12120010 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 913&915 MILLER AVE CONTRACTOR:CALIFORNIA DELTA PERMIT NO: 12120010
MECHANICAL INC
OWNER'S NAME: STEPHEN&ROBIN ERLACH 6056 E BASELINE RD STE 155 DATE ISSUED: 12/04/2012
OWNER'S PHONE: 831-419-58 MESA,AZ 85206 PHONE NO:(866)692-5273
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class C`Z d Li,.N. P//// y 913 MILLER-REMOVE AND REPLACE FURNACE IN SAME
��
LOCATION
Contractor 7f7 �1//,OJc? Date�2.—�L'-�7
I hereby affirm that I am Iicensed 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. Sq.Ft Floor Area: Valuation:$2800
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 APN Number:36919046.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS M LAST CALLED INSPECTION.
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 Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
�Z- RE-ROOFS:
Signature Date' `� 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.
❑ OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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,
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 2550 5533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this r/2_
permit is issued. Owner or authorized agent• Dale
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 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
I certify that 1 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 4o save ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
GENERAL PERMIT APPLICATION Irl E P
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 950143255 n Cb w A ' A /�
CUPERTINO (408)777-3228• FAX(408)777-3333• buildingG(Dcuoertino.oro �\!/ �!Y(' v\ (�/
❑PLUN LNG AMECHAMCAL ❑ELECTRICAL ❑MISCELLANEOUS
PROIECLADDPMS
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❑ OWNER ❑ OWNER-BUDDER ❑ OWNERAGENT ❑ CONTRA=?. CONTRACTOR AGENT ❑ ARCt=Cr ❑ENGA'EEK ❑ DEVELOPER ❑ TENANT
W �CTf1RNAME L7 SE NUMBER LICcT`SE TYPE BUS.LIC:
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ARCMECVFNGRZEERNAME LICENSE NUI44?;ER// BUS.LIC,Y
COWANYNA),,2' E-MAIL. FAX
STREET ADDRESS CITY,SPATE,ZIP PHONE
USE OF [ISFO.DUPLEX MULTI-FAMILY PRO]ECTINWILDLAND ❑ YES I PROJECPIN ❑YES I5THEBLDGAN ❑ YES
BUILDING: I]COMMEStCIAL URBAN INTERFACE AREA NO FLOOD ZONE EI No FJC}D_TR HOMET ❑NO
DESCRIPTION OF WORK
TOTAL VALUATION: 2 ao b RECEIVED BY:
By my signature below,I certify to each of the fol g: I am the property owner or authorized agent to act on the prop owner's bebalf. I bave nerd this
application and the inio;nation I have pirovi is correct I have zed the Description and verify it is accurate. I agrcc jo comply with all applicable local
ordinances and state laws relating to construction. I authorize re ves of Cupertino to enter the above-iidentifileedd'pmpe y for inspection pufposes.
Signature of AnnlicanNAgent• Date:
INFORMATION REQUIRED OFFICE USE ONLY
u ❑ OVER-THE-COUNTER
❑ EXPRESS
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M&P.Wuc4pp_2011.doc revised 06111111 -
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
1cl ADDRESS: 913 MILLER AVE DATE: 12/04/2012 REVIEWED BY: mendez
APN: BP#: *VALUATION: $2,800
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Duplex PENTAMATION FURN/AC
USE: PERMIT TYPE:
WORK REMOVE AND REPLACE FURNACE IN SAME LOCATION
SCOPE
Mech.Plan Check 0.0 hrs $0.00 Plumb.Plan Check Elec. Plan Check
Mech.Permit Fee: IMPERMIT Plumb.Permit Fee. Flec Permit Fee:
Other Mech.Insp. 0.0 hrs $45.00 Other Plumb Insp. Li I Ocher Elee.Insp.
ileeh Insp. Fee.' Plumb. Grip. Fee: Dee,Insp.live:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District etc.). These fees are based on the PrefinWdna information available and are only an estimate. Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eft 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 1 # Mechanical
Suppl. PC Fee: Q Reg. Q OT 0.0 Thrs $0.00 $133.00 IMFR=<100 I Furnace,Forced-Air
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee-.0 Reg. Q OT O,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $45.00
Const rection Tax:
Administrative Fee: IADMIN $42.00 O
Work Without Permit? ® Yes (E) No $0.00 0
Advanced Plannine Fee: $0.00 Select a Non-Residential (D
Travel Documentation Fee: ITRAVDOC $45.00 Building or Structure
A
Stron¢Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item
Blda Stds Commission Fee: IBCBSC $1.00
$133.50 $133.00 " 1 .TOTALFEE„' $266.50
Revised: 10/01/2012
Prescriptive Certificate of Compliance: Residential CF-IR-ALT
Residential Alterations Page 5 of 5
P oieet Name: Climate Zone# #of Stories
HERS VERIFICATION SUMMARY The enforcement agency should pay special attention to the HERS Measures specified in this
checklist below. A completed and signed CF-4R Form for all the measures specified shall be submitted to the building inspector beforefinal
inspection.
