12080011CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21604 CASTMON ST
CONTRACTOR: PELLE HEATING & AC INC
PERMIT NO: 12080011
ON;NT:1d'S NAJIK: SHERI'IAR & APARNA VARANASI
3728 C C11AR'I'I?R PARK OR
DA'Z'E ISSUED: 08/028012
ON;NIiR'S Pl IONE: 2244201814
SAN.IOSE, CA 95136
PHONE NO: 140319721-7060
❑ LICENSIiD CONTRACLyOR'S DECLARATION
r r r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class `ZG Lic. d // ��D p
r r r
,/��
Contractor A��/T{�/f� Date z /
D1EC11 RESIDENTIAL C0�11AIERCIA I.
hereby affirm [hal 1 am licensed under the prorisiuns of Chapter 9
3013 DESCRIPTION: REPLACE FURNACE, AND 13 SUPPLY AIR DUCTS
(con] nencing with Section 7000) of Division 3 of the Business & Professions
Code and that Inv license is in full force and effect.
hereby affirm under penally of perjure one of the following two declarations:
I have and will maintain a cert: ficate of consent to self insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
perlbmlance of the work for which this permit :s issued.
Sq. Ft Fluor Area:
Valuation: $6814
1 have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of Ole work for which this
APN Number: 35620045.00
OccupancyType:
permit is issued
APPLICAN 1' CER'1'IFIC TIf )N
I certify that 1 have read this application and state that the above information is
correct. l agree to comply with all city and county ordinances and sone laws relating
PERMIT EXPIRES IF WORK IS NOT STARTED
to building Construction, mid hereby authorize representatives Of this Citto eater
upon the above mentioned property for inspection purposes. (We) agree to save
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnity and keep hamdess the City of Cupertino against liabilities, judgments,
18U DAYS ROM LAST CALLED INSPECTION.
costs, and expenses which may accrue against said City :n 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
Issu / a' Date:
9.18.
Sign:nbrc Date_G7�'��.
RF: ROOFS:
❑ OWNER -BUILDER DECLARA'T'ION
NI roofs shall be inspected prior to my roofing material being installed. if a roof is
installed without first obtaining an inspection, 1 agree to remove all new materials for
ha'eby affirm [hat T am exempt from the Contractor's License Law for one of
inspection.
the following two reasons:
I, as owner of the property, or my employees with wages as their sole compensation,
Signmure 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, ani exclusively contracting with licensed contractors to
ALL ROOF COVERINGS TO 13E CLASS "A" OR BEATER
construct the project (Sce.7044, Business & Professions Code).
hereby affirm under penalty of perjury one of the following three
HAZARDOUS MATERIALS DISCLOSUR
declarations:
I have read the hazardous materials requirements under Chapter 6.95 of the
I have and w:11 maintain a Certificate ofConscnl Io self -insure for Worker's
California Ilealth & Safely Code. Sections 25505, 25533, and 25534. 1 w:ll maintain
Compensation, as provided for by Section 3700 of the Labor Code, for the
compliance with the Cupertno Mun:c:pal Cade. Chapter 9.12 and the Health &
performance of the work for which this permit is issued.
Safety Code, Section 25532(n) should 1 store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance, as provided for by
Additionally. should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code, for die performance of the work for which this
contaminants as defined by the Day Area Air Qualhy Management District 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.1_tand the
pemnit is issued.
Health & Safely Code. Sections 25505. 25533, and _5534.
1 certify that in (lie perl'onnance of Ohc work for which this pemnil is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
Owner�ThoJyed agars:
Compensation laws of California. If, after making this certificate ofesemption, I
Date:Q! �L�Z
become subject to the Worker's Compensation provisions of the Labor Code, 1 must
forthwith comply with such provisions or this pemnit shall be deenhed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a constriction lending agency for the performance of vork's
APPLICANT CERTI FICATTON
for which this permit is issued (See. 3097, Civ Q
I certify that 1 have read this application and state that the above information is
Lender's,Name
correct. I agree to comply with all city and county ordinances mid state 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 sax
indenhnify and keep harmless the City of Cupenino against liabilities, judgments,
ARC[ I]Tll"CI"S DECLARATION
costs, and expenses which may meme against said City :n consequence of the
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 Date
� CITY OF CUPERTINO
F"_7 I FEE ESTIMATOR—BUILDING DIVISION
APPLIANCE / EQUIP TYPE
ADDRESS: 21604 Castleton st
DATE: 08/02/2012
REVIEWED BY: sylvia
UNITS
APN:
BP#:
'VALUATION:
$6,814
"PERMITTYPE: Mechanical Permit
PLAN CIIrCK TYPE: Alteration / Addition / Repair
PRI�L�RI'
USE: SFD or Duplex
$133
PENTADIATION
PERMITTVPE: FURN/A(;
WORT:
e lace furnace and 13 supply air ducts
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
Plumb. Plan Check
QTY
UNITS
BP FEES
Vec•. Permit Fee:
Furnace, Forced -Air
1MFR=<100
Other Elec. Insp.
