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12050032
I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS:122921 LONGDOWN RD CONTRACTOR:CALIFORNIA DELTA PERMIT NO: 12050032 MECHANICAL INC OWNER'S NAIVE: GUPTA AJAI AND ANIANA 6056 E BASELINE RD STE 155 DATE ISSUED:05/02/2012 OWNER'S PHONE: 4082184738 MESA,AZ 85206 PHONE NO:(866)692-5277 ❑ LICENSED CONTRACTOR'S DECLARATION r r r I BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class C—Z rd Lic.q ��/�V r r r 2_V7 MECH RESIDENTIAL COMMERCIAL Contmct � 2 Date V2 I JOB DESCRIPTION: REPLACE FURNACE LOCATED IN BACK PATIO 1 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 Icertificate 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 W which this permit is issued. Sq.FI Floor Area: Valuation:$6364 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 permit is issued- J(� j APN Number:34240007.00 Occupancy Type: APPLICANT CERTIFICATION C" r 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS M LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the , granting of this permit. Additionally,the applicant underslands and will comply with all non-point source r tions per the Cupertino Municipal Code,Section Is u �, lam• Date: 9.18. Signal - - —Date/--2-/Z RF.-ROOFS: ❑ OWNERIBUILDF.R DECLARATION All roofs shall be inspected prior to any roofing material berg installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: I,as owner of the propeny,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) 1,as owner of the property,!am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.1044.Business&Professions Code). I 1 hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE: declarations: I I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(x)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should 1 use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District l will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work forwhich 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'sOwn - trued agent: Compensation laws of California. IC after making this certificate of exemption,I S Date, become subject to the Worker's Compensation provisions of the Labor Code,I musfo forthwith comply with sucFi provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm That there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and stale that the above information is Lender's Name correct.I agree to comply with all city and county ordinances and stale laws relating to building construction,and hereby authorize representatives of this city to enter Lender's Address 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 ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Dale Simplified Prescriptive Certificate of Compliance:2008 Residential HVA C Alterations CF-IR-ALT-HVAC Climate Zones I.and 3-7 Sit*Address:l Enforcement Agency: D e: Pamir p: 4 't21' Go.vG ,. -2-Z Conditioned Duct insulation Equirment Tvpc List Minimum Efficiency- Floor Ansa requirement Thermostat LI Packaged Unit Furnace , Q AFUE�aq ®COP Over ft of duos Served by system added or oned S d m ®.Setback indoor Coll SEER_ HSPF_ O() sf unconditioned spas �rtp1dre°dyp"sou'"""`b` Condensing Unit 0 EER_ ©Raistarice aama0eO Other Q R 6 (LZ 1,3-5) , 1.Equipment Type:Choose the equipment being installed;if more than a=system,use another CF-I R-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) • 1 oenify that this Certificate of Compliance documentation is accurate and complete. • I am eligible under Division 3 of the California Busmen 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 our this Certificate of Compliance conform to the requirements of Title 24,Pats I and 6 of the California Code of Regulations. • The design features identified on this Certificate of Compliance are camisr®t with the information documented on other applicable compliance fomes,worksboem,calculations,plans and specifications submitted to the enforcement agency for approval with the permit application. n Name: N C //�'9 v0 Signatim: -Company: % Date Address; _ - Limuse: n n y City/Slate/Zip:, Phone: -S,21?-070 ] 2008 Residential Compliance Forms.doc revised 04/10/12 CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 34240007. 