12070167 CITY OF CUPEIRTINO BUILDING PERMIT
BUILDING ADDRESS: 10669I1ALE rl, CON' RAC1'OR: RIWMB Ilon1li 1'ICItM I'I'NO: 12070167
PERFORMANCE
OWNER'SNAME: MYER10HNWANDCATARINAT 120 PARNASSUS AVE STET DATE ISSUED:07/20f)012
OWNER'S PHONE: 7075953288 SAN FIG\NCISCO,C\ 94117-3266 PDORE ND:(415)214-ssa5
p pp1 ICI'N*SI'D CON fR ACTOR'S DECLARATION 13UILDINC PER\IIT INFO: BLDG r ELECT r PLUMB r
License Class U t C2 D 1-ic.q q�q 11 b iMECIi r RESIDENTIAL F_ COMMERCIAL r
Contractor 1i4_? "o Dale I 12opp
.1013 DESCI21 P'I'TON: DUI'LIiS/�b,K 10771 I IALIi PI.REPLACE FURNACE IN
I hereby affirm that 1:un licensed under the provisions or Chapter 9 1301'11 DUPLliViti.li\'I'IiND IiVS'I'ING DUCTWORK.ADD
(conhmencing wi lir Section 7000)of Division 3 of the Ilosiness& Professions ADDI'HONAI.INSULA'I 10N.
Code and that nnp license is in fail force and effect.
I hereby affirm under penalty or peijury one of the following nen declarations:
I have and will maintain a eenif¢ate of consent to Nell'-insure for\\'orker's
Compensation,as provided for be Section 3700 of the Labor Code,for the
.inedonnanee ol'the work for which this pemhit is issued.
I have and will maintain Worker's Compensation Insurance,as provided IDr by
Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Flour Area: Valuation:$20000
xTrait is issued.
CERTIFICATION AI'\Number:32640010.00 Occupancy T.Vpe:
I cenity that I have read this application and state that the above immolation is
correct.I agree to comply with;dl city and county ordinances and state laws reining
.!u building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property forinspection purposes, IWO'agree tosave PERMIT EXPIRES IF WORD IS NOT STARTED
indemnify and keep harmless the City of Cupcnino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE. Olt
cgsls,and esp-lses which may accrue against said CiI% in consequence o1 the _10N.
granting of this permit. Addiuonally,the applicant understands:red will comply 180 DAYS FROM LAST CALLED INSPECTION.
with at:nun-paint source regulations per the Cupcnino Municipal Code.Section
__— (2U ILZ Issued by:
1 C:gnatnl'e / D'Jhl' 1 I— a
Fl I \'NE'R-BUILD1elt DECLARATION' '
NE-ROOT'S:
I nrrebv affirm than 1 am ewempt from the Cmuractur's License Law for one of All roofs shall he inspected prior to any roofing material being installed. If a roof is
the following Iwo reasons: installed without first obtaining an inspection, I agree to remove all new mmcriuls lot
1,s owner of the property,or my emolo)ces wth wages as their sole compensation. ;nspection.
will do lire work.and the shmetme is not intended uI•i:Iered for one(Sec.7044.
Rt;incssX Prnlissions Codd
Signature of Applicant. Date:
as owrl of the property,am csclusivel•contracting with licensed contractors to
construct the project lSec.7044,Business fi Professions CodaLALT,ROOF COVI':RINGS TO BE CLASS":\" OR 11171-1 I':
It
I lo'Cl•v affirm under penally of perjury wit of the rolluw'ing three
decawAlions: HAZARDOUS MA'T'ERIALS DISCLOSURE
I hnwe laid will ntninmin it Cenilicne of Cotts'ent to self-insure for\\'01ker'5
Compensation,as provitted for by Section 3700 of the Labor Code.for the 1 tare read Thr hazardous materials requirements under Chapter(.95 ill the
perlonn;mce of the work for whidt this permit is issihed. California IT call[)&Safety Code,Sections 25505.'_5533.and25534. 1 will maintain
z compliance I lir the Cupertino Municipal Code.Chapter 9.12 and the Il Nal lir S
I have and will maintain Workers Compensation Insurance.as provided for by ,
Safety Code.Section_553_,
(x)should I store or handle hazardous material.
