29534 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY:' - 1
CITY OF
CUPERTINO BUILDING-ELECTRICAL PERMIT NO. ^a�
BUILDING DI VISION APPLICATION/PERMIT' PLUMBING-MECHANICAL" L J4 J{
BUILDING PROJECT IDENTIFICATION
BUILDINGADDRESS: SANITARY NO., APPLICATION SUBMITTAL DATI
/ '56_73
OWNER'S NAPHONE: CONTRACTOR'S NAME: LIC NO'
'-T C- T� ...p NIC' s CONTROL It
IR
CHITF,CT GINEER: _r LI NO: ADDRESS
y X30
CGRTACr: PHONE: BUILDING PERMIT INJO
LA,_ I 1410 ❑ Consultant Fres Paid by Applicant(Initial) BLDG CT MEC
Ct
LICENSED CONTRACTORS DECLARATION QTY. ELECTRIC PERMIT FEE
I hereby affirm that l am licensed under provisions of Chapter 9(commencing JOB DESCRIPTION
'D�'Z with Section 7000)of Division 3 of the Business and Professions Gda,and my,fieverm is PERMIT ISSUANCE ,NTIAL:
FOO wt full force and effect.
1 W F tn, UWL ❑KITCHEN REMODEL
Q U Laeme Class Lim.N
t VV as, Date Contractor APPLIANCES—RESIDENTIAL 'O ADDTTION ❑PLUMBING RE-PIPE,
p,Dr��rn ARCHITECT'S DECLARATION ❑MOLT!-UNIT STRUCTURAL
'O0n4 I understand my plana shall,be used as public records• PANELS
r
INTERIOR ❑CHIMNEY REPAIR
tOMODIFICATION
UP T02W AMPS ❑�i licensed Prnlca,kaml 201-I00s)AMPS IMPROVEMENT� OWNER-BUILDER DECLARATION
4�"��•••• I hereby art',.that I am exempt bromidic Commemr's License Law,for the OVER IOW AMPS ❑BATH REMODEUREPAIR D DEMOLITION
'3 U following reason.(Section 7031.5,Business and Professions Code:Any city or county ❑OTHER
.W.W which re vires a SIGNS ELECTRICAL
O N q permit re ammmct,aIle!.Improve,demolish,or repair any tamcthrc
ts
it that heor slicenedpursuant to theres previsions of for such Compactor's Licensle a signed ow(Chaemem SPECIAL CIRCUIT/MISC.
'N that he is licensed pursuant mtheprovislons of the Contractor's License Law(Chapter d' (cammenming with Section 7000)of Division 3 ofiho Business and Professions Code) ,b
❑O TE METER OR POLE!NST. fI
d y o C that he is exempt Iheiefrom and the basis for the allege)excerption.Any violation of NE BL DDITIONS.LL�DEMOLITION,
tiiCl 4• Section 7031.5 by any applicant for a permit sonars the applicant m a civil penalty of POWER DEVICES ENANT '0 FOOD SERVICE
F y not more than five hundred dollars($50% ��j 1y'��ROVEMHNT
.t
C] as owner of the Property,or my employees with wages as their sole compensation, SWIMMING POOL ELECTRIC L/_'j
/F will do the work,and the s[meture is noiintendcdoroffererl basalt,(Sce.7044,Business LJ QGFIER � IN 31999'
Lw$ and Professions Code:The Contractor's License Law does not apply to an owner of OUTLETS—SWITCHES-FIXTURES
property who builds or improves thereon,and who does such work himself or through -
his own employees,provided that such improvements are not intended or offered for NEW RESIDENTIAL ELECTS SQ Er. 5`174 i lr :I H- ,K)
sale:If,however,the building or improvement is sold within one year of completion,the SQ.PL FLOOR AREA $ISQ.FT. '
owner-builder will have the burden of proving that he did not build or improve for par- O (r!►�' EO sem' 7` t
• E]1,masala,. 0.16
w�
❑1,osowner of the pmpetty.um exclusively cnnnaoting with licensed contractors to L.7- L/ •LJ
onmmct the project(Sec.9044,Business and Professions Ciaae)The Conitrwlora li-
cense Law does not apply to an owner of property who bui Ids or improves therem,and QTY. PLUMBINGPERMIT FEE �y
who ambraets for such p]eats with a esudearm s)licensed pursuanuo the Commedus T I Ili;0
License Law. -
❑I am exempt under Sec. B&1P C for this reason PERMIT ISSUANCE; .