00 DATE ISSUED. . . . . . . : 05/02/2012 RECEIPT #. . . . . . . . . : BS000016689 REFERENCE ID # . . . : 12050032 SITE ADDRESS . . . . . : 22921 LONGDOWN RD SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : GUPTA AJAI AND ANJANA ADDRESS . . . . . . . . . . : 22921 LONGDOWN RD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : CALIFORNIA DELTA CONTRACTOR . . . . . . . : TODOR KITCHUKOV LIC # 32375 COMPANY . . . . . . . . . . : CALIFORNIA DELTA MECHANICAL IN ADDRESS . . . . . . . . . . : 6056 E BASELINE RD STE 155 CITY/STATE/ZIP . . . : MESA, AZ 85206 TELEPHONE . . . . . . . . : (866) 692-5273 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ------ ---------- -ADMIN HOURS 1.00 41. 00 0. 00 41 .00 0. 00 1BCBSC 'VALUATION 6, 364 .00 1. 00 0. 00 1 .00 0. 00 1BSEISMICR VALUATION 6, 364 .00 0. 64 0 . 00 0 .64 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. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 260.64 0 .00 260 .64 0. 00 METHOD OF PAYMENT AMOUNT - REFERENCE NUMBER ---------- --------------- -------------------- CHECK 260.64 #2799 --------------- TOTAL RECEIPT 260.64 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ------------------------- -------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 22921 Longdown Rd DATE: 05/02/2012 REVIEWED BY: Sylvia APN: BP#: 'VALUATION: $6,364 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: PERMIT TYPE: WORK REPLACE FURNACE LOCATED IN BACK PATIO SCOPE Mech. Plan Check 0.0 hrs $0.00 Plumb. Plan Check Elec.. Ilan Cluck Mech. Permit Fee: I MPERMIT I Plumb. Per»,li Fee: liter. Parnut Fe': Other Mech. Insp. Low1hrs $44.00 Other Plumb Insp. Other/:ler.lisp. .bkrh. lisp. Fce, Plrmrh. /u:p. Fee: tiler. 111.1/1. Fie: NOTE: This estimate does not include fees due to other Departments(ie.Planning,Public Works, Fire,Sanitary Sewer District,School District,etc.). Thesefees are based on the prelinddita information available and are only an estimate. Contact the Dept for addn7 in o. FEE ITEMS (Fee Resolution 11-053 FB' 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Mechanical Suppl. PC Fee: Q) Reg. Q OT 0.0 hrs $0.00 $130.00 IMFR=<I00 I Furnace, Forced-Air PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $44.00 Construction Tax: Administrative Fee: (ADMIN $41.00 O Work Without Permit? O Yes (E) No $0.00 0 Advanced Planning Fee: $0.00 Select a Non-Residential Travel Documentation Fee: ITRA VDOC $44.00 Building or Structure A Strong Motion Fee: IBSEISMICR $0.64 Select an Administrative Item Olde, Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $130.64 $130.001 TOTAL FEE: $260.64 Revised: 04/01/2012 GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 M I /� CUPERTINO (408)T77-3228 • FAX(408)777-3333• building(c cuoerdno.orG (v' gqP�L/UMBING / IAC—H"CAL nEc-mCAL miscurANF0U5 PROff1T ADDRESS 2 /21 �DA/V L OWNERNAMEPHONE E.—ftdAD. V SIREETADORM . COY, SCALE.JJP FAX G / G // CONTACT NAME PHONE EMAIL STRADORESS CTf Y,STALE, ZIP FAX EET ❑OwNEII ❑ OWNER-HUODER ❑ OWNER AGENT. ❑ coN[RACTOR CONTRACTOR AGENT ❑ AROMMa ❑ENGWEFRR ❑ DEVELOPER ❑ TENANT WNIRA RN _ a/I1 UCENSE NUMBER LICENSE TYPE RI14 rJCI -3237\ W ANY FAX J C, /El IIP PrsONE r i U -0 70 7 ARCIO TECT ENIGWEER NAME flCENSE NUMBIER EUS.LIC R COMPANY NAME' E-MAIL FAX STREET ADDRESS CITY.STATE;ZIP FHONE USE OF ❑SF'D m DUPLEX MULTFFA.MMY FROIELTM WODLANO ❑ YES PAOTEC7 Sa ❑Y6 IS Tt1E pf rN:AN YES RUDDDIG: ❑cQwAmrr•r URBAN RO'DIFABAREA ❑ NO FLOODZONE [3 NO MCHLER HOAOO [3 NO DFSCRIPTION OF WOAR //__ ke �C !/�/fCY�P d ee 0 11gzz-iiz Nc✓C'I P� 1 o 140272 C TOTAL VALUATION: D D RECEIVED BY: V L By my signage below,I certify to each of the fallowing. I am the property owner or androrlmd agent to act as the property owners Schalf I have read this application and the information 1 have provided is cmrecL j have read the Desaipdm of Work and verify it is accurate. I agree to comply with all applicable local ardmanen and slate laws relating to boldin on. I msthoria representatives of Caperdno m cater the above-identified property far inspection p*oscs. Sigmdme ofApplicantlAgenC Dare: f 2 2 P AL INFORMATION REQL1QtED OFFICE USE ONLY OVER-THF-COUNTER s ❑ EXPRESS Y u 'u ❑ srArroARD ❑ LARGE 6 ❑ MAJOR MEPMucApp_2011.doe revised 06121111