1
#
$133
Permit Fee:
Supp/. Insp Fee
PME Unit Fee:
$133.00
PME Permit Fee:
$45.00
Cons•ttttction Tux:
Administrative Fee: 1,11)MIN
$42.00
Work Without Permit? O Yes Q No
$0.00
TOTALS:
Travel Documentation Fee: ITR,IVDOC
$133.00
Strong Motion Fee: IBSFISMICR
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Server District, School
District. etc.). These feev are based oat the Prelitninorr information available and lire only an estimate. Contact the Dent for addn'I info.
FEE ITEMS (Fee Resohnion 11-053 Eli' 71/11 /)
Mech. Plan Check 0.0 hrs $0.00
Plumb. Plan Check
Flee. Plan Check
Mech. Perini t Fee: ImPF.RMIT
Plumb. Permit Fee:
Vec•. Permit Fee:
Other b1ech. Insp. 0.0 hrs $45.00
Ocher Plumh Insp.Ll I
Other Elec. Insp.
:Wech. Insp. Fee:
Plumb. Insp. Fee:
Race. lay. Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Server District, School
District. etc.). These feev are based oat the Prelitninorr information available and lire only an estimate. Contact the Dent for addn'I info.
FEE ITEMS (Fee Resohnion 11-053 Eli' 71/11 /)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
PME Plan Check:
$0.00
Permit Fee:
Supp/. Insp Fee
PME Unit Fee:
$133.00
PME Permit Fee:
$45.00
Cons•ttttction Tux:
Administrative Fee: 1,11)MIN
$42.00
Work Without Permit? O Yes Q No
$0.00
Advances/ Planting Fees:
Travel Documentation Fee: ITR,IVDOC
$45.00
Strong Motion Fee: IBSFISMICR
$0.68
Select an Administrative Item
13ldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$266.68
$0.00
TOTAL FEE:
$266.68
Revised: 07/01/2012
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAiterations CF -IR -ALT -HVAC
Climate Zoues I and 3 - 7
Site Address: �
Enforcement Ageng•:
Dm
Permit P:
,fl
2
Conditioned
Duct insulation
Equipment T l
List Minimum Efficiency t
Floor Area
mquirem6t
Thermostat
Packaged Unit
® Furnace
® AFUE 0,b .
8 COP
Served by system
Over 40 0 of ducts
added or replaced in
j�Setbxk
Indoor Coil
®
[]SEER
HSPF
sf
unconditioned space
afjor ohmdvprumr, mwt be
Condensing Unit
❑ EER _
❑ ResLstance
/iumlledJ
Other
/. Equipment Type: Choose the equipment being installed; if mom than one system, use another CF -1 R-ALT-IiVAC 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 Slateniient)
• 1 certify, that this Certificate of Compliance documentation is accurate and complete. .-
• 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this
Certificate of Compliance.
• 1 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 fcattues 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:�/
Date
c
4
Address' l7` n Lyda/ �e-7
LicenspG
City/Staiee(LipJ 4.;,2OJt/,G
PAono. f/IIYGJ S'76'-7DG D
2008 Residential Compliance Forms.doc revised 04110/12
jZv9-Uvt
CONSTRUCTION PERMIT APPLICATION
LU COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildinG(acupertino.oro
CLIPERTINO I—I
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❑ OWNER ❑ OWNER -BUILDER OWNER AGENT CON RACTOR ❑COSRACTORAGENr ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME-
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ARCHTTEC (ENGINEER NAME
LICENSE NUMBER
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COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTIONOF WORK ':fv V ^ i CL ^ / k /
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EXISTING USE*AREA1
CONST. TYPE
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VALUATION (5)
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REMODEL AREAA REMODELAREA
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DECK RCII AREA GARAGE AREA: DETACH
❑ ATTACH
8 DWELLING UNITS. ISASECONDUSIT ❑YES
SECONUSrORY DYES
BEING ADDED' ONO
ADDITION' ONO
PRE -APPLICATION OYES IF YES; PROVIDE COPY OF
PUNNING APPROVAL LETTER
IS'IUEDI.DGAN OY[S
EICIILERHOME! ONOY/0
REC VG BY: JOT VALUATION'
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PLANMNGAPPLM ONO
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By my signature below, I certify w each of the following: I am the property owner or authorized agent to act on the property owner's behalf. 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 const etion. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED
PLANCIIF.CK TYPE
ROUTfNOSLIP'
K'9
❑ 'BUILDING PLAN REVIEW'
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
❑ EXPRESS
❑ PLANNING PLAN REVIEW
_Commercial Bldgs: Provide a completed Flazardous Materials Disclosure
❑ STANDARD
O PUBLICwORKS
form if any Hazardous Materials Eire being used as part of this project.
',
' ❑ '
❑ LARGE _
FIRE. DEIT�
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
-
❑ ENYINO\xIEPTALi1F]\LT'11-
BldgApp_2011.doc revised 06/21/11
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