Section 3700 0l the Labor Code.Ibr the performance al��i•work lis which this Addilinnally,should 1 use cquilonew or devices which emit haz3rd0u1 air
penult is issued ,j3' cumammarts as defined b)'the It:', Area Air Ou:dits_Management District I will
I certne that in the perlunnance of the work 1i,r which this permit is Issued.I shall maintain compliance with the Cupertino Municipal Cade.Chapter 9.1'_:old the
Y
inot employ am person in any.manner so as to beconie,subJect to the\Volker, I leal�h Sarery'Code.Sections 255115.25533,and 255 4.
Compensation Imws of Caliform:l. It',after making this cntiliane of esemplion.I
Uscnci' r n on)4�d' rh C
bcconu,jib ect to the Worker s Compensation provisions of the Labor Code,I nasal , —_K_ )otter two - —
:binhwith .00mph•i:'ith such provisions or this permit shall oe deencd revoked. —
z
'
APPLICANT ' a
CONSfRCCTION G \(;F-";"
I Cerllt) ltal I Ilalread II1s application and state thattile above
In lJllnatlr)n is I neeby;:Mine duan there is a eunstmcuon lending agent)'iia the performance of s"ork'S
liar which.Ibis ennt iu issued(Sec.3097.Civ C.}
creed.I agree to conhply with all city and county ordinances and mile laws reluuug P
I0 building construction,and hereby authorize repwNenlatives of this city In enter Lruder'> —.---
upon lilt above mentioned propeny for inspection pnposes.(We)agee to save _—_----
indcnmily and keep harmless the City ul'Cupcnino againv liabilities,pldgmmrtLender's Addresss, —._------------
costs,and cspenses which may accrue against said City in consequence of the
granting of this permit.Adoitionall'.the applicant understands and will cunlply ,\ItClll'1'h:Cl"S DECLARA PION
with ali non-point source regulations per the Cupertino Municipal Code,Section
Q.IF. I undelsmmi r.) plans shall ne used as ptlblit records.
Signature Dale._
Licensed i'ndesiionxl--
I - —
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
!121 ADDRESS: DATE: 0712012012 REVIE`,YED BY: bobs.
APN: BP#: MO 7121427 1 *VALUATION: $20,000
*PERMITTYPE: Mechanical Permit PLAN CIIECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Duplex PENTAMATION
USE: pPERMIT Tl'PE: FURN/AC
NYORK sfd duplex replace 2 furnace extend existing ductwork add additional insulation.
SCOPE.
APPLIANCE I EQUIP TVPE FEE ID QTY UNITS BP FEES
Furnace, Forced-Air 1MFR=<100 2 # $266
Heating System 1MRRAA 1 # $67
TOTALS: 1 $333.00
Mech. Plan Check 0.0 hrs $0.00 Plumb,Plan Check Elec. Plan Check
Mech. Permit Fee: IMPERMIT Plumb.Permit Fee: Elec. Permit Fee:
Other Mech. Insp. 0.0 hrs LnH Other Moab Insp. Other Eke.Insp.
Alech. Insp.Fee: Plumb.bap.ree: Elec. fncp. Gee:
NOTE: This estimate doev not includefeec due to other Departments(i.e. Planning, l uhlic Works, Fire,Sanitary Sewer District.School
District.etc.). Thesefees are based on the preliadnan information avoilahle and are rush•an ectinrate. Contact the Dept for adhbt7 info.
