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13020029 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1141 HOLLYHEAD LN CONTRACTOR:AIR AND PLUMBING PERMIT NO: 13020029 SYSTEMS OWNER'S NAME: PATRICIA CORNELY 285 SOBRANTE WAY STE P DATE ISSUED:02/07/2013 rrrOWNER'S PHONE: 5103777381 SUNNYVALE,CA 94086 PHONE NO:(408)733-2000 pt LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL (License Class C 2f� Lia q Z REPLACE(E)FURNACE,SAME LOCATION Contracmr �el'- Date 4Z �T I hereby affirm that 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:$2500 1 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:36226018.00 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 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,FST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, �1 costs,and expenses which may accrue against said City in consequence of the Issued 1�2Date: li granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signamre� Date �Z d7 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: 1 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) 1,as owner of the property,aexclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE m 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 25505,255339 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 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 25505 2y.?nd 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized a Date: ©L permit is issued. —"— 1 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certificate of exemption,1 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 1 certify that I have read this application and state that the above information is cored 1 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 otic GENERAL PERMIT APPLICATION o M E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 M ' SC CUPERT4N0 (408)777-3228• FAX(408)777-3333 (a • buildingcuoertino.org PLUMBINGee MECHANICAL ❑ELECTRICAL MISCELLANEOUS EC PROJTADDRESS' - // 0 APN. V Z Z'6 — D OWNER NAI.fE PH VO It E-MAIL STREETADDRESS /� / l CITY, STATE;ZIP LL a 0 FAX CONTACT NAME ✓( // , PHONE / 6 y/3 7!_ �G�VVVE YMA` l./,,nnn STREETADDRESS C ,IAn, CITY,STATE, ZIP C/ `( /j) /�� FAX 110 ❑ 00.NER-BUILDER ❑ OWNERK AGENT CONTRACTOR ❑CONTRACTORAGENT ❑ ARCJHTECT ❑ENGIKEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMEp�/� LICEN SENUMBER -Ji-/ LICENSE TYPE /� BUS.LLLI"nC,r# AME '72 COMPANY N �� �l �� -� E-MAIL ///��� STREET ADDRESS `J�� 1 (.J�i � p�al I CITY,STATE,ZIP f��Q ��� /'� ARCHITECTIENGAEERNAME J /t Ih LICENSENUAEER ( BUS.LIC`## C COMPANM Y NAE E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF SFDor DUPLEX ❑ Mt1LT1-FAFRLY PROJECTNWILDLAJ.RJ ❑ YTS PROJECTS ❑YES ISTHEBLDGAN ❑ YES BUILDNG: ❑COM.MERCIAL URBAN NTERFACE.4REA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK TOTAL VALUATION: O✓ c RECEIVED BY: 15S p( By my signature below,I certify to each of the following: I am the property owner or authorind agent to act on the property owner's behalf. I have 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 building constmction...l-iAtuiie reWrfentati.i of Cupertino to enter the above-identifie proype for inspection pulposes. Signature of ApplicanVAgent: K Date: SUPPLE AL INFORMATION REQUIRED OFFICE USE ONLY YER-THE-COUNTER ❑ EXPRESS 1 U U ❑ STANDARD U Z ❑ LARGE L ❑ MAJOR WEPATucApp_2011.doc revised 06/21111 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 1141 HOLLYHEAD LN DATE: 02/0712013 REVIEWED BY: MELISSA APN: 3E268 BP#: VALUATION: $2,500 *PERMIT TYPE: g Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY PENTAMATION FURN/AC USE: SFD or Duplex PERMIT TYPE: WORK REPLACE E FURNACE SAME LOCATION SCOPE Mech.Plan Check 0.0 hrs $0.00 Mech.PermitFee: IMPERMIT 14unri. Pi nni!N,c: l-a,x. P,,-mir lrcr Other Mech.Insp. 0.0 hrs $45.00 omc, l',ww;, b, ,­ 1, ,/1,eh. /rnp, l' c1-Ar: tilrr. Gzip. /4'a. NOTE:This estimate does not includejees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School District,etc). These fees are based on the prefiminary information available and are only an estimate. Contact the Dept for adda7 info. FEE ITEMS (Fee Resolution 11-053 E/7' 711/121 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 # Mechanical Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $133.00 IMFR=<)oo Furnace,Forced-Air PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-.0 Reg. O OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $45.00 C'orrsjrut non !ak. Administrative Fee: IADMIN $42.00 O Work Without Permit? O Yes (F) No $0.00 0 Advanced Planning Fee: $0.00 Select a Non-Residential 0 Building or Structure Travel Documentation Fee: ITRAVDOC $45.00 Strong Motion Fee: IBSEISMCR $0.50 Select an Administrative Item Blda Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $133.50 $133.001 TOTALFEE: $266.50 Revised: 01/01/2013 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAlterations CF-IR-ALT-HVAC Climate Zones 1 and 3-7 Site Address: /,// O •.i)Q�-.I Enforcement Agency: Date: Permit#: ll V Conditioned Duct insulation Equi ment Type' List Minimum Efficiency' Floor Area re uirement Thermostat Lj Packaged Unit Over 40 It of ducts Furnace AFUF. S COP Served b system added or replaced in ©Setback Indoor Coil SEER_ H HSPF j� pfnot dreadypreseni,mast be Condensing Unit ®EER ®Resistance L-�M sf unconditioned space installed) ®Other ®R 6 (CZ 1,3-5) 1.Equipment Type:Choose the equipment being installed;if more than one system,use another CF-I R-ALT-HVAC for each system. 2.Minimum Equipment Efficiencies: 13 SEER,78%AFUE,7.7HSPF for typical residential systems. Contractor(Documentation Author's/Responsible Designer's Declaration Statement) • I 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. • 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 enforcement.agency for approval withthe permit application. Signat Name: ure: _ Company: ___ . .Date: C)Z U T Address: Cv� �,7/y License: L!- City/State/Zip:O �7�J C �(��' Phone: -- 2008 Residential Compliance Farms March 2010