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12040043 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10524 S FOOTHILL BLVD CONTRACTOR:SANTA CRUZ PERMIT NO: 12040043 MECHANICAL OWNER'S NAME: CRUZ ERNEST M ANDGRACE R TRUS 2511 S RODEO GULCH RD DATE ISSUED:04/06/2012 OWNER'S PHONE: 4085373030 SOQUEL,CA 95073 PHONE NO:(831)477-0845 %_ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class C20,C41 Lic.q 59894 S r r r MECH RESIDENTIAL COMMERCIAL Convector Srt-rrOCr�uZ MaiHtCAI, Date y 1 11- I hereby affirm that I am licensed under the provisions of Chapter 306 DESCRIPTION:REMOVE AND REPLACE FURNACE (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 penally of perjury one of the following two declarations: I have and will maintain a certificate of consent to sel6insure 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.FI Floor Area: Valuation:$2000 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 permit is issued. APN Number:35705054.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and stale that the above information is correct. I agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspeclion purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 D YS FRO ST CALLED INSPECTION. costs,and expenses which may acerae against said City again consequence of the granting of this permit. Additionally,the applicant understands and will comply Iy '_— with all non-point s er the Cupertino Municipal Code,Section Issued by: ' Date: 9.18. Signor Date RF.-ROOFS: ❑ OWNER-BUILDER DECLARATION 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 I hereby affirm that 1 am exempt from the Contractor's License Law for one of inspection. the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sce.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penally of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: 1 have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the labor Code,for the compliance with the Cupertino 111 unicipal Code.Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(x)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the &S I certify that in the performance of the work for which this permit is issued,I shall health a lions 25505,25533,and 25534. not employ any person in any manner so u to become subject to the Worker's Owner o ed agent: Compensation laws of California. If,alter making this certificate of exemption,I Dale: y /Z become subject to the Worker's Compensation provisions of the Labor Code,I mus forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDL G AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that l have read this application and state that the above information is Lender's Name correct.1 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities.judgments, ARCHITECT'S DECLARATIONcosts,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 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 . . . . . . . . : 35705054 .00 DATE ISSUED. . . . . . . : 04/06/2012 RECEIPT #. . . . . . . . . : BS000016485 REFERENCE ID # . . . : 12040043 SITE ADDRESS . . . . . : 10524 S FOOTHILL BLVD SUBDIVISION . . . . . . : CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : CRUZ ERNEST M AND GRACE R TRUS ADDRESS . . . . . . . . . . : 306 LOS OLIVOS WAY CITY/STATE/ZIP . . . : MODESTO, CA 95351 RECEIVED FROM SANTA CRUZ MECHANIC CONTRACTOR BILL HALL JR LIC # 33423 COMPANY . . . . . . . . . . : SANTA CRUZ MECHANICAL ADDRESS . . . . . . . . . . : 2541 S RODEO GULCH RD CITY/STATE/ZIP . . . : SOQUEL, CA 95073 TELEPHONE (831) 477-0845 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 2, 000.00 1.00 0. 00 1.00 0. 00 1BSEISMICR VALUATION 2, 000 .