29532 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY '
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMITNO2
. ^9 r ^
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL L y 'V1 JK L
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: il SANITARYNO. APPLICATION SUBMITTAL DATI
OWNER'S NAM•: e-4 ^ PI{DN@: CONTRACTOR'S NAME: LIC NO: N/C CONTROL p
QF
/ sR HFFE .NGINEER: l_ 7LII1C NO. A DRESS:
( , e G i/2-3 o
CONTACT: PHONE: BUILDING PERMIT INFO
s (0417 37-b 9 ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION / QTY ELECTRIC PERMIT FEE
1 hereby affirmthat I am licensed under provisions of Chapter 9(commencing JOB DESCRIPTION
aZ with Section?OfNBof Division 3oDhe Businessmal Professions Cala and my license is
al in full force and effect. PFiRMIT ISSUANCE
M�U� GYF
Li R Al
cense Class Lk.is - SFDWL [I KITCHEN REMODEL
rF Za Date Comma,... APPLIANCfig-RIiSIUENTIAL ❑ ITION ❑PLUMBING RE-PIPE
F,Om ARCHITECTS DECLARATION ❑MULTI-UNIT ❑STRUCTURAL
I understand m PANEIS
Z Ori.7f my shell M1c used as public records MODIFICATION
OZ— UPT0200AMPS El INTERIOR ❑CHIMNEYREPAIR -
r44 Licensed Professional 281-IINNIAMPS REI,
PROVEMENT
f aV aS OWNER-BUILDER DECLARATION
W I hereby affirm that I ren exempt from the Convector's License Law for the OVER["AMPS ATH REMODEUREPAIR ❑DEMOLITION
OEU following mason(Sevin.903 L5,Business and Professions Code:Any city or coumy SIGNS ELECTRICAL []OTHER
which requires a perrnit to construct,alter,improve,demolish,or repair any swcturc
[;may frrisc iuissuance,also requiresmaapplicant for such Lino fileasilimildatement SPECIAL CIRCUIT/MISC. ft
vvWW11y that he is licensed Invariant to the provisions of the Contractor's License Law(Chapter 9
COC) (mmremcingwith Section]o0Dof Divdrm3 ofthe Businessand Prcfessions Cude)u TEMP.METER OR POLE INS'LMMERCIAL: " ay d U '
that he is exempt therefrom and the basis for the alleged exemption.Any violation of EW BLDG/AD ON ❑DEMOLITION
Section7031.5 by any applicant for a permit suhjectsthe eplicam to a civil Penalty of POWER DEVICES NANT JUN �FQOD SERVICE
notmdiremanfivehundreddollars(5500). PROVEMENT ,II 1998❑Los owner of me property.or my empinyecx wire wages us theirsole compensation, SWIMMING POOL ELECTRIC will do the work,and the structure is not intended soutfcrtd for sale(Sec.90M,Business THER f'nd Professions Code:The Contractors License Law does not u I a,an owner of OUTLETS-SWITCHES-171XTURESy L/r Ppi UIproperty who builds m improves Hereo,and who does such wrote hies.,or through s uvk/hisown employees,building that such m nt is micutsdw are not immnded or pletiodibe NEW RESIDENTIAL IiLECfH SQ FT.owner-howeveallhave theburng den ofUrmcnt ithat he id noneildori provetion,the SQ.FT.FLOORAREA LSQ.IT.
