12070203 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10588 WHITE FIR CT CONTRACTOR:' -` PERMITNO: 12070203
OWNER'SNAME: WILSON GUY C'I'RUS'I'EE TpM Fyt.•r-kl; 1� � l.a>� DATE ISSUED:07/2 /2012
OWNER'S PHONE,: 487282390 I'IIONF NO:
❑ LICENSED CON'I'RACI'OR'S 1I1^1iCLARAAT�ION BUILDING PERMIT INFO: BLDG 17 ELECT r PLUMB r.__
License Class . ILie./qG /'7' � / 6 O EL
Glht1�L/X. 2 6 �� MECH r RESIDENTIAL r COMMERCIAL
F,RCL\L r
Contractor ate
hereto aBirm that lain licensed oiler the provisions of Cha ptcr9 JOB DESCRIPTION: REMOVE AND REPLACE THE WA'T'ER HEATER AND
(commencing with Section 711011)of Division 3 of the Business S Professions FURNACE
Code and thin nslicense is in full force and effect.
1 here M'affirm wider penally of perjury tine of the following two declarations:
I have and will maintain a certificate of consent to self insarc 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.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of die work for which this Sq.Ft Floor Area: Valuation:$1400
permit is issued.
API'LIG\N'I'CER'I'I PIG\'PION APNNumber:35905126.00 OccupancyType:
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 ordinmmcs and state Ines relating
to building construction,and hereby anthorire representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City ol'Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additions ly,the applicant understands and will comply r
with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18. ' / P'
Issued by: T 7 Date: 'a6'I
Signatures �ac^L �
❑ CI\VNER-BIIILDER DECLARATION
RE-ROOFS:
1 hereby affirm that 1 run exnnpn from the Contractor's License Law fur one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or illy employees with wages as Ihcir sole conirensalimn, inspection.
will do the work,:rad the structure is not intended or ollered for sale(Sce.7044,
Business S Professions Code) Signature of Applicant: Dale:
I,as owner aRhe properly,am esclirsively contracting with licensed contractors to
construct lire project(Sce.7044,Business&Professions Code). ALI,ROOF COVERINGS TO BE CLASS"A"Olt BE I-PER
herchy affirm under penalty of perjurr one of the following three
declarations:
I have and will maintain a Certificate of Consent to self-insure I'or Worker's IIA-LARDOUS MA'T'ERIALS DISCLOSURE
Compensation,as provided for by Section 3700 oflhc Labor Code,for the I Iravc read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health S Safely Cade.Sections 25505,25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code.Chapter 9.12 and the Health S
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code.Section 25532(a)should I store or handle hnzardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the
not employ any person in any manner so as to became subject to the Worker's Health x Safety Code.Sections 25505,25533,and 25534.
Compensation Imes ofCalifar ia. If,after making this certificate of exemption.I
become subject the Worker's Compensation provisions the Labor Code,1 must �
forthwith complyy with such provisions or this permit shall bebe deemed revoked. ` 1)at ° �(O
APPLICANT CFRTI FIG\TION CONS'TRUCT'ION LENDING ACF;NCY
I cenifv that I have read this application and state that the above infomration is 1 hereby affirm that there is a construction lending agency for the performance of work's
correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property far inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCIII'I-F.CI-'S DECLARATION
9.18. I understand my plans shall be used as public records.
Signature Date Licensed Professional
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAlterations CF-IR-ALT-HVAC
Climate Zones 1 and 3-7
site Address: EnforC mAgency: Dme: Permit d:
Conditioned Duct insulation
Eoui went Tv r List Minimum EtScien ' Floor Area requirement I Thermostat
lPackaged Unit Over 40 ft of ducts
FuraIndoor ❑AFUE ®COP et„-,t t,,,system added or replaced in I Setback
Indoor Coil SEER HSPF_ Dl]"' (1/tnor alreadypresmq mrue 8e
CondermingUnit EER_ Resistance sf comditioned spas Imml/ed)
Other
R 6 (CZ 1.3-5)
1. Equipment Type:Choose the equipment being instilled;if more than one System,use another CF-1 R-ALT-HVAC for each system.
2.Minimum Equipment EfTiciencics: 13 SEER 78%AFUE,7.7HSPF for typical residential systems.
Contmetor(Documentation Autbor's/Responsible Desiguer's Declaration Statement)
• 1 certify that this Certificate of Compliance documentation is accurate and complete.
• 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.
• 1 certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of"fide 24,Parts I and 6 of the California Code of Regulations.
• The design leatures identified on this Certificate of Compliance are consistent with the information documented on other applicable
compliance Tomas,worksheets,calculations,plans and specifications submitted to the enforcement agency for approval with the permit
av licadon.