ALTER—DRAIN&VENT-WATER(EA)
Owner Dom VALUATION _
WORKER-SCOMPENSATIONDECLARATION BACKFLOWPROTECT.DEVICE
Ze�3�
!hereby
affirm under penalty of perjury one of the following dpnlaratinns:
I have and will maintain a Ceriificam of Coastal o self-insure far Workers Compen- DRAINS—FLOOR,ROOF,AREA,GOND.
cation,as provided for by Section 37M of the Labor Code,for the performance of the STORIES TYPE CONSTRUCTION
work for which this permit is issued. FIXTURES—PER TRAP "
1 have and will maintain Worker's Compensation Insurance,as required by Section
37M of the Labor Cole,for the performance of the work for which this permit is issued. GAS—EA.SYSTEM-I INC.4 OUTLETS OCC.GROUP APN
My Worker's Compensation Insurance carrier and Policy number are: - .
Cartier: Policy No.: GAS—EA.SYSTEM-OVER 4(EA)
„ CERTIFICATE OF EXEMPTION FROM WORKERS'. -
COMPENSATION INSURANCE GREASUINDUSTRL WASTE INTERCEPTOR, BUILDING DIVISION FEES(This section ncartel be completed ifthe permit is foiona hundred dollars PS HIP OREASE TRAP
or leis.) u PLANCHECK FEE' 1 1 �• '
Iperformanceiss
certify that in the performance of the work for which this permit is ued.I shall
not employ any person in any manner so as to become subject to the Warkers'Compen. SEWER--SANITARY—STORM EA.2M FT. ENERGY FEE
,Z smion Lwsof Califomio:Date
Oe
Applicant WATER HEATER WNENT/ELECTR GRADING FEE
Vx
NOTICE TO APPLICANT.If,after making this ionof Exemption, should WATER SYSTEM/TREATING
yrEN•"+ "'� became subject m the Worker's Compensmian provisvisionss of of the Lahr Code,,you must SOILS FEE I Ye
forthwith comply with such provisions or this permit shallbe deemed revoked. WATER SERVICE
rTz CONST RUCTION LEN DING AGENCY NEW RESIDENTIAL PLMB. SQ.FT PAID
U 1herebyatfimt the,be.is.construction lendingagwcy for the performance of Dat R IpIM
4ks NNe work far which this perch is issued(Sou.3099,Cie C) '
Q U Lender's Name - TOTAL:
W Lender's Address ^(
pt 1 certify that 1 have read this application and state that the above information is "TVA.,
U 1wooda.I agree to comply with all city and county ordinances and state laws relating to QTY.
Y. MECHANICAL PERMIT FEE
U building constructiand hereby.utlmrtamprexenlatives ofthis city m erraticism the SETS 1 E G..
-� above-mentioneJpproperty for inspection
purposes. PERMIT ISSUANCE
(We)agree m save,indemnify and keep harmless the City of Cupertino against ELE TR '
liabilities,judgments,costs and expenses which may in any way aceta¢against said City ALTERORADDTOMECH. PLUMBING FEE d
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON.POINT pIft HANDLING UNIT(TO IO,IXIO CFM)
SOURCE REGULATIONS. MECHANICAL EtE d'
• AIR HANDLING UNIT(OVER I0.000 CFM) CONSTRUCT! NTAX
Simon.of ApplicanUComracmr Date EXHAUST HOOD(WIDUCT) HOUSINGM GATION FEE
HAZARDOUS MATERIALS DISCLOSURE _ '
Will Ne applicant or future building occupant store or handle hazardous material HEATING UNIT(MI00,00)BTU) t t
as danced by the Capenino Municipal Code,Chapter 9.12,and the Health and Safety
,Cads,Sweden 25532(.)9 HEATING UNIT(OVER 100,0100 BTU)
[_1 Ya, F7 No ,VENTILATION FAN(SINGLE RESID) PAID
Will theapple am or future building Date .Raccipt#
g occupantuse equipment devices which BOILER—COMP 3HP OR IW,000 BTU)
nit haxartlous air contaminants as defined by the Bay Area Air Quality Management
Uisvlet? s TOTAL:
❑Yes - ❑No BOILER—COMP(OVERI W,(NIB BTU7
I have read the hamrdocs mammals requirements under Chapter 6.95 of the Cali- AIR CONDITIONER _ ISSUANCE DATE
fomia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the NEW RESIDENTIAL MECH. SQ.-FT.
building docs mn currently haven tent,the[it is my responsibility to notify Ne oecupant
of the requirements which must Is,met prior to issuance of a Certificate of Occupancy. - - -
Owner or authorized agent Data ` 1.
