12070217 CiTY OF CUPERTINO BUILDING PERMIT
RUILDING ADDRESS: 21537 ROSARIO AVE CON'T'RACTOR:HERITAGE PERMIT N0: 12070217
CONSTRUCTION AND
OWNERS NANI E: BI IATF IIASIT II AND SWATI I4710 COD,1,N DA'I'1; ISSUF`D:07272012
OWNER'S PHONE: 4086461429 SARATOGA.CA 95070 PlIONe,NO:(408)867-6881
❑ LICENSED CON'FRACI-OR'S DECLARA'HON BUILDING PERNIIT INFO: BLDG r r ELECT PLUMB r
nn
License Chiasms Lica tt.__� IS q_?— Mr 1' r r
ECIi RESIUEN' L\L COMMERCIAL
Contractor i LAOCT TRAM Dare L:),`
hereby affirm that 1 am licensed under the provisions of Chapter 9 .TOB DESCRIPTION:REMOVE AND REPLACE FURNACE AND DUCT'S,REMOVE
(commencing with Section 7000)of Division 3 of the Business S Professions AND
Code and that my license is in full force and effect. REPLACE WATER HEATER
I herebyfir
affirm under penalty of perjury one of the following two declarations:
I he and will maintain a cenificate 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.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for die pedoriance of die work for which this
pemiit is issued Sq.Ft Floor Area: Valmrlion:$5500
.\I'1'LICAN-f CER'I'I PIC,\TION
I certify that I have read this application and state that the above information is Al�N�Numbcr:35619026.00 Occupancy Type:
correct. I agree to comply with till city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned propeny for inspection purposes. (We)agree to save
indemnify and keep harmless Elie 6tyofCupertino against liabilities,judgments, PERMIT EXPIRES iF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of this pemiit. Additionally,the applicant undersumilsand will comply WiTHiN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source regulations per the Cupertino Municipal Code,Sectiai 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signature� Date a'� Issued by: Date:7-i77-7-1'.
❑ OWNER-BIHLDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law formic of RE-ROOFS;
the following two reasons: All roofs shall be inspected prior to any roofing material beiig installed.If a roof is
I,as owner of the property,or my employees with wages as their sole coniRnsation, installed without first obtaining an inspection,1 agree to remove all new materials for
will do the work,and the simcture is not intended or offered for sale(See.7044, inspection.
Business&Protbssions Code)
I,as owner oflhe property,am exclusively contracting with licensed contractors to Signature of Applicant: Date:
construct the project(Sec.7044,Business R Professions Code).
I hercbp affirm under penalty of perjuryeme of the following three ALL ROOF COVERINGS TO BP,CLASS"A"OR BE11171t
declarations:
I have and will maintain a Certificate of Consent to self insure for Worker's HAZARDOUS%IA1'ERIAI S DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance ofthe work for which this permit is issued I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided ter by California Itealth 3 Safely Code.Sections 25505,25533,and 25534. I will maintain
Section 3700 of the Labor Code,for the performance of die work for which this compliance with the Cupertino Municipal Code.Chapter 9.12 and the Itealth S
Safety Code Section 25532(a)should 1 store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of the work formbich this permit is issued I shall, contaminants as defined by the Rap Area Air Quality\lunagement District I will
not employ any person in any manner so as to became subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of Cal ifomia. If,after making this certificate of exemption,I Health J Safety Code,Sections 25505.25533.and 25534.
become subject to the Worker's Compensaion provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked fl``'ier or authorized ag /
Utile: 2�1� ( Z
AI'I'LIC.\\I'CEIfPIFIC.\'TION CONS'FRUCfION LENDING AGENCY
I certify that I have read this application and slate that the above information is
correct. I agree to comply with all city and county ordinances and state lays relating I hereby affirm that there is it construction lending agency for the performance of work's
to building conSVuclinn,and hereby authorize representatives of this city to enter far which this pemiit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
indeamify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Lender's Address
grinning of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. ,\RCI I I'I'FCI"S IIECI,.\RA'I'IUN
I understand my plans shall be used as public records.
Signature Dale
Licensed Professional
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAlterations CF-IR-ALT-ffvAC
Climate Zones I and 3-7
Sire Address En/or emanr Agency: Dare: Pernul q:
-2153 noS. �io �i �c.�ri,✓o 7'.a7i?�
Conditioned Duct insulation
E i ment Tv t List Minimum Efficiency: Floor Arca requirement 'Thermostat
Packaged UnitFurnOver 40 R of ducts
Indoor ❑e\FIIE= - COP Smed.by system added or replaced in ❑Setback
Indoor Coil ❑SEER HSPF s( uownditioncd spaw Plnor ahradvpr<unr.mutt b<
Condensing Unit ❑ EEK ❑Resistance irumlbdj -
❑Other ❑R 6 (CZ 1.3-S) I t,)
1. Equipment Type Chouse the equipment being installed;if more that one system,use another CF-IR-ACF-HVAC for each system.
2-Minimum Equipment Efficiencies: 13 SEEK 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
Certi fma:of Compliance. '
• I certify that the energy features and performance specifications for the desiym identified on this Certificate of Compliance conform to the
requirements of Title 24,Parts I and 6 of the California Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with the information documenmd on other applicable
compliance forms,worksheets,calculations,plans and specifications submitted to the enforcement agency for approval with the permit
—application. / ✓
Name: -u _ .� Signature:
Company: L f / Dam:
Q 1T l 10. _ r �iyrn'C `>>^- �S C(� �l?�t
Address: License: F�- C C, SiS`7L
Citylslwc/Lip: � zjC <� Cn n Phane' AoRl
2003 1?,sidentinl Cmnpliance Form.s.dac revised lU/1002
1 -7C�> Z1 -7
GENERAL PERMIT APPLICATION M E P
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95017-3255
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(408)7T/-3228 • FAX(408)77777-3333•buildinc(G�Guoer5no.orD
CUPERTINO I\s/'
SC
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OWNER NAME PHONEgo - / I E MAM P t0
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CONTACT NAMEI 1 PHONE E-MAIL
STR ETADDEESS I �i Gp I MY,STATE IIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ Ow AGENT CONTRA=R ❑00MR NRAGENT ❑ AROUT°Cr ❑ENGINEER ❑ DEVELnPER ❑ TENANT
CONTRACTOR NAM'. LICENSE NUMBER Cl c TYPE I BUS.GC 4
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COMPANY NAME E-MAli I FAX
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USE OF FDar DUPLEX ❑ MULST-FA Y PROI NWILDLWD ❑ YFS I PRO=N TN
❑ YES I UE BLDG AN [I YES
UIL:TTN
BG: WA CIAL URBAN -Ar AREA NO FLOOD ZONE NO EICHLEI HOMF. NO
DESCUMON OF WORK _
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TOTAL VALUATION: RECEIVED BY:
By my signature below,I certify m each of the following: I am the pmperty owner or authorized agent to act on the property owner's behalf. I have read this
application and the information.I have provided is conic: I have.read the Description of Work and ver fy it is a==m. I agree to comply wii all applicable local
ordinances and scams laws relating to building conn, tcdCal_�I authorize representatives of Cuperatc enmr LSe above-ideati5e3pmpe.—.y for inspection purposes.
Signamm ofApplian
ct(Ag= �, / q — Dam: Z
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SUPPLEMENTAL INFORVLATION REQUIRED OFFICE USE ONLY
y OVER-THE-COUNTER
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EXPRESS
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❑ LARCE
❑ MAJOR
,TEP.,Wuc4pp_2011.doc revised O6PI111