powof safe.).willhav<the burden ofgravingthat he Jid nm M1uiWnrimPruvc forpnr- -j
pose of sale.). yl
❑ 1,ms ownerotthe pronemy,am exclusively and contracting with licensed comeces i- TOTAL:
Ouse a d project(Sec.JM4,Business and Professions,whobud d.,or improve,Thethe ., Li-
se Lawdceor suchs of plytman itha ontract my who sed Istor1.hthereon,and QTY. PLUMBING PERMIT FEE t
who contacts for such pmjwn with a convactotn)lianas.pursuant to the Cmnrractnr's
License Law. PERMIT ISSUANCE
' ❑ Tem exempt underSu. ,D&PCfnr this reason '
ALTER-DRAIN&VENT-WATER(EA)
nr•... VALUATION
WORKER'S COMPENSATION DECLARATION BACK FLOW PROTECT.DEVICE e1(;';C k11 Op
I hereby affirm under penalty of perjury one ret the following declarations: _ VVVV
.I havemd will maintain aCindficxte of Consent to self-insure for Wanes Compen. DRAINS-FLOOR.ROOE AREA.COND
t . STORIES TYPE CONSTRUCTION
on,as provided for by Section 37W of the Labor Code,for the Performance of the
work for which this permit is issued. FIXTURES-PER TRAP
❑ I have and will maintain Worker's Conpensatitn Insurance,as required by Section
3000 of me labor Code,fonhe performance of the work for which this pemtt is issued. GAS-EA.SYSTEM-I INC.4 OUTLETS
My Worker's Compensation Insurance camicr and Policy numbOCC.GROUP APNer are:
Cartier. Policy No.: GAS-EA.SYSTEM-OVER 4(EA) '
CERTIFICATE OF RXEMPTION FROM WORKERS'
COMPENSATION INSURANCE GREASF/INDUSTRL WASTE INTERCEPTOR '
(This section need not he completed ifthe pemnit is for one hundred dollars($IIXO BUILDING DIVISION NETS
or le"'.) GREASE9'RAP
PLANCHECK PEE
I certify mut in the performance ofthe work for which this permit is issued,l shall
not employ any person in an manner so as to become subject the Workers'Com n- SEWI?R-SANITARY-STORM EA.2(10 Pf.
P Y Y pe ENERGY FEE
Oz sedan Laws of California.Data WATER HEATER WNENILMLECFR -
z 0 Applicant GRADING FEE
�i NOTICE TO APPLICANT:If,aper making this Certificate of Exemption,you should WATER SYSTEMOREATING
�lr� become timed to the Workers Cnmpenaation pmvisions of the Labor Cade,you most SOILS FEE
C0 forthwith comply with such Provisions mthis pc man shall he deemed revoked. WATER SERVICE
CONSTRUCTION LENDING AGENCY NEW RESIDENTIAL PLMB. SQ.Fr. PAID pate Reaiptp
U p I hereby affirm thatthem is a construction landing agency for the permanence of -
Fme work for which this permit is issued(Sec.309'/,Civ.C.) '
U Lender's Name TOTAL:
DI Lander's Address TOTAL:
P4 I certify that 1 have read this application and state that the above information is BUILDING
V) coned.l agree to comply with all city and county ordinances and stem laws relating to QTY. MECHANICAL PERMIT FEE
U building construction,and hereby authorize renreserniives of this city to enter upon the SEISM : E
above-mentioned property for inspection f urpasex. I
PERMIT ISSUANCE
(War agree to save,indemni fy and keepr
hadess the City of Cupertino against E L E C 1
liabilities,judgments,casuistical expenses which may in any way accrue against said CityALTP.R OR ADD TO MECH. PLUM FEE
in consequence of me granting of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT ATR HANDLING UNIT(TO 10,000CFM) -
SOURCP.REGULATIONS. - MF,CHANICAL FEE
7A 72e-
AIR HANDLING UNIT(OVER Ill..CFM) CONSTRUCTION TAX
Signature nfApplicnnoConumtur Uwe EXHAUST HOOD(W/DUCI) HOUSING MITIGATION]ME
MATERIALS DISCLOSURE O •/
Will the applicam or bounce building occupant store or handle hazardous material HEATING UNIT TO I W."BTU)
as defined by the Cupsi inti Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(0)? HEATING UNIT(OVER 100,000 BTU)
❑Yes ❑No -.
VENTILATION FAN(SINGLE RESID) PAID
Date Receipt#
Will the applicant or rets a building occupant use equipment or devices which BOILER-COMP OHP OR IOm000 BTU)
mit-civil
ams lir contaminants as defined by the Ray Arca Air Quality Managemmut TOTAL:
istrid?
❑Yes ❑No BOILER-COMP(OVER 100.000 BTG)
1 have read the hezamous materials requirements under Chapter 6.95 of tae Cali- AIR CONDITIONER ISSUA ' E ATE
food.Health&Safety Cole,Sections 2,S505.25533 and 25534.1 understand that if the NEW RESIDENTIAL MECH. SQ.IT. -
building does not currently have a tenant that it is my responsibility to notify the occupant
of the requirements which must be met prior to issuance of a Cenilicale of Occupancy.
Owner or oallar ..,cut Date TOTAL: ISSUED BY:
OFFICE
INSTALLATION CERTIFICATE CF-6R
_}lee of this form to satiety the requirements of the Administrative Cods Is optional, but the Information must be provided and posted.