ISSUED BY:
OFFICE
INSTALLATION CERTIFICATE CF-6R
Use of this fwm to satisfy the na ramenI of the Administrative Code la optional, but the Information must be provided and posted.
X77 �f
• Site Address Permit Number
An installation certificate is required to be posted at the building site prior to the issuance of the occupancy
permit: this form may be used to meet these requirements. All appliance categories listed below are the actual
equipment installed. Note that the efficiency and type of the appliance installed must be equivalent or better
than the appliance specified on the certificate of compliance (Form CF-1 R). This certificate (or its equivalent)
shall be prepared and signed by the person(s) assuming overall responsibility for the appliance installation.
Refer to the reverse side of this certificate for an explanation of information required.
I, the undersigned, verify that the equipment listed in the category above my signature is the actual equipment
installed and that the equipment meets or exceeds the requirements of the Appliance Efficiency Standards.
In addition, I have verified that the equipment is equivalent to or more efficient than the equipment specified
on the Certificate of Compliance submitted to demonstrate compliance with the Energy Efficiency Standards
for residential buildings.
HVAC SYSTEMS:
Heating Equipment
Heating Equip. CEC Certified Actual Distributio uct r Heating Load Heating
Type (Packaged Manuf.Make& Efficiency Type and Viping Before Over- Equipment
Model Number jeFUE. etc.l Location Si7inq (Stuhl Canacity (Stuh)
Cooling Equipment
• Cooling Equipment Actual
Type (Packaged CEC Certified Compressor Unit Efficiency Duct Duct
heat oumn. etc) Man t Make&Model Number (SF_ER) Location R-value
ignature, Date HVAC Subcontractor(Co. Name)
OR General Contractor OR Owner
WATER HEATING SYSTEMS
Distrib. Water CEC Certified Energy Tank Insul Internal Pilot Rated Solar/
System Heater Manuf. Make & Factor/ Volume Wrap Insul. Standby Light Input Wood
jyge Type/ft Model it Ethic. (gallons) R-value le R-yal a Loss (%) IBI& Wk /Btu Credits
! skit A D `fi/Y Z 8'g _0�0 -14 C'IG '05 oma n o
FAUCETS & SHOWER HEADS:
• Alsho s instal ed in the Commissions Directory Of Certified Faucets And Showerheads,
p . P 6, Subc p r 2, S ction 111.
",e )lr
ignature, Date Plumbing Subcontractor(Co. Name)
OR General Contractor OR Owner
Insulation Certificate
• umber and Scee[ City
County Subdivision
Description of Installation
ROOFZ �y�.
Material // /� Brand Name �p/Y1 19, X 4,jzoVf7 1V-P7
Thickness(inches) 0 /- Thermal Resistance(R-Value)
CEILING #
at r Blanket Type Brand Name �. IJ �7K—
Thickness(inches) Thermal Resistance(R-Value) 1e--4 O
Loose Fill Type /ua Brand Name
Contractor's minimum installed weight/ft` lb Minimum thickness�_ inches
Manufacturer's installed weight per square foot to acheive Thermal Resistance(R-Value)
EXTERIOR WALL �J
Material ASot Brand Name &�lIal,1E�
Thickness(inches) Thermal Resistance(R-Value)
RAISED FLOOR
Material ;!�e Brand Name gc//e ✓C
• Thickness(inches) /tl Thermal Resistance(R-Value)
SLA FLOOR
Matena _ Brand Name
Thickness(inches) _ Thermal Resistance(R-Value)
Width (inches)
FOUNDATION WALL A /
Material J�/ � Brand Name
Thickness(inches) Thermal Resistance(R-Value)
Declaration
I hereby certify that the above insulation was installed in the building at the above location in conformance
the current Building Energy Efficiency Standards for new residential buildings contained in Title 24 of the
California Administrative Code.
eral one o[or(Builder) License Number
-/3 - �7
Signature tle Date
��1�
•
Sub-Contractor(lnsulationlnstaller) Lice eNumber
c.-13 - 7
Signature and Tide Date
Compliance Fonns Jarman 1. 1995
INSTALLATION CERTIFICATE CF-6R
'1 The following is an explanation of many of the input values required on the opposite side of this form:
HVAC SYSTEMS
Heating Equipment T e- must be one of the following:
• Furnace: Gas or oil-fired central furnaces & soace heaters.