FEE ITEMS (Gee Resolution 11-053li'ff 7/1/11) FEE QTY/FEE MISC ITEMS
P1ctn Check Fee:
Supp/. PC'Fee
PME Plan Check: $0.00
Pe iwdt Fee:
Suppl. Insp Fee
PME Unit Fee: $333.00
PME Permit Fee: $45.00
C'Onshvction Vim:
Administrative Fee: I,iD I/N $42.00
Work Without Permit? Q Yes Q No $0.00
Advanced Planning re es:
Travel Documentation Fee: 17RAVDOC $45.00
SUona Motion Fee: I&VIS,UICR $2.00 Select an Administrative Item
Blds Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: 1 $468.00 $0.00 TOTAL FEE: F$468.00
Revised: 07/01/2012
Prescriptive Certificafe of Compliance: Residential CF-112-ALT
' Residential A1leratioas (Page 4 of 5)
Traject Namc: Climate Zone N N of Stories
ot&q -f 0771
IIVAC SYSTEMS- I-IEATING
ibtininuun Duct or Piping Configuration
Beating Equipment Elliciency Distribution Insulation Thertnostat (Central, Split.
TN-pe and Ca acavi=,3 (AFUH or IISPF) 'ry e and Location' R-Value 'I\• c Space. Package or I lvdronic)
> MdCc TavJ )C
1./nrlicnte Hearing Type(Centra/Furnace, IMa//Fttrnnce, Hent pu tp, Boiler, Electric Resistance. etc)
2.Electric resistance hearing is allotted only in Component package C. or except where electric heating.is supplemental(i.e.. if total capacity
<2 KII'or 7,000 Bndlnr electric heating is controlled by a time-lintiling(ievice not erceeciing 30 ainmes). See§151(b)3 erception.
3.Refer to the HERS Verification section on Page 4 of the(71—IR-ALT Form foradditional requirements and check applicable boxes.
4. Indicate Ttpe at,Location(Ducts, Hydronic in Floor. Radiators.etc.)
IiVAC SYSPENIS-COOLING
Minimum
Ef icienev Duct or Piping Configuration
Cooling Equipment (SIiFIUHER or Distribution Insulation Thermostat (Central. Split.
'['%,pc and Ca acitvr 2 CO;,; Tv a and Location3 R-Value 'I've Space. Packaee or Ilvdronic)
1. Indicate Cooling hpe(A/C. lleat pump, Evap. Cooling, etc)
1. Refer to the HERS Verification section on Page 4 of the CF-I R-ALT Foran for additional requirements and check applicable boxes.
3. Indicate Type or Location(Ducts, Hydronic in Floor, Radiators, etc.)
WATER HEATING
List water heaters and bolters far both domestic hdt water(DHII')heaters and hydronic space heating. Individual duelling DHIV heaters must be
gas or propane feed. Hot water pipe insulotion from the DHIV heater to the kirchen(s)and on till underground hot water pipes is required in all
component aeknees in all clintate zones.
External•rank
Water I leater Type/Fuel Distribution Type Number In 'Pork Energy Factor or Insulation
Ty en (Standard.Recirculating)'- S•stem Capacity(gal) Thermal Efficienev R-Valuc3
l..Indicate Tipe(Storage Gas, Heat Purnp. instantaneous, etc.)
2. Recirculntiitg s yctenrsserving multiple duelling units shall meet the recirculation requirements of$I50(n). The prescriptive requirenaenlc do
not allow the installation ofa recirculating water heatingsystenr forsiaagle duelling units.
3. The external nater heating tank and pipes shall be insulateal a rneet the requirements 001-50(j).
SPECIAL FEAT U11 ES'fhe enforcement agency should pay special attention to the Special Features specified in this checklist below.
These itenismay require writen justification and documentation and special verification.
NEW ROOF ASSE\IRLY-Radiant Barrier
The radiant barrier r iremem of i I51(l)2 docs nota ly to roof alterations.
Slab Edge(Perimeter) Insulation \'ES NO
YES: In Climate Zone 16 in Component Packages D. R-7 insulation is required.
Healed Slab Insulation [] YES NO.
