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12030138 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10856 BROOKWELL DR CONTRACTOR:SAN JOSE AIR PERMIT NO: 12030138 CONDITIONING,INC. OWNER'S NAME: RAJESH SHAH 476 W TAYLOR ST DATE ISSUED:03288012 OWNER'S PHONE: 4082557075 SAN JOSE,CA 95110 PIIONF"NO:(408)286-2047 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class a ie.N J / /1� n �7 Z MECH r RESIDENTIAL r COMMERCIAL r Contractor G / ��// Date —`� � / 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE AND REPLACE THE FORCED AIR UNIT(D&N (commencing with Section 7000)of Division 3 of the Business&Professions G8MYL0902116A) Code and that my license is in full force and effect. 1 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 peril is issued. I have and will maintain Workers Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$900 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued APN Number:36921026.00 Occupancy Type: APPLICANT CERTIFICATION 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 stale laws relating to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. 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. Issued by: �h/ Date: �/�- pp 1 Signature ate _Z O— ❑ OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is hereby affirm that 1 am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection 1,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, Signature of Applicant. Date: Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Ceni Bcate of Consent to self-insure for Worker's 1 have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534, 1 will maintain performance of the work for which this peril is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Ilealth& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should 1 store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should 1 use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will peril is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Ilealth&Safely Code.Sections 25505,25533,and 25534. 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 Ow nerdPpgy! riz .�enl: �7 U become subject to the Worker's Compensation provisions of the Labor Code,1 must �� `"' Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION 1 hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and stale that the above information is for which this permit is issued(Sec.3097,Civ C.) correct. I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may acerae against said City in consequence of the granting of this peril Additionally,the applicant understands and will comply .ARCIIITF.(T'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: 'Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36921026.00 DATE ISSUED. . . . . . . : 03/28/2012 RECEIPT #. . . . . . . . . : BS000016384 REFERENCE ID # . . . : 12030138 SITE ADDRESS . . . . . : 10856 BROOKWELL DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : RAJESH SHAH ADDRESS . . . . . . . . . . : 10856 BROOKWELL DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : A-1 HEATING&COOLING CONTRACTOR . . . . . . . : WILLIAM GENTILE LIC # 24783 COMPANY . . . . . . . . . . : SAN JOSE AIR CONDITIONING, INC ADDRESS . . . . . . . . . . : 476 W TAYLOR ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95110 TELEPHONE . . . . . . . . : (408) 286-2047 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- --------- -ADMIN HOURS 1 .00 41.00 0.00 41.00 0. 00 1BCBSC VALUATION 900.00 1.00 0 .00 1 .00 0.00 1BSEISMICR VALUATION 900.00 0.50 0 .00 0 .50 0.00 1MFR=<100 UNITS 1.00 130.00 0.00 130.00 0. 00 1MPERMITFE FLAT RATE 1.00 44 . 00 0.00 44 .00 0.00 1TRAVDOC FLAT RATE 1 . 00 44 . 00 0. 00 44 .00 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 260. 50 0 . 00 260 . 50 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ------------- CHECK 260.50 #2080 --------------- TOTAL RECEIPT 260.50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- -------------------- -------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO 191. FEE,ESTIMATOR- BUILDING DIVISION ADDRESS: 10856 Brookwell Dr DATE: 03/28/2012 REVIEWED BY: Sean APN: BP#: 'VALUATION: $900 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition / Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: PERMIT TYPE: WORK Remove and replace the forced air unit (D&N G8MYL0902116A SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air iMFR= 100 1 # $130 TOTALS: $130.00 Meeh.Plan Check 0.0 hrs $0:00 Plumb. Plop Chcck @iec Plan(:heck Meeh. Permit Fee: IMPERMIT Plumb. Permit Fac: Elec. Per..b Fee: Other Mech. Insp. 1 0.0 hrs $44.00 Other Plumb Insp. O/Ger