Boiler: Gas or oil-fired boilers.
PckoHeatPump: Packaged central heat pumps.
SolitHeatPump: Split central heat pumps.
RoomHeatPum : .Room heat pump.
LroPck HeatPum : Lar a Packa ed Heat Pumps (>_i5,000 Btuh output).
Electric: Electric resistance heating HSPF=3.413. Radiant electric resist. heating HSPF=3.55
CombinodH dro: Reference water heater under water heating systems, below.
Refer to CEC publication "Appliance Efficiency Regulations', P400-92-029.
CEC Certified Manuf. Make & Model Number; from applicable CEC appliance directory.
Actual efficiency; from applicable CEC appliance directory.
Dlstrlb type & locatlon; Distrib type is "Ducts", "Piping-or both. Duct location is "Attic", "Craw/space",
'CVCcraw/space'or"Conditioned space". Piping location is to be listed as 'Cond."or 'Uncond.".
Duct or Piping R-Value; from the Directory Of Certified Insulation Materials and/or manuf's data.
Heating Load Before Oversizing; refer to CEC -approved heading load calculation procedure. This is the heating
load result prior to application of the factor recommended in the bad calculation procedure for oversizes the appliance to
account for the use of a setback thermostat.
Heating Equipment Capacity; from the applicable CEC appliance directory. Note; location elevations over 2000 It
above sea level require a derating of output capacity(refer to manufacturers literature).
Cooling Equipment T e• must be one of the following:
SolitAirCond: Solit system air conditioner.
PckcAirCond: Packaged air conditioner.
SolitHeatPum . Split sstem heat Dump.
Pck HeatPum : Parka ed heat PUMP.
RoomHeatPumo: Room heat pump.
LgPckgHeatPump: Large Packaged Heat Pumps (265,000 Btuh output). Substitute EER for SEER when
SEER is not available.
RcomAirCond: Room air conditioner. Min. SEER varies'
• LrgPckgAirCond: Large Packaged Heat Pumps (>_(35,000 Btuh output). Substitute EER for SEER when
SEER is not available.
EvapOirect: Direct Evaporative Cooling System. The SEER is fixed at SEER=11.0. The duct
condition is to be fixed at location=attic and duct insulation R-value=4.2.
Evapindirect: Indirect Evaporative Cooling System. The SEER is fixed at SEER-13.0. The duct
condition is to be fixed at location.attic and duct insulation R-value=4.2.
Refer to CEC publication*Appliance Efficiency Regulations', P400.92.029.
WATER HEATING SYSTEMS
Distributions stem t e: refer to Residential Manual for more details.
Standard: Standard POU/HWR:I Point of use/Hot water recovery
Pipe Insulation: Pipe Insulation RecirclNoControl: Recirculation loop with no control
RecirctTimar Recirculation loop with a timer Recirc/Demand: Recirculation loop with demand
control
RecirdTime+Temp: Recirc.loop with timer and temp Recirc/Temp: Recirculation loop with temperature
control control
The table below summarizes the water heatinq system items needed by water heater type.
Input item NAECA NAECA NAECA Instant. Instant. Large Indirect
Storage Storage Heat Gas Electric Storage Gas
Gas or Oil Electric Pum Gas Boiler
Energy Factor Yes Yes Yes Yes
Pilot Input, Btu Yes Yes
Recov. Eff., fraction Yes Yes (AFUE)
StandbyLoss, % Yes
Tank Volume, gal, Yes Yes Yes Yes Yes
Tank Insulation, R Yes Yes
Ext. Insulation, R Yes Yes Yes Yes Yes
• Additional Information Required If Combined Hy dronic System:
Rated Inout, kBtuh Yes Yes Yes
Rated Input, kWl Yes Yes
Rec. Eff, fraction Yes