Name: ,�
Company: C.te /�if:�/ d ��.Ul7 'LlD %p�
Address: /Q6. f7D�`� ��1� I License: 7Z 764JS
Ciry/State/Lip: �i✓ (f— alaPhone: �/ Z
2008 Residential Compliance Forms.doc revised 04/10/12
LZv-Z �Z� 3
GENERAL PERMIT APPLICATION M E P
COMMUNITY DEIIELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE -CUPERTINO, CA 950143255
CUPERTINO (408)7771-32277-33338 • FAX(408)7 -3333 • Suildinc0cuoerdno.crcMISIC
I�
PLUMBING ��I////�PcCC'rLi,`1iC.i�Lc FLECIRiCAL L�Q/STTI 'C/vc./L'a.NEOUS
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PROIECTADDRESS D� �/i `Gs
OWNER NAME A/ JJ 16r1�a / PHONE Df/
STP=ADORE� G—�� v�� CITY,SATEE,ZIP Y `O FAX
COMACi PHONE I E-MAIL
STREET ADDRESS I�•�/(/�V =,STATE L"' I FAX
❑OwNEA ❑ OWNER-BtJB m ❑ OWNEi AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARNGMEuZ ❑ DEVELOPER ❑ TENANi
CONTRACTORNA.ME /!-„(J/l�j� LICENSE NUMBED` NSE jZ CEE I BUS.EC
Ne .NY AI
COANAME �O� E-ML I FAX
STREET ADDRESS ,sy/� /�CIiY.SIATEI;P, rl ,..- J/J� ` A/J I PHD CT7J CYL—
ARCIT.=zCTFNGIt=NAME' (M^ I LICENSE NUMBER BUS.tic 44,
COMPANY NAME' E-MAB. I FAX
STREET ADDRESS CITY,STATE,ZIP I PHONE
USE OF [ISM-DUPLEX ❑ MULTI-FAMB.Y PROJECTN WIIDLAND ❑ YES .PROJECT IN ❑YES IS iTB:BLDGAN ❑ YES
BUIL NG: ❑COMMERML UREAN NTERFACE AREA ❑ NO FLOOD ZONE ❑NO ELCR.ER HOME: ❑ NO
DESCRIPTION OF WORK
TOTAL VALUATION: / DG I RECEIVED BY:
By my signature below.I cert y to each of Lhe following: I am the property owner or andwrized agent to act an the property owner's behalf. I bave read this
application and the information I have provided is correct. 1 have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buildin consL-uction. I antho - C.
tatives of meri:c:c enter the:above+-/id �e3/mop ./:dor inspection pu jwses.
Signature of AppliCant/Agenn i Date:
SUPPLENMINT s.L.NFORM-kTiON REQUIRED OFFICE USE ONLY
v *OVER-THE-COUNTER
EXPRESS
' Y
V
❑ STANDARD
i V
< ❑ LARGE
❑ MAJOR
:LIE-PMuc3ppj011.dcc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
12 �,DRESS: 10588 White Fir Ct DATE: 07/26/2012 REVIEWED BY: Sean
: BP#: 'VALUATION: $1,400
*PERMIT TYPE: Building Permit PLAN CIiFCK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTADLYTION PRWHEATR
USE: PERMIT TYPE:
WORK Remove and replace the water heater and furnace.
SCOPE
Mech. Plan Check 0.0 hrs $0.00 Plumb. Plan Check 0.0 hrs $0.00 Elec.Putt Check
Mech. Permit Fee: IMPERMIT Plumb. Penni! Fee: IPPERMIT Elec. Permit ree:
Other Mech. Insp. 0.0 hrs $45.00 Other Plumb Insp. 0.0 hrs $45.00 Other Mee.Insp.
Mech Insp. Fee: Plumb. htcp.Fee: Cleo.Iny.fee:
NOTE: This estitnate does not include fees due to other Departments(i.e. Planning, Public Works, Fire,SanitarySewer District,School
District,etc.). These feev are based on the rrelinrivary in orvnation available and are only an estimate. Contact the Dept for adtbt'I info.
FEE ITEMS (Fee Resohnion 11-053 Ef 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Plumbing
Supp!. PC Fee: (F) Reg. 0 OT 0.0 hrs $0.00 $27.00 IPRIVIIEATR I Water Heater
PME Plan Check: $0.00 1 # Mechanical
Permit Fee: $0.00 $133.00 Id-IFR=<loo Furnace, Forced-Air
SUPPI. Insp. Fee-.0 Reg. 0 OT 0.0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $90.00
Conswuction Tax:
Administrative Fee: !ADMIN $42.00 0
Work Without Permit? 0 Yes (F) No $0.00 E)
Advanced Planning FCC: $0.00 Select a Non-Residential 0
Travel Documentation Fee: 1TRAVDOC $45.00 Building or Structure 0
A
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Blchg Sids Commission Pee: 1BCBSC $1.00
SUBTOTALS: $178.50 $160.00 TOTAL FEE: $338.50
Revised: 07/01/2012