'E
USE OF or DUPLEX ❑ MULTi-FAMII Y PROSECf IN WII.DLAIID ❑ YES PRO7EC'I II3 ❑YES TS THE BLDG AT� 0 1'ES
BLIILDING � �CONJ�RCIAL ' URBAN ATERFACE AREA O I FI.00D ZONE ,�'AO EICHLER HOIJlE7 ��O �
DESCRIPTION OF W'ORK �C fj. S ,n (� �D C���v
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TOTAL VALUAT'IOI�: �E � � � �� -
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By my signature below,I certify to each of the follovrin�: I 2m the properiy o��,mer or authorized agent to a n rty o��,mer's behalf. I have read this
application and the information I ha pro ided is cocrect h ve read the Description of Work and veri'ry it is accurate. I aeree to comply v,�ith al]zpplicable local
ordinances and state Iz��,�s relatin�` buildi consL ucti . or' �representatives of Cupertino to enter the a ove-i ntifie p;operty for inspection purposes.
5 i�ature of Applicant'Agent: Date:
��- -�.-�-�--
SUPP MEI�TTAL lI�TFORA�Ir^.TION REQUII2ED ���=oF�icEvs��,�.��,�-
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• . � �PMisctlpp_2011.doc�•evised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 1202 BELKNAP CT DATE: 06/30/2014 REVIEWED BY: MELISSA
APN: 362 10 028 BP#: �VALUATION: $2,950
YPERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Du lex PENTAMATION FURN/AC
USE: p PERMIT TYPE: �
WORK REPLACE E FURNACE SAME LOCATION
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced-Air 1MFR=<100 1 # $139
TOTALS: $139.00 ';
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- ���_ f.i� . �������c���� ��.�', .
;.�R�
Mech.Plan Check 0.0 hrs $0.00 1'lrro,rC�.I'Irrr�t:'iir.�c�n' 1:�lrc'.f�'iEx-'�C:`la='<.'k
MeCh.Permlt Fee: IMPERMIT �'lum7�. ?'t -rnft l�'R<��: 7 re�s�� 7'�<r �:,f'£�<>�
Other MeCh.Insp. 0.0 hrs $47.00 C)�ize;1':`u�r:1>Irr,sj�. C1tri�>i°c1��r.�-.'F�s�:�.
i.t�'rrz !i?s7%, f c>c.. P12±)ttU. 13ir�).�c.e" 1 `E'C�. If) �..�..'s,�:,.
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These ees are based on the reli»tina in ormation available and are onl an estimat� Contact the De t or addn'1 in o.
FEE ITEMS (Fee Resolution 11-053 E f 7/1/13Z FEE QTY/FEE MISC ITEMS
i'l:��r �:'.,��c:?: ;f'.,�
`>,`.if'i'1(, d'.`� z'`�;'�
PME Plan Check: $0.00
,_
J3t:"JI'ilf t`x'�?.
,°i1f�T��'r1. ti7;s1?�'�e�'
PME Unit Fee: $139.00
PME Permit Fee: $47.00
�.(11t,S't7`LiCli,'1f7�t7'i: �
Administrative Fee: IADMIN $44.00 �
Work Without Permit? � Yes � No $0.00
�'�E�i'��i2�a,C�:x�l�.i?)F?Y�r�`t'E'b`: �
Travel Documentation Fee: 1TRAVDOC $47.00 �
Stran�Motion Fee: �BSEIs�t�tlCn $0.50 Select an Administrative Item
Br�� Stds Commission.Fee: 1BCBSC $1.00
�������,��'�" � �� �i i � $278.50 $0.00 TOTAL FEE: $278.50
� {������.� ��F��� ,�=�A��.,
Revised: 04/01/2014
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:;i,}c;;.: . Z�08 Residential Complianee Farms.doc revised 04/10/12
��u(�a S�-t 1 rv c.,
� C�-1R-AZT
Pa e4of5
Prescri tive Certifcate of-C. rn liance: ResidenCial #ofStories
. __ __ ' �')imace Zone# • ,
33eSidentiat Alterations
Project�ame: �ZV� �I,!' '��Y � + ' ��
�
� . '• Configuration
HVACSYST+�I1yIS-HEATIIVG pu:Cr°�'.Pip"�g Thermoscac (Central,Split,
Nlinimum � Insula�ion
�ffieiency Distributio� R.Value T e S ace,Packa e or H dronic)
Heacing�quipment � `FVE or HSPF T e and�.ocotion�
i.i,�
T e�nd Ca•.aci ,
�� �� - .
r acka e C, or excepr where elecn•ic hearing is sUpplemema!('jeeCc�o(on�RPa�'�'
!.lrrdrea�e Nenirng Type(Cenrra(Furnace, .Wal�Furnace, N�ai pumP. Boiler. Elecrric Resisr�nce, e�c.J b
?:Elecrric resrs�ance heatt7ig is allowed only rn Componen �
he CF•1 R•�I LT Form for acldi�+onQ�reyuiremenls and check applicable boxes.
