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13010015I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 22406 ST ANDREWS AVE I CONTRACTOR: RESCUE AIR SERVICE PERMIT NO: 13010015 OWNER'S NAME: UMESH SHAW 16007 MAJORCA CT I DATE ISSUED: 01/02/2013 1 OWNER'S PHONE: 4082038437 MJ LICENSED CONTRACTOR'S DECLARATION License Class L 2 o Lic. # Contractor 1 ZED S(,�S (` Date I hereby affirm that I 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. 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 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. Signature �����Cec Date t� �—� l ❑ OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 the property, am exclusively contracting with licensed contractors to construct 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. I 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 with such 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. Signature Date SAN JOSE, CA 95120 PHONE NO: (408) 655 -9916 JOB DESCRIPTION: RESIDENTIAL u COMMERCIAL REPLACE (E) FURNACE, SAME LOCATION Sq. Ft Floor Area: I Valuation: $3150 APN Number: 35603006.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LA.,LED INSPECTION. Issued Date: Z 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(a) 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, Sections 25505, 25533, and 25534. Owner or authorized agent: cc,- Date: 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 Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional Fm_CITY OF CUPERTINO I FEE ESTIMATOR — BUILDING DIVISION im, ADDRESS. 22406 SAINT ANDREW AVE DATE: 01102/2013 REVIEWED BY: MENDEZ UNITS APN: 35603006 BP #: *VALUATION: 1$3,150 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair _T PRIMARY SFD or Duplex USE: $133 PENTAMATION FURN /AC PERMIT TYPE: WORK REPLACE E FURNACE SAME LOCATION SCOPE F71 APPLIANCE / EQUIP TYPE FEE ID t'l;+r:rn. lyloa (Jw(l QTY UNITS BP FEES Fl "c P( rmil l ec, Furnace, Forced -Air 1MFR = <100 ��r,`r� t 1;iec. lwq). 1 # $133 Perinit 1 "e't': Sayppl. Insp F("(" F71 PME Unit Fee: $133.00 PME Permit Fee: $45.00 Ot 2,0'7(c`l1OY7 TIM'.' Administrative Fee: IADMIN $42.00 Work Without Permit? Yes (F) No $0.00 TOTALS: Travel Documentation Fee: ITRAVDOC $133.00 Strong Motion Fee: 1BSEISMICR NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Fewer District, School District etG These ees are based on the prelim ina information available and are on1v an estimate Contact the Dept for addn 7 info. FEE ITEMS (Fee Resolution 11 -053 Eff. 7111121 Mech. Plan Check 07.0hrs $0.00 t'l;+r:rn. lyloa (Jw(l !'lt c' Phin �'6aach, Mech. Permit Fee: IMPERMIT ,'rrrr�:i -. h f = d 1 cc' Fl "c P( rmil l ec, Other Mech. Insp. 0.0 hrs $45.00 01 /lvr 1' , IYS,> Li ��r,`r� t 1;iec. lwq). PME Plan Check: $0.00 NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Fewer District, School District etG These ees are based on the prelim ina information available and are on1v an estimate Contact the Dept for addn 7 info. FEE ITEMS (Fee Resolution 11 -053 Eff. 7111121 FEE QTY /FEE MISC ITEMS Plan Check FCC Sliphl. PC Fee PME Plan Check: $0.00 Perinit 1 "e't': Sayppl. Insp F("(" F71 PME Unit Fee: $133.00 PME Permit Fee: $45.00 Ot 2,0'7(c`l1OY7 TIM'.' Administrative Fee: IADMIN $42.00 Work Without Permit? Yes (F) No $0.00 ,1dti'utu'ecl.Plitrntrrl� I�'c�cs: Travel Documentation Fee: ITRAVDOC $45.00 Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $266.50 $0.00 TOTAL FEE: $266.50 Revised: 10/01/2012 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVA C Alterations CF -IR- ALT -HVAC Climate Zones 1 and 3 - 7 Site Address: 22 (� S \d► r.P ws Enforcement Agency: Date: Permit #: t< 2 Conditioned Duct insulation Equipment T el List Minimum Efficiency 2 Floor Area requirement Thermostat El Packaged Unit Wumace MrAFUE R1 ® COP Served by Over 40 ft of ducts Setback ® Indoor Coil Condensing Unit [I SEER n EER HSPF _ © Resistance system \001z) sf added it replaced in unconditioned space (If not already present, must be installed) Other ® R 6 (CZ 1, 3 -5) 1. 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: CC h k4 4Y-\ Signature: Company: Date: Address: � vO1 Yn �, r cu, r 1 License: City/State /Zip: C S .Z Phone: _t 2008 Residential Compliance Forms March 2010 CUPERTINO GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 5- 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 O (408) 777 -3228 •FAX (408) 777 -3333 • buildinp(d)cupertino.orp � MISC [71 PLUMBING IvIMECHANICAL ❑F,LECTRICAL nMlerFtIAMPCIITc PROJECT ADDRESS 2-_2-40(o , � C %l. APN k ?>S6 O O O 3 Lv OWNER NAME. / ,. PHONE r E -MAIL S SIREIir: \UDRLSS CITY, STATE, ZIP G ` FAX CON "I "ACI NAME � �C PHONE 6 u . /' cs,; � �j E -MAIL SI'RFET ADDRESS //� y� tOL V 1 1 " rr (ill 0-L ik L CITY, STATE, ZIP U se y FAX ❑ OWNER ❑ OWNER- BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT ( (N IRA(I "OR NAME (7f�r `- \ -T J LICENSE NUMBER 'Ro-24.2- {,} LICENSE TYPE ,20 BUS. LIC 4246_ j'1 I I`' -.\3 • `.) (OMP, \�N) N - \MI. E-MAIL F'AX ST'RF:ETADUKE:SSr ..� \ NAME V� �3 CITY, STA'T'F.,ZIP N �� C1(;V qX `, L J�� PHONE ARCHITECT /ENGINEER LICENSE NUMBER BUS- LIC H COMPANY NAME E -MAIL, FAX STRFEI" ADDRESS CITY, STATE, ZIP PHONE I'M OF ❑ SFD or DUPLEX ❑ MULTI- FAMILY BUILDING ❑COMMERCIAL PROJECT IN WILDLAND ❑ YES URBAN INTERFACE AREA ❑ NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YFS EICHLER HOME? ❑ NO UESCRIP "LION OF WORK .Q!�— 1V`e_ 101.A1. VALUA -FION- 1 'S C" -- RECEIVED BY: By my signature below. I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I 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 construction. I authorize representatives of Cupertino to enter the above - identified property for inspection purposes. Signature of Applicant/Agent Date: SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY W ❑ OVER- THE - COUNTER EXPRESS rj m v d STANDARD LARGE y El MAJOR MEPMiscApp 201 Ldoc revised 061121 11 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: 2L–ib CP _ Ace— 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 City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: 1/ ©'Z/ I -� f Date W 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 W Owner / Contractor Signature Date