\'ES:Slab cd•c insulation re uireei for all heatecl slabs in all Climate Zones. See details in Table I IR-A of the standards.
Raised Slab Insulation YES ❑NO
YE'S: In Climate Zones 1.2. 11. 13. 14 ti 16. R-R insulation is required: in Climate Zones 12 K 15. R-4 is required under component Package D.
'hhenn:rl Al ass
'I'o obtain Com Bance Credit for the installation of thermal mass,use the Performance A roach.
JUL 20 2n» 10
� 16
Regis woon.-Mu'rr-F - ..-.Regiaaxation Daite17,innc:.. l/F.A.S�P au irlen:t _
2008 Residential Compliance b, 5.ti—9 _— Ylarch 2010
y
GENERAL PERMIT APPLICATION M E P
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 950143255
CUPERTINO MI
/�
(408)777-3228 • FAX(408)777-3333 •buildingr5woerdno.orD v\
PLUMBING �N[ECFANICAL ELECTRICAL ❑,,IISCELL.NEOUS
PROJECT ADDRESS IAPNB 3a�
/ot6S. X771 114 CC- o lU
OWNER NAME(
I , PHONE E-MAM
I r! J -<-6 F,-3Z' weS r �' . cowl
STREET ADDV_S , ` , t� CIN. ST T.Z O� FAX
65�
CONTACT NAME�CF'�- /v/V ( P ONE _
keJc��uwtt , coP t
STREET ADD 5 CITY,SCATS Z@ FAX
c , c �koCA
❑OWNER Cl OWNER-BUILDER ❑ OWNER AGENT 53/M �ALTOR ❑CONTRACTOR Ar?rC ❑ ARCHREC; ❑c GINEER ❑ DEVELOPER ❑TENANT
CO:VTRACTOR.`lA.ME LICENSE. s ER q LICENSE TYPEZO BUS.LIC N 3 3 6 d
0
CDMP NY NAME // E-MAIL FAX
JL l ovist CVC I -ie. o Nn
STREET ADDRESS CITY,STATE,IIP E
20Zr Are #� Ac:�C- CA q(4 117 I PHON!T1-3 756
ARCdT ECC/FNGWEER NAME LICENSE NUMBER I BUS.LIC#
wMPANY NAME' E-MAIL FAX
STREET ADDRESS LTTY.STATE,ZIP. I PHONE
USE OF SFc.DUPLEX ❑ MULTI-FAMILY PROJECT N WIDLAND ❑ YES PROJECT N ❑YES ISTHEBLDGAN ❑ YES
EUILDNG: ❑COMMERCIAL URSAN LN=FACE AREA a NO FLOOD ZONE ty yNO EICHIM HOME. 91N,
DESCRIPTION OF WORKQ
e lace ! t a U? � rnaccs ! b 2 r 7 /�/
D AFLL
{ tit. �-a FL,,/A1,LCs . S 1 P_?(5� I
in ace ''r5 , \c.�e t + R �6 1< ins 1�kt�. vac rc�L
a 3 S • F&C t, LAI) i 5
too I.J r) - 0,-�eNkc s
TOTAL VALUATION: 42-o O o I RECEIVED BY: ilk
By my signature bel w,I certify to each of the following: I am the property owner or authorized agent to act on the pmpe y owner's behalf. I have read this
application and the information I have pro ed is correct 1 have read the Description of Work and verify it is accurate. I agrce m comply with all applicable local
ordinances and smote laws relating m buil ns action. anthoriu repmsrnmtivu of Cunccduc to toter the above-identified rope..—,1 Car inspection pu',poses.
Signattne of Applicatt/Agenn i Dart:
S I , AL INFORNLAZION REQUIRED OFF USE ONLY
y OVER-THE-COUNTER
- ❑ EMPRESS
2
U
❑ STANDARD
V
Z ❑ LARGE
❑ MAJOR
;blHP,Vac4pp-2011.doc revised 06121111