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12050066 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 6375 MYRTLEWOOD DR CONTRACTOR:CONDITIONED AIR PERMIT NO: 12050066 OWNER'S NAME: SA13ADO ANTONIO A AND ELIZABETH 1701 LITTLE ORCHARD ST DATE ISSUED:05/07/2012 OWNER'S PHONE: 4082524683 SAN JOSE,CA 95125 PHONE NO:(408)291-2220 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL CONINIF.RCIAL LJ LiccnscClas/n C-Zee I 14 p L c-� /(�- REPLACE A/C IN SAME LOCATION Contractor ( QN hY IUvte Cv It:� Datc O1 z- I hereby affirm that 1 am licensed under the provisions f 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 whichthis permit is issued. Sq.Ft Floor Area: Valuation:$2400 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:36917003.00 Oeeupanev'I}'pe: permit is issued APPLICANT CERTIFICATION I certily that I have read this application and slate 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 OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mcuioned propcny for inspection purposes. (We)agree to save 180 DAYS M LAST CALLED INSPE ION. indcmni fy and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the granting of this pcmmit. Additionally,the applicant understands and will comply Issued by: L• Date: with all non-point source regal flans' er the Cu crone M icipal Code,Section i 9.18- S/ RF.-ROOFS: Signature DatAll 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-BIIILDF.R DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following Iwo 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 Elie property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE: construct the project(Sce.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 1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Cade,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 ofConscntto self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Scction 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District 1 performance of the work for which(his 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.Sectio/ns 255!05,2553 ,and 25534. Section 3700 of the Labor Code,for die performance of the work for which this Owner or authorized agent ` Date:�r 7 z�� permit is issued - I certify tied in the performance of die work for which this permit is issued,l shall not employ any person man),manner so as to become subject to the Worker's Compensation Imes of California- If,after making this certificate of exemption,1 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. w'ork's for which this permit is issued(Sec.3097.Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I cenify 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 propcny for inspection purposes.(We)agree to save indemnity and keep harmless the City of Cupertino against liabilities,judgments, ARC.111'I'E:CT'S DF:f.LARATION costs,and expenses which nmay 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 Simplified Prescriptive Certificaie of Compliance:2008 Residential HVA C Alterations CF-IR-ALT-HVAC • Climate Zones I and 3-7 Sired*fsr^ Enforcement Agency: Date: Permit q: / - Conditioned Duct insulation f1padoor ment T L List Minimum ERcienc r Floor Area requirement Thermostat kaged Unit Over 40 R of ducts ace FUE eCOP Setback $efve _Zysystem added or replaced in Coil SEER HSPF_ (Ifni alreod),present,mass be densing Unit [3 EER 0 Resistance sf unconditioned spaer /. 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,7.71HISPF for typical residential systems. Contractor(Documentation Author's/Responsible Designer'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. • 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,Pails 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 enforce nt agency for approval with the permit apttkation. Name:r Signature: Company: ,r Date: Address: " t 1 f1 Licctsqlj { City/State/Zip: U Phone: J 1 b 2008 Residential Compliance Forms March 2010 CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: SylviaM COPY # : 1 Sec : Twp: Rng: Sub: Blk: Lot: APN 36917003 .00 DATE ISSUED. . . . . . . : 05/07/2012 RECEIPT #. . . . . . . . . : BS000016731 REFERENCE ID # . . . 12050066 SITE ADDRESS . . . . . : 6375 MYRTLEWOOD DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : SABADO ANTONIO A AND ELIZABETH ADDRESS . . . . . . . . . . : 6375 MYRTLEWOOD DR CITY/STATE/ZIP . . . : CUPERTINO, CA, 95014 RECEIVED FROM . . . . : CONDITIONED AIR CONTRACTOR . . . . . . . : RICHARD READ LIC # 22334 COMPANY . . . . . . . . . . : CONDITIONED AIR ADDRESS . . . . . . . . . . : 1701 LITTLE ORCHARD ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95125 TELEPHONE . . . . . . . . : (408) 291-2220 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 2,400.00 1. 00 0 .00 1 .00 0 .00 1BSEISMICR VALUATION 2,400 .00 0.50 0. 00 0.50 0. 00 1MFR=<100 UNITS 1 .00 130. 00 0. 00 130 .00 0. 00 1MPERMITFE FLAT RATE 1.00 44 . 00 0 .00 44 .00 0.00 1TRAVDOC FLAT RATE 1.00 44 .00 0 . 00. 44 . 00 0 . 0.0 ---------- ---------- ---------- ---------- TOTAL PERMIT 219.50 0. 00 219 .50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 219.50 visa --------------- TOTAL RECEIPT 219.50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 I ■V_ (408)777-3228• FAX(408)777-3333•buildina(Bcuoett marO CUPERTINO I;�� ❑PLUIv^®ING _ CHAMCAL ft ❑EXCTRICAL ❑MISCIM ANEOUS FROIECTADDRESS /Z / V�� P, 1--? W3- OWNERNAME ` PHO 1,.�`L V� E-MAIL STREETADDRESS CrIY.STATE.ZIP ' FAX CONTACT NAME PHONE E-MAD. STREETADDRFSS CLTY,STATE ZIP FAX ❑OWNER ❑ OWNFA-BrELDER ❑ OWNERAGENT ❑.WNTRAcroR ❑CONTRACTORAOENT ❑ ARCHrmcr ❑E ounn]t ❑ OEVELOFER ❑TENANT CONTRACTORNAME(.,) ll SE]](PE„ Bus.IIC0 C. L(% COMPANY NAME F.MAIL FAX STREETADDRESS �. ZIP PHONE ti ARCEEITECUE GINSE t NAME LICENSE NUMBER BUs.LIC 0 COMEANY NAME' E-MAIL FAX STREEr ADDRESS CITY,STATE.ZIP PHONE USE OF ❑sFo.DUPLE( ❑ MULTFFAMB.Y PROJECT IN WO.OIAMI ❑ YTS PROIERIN [3 YES EICHLEIS TIM HORN ❑YES BUDJJING: 13 W URBAN INTERFACE AREA 11 NO FCOOD ZONE ❑NO Dl7lI1•It HOMO \❑NO DESCRI TION OF WORK TOTAL VALUATION: RECEIVED BY: By my signature beril-z", certify to each a fallowing:� I am the property owner¢r authorized agent m act on the property owner's behalf I have read thus applicacon and theatlo¢I have pmvi is correct have read the Descriptio¢of Work a:d'ie:ify it is actuate• I agree m co . 1-1 with all applicable local ordinances ands buildiag c stm on. I Drize represrntatives of Cupertino to corer the above-idrnti5e prop far inspecdo¢pu(pasa. Sig¢anae of Applicant/Ag=tr Dom' SUPPLEMENTAL INFORMA ON REQ OFFICE USE ONLY W ❑ OVER-TBE-COUNTER y� F ❑ EXPRESS Y Y ❑ STANDARD u S ❑ LARGE d ❑ MAJOR hff'PAfwcApp_101 Ldoc revised 06121111