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13010066 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11640 WILDFLOWER CT CONTRACTOR:AIR QUALITY HEATING& PERMIT NO: 13010066 AIR OWNER'S NAME: SHAIKH KHUSHROOBANU I 720 NORTHRUP ST DATE ISSUED:01/10/2013 OWNER'S PHONE: 4089739405 SAN JOSE,CA 95126 PHONE NO:(408)293-7138 LICENSED CONTRACTOR'S DECLARATION r F OBUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# `T �� f— MECH RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I am licensed unher the provisions of Chapter 9 JOB DESCRIPTION:REMOVE AND REPLACE FURNACE AND A/C IN SAME (commencing with Section 7000)of Division 3 of the Business&Professions LOCATION. 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 Sq.Ft Floor Area: Valuation:$5000 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:36619058.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS F ST CALLED INSPECTION. 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. 111IT by: Date: Signature DateE� - - 3 ❑ OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Date: Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air permit is issued. 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 I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. 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 Owne ora horized agent: become subject to the Worker's Compensation provisions of the Labor Code,I must Date: l 3 forthwith comply with such provisions or this permit shall be deemed revoked. ry VV CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 1 understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date 11AGENERAL PERMIT APPLICATION E P COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 CUPERTFNO (408)777-3228• FAX(408)777-3333• building(c�cuD2rtino.org MISC ❑PLUNMING MECHANICAL ❑ELECTRICAL tet❑ EL /MISCLANEOUS PROJECT ADDRESS I l/ ' !` / /� j�' n / APN f '1/�//, �r i �/ 0� EJ STREET ADDRESS ( CITY, ATE,ZIP FAX Ct CONTACT NAME / PH + E-MAIL STREET ADDRESS jLJ /„ I V ',r f n CITY,STI, ZIP ❑OWNER ❑ OWNER-BUILDER v1/ r❑ OOWNER AGENTCONTRACTOR ❑CONTRACTOR AGENT EIARc=.cT El ENGINEER 11 DEVELOPER El TENANT COW N LICENSE NUMBER LICENCE TYPE ^ BUS.LIC COMPANY E-MAIL FAX STUET ADDRESS 'y CITY ST PHO 4p ,I�3 713 ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF SFD or DUPLEX ❑ MULTI-FAMILY PROJECT BJ WD-DLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES BUP-DING: COMMERCIAL URBAN INTERFACE AREA NO FLOOD ZONE NO EICHLER HOME? O 11 1 DESCRIPTION OF WORK jej TOTAL VALUATION: ) RECEIVED BY: �4,--21V' 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 b ] in construction. I authorize representatives of Cupertino to enter the above-id t, ed pr er y for inspection puiposes. Signature of Applicant/Agent: Date: DL SUPP MENTAL INFORMATION REQUIRED OFFICE USE ONLY OVER-THE-COUNTER r `' ❑ EXPRESS U ❑ STANDARD U ❑ LARGE ❑ MAJOR MEP1v1ucApp_2011.doc revised 06/21111 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 11640 Wildflower Ct DATE: 01/10/2013 REVIEWED BY: Sean APN: BP#: �� ) 'VALUATION: $5,000 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: PERMIT TYPE: WORK Remove and replace furnace and a/c in same location. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES A/C Units (<=10K cfm) 1BREMAIR 1 # $67 Furnace, Floor 1MFLRFURN 1 # $67 TOTALS: $134.00 Mech.Plan Check 0.0 hrs $0.00 .arab.1'i�an Check t>iec.i';cu: Mech.Permit Fee: 1MPERMIT Fyitimn. Pern it Fee. t>!c>c.Permit Other Mech.Insp. 0.0 hrs $45.00 ofiae r P!fr i.IrrsrJ. ott e t:i:.::. zn.s,. El , NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Thesefees are based on the preliminar information available and are only an estimate. Contact the De t or addn 7 info. FEE ITEMS LFee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS Man Check Fee: .Str,ppl, PC Fee PME Plan Check: $0.00 .l'ertial T'ee' PME Unit Fee: $134.00 PME Permit Fee: $45.00 Administrative Fee: 1ADMIN $42.00 Work Without Permit? 0 Yes C) No $0.00 Travel Documentation Fee: ITRAVDOC $45.00 Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $267.50 $0.00 TOTAL FEL: $267.50 Revised: 10/01/2012 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVA C Alterations CF-IR-ALT-HVAC Climate Zones I and 3-7 Site ddress. Enforcement Agency: Date: Permit#: lL Conditioned Duct insulation Equipment T ' List Minimum Efficiency Floor Area requirement Thermostat Packaged Unit Over 40 ft of ducts Furnace RM 90 ®COP etback Served by system added or replaced in Indoor Coil EER HSPF_ (Ifnot already present,must be Condensing UnitRE, ER Resistance + a—sf unconditioned space installed) 90ther I Q 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 Autbor'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,Parts I 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: Wt Signature:6K I Company: Date: //0/, l Addre License: C y/ City/State/Zip: Phone: Lot3._ /3 2008 Residential Compliance Forms.doc revised 04/10/12 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone:408-777-3228 C U P S RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: PERMIT# oO OWNER'S NAME: PHONE# d pS GENERAL CONTRACTOR: /� BUSINESS LICENSE# ADDRES Q ITY/ZIPCODE: *Our municipal code requires all gusinesses 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 Date Please check applicable subcontractors and complete the following information: V 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 Dat