13050203 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10650 CULBERTSON DR CONTRACTOR:ONE HOUR HEATING PERMIT NO:13050203
AND AIR
OWNER'S NAME: PARAMA DUTTA 1400 PETALUMA HILL RD DATE ISSUED:05/29/2013
OWNER'S PHONE: 4088967363 SANTA ROSA,CA 95404 PHONE NO:(707)545-1800
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALE]
License Class GGo L Lic.# _740q I"I REMOVE AND REPLACE HVAC IN SAME LOCATION
Contractor Date S* 29��
I hereby irr a am licensed under the provisions of Chapter 9
(comm ci with Section 7000)of Division 3 of the Business&Professions
Code an 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:$15000
I 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:37534028.00 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 WIT fIIN 80 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 DA OM 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 Issued by Date:
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. G
2 ! 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
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
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 5505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent Date:�2�
permit is issued.
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 CONSTRUCTION LENDING AGENCY
Compensation laws of California. If,after making this certificate of exemption,I
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.)
Lenders Name
APPLICANT CERTIFICATION Lender's Address
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
upon the above mentioned property for inspection purposes.(We)agree to 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 o MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300'TORRE AVENUE•CUPERTINO,CA 95014-3255 {� MISC
CUPERTIINO (408)777-3228•FAX(408)777-3333•building(ftuoertino.oro
❑PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS i o ` c u j bmrsoN p R. pg APN# 344
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OWNER NAME V/_1bt i „ ✓>,,•+'v QW�^' TO •846 X 363 E-MAIL
STREET D S ,-• /'r ITY, ,ZIP FAX
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1,T w Q. �UPL� INO CA 4?!501 Lf
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE, ZIP FF
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTR�IC�O I AME e�e tee LICENSE ) B��R�41 LI O TYPE BUS.LIC#
7� �S TYPE,
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COMPANY NAME E-MAIL FAX
one hour- ke4*tA
S T DD S CITY,STAT ,ZIP ONE
�[�o e�aluwta I�a(1 �- 9a;q' . 20SP.,-, c� 95V o'1-585-1806
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD.r DUPLEX ❑ MULTI-FAMILY PROJECT IN WHDI AND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK ,^
C 14,q
TOTAL VALUATION: l 5 RECEIVED B
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act one operty 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 acc e. I agree to comply with all applicable local
ordinances and state laws relating to buil ' tru authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: Z 13
AL INFORMATION REQUIRED OFFICE USE ONLY
W ❑ OVER-THE-COUNTER
❑ EXPRESS
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❑ STANDARD
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MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10650 culbertson dr DATE: 05/29/2013 REVIEWED BY: MENDEZ
APN: BP#: *VALUATION: 1$15,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Du lex PENTAMATION FURN/AC
USE: p PERMIT TYPE:
WORK remove and replace HVAC same location
SCOPE
�:
Mech.Plan Check 0.0 hrT1kPERM7T
.Plan Check Elec.Plan(:heck
Mech.Permit FePlumb.Permit Pere: Elec. Permit Fee:
Other Mech.Insp. 0.0 hrs $45.00 Other Plumb Insp. Other Elec,Insp.
Alech.Insp. Fee: Plumb. hap.1^ec Eke.Insp.Fee:
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 prelimina information available and are only an estimate. Contact the Dept for addn'l info,
FEE ITEMS (Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 1 # Mechanical
Supp/.PC Fee: Reg. Q OT 0.0 hrs $0.00 $133.00 IMFR=<100 Furnace,Forced-Air
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee0 Reg. Q OT0,0 his $0.00
PME Unit Fee: $0.00
PME Permit Fee: $45.00
Construction Tax:
Administrative Fee: 1ADMIN $42.00
Work Without Permit? ®Yes (E) No $0.00
Advanced Planning Fee- $0.00 Select a Non-Residential
Travel Documentation Fee: 1TRAVDOC $45.00 Building or Structure
Strong Motion Fee: 1BSEISMICR $1.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
$134.501 $133.00° $267.50
Revised: 04/29/2013
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-lR-ALT-HVAC
Climate Zones 1, 3-7
Site Address: Enforcement Agency: Date: Permit#:
10650 CULVERTSON DR CUPERTINO, CA 95014 City of Cupertino May 28, 2013
Duct insulation Conditioned Floor
Equipment Type1 List Minimum Efficiency2 requirement Area Thermostat
❑Package Unit
11 Furnace 19 AFUE 95% ❑COP ❑R 6(CZ 1 3-5) Served by system ®Setback
[3 Indoor Coil ®SEER 14.0 Q HSPF Z 6 7 If not already present, must be
®Condensing Unit [3 EER [3 Resistance
R 42CResistance ( ) 11350 sf installed)
❑Other
1.Equipment Type:Choose the equipment being installed;if more than one system,use another CF-SR-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)
•I 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 1 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: Kevin Schaff Signature: Kevin Schaff
Company: BIGHAM SERVICES INC dba ONE HOUR HEATING&A/C Date: May 28, 2013
Address: 1400 PETALUMA HILL RD License: 740999
City/State/Zip: SANTA ROSA/CA/95404 Phone: (707) 545-1800
w
go e
. "M .
Reg: 213-A0032089A-000000000-0000 Registration Date/Time: 2013/05/28 10:92:33 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms July 2010
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O , `+. Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: CCA B E4T's oN PERMIT##
OWNER'S NAME: PPrDA46 ASpAti PHONE#
GENERAL CONTRACTOR:09VF ffooz Hr-6TINC4 BUSINESS`LICENSE##`7 CO'P'T
ADDRESSI LlJGL CITY/ZIPCODE: NTl_ RoSI4 C�- z{-EploWOy
*Our municipal code requires all businesses working in the city tU have a.City of.Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCIEDULED 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 .
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 g
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
ontractor Signature ` Date