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 #9326 --------------- TOTAL RECEIPT 260.50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION 1172 ADDRESS: 10524 S. Foothill Blvd DATE: 04/06/2012 REVIEWED BY: Sean APN: BP#: 'VALUATION: $2,000 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: PERMIT TYPE: WORK Remove and replace furnace. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $130 TOTALS: $130.00 Mech. Plan Check0.0 hrs . $0.00 Phnub. Plan Check Elec. Wan Check Mech. Permit Fee: IMPERMIT Plumb. Permil Fev: /ilex. Pdrmit bbd: Other Mech. Insp. 0.0 hrs $44.00 Ochry Plumb/n,p. Lj Ocher Elec. lusp. ,Llerh. lrrep. lSrc: Plumb. he,p. Fed.- like.lusp. Fcc 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 prefiWna information available and are only an estimate Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-053 LB' 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fru: Suppi. PC:Feu PME Plan Check: $0.00 Perini! Fee: Sit/)/)/. lu.vp Feu PME Unit Fee: $130.00 PME Permit Fee: $44.00 Consnvcaon Tut: Administrative Fee: (ADMIN $41.00 Work Without Permit? O Yes 0 No $0.00 Ae/ranced Plaiming Fees: Travel Documentation Fee: ITRA VDOC $44.00 Strong Motion Fee. IBSEISMICR $0.50 Select an Administrative Item 131de Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $260.501 $0.001 TOTAL FEE: $260.50 Revised: 04/01/2012 Prescriptive Certificate of Compliance: Residential CF-IR-ALT Residential Alterations to Eidsdng Buildings (Page 4 of 4) Site Address: - Enforcement Agency: Date: 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 before final 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)l Dii and the newly installed ducts are to be insulated per§15l(f)10. ❑ EXECPTION: Existing duct systems that are extended,which are constructed,insulated or sealed with asbestos. ❑ YES ❑NO Yes:In Climate Zones 2 and 9-16, if an entirely new ducted system is installed,the ducts are to be sealed per§152(b)l Di. ❑ YES ❑NO Yes:In Climate Zones 2 and 9-16,if the existing HVAC 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,of the furnace heat exchanger)the ducts are to be sealed per§152(b)I E. "- 13 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. ❑ EXCEPTION: Existing ducts stems constructed,insulated or sealed with asbestos. Cooling-Split System HERS verification is required for this measure. ❑YES ❑NO YES:In Climate Zones 2 and 8-15,when the existing ducted split A/C or heat pump is replaced(including the replacement of the air handler,outdoor condensing unit of a split system A/C or heat pump,cooling or hearing coil,or the furnace heat exchanger)the refrigerant charge shall be verified per§152(b)I F. 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 for this measure. ❑YES ❑NO YES: In Climate Zones 10 through 15,when the entire existing space conditioning system(HVAC equipment plus the ducts)is replaced,the airflow and fan watt draw shall be verified per§152(6)I Ci to meet the requirements of§151(f)7B. Documentation Author's Declaration Statement , • I certify that this Certificate of Compliance documentation is a nd corn tete. Name: Si Jf►R4i0 Company: Date: rt'CIA GRUZ tVl�fl4R/u^�FL Address: - EA# aSH/ 50. f�Ot>C� (yu�G� RD it�I CEPE# City/State/Zip: Phone: Principal Envelope Designer's Declaration Statement • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the envelope design. • This Certificate of Compliance identifies the envelope features and performance specifications required for compliance with Title 24,Pages I and 6 of the California Code of Regulations. • The design features represented on this Certificate of Compliance are consistent with the information provided to document this 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: Company: - Date: Address: License# City/State/Zip: Phone: For assistance or questions regarding the Energy Standards,contact the Energy Hotline at:1-800-771-3300. Registration Number. Registration Date/Time: HERS Provider 2008 Residential Compliance Forms December 2008 y '.7.1-'t`S""-,S'•''*ryr 'Ac„''17/rr^ y`.'R'rTi r/ry�t ri7r J-.y t.