Oct..hmp. 3loch.Imp. Fee: Plum& Giep. Fe". Eler.hisp. I-e NOTE:This estimate does not includejees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,eta). These fees are based on the prelimina information available and are only an estimate. Contact the De t or adds 7 info. FEE ITEMS(Fee Resolution /1-053 EI7/1/111 -FEE QTY/FEE MISC ITEMS Plan Check Pee: Supp/. PC l e e PME Plan Check: $0.00 Pconit Fire' .Sapp/. Grsp Fce PME Unit Fee: $130.00 PME Permit Fee: $44.00 Consirin:iion has: Administrative Fee: (ADMIN $41.00 Work Without Permit? Yes (E) No $0.00 .1 rhvnic ed Maiming Fees: Travel Documentation Fee: ITRA VDOC $44.00 Strone Motion Fee: (BSE/SMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $260.50 $0.00 TOTAL FEE: $260.50 Revised: 1/19/2012 Prescri Live Certificate of Compliance: Residential CF-IR-ALT Residential Alterations to Existing Buildings (Pae I of 4) Site Address: Enforcement Agency: Date: Project Name: Climate Zone# Hof Stories Project Type❑Alterations Building Type❑Single Family❑ Multi Family Circle the Front Orientation:N,E,S,W,or degrees Conditioned Floor Area of Altered Space(CFA): Fuel Type(Gas,Electric,etc): NOTE:Complete and submit applicable sections of the CF-IR-ALT Form for the altered building cornponent(s). Opaque Surfaces Assembly Alteration ❑ Opening of framed cavity alone—Alterations that involve the opening oftheframed cavity of n•all, ceiling•orfoor must insmll the mandatory mininmm insulation value per§150for the altered assembly. ❑ Replacement of entire assembly—Replacement ofan entire wall, ceiling,orfoor assembly requires the installation of Component Pack-age D insulation values in Table 151-C. Assemblies: Standard Wood-frame'3 Assemblies: Other Than Standard Wood-frame 2,3 Standard Assembly Pro osed Assembly 1 2 3 4 5 6 7 8 9 10 Assembly Type Frame Type Cavity Continuous Ref.JA4 Column U- Ref.JA4 Column U- Roof,Wall,Floor Wood,Metal,Mass R-Value R-Value Table and Row factor Table and Row factor (Sample)Wall Wood 13 6 4.3.1 A5 0.069 4.3.1 D3 0.063 i. Fill out Columns 1-4 o ly for wood frame built assemblies that meet the Component Package minimum Cavity R-value. /f unable to meet the Cavity R-value then ALL 10 colmnns must be filled out. 2. For all other assemblies fill out ALL 10 colunms by indicating values fi-onh the Reference Joint Appendix JA4. The U factor of the Proposed Assembly most be equal or less than the Prescriptive Standard Wood Frame assembly. 9. Refer to the Special Features section on Page 4 of the CF-IR-ALT or additional requirements and check applicable boxes. FENESTRATION PROPOSED AREAS & ENERGY FACTORS ❑ Replacing window alone—Replacement windows shall meet the LI-Factor and SHGC Value requirements of Component Package D in Table 151-C. 71re Total Fenestration and West facing Area requirenhents are not applicable. ❑ Adding 50ft'or less of window area—Newly installed windows shall meet the U-Factor and SHGC Value requirements of Component Package D in Table 151-C. The Tota!Fenestration Area requirement is not applicable, but the existing hwest facing fenestration area shall not be increased by more than 50 fit. ❑ Adding more than 5011=ofwindow area— Newly installed windows shall meet the U-Factor and SHGC Value and the Fenestration Area requirements of Component Package D in Table 151-C Complete the Altered Fenestration Allured Area Table on Page 2 of the CF-IR-ALT Fenestration Type Orientation PropsedArea Maximum Maximum (Window,Glass Door or Skylight) (North,East,South,West) (ft) U-factor2.3 SHG C2.II 1. Fenestration area is the area of total glazed product(i.e.glass plus frame). Exception: When a door is less than 50%glass,fenestration area may be glass area plus 2" frame"around the glass. Enter voluefr-om Prescriptive Package Requirementsfn-onn either Table 151-C. Actual fenesnotioh products installed shall be equivalent to or have a loner U Inchon and/or a lower SHGC than that specified on the Installation Certificate(Form CF-6R-ENV). 4. .4ubmlt a cam leted IVS-3R if a reduced SHGC is calculated with exterior shading. Registration Number: Registration DatelTirne: HERS Provider: 2008 Residential Compliance Fornis December 2008 • Prescriptive Certificate of Compliance: Residential CF-IR-ALT Residential Alterations to Existing Buildings (Page 3 of 4 Site Address: Enforcement Agency: Date: HVAC SYSTEMS-HEATING Minimum Duct or Piping Heating Equipment Efficiency Distribution Insulation Thermostat Configuration T ''3 Type and Ca acit � (AFUE or HSPF) Type an Location R-Value" T e (Split or Package) C/ a I.Indicate Heating Type(Central Furnace, Wall Furnace,Heat pump,Boiler,Electric Resistance, etc.) 2.New Treating equipment shall be limited to natural gas, liquefied petroleum gas, or the existing fuel type. Electric resistance hearing is allowed as supplemental heating if the total capacip+<1 KW and electric heating is controlled by a time-limiting device not exceeding 60 nninutes 3.Refer to the HERS Verification section on Page 4 of the CF-IR-ALT Fornr for additional requirements and check applicable boxes. 