13010095CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19479 ROSEMARIE;PL CONTRACTOR: AAA FURNACE & AIR PERMIT NO: 13010095
CONDITIONING -
OWNER'S NAME: DAVID COHEN.
OWNER'S PHONE: 6508625545.
❑ LICENSED /CONTRACTOR'S DECLARATION
License Class .0-a6 cNie. q 76197671 p
Contractor /lHTq rviw9ce Date ^L —�J
1 hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 o 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:
1 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.
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
permit is issued.
APPLICANT, CERTIFICATION
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 buildingconstruction, and hereby authorize representatives of this city to enter
upon the above.mentioned propertyfor!inspection purposes. (We) agree to save
indemnify 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 permit., Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18. ('
�.__.._ C/,0,(.� : ;,n,. ( /6 7
❑ - OWNER-BUILDER.DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
concoct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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
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
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply withsuch provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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
indemnify 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 permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18...
1712 STONE AVE I DATE ISSUED: 011172013
SAN ]OSE, CA 95125 PHONE NO: (408)293-4717
JOB DESCRIPTION: RESIDENTIAL V COMMERCIALU
UNIT 4- REMOVE AND REPLACE FURNACE IN EXISTING
LOCATION
Sq. Ft Floor Area: I Valuation: $2460
APN Number: 37501007.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
W rTHIN 1" DAYS OF PERMIT ISSUANCE OR
180 DAYS/Fjt9M LAST CALLED INSPECTION.
Issued by: 7y'Y Date:/, /Z - L?
RE -ROOFS:
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. .
Signature of Applicant: Date
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(x) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Section 255051 25533 nd 25534.
Owner or authorized agent: C Date/�6 /3
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records. .
Licensed
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION r�V
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777.3333 • buildingCCD upertino.org V\
71 PLUMHTNG XVbfECHAMCAL
7 ELECTRICAL 7MI510ELLANEOUS
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❑ OWNER ❑ OWNER•SUILDERy. ❑ OWNERAGEM
CONTRACTOR ❑CONTXACIORAGENT ❑ ARC MCT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACramma A -1N11 yt'rAt/a �
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LTCENSENUMHER
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IJCENS TYPE
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COMPANY NAME
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ARCTDTECIENODVEERNANO!
LICENSE NUNMER
EUs. UCa
CONPANYNAW
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZTF
PNONE
USE OF SFD 0[ DUpICX ❑Multi-Fatnily
STRUCTURE: ❑ DOnrne[Clal
PROTECT W WLLDLAND
URBAN PfIIIWACEARTA C] Yes ❑ No
PROIER EI
FLOOD ZONE ❑ Yes ❑ No
DESCRIPTION OF woRX r'�' (�
O, nr✓1!�-ir Ta(yY.1C�
TOTAL VALUATION: 42ACO,
By my signature below, i certify o e of the fbllo 'ng: I am the property owner or authorized agent to not on the property owncr'a behalf. I have tend this
application and the informetfon have p Yided�i rrect.I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state lawn min I to build) g c ction, I authorize repmaentatives of Cupertino to enter the abo a-ide tiified property for inspection purposes.
Signature of Applicani/Agent Date: 1Z-
SUPPL AL INFORMATION REQUIRED
ii
MEFhfircApp 1011.doc revised 03/16/11
In
$133.501 $133.00 7'•,,:;�oiwnn.aul
.. Revised: 10/01/2012
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAIterations CF -IR -ALT -HVAC
Climate Zones 1 and 3 - 7 -
Site Address:•
Date:
Permit#:
lEnforcementAgency:
Conditioned
Duct insulation
ui ment Type'
List Minimum Efficicaey2Floor
Area
rement
Thermostat
Packaged Unit
umace
®. FEmS4
N
COP
Served by
Over ft of ducts
in
Setback
Indoor Coil
OSEER_
HSPF
system
�— sf
added or replaced
o
(minlldreadypresenr, must 6e
Condensing Unit
® EER _
® Resistance
unconditioned space
®R 6
insralledl
❑ Other
L Equipment Type: Choose the equipment being installed; if more than one system, use another CF -IR -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 with the permit
application.
Name:
Signature:
Company: I I
!t'V
(f! r✓
Date:
-'-
Address: 711-
License:
City/State/Zip:
Phone: pi 3_ Lf71
2008 Residential Compliance Forms March 2010
CITY OF CUPERTINO
UUU UQ'lr k4A'r'nID—RTTTT.TITNf_' DMRMN
Mech. Plan Check 0.0 hrs $0.00 Plumb. Plan Check
Mech. Permit Fee: 1, PM/TERPlumb. Permir Pee:
Other Mech. Insp. 0.0 hrs $45.00 Other Plume Insp. Li
Hech. Insp. Fee: Plumb. Insp. Pee:
NOTE: This estimate does not includefees due to otherDepartmens (Le. Plot
Flee. Plan Check
Dec. Permit Fee:
Other Elec. Insp. Li
Elec. Insp. Fee:
Public Works, Fire, Sanitary Sewer District, Sehoc
urs[rres el"'. irresc
FEE ITEMS ?Fee Resolution I1-053 E . 7�
19479 Rosemarie pl #4 -- --- —
DATE: 01/17/2013
REVIEWED BY: mendez
LaADDRESS:
i APN:
BP#:
`VALUATION:
$7,460
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY- SFD or Duplex
p
hrs
PENTAMATION FURN/AC
PERMIT TYPE:
USE:
$0.00
WORK
remove and replace furnace in existing location
Suppl. Insp: Fee>0 Reg. 0'OT
0,0
SCOPE
$0.00
Mech. Plan Check 0.0 hrs $0.00 Plumb. Plan Check
Mech. Permit Fee: 1, PM/TERPlumb. Permir Pee:
Other Mech. Insp. 0.0 hrs $45.00 Other Plume Insp. Li
Hech. Insp. Fee: Plumb. Insp. Pee:
NOTE: This estimate does not includefees due to otherDepartmens (Le. Plot
Flee. Plan Check
Dec. Permit Fee:
Other Elec. Insp. Li
Elec. Insp. Fee:
Public Works, Fire, Sanitary Sewer District, Sehoc
urs[rres el"'. irresc
FEE ITEMS ?Fee Resolution I1-053 E . 7�
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
1 # Mechanical
$133.00 1MFR=<100 I Fumace, Forced -Air
Suppl. PC Fee: 0 Reg. 00
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp: Fee>0 Reg. 0'OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$45.00
Constmetion Tax:
Administrative Fee: tADM1N
$42.00
0
0
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee:.
$0.00
Select a Non -Residential
Building or Structure
0
0
Travel Documentation Fee: 1TRAVDOC
$45.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bide Stds Commission Fee: IBCBSC
$1.00
$133.50
$133.00 Oq
$266.50
Revised: 10/01/2012 .
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS:
QI Nr 1-e P PERMIT #
OWNER'S NAME:
PHONE #
GENERAL CONTRACTOR:
BUSINESS LICENSE #
ADDRESS:
CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a Uity of Uupertmo ousmess license.
NO BUILDING FINAL OR FINAL 'OCCUPANCY INSPECTIONS) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL UBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable sabcontra tors and complete the ollowing information:
Owner / Contractor Signature
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting. .
Linoleum / Wood
Glass / Glazing -,
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner / Contractor Signature
Date