�1/^L / 7771 1f 441 Gam a 75 31:2-
• 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 Distribution (9%r Heating Load Heating
Type (Packaged Manuf. Make & Efficiency Type and Piping Before Over- Equipment
heat pump, etc) Model Number r Location R-Value Sizing fBtuh) Capacity (81uh)
C A5 l'r. &L An oil Ni '> 376 rM°b d C_ 4. 11- c oo
Cooling Equipment
f• Cooling Equipment Actual
Type (Packaged CEC Certified Compressor Unit Efficiency Duct Duct
beat pump, etc) Manuf Make&Model Number (SE R) Location R-value
/ V I
gnature, Date HVAC Subcontr or(Co. Name)
O eneral Contrac!-o'tpR 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
Iygj /# Model# Effic. ilea tonal R-talus R:yalue Loss I!%) jBjubl kW/Blu Credits
CARS O. S ' N z5 SD P=16 Kms_ ' y 3SOw Wo
�k fCjlQ Xe 236
FAUCETS & SHOWER HEADS:
All faucet showerheads installed are listed in the Commissions Directory Of Certified Faucets And Showerheads,
• pure ret Title- rt 77!ec6on 111.
y/,,e�l fL� a54 r1c f'Cry
ignature, Date Plumbing actor(Co. Name)
OR eneral Contractor R Owner
Insulation Certificate
Number and Street City
54A)/"
County Subdivision LoiNu.-tber
Description of Installation
ROOF �// i idrUod���✓e
Materia] /i I.� Brand Name /YfO/A / F" X
Thickness(inches) /' " Thermal Resistance(R-Value)
CEILING �p
at or Blanket Type &P— Brand Name 0
Thickness(inches) 6 Thermal Resistance(R-Value)
Loose Fill Type t+ Brand Name
Contractor's minimum installed weight/ft' Ib Minimum thickness � inches
Manufacturer's installed weight per square foot to acheive Thermal Resistance(R-Value)
EXTERIOR WALL., ///
Material 0 Brand Name 5a' At o Ie—)e-
Thickness
aleThickness(inches) Thermal Resistance(R-Value) R=l�
RAISED FLOOR
• Material 6A-# Brand Name Jrl_A"
Thickness(inches) _� z Thermal Resistance(R-Value) — /
SLAB FLOOR
Material Brand Name
Thickness(inches) Thermal Resistance(R-Value)
Width (inches)
FOUNDATION WALL
t`
Material /V 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 with
the current Building Energy Efficiency Srandards for new residential buildings contained in Title 24 of the
California Administrative Code.
ever nea or(Builder) License Number
-5v / —/3 -9'7
Si eand Tid Date
��A" N,sv A4tPnD 3sya5- v
• Sub-Contractor(Insulation Installer) License Number
-13 —97
Signanue and Title Data
Compliance Fonns Jmman 1, 1995
INSTALLATION CERTIFICATE CF-6R
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.
PckaHeatPump: Packaged central heat pumps.
SolitHeatPum ., Solft central heat pumos.
RDomHeatPump: Room heat Dump.
Lr PckaHeatPum : Larcle Packaged Heat Pumos (>65,000 Btuh output).
Electric: Electric resistance heatinq HSPF=3.413. Radiant electric resist. heating HSPF=3.55
CombinedH 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 & location; Distrib type is 'Ducts", -Piping'or both. Duct location is "Attic-, 'Crawlspace",
"CVCcrawlspace"or"Conditioned space'. Piping location is to be listed as "Gond.'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 : Splits stem heat pump.
Pck HeatPum : Packa 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.
RoomAirCond: Room air conditioner. Min. SEER varies'
• LrgPckgAirCond: Large Packaged Heat Pumps (265,000 Blurt output). Substitute EER for SEER when
SEER is not available.
EvapDirect: 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:I Standard POU/HWR: I Point of use/Hot water recovery
Pipe Insulation: Pie Insulation RecircINOControl: Recirculation loop with no control
RecircTimac Recirculation loop with a timer Recirc/Demand: Recirculation loop with demand
control
ReciroTime+Temp: Recirc.loop with timer and temp RecircJTemp: 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 Pump Gas (Boiler)
Energy Factor Yes Yes Yes Yes
Pilot Input, Btu Yes Yes
Recov. Eff., fraction Yes Yes (AFUE)
Standby Loss, % 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 H dronic System:
Rated Input, kBtuh Yes I I I Yes Yes
Rated Input, kWl Yes Yes
Rec. Eff, fraction Yes