4. Indicate Tvpe or Location(Ducts, H ydronic in Float-,Radiators, etc.) HVAC SYSTEMS-COOLING Minimum Efficiency Duct or Piping Cooling Equipment (SEER/EER or Distribution Insulation Thermostat Configuration Type and Ca aci t.2 COP) Type and Location R-Value3 Type (Split or package) 1. Indicate Cooling Type(A/C,Hear pump,Evap. Cooling, etc) Refer to the HERS Verification section on Page 4 of the CF-IR-ALT Form for additional requirements and check applicable bores. J. Indicate Tipe or Location(Ducts,H ydronic in Floor,Radiators, etc.) WATER HEATING List water heaters and boilers for both domestic hot water(DHW)heaters and hydr onic space hearing. Individual dwelling DHIN heaters nmst be gas a-propane fired, and nay not exceed 50gallons. Hot water pipe insulation from the DHIV heater to the krichen(s)and on all underground hot water pipes is required in all cont onenr packages in all climate zones. Water Heater Type/Fuel Distribution Type Number Tank Energy Factor or Tank Insulation Ty eI= (Standard,Recirculation)' In System Capacity(gal) Thermal Efficiency R-Value' 1. Indicate ripe(Storage Gas,Heat Prmrp, Instantaneous, etc.) 2. The new water heater type shall be limited to natural gas, liquefied petroleum gas,or the existing fuel ripe. 3. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of§150(x). The Prescriptive requirements do not allow the installation ofa recirculating water heating systern for single dwelling units. 4. The external water heating tank and pipes shall be insulated to meet the requirements of§1506i). SPECIAL FEATURES The enforcement agency should pay special attention to the Special Features specified in this checklist belov. These items may require t+riven justifncation and documentation and special verification. NEW ROOF ASSEMBLY-Radiant Barrier O YES O NO Yes: In CIZs 2,4,and 8-15,replacing the entire roof assembly requires the installation of a radiant barrier to meet§151(02. Slab Edge(Perimeter) Insulation O YES ONO YES: In Climate Zone 16 in Component Packages D,R-7 insulation is required. Heated Slab Insulation O YES O NO YES: Slab edge insulation required for all heated slabs in all Climate Zones. See details in Table 118-A of the standards. Raised Slab Insulation O YES O NO VES: In Climate Zones I,2, 11, 13, 14& 16,R-8 insulation is required;in Climate Zones 12& 15,R-4 is required under component Package D. 3 hermal Mass fo obtain Compliance Credit for the installation of thermal mass,use the Performance Approach. Registration Number: Registration Date/Tune: HERS Provider: 2008 Residential Compliance Forms December 2008 GENERAL PERMIT APPLICATION �� O S EP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014255 I CU77 PERTINO (408)7 -3228• FAX(408)777-3333•'buildinalODcuoerSno.OrD sc PLUMBING MECHANICAL =CIRICAL MIISSCELLANEOUS PROJECT ADDRESS S— til L APN s OWNER NAME .J12L. A�J PHONE a fS 70YJ - ' STREh7ADDRESS _. ` /�'+ n .0 CRY.STA 7$ /��^ FAX CONTACT NAME `J /V PHONE E-MAIL STREETADDRESS CITY,STATE ffi FAX ❑OWNER ❑ OwNER-BumLUm ❑ OWNER AGENT ❑ CONTRACTOR ❑CON?RACIOR AGENT ❑ ARamH.T ❑ENGINEER ❑ DEVEIAPER ❑ TENANT CONTRACTOR NAMELICENSE NUMBER LICENSE TYPE BUS.LIC p '-7f COMP E-MAIL FAX J J i7 ? S %/L O STREET ADDRESS MY,STATE,ZD' PHONE ARCHITECTIENOWEFR.NAME LICENSE NUMBER BUS.LIC M COMPANY NAME' E-MAIL FAX STREET ADDRESS CRY.STATE.ZIP PHONE USE OF ❑SFDaDUPLEX ❑ MULTI-FANNY PROJECT IN WB.DIAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL- URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EIOB.FJI HOME? ❑NO DESCRIPTION OF WORK TOTAL VALUATION: 9 D 4 ` RECEIVED BY: By my sigoatu e below,I certify to each of the following. I am the property owner or®thoriud agent to act on the property owner's behalf. 1 have read this application and the information I have provided is correct have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and sate laws relating to ho' ' g trucdon. I authorize represrnmtiv f Cupertlno to enter the above-identified pm erry forCinspecuo/¢puFJposes. Sigaatm ofApplicant(Agent Date: � o �r SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY y OVER-THE-COUNTER 6 ❑ EXPRESS Y O m ❑ STANDARD 'u 3 ❑ LARGE ❑ MAJOR MEPMtrcApp_2011.doc revised 06/21/11