Duct Sealing&Testing HERS verification is required for this measure.
YES ❑NO YES:In Climate Zones 2 and 9-16,if more than 40 linear feet of new or replacement ducts are installed in unconditioned
space,the ducts are to be sealed per§152(b)1Dii and the newly installed ducts are to be insulated per§151(t)10.
❑ EXCEPTION:Existing duct systems that are extended,which are constructed,insulated or sealed with asbestos.
DYES ❑NO YES:In Climate Zones 2 and 9-16,if the existing space-conditioning system(HVAC equipment and ducting)is replaced,the
ducts are to be sealed per§152(b)IDL
DYES ONO YES:In Climate Zones 2 and 9-16,if the existing HVAC equipment is replaced(including the replacement of the air handler,
outdoor condensing unit of a split system,cooling or heating coil,or the furnace heat exchanger)the ducts are to be
sealed per§152(b)lE.
❑ EXCEPTION:Duct systems that are documented to have been previously sealed confirmed through HERS
verification in accordance with procedures in the Reference Residential Appendix RA3.
❑ EXCEPTION:Duct systems with less than 40 linear feet in unconditioned space.
rl EXCEPTION:Existing ducts stems constructed insulated or sealed with asbestos.
Refrigerant Charge-Split System HERS verification is required for this measure.
❑YES ❑NO YES:In Climate Zones 2 and 8-15,when the existing HVAC equipment is replaced(including the replacement of the air
handler,outdoor condensing unit of a split system A/C or heat pump,cooling or heating coil,or the furnace heat
exchanger)arefrigerant charge measurement shall be verified per§I52(b)IF.
Central Fan Integrated(CFI)Ventilation System and Fan Watt Draw
The ventilation requirements of§150 o do not apply to existing residential homes.
Ducted Split Systems-Air Conditioners and Heat Pumps:Airflow HERS verification is required forthis measure.
❑YES ❑NO YES:In Climate Zones 10 through 15,when the existing space-conditioning system(HVAC equipment andducting)is
replaced,the airflow and fan watt draw shall be verified per 152 b lCi to meet therequirements of 15l 7B.
Documentation Author's Declaration Statement
• I certify that this Certificate of Compliance documentation is accurate and complete.
Name: Signature-
e-- c
ignature:Fc O
Co pan Date:
Add ss: � If Applicable LJCEA or nCEPE
jp p e (Certification#):
City/State/Zip: Phone:
oe-,tr- Ir P o A?y-01;ZP-0 �o >
Responsible Building Designer's Declaration Statement
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design identified on
this Certificate of Compliance.
• I certify that the energy features and performance specifications for the building 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 building design features identified on this Certificate of Compliance are consistent with the information provided to document this
building design on the other applicable compliance forms,worksheets,calculations,plans and specifications submitted to the enforcement
agency for approval with this building permit application.
Name: Signature:
il/G� C .e li0
Compan/y: Date:
P71 d h�
Ad s: /� .. License:
O
City/State/Zip: Phone:
Q z
;Pr F_ F? ' ,
For assistance or questions regarding the Energy Standards,contact the Energy Hotline at:1-800-772-3300.
2008 Residential Compliance Forms March 2010
Building Department
City Of Cupertino
10300 Torre Avenue
C�mPrlinn:C�Otl11�_1�E[
CUPERTfNO Fax: 408-777-3333
(CONTRACTOR/SUBCONTRACTOR LIST
JOB ADDRESS: 9/_7', PERMIT#
OWNER'S NAME: Gp i .2 riper PHONE# '"I- � SW
GENERAL CONTRACTOR: SINESS LICENSE#
ADDRESS: C CITY/ZIPCODE: fie! rTfi
*Our municipal code requires all businesses:working in the city to have a City of Cupertino business license.
NO BUILDING FINAL ORFINAL OCCUPANTO
CY CTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR.AND ALL,.SUBCO CRS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. c/
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and:complete the following information:
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/ ntractorSignature Date