�• , � ?KW or 7,000 Biu/hr eLecrric>Mearing is cvn���vlled by a rime-Pimiring device no�ezceedtng 30 minures). See 3151
j..ReJ'er ro rhe HERS Verrficati�n seciion on Pnge 4 oj�
• 4. Indicnie Type or Loca�ion (Dzrcrs. Hydronic rn Floor, Rad�arors,ercJ
HVAC SYSTElVIS -COOLIN��nimum Configuration
�fficiency Duct or Piping Thermostat (Central,Split,
Dis�ribution lnsulation T e g ace,Packa e or H dronic
Cooling Equipment (SEER/�ER or R•Value
' COP) T e and Location�
T e and Ca acit �"
!. lndicnre Cvoling Ti�pe(i1/C. Hear pirmp,'Evap: Cooling,ercl
?. ReJer to rhe NERS Verification sec�ron on Page 4 of�nR��i(�Rs,�ere,��rm Ja•Addirional requiremenls and check app(icabte boxes.
�, lndicaie T e or Locanon (Ducts; H dronic in Flo ,
WA'TET�Fi�ATING
' n rom!he DHW heaie�ro �he ki�chen(sJ artd o�al�underground
nd boile��s or bo�h�dome,s.�ic hor rvarer(DNW)hearers a(d�hydronre space hearing. /ndivrdual ative(fing DNW hearers musr b�
Lisr wa�er heUrers a f A��ons. Noi warer pipe insula f
gns or.p'ropnne Jired, and may no�exceeci SO g Extemal Tank
�vr:}vaier,:.i es is re urred in al!com.pnenr acka es in all climaie zones. Ener Factor ot lnsulation
Number(n Tank � R_Val�e}
Water Heater Type/Fuel Distribution Type S stem Ca aci ( aq Thermal Efficienc
T �� (Standard, ftecirculatin )'"
!. fndicare Tvp'e(Srorage Ga,s, Hear Pump, lnslaiTi�neous, e�c•)
R !SO(nJ. The Preseriprive requi�eme�s�
?.Recirculattng svstems s n o�na recir u!!a�grw'Q er heQr ngrsys em Jor srngle dweUing uni�sments of§
nor allow�he ins�allatro f
` �. The ex(ernal waler h�at�n �ank.and r es shall be insulared io meer ihe re uirements o !50 � •
.�:--
n orcemenl agenev shoirld pav specra!a�ten�ion ro �he Special Fearures specified in this check(ur be�o�''•
S�E�IAI:, F�?►TU.RES The e f
These.ir�ms:m�rv re a�ire wrrtten 'usti icp►ion and documenrarion and s ecia!veri icano
. NEW.ROOF ASS'�1�'T�I�Y •R�adia'nt Barrier
` The radiant barrier[e yirem�nc of I S l( 2 doas not a�� �o roof alcerations.
Slab�dge(Perim'et�r) Insulation O YES 0 NO
1'�S,ln Climate�Zone 16 in Component Packa$es P,
R•7 insulation is required.
Heated Slnb [nsulofion C7 YES Q NO
YE$:Slab ed e insulation re uire.d.for a11.heated.slabs in aII Clima[e Zones. See details in Table 1 l8 A ofrh Usred�undet com oncnc P
Raised Slab Insu:lallon C7 1'ES � N� R;g insulation is.re:uired; in Climare.�dnes C3,& I 5,R-4.is
YES:in GfimA[�Zones l,2, � �, 13, .�Q& t6,
' ' Thermal N'Iass
To obtain Co� li.ance Credit.f.or[he installation af the. '�I mass;;u�e the;P�rforin�nce.A' :�oac .
HERS Provider: �u�t I
• Regisrraiion Dare/1'ime:
Regisira�ion Number:
2008 Residential Compliance Forms