° Y rx. ,, /'�{Tr .nu» y �`�� ) l' 1+ 'r i t'l'{ { �� C Y f 'l,.i I i V l 1 � 1�'`i• "� SSC y N tt .t}**//(0•ly.y f� iiyy??ry�; 4 y�{�'� �� `A'� yAt4 j�l,:Jai;�.+�5 y1 r � 4A t11"a.� ,}e h .tt/! n',F` lF.(! y�d I • ( '�� t4'i tiM�Piu' rytiu75�i 'rfSShct�i r�t� 4ry4 S I lwp d i V"" + [ �p 12; . 'S r ` Sr*RS'tri t CLQ f M' Nrj rn jypm rtip / � I J ` Y/ � i✓v."}ur�t in��'�q,}At`t),rFaryl�., �9xi�, IGS r.f1ts�«I�Y� y,'`�4.rk,�t�t�r l"i^rJv'y r11�� ly 3,�yt P� �d lrt 4 a•l: ��yy t 1 1 1 n 6 YR4��'•r ) >{R 7cw% s ��2 �w ( F r '' i t w lV 5`l*.ttlntl: r' "9 }} „yd", V! r � 5 y'nt f 4 1 I' ✓� i`k^ >r F y/'R•rL,,l7ty LFSIS`yy; ,1�lar U t� p a�iSlrJlydR�rP'��ptPrSO.. J 4Y •/ ��k r)L�' 7a 11)r N,4. .{)14� 4 tnr�a � �{Jf Ql �!}c ` .! l-103 �) ProductrSpe'c�ficat�onS , 80% Single Stage Heating Furnace EASIER TO SELL •80%AFUE • Flame roll-out sensors standard • Category I venting �. • Blocked vent switch • Louvered door f r • 24 VAC and 115 VAC humidifier terminal • Electronic air cleaner terminal 1. •Twinning furnaces of same heating and cooling sizes with approved kit ') • N8MSL California NOx approved TOUGHER era • PSC blower motorK>' , • Adjustable heating blower OFF dela ± '1 .:r ' "•' '� "'`" • Factory set blower ON delay • RPJ aluminized steel heat exchanger 9 „ Yi • High temperature limit control prevents overheating • Direct ignition with Silicon Nitride ignitor • One piece prepainted steel cabinet Illusuelions and pholoprephs are only lapmentative. QUIETER sem°product models may very. • In-shot bumers EASIER TO INSTALL AND SERVICE WARNING • 33 1/3" (847mm) hlgh,for ease of installation This urnace is not designed for use in mobile homes, , • Innovative knobs for easy door removal and secure attach- trailers, or recreational vehicles.Such use could ment result in property damage and/or death. • Factory shipped for natural gas,with propane gas conversion kits available • Four position-upflow/downflow/horizontal (left/right) CERTIFIED- installation • Three position inducer elbow capability use of the MRI camfied na Mark indicates a •Through the casing flue pipe for counterflow applications m,snufardurees participation in IM program.For verificcalm of certification for individual producb, • Common venting with other Category 1 appliances gutov°vay.anridvwo,y.org. • Masonry chimney adapter available Iso 9001:2000 aESleh • Self diagnostics • Slide out blower assembly WARRANTY- * ARRANTY•• 20 year heat exchanger limited warranty oFprlttt°® • 5 year parts limited warranty With timely registration,an additional 5 year parts limited warranty • Applies to original purchaser/homeowner,some limitations may apply.See warranty certificate for complete details. Cooling Capacity Input Efficiency CFM range Dimensions H x W x D Shipping Wt. Model Size (MBTUH) AFUE ®.a In.w.e.(125 Pa) Inches(Millimeters) Lbs(Kg) 7777x77777TZMa x 29(847 x 360 x - - x x x x 7 . 6 � x x x Jw x -1 rJ x x x 30U x 737) N8MSN - x - x x 445 x _ N8MSL 33-11.3 x - x (8477Z977777- -2165 33-1/3x 21 x x 533 x 7 146(66) -ZWU* Ji-iri x P-XT§747 x 633 x 5 x Zi x x x 1352422A - - x x x 622 x 73 1 4 d0°•�•11b'p 10d1•�'ad°ei°°'� 441 14 1401 04 Oct. 2010 12-0 (+ GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 M ' A CUPERTINO (408)7T7-3228• FAX(408)T77-3333•buildino(�cuoertino-ora (v' ❑mumBAIG M)ECHANICA.L ELECTRICAL ❑MISCIMLANEOUSS� yf� PROJECTADDBEST , 1 \\�. V1� ,w,,�,��py.�� Na�S OWNER NAME IW `1 Z tl G/ PH 'El�j'►S 3�(3O� E MAD. STREET ADDRESS Q— 1 . OST \lL "'�, STATE, pcRTINU FAX —1 �Jg 9561 CONTACT NAME n. PHONE Jy 1—C�-1 --3p EMAIL STAFSTADDRFS91 05^L"1 CL7Y,STATE�3ZIP� J FAX V P �7 J VlJ V 1W612Ttiv0� OWNER OowNER.aurLom . ❑ OWNFAAaENr ❑ mNTR =R ❑mNtRwCTORAGENT ❑ cARRt+]sV=r ❑woD14A ❑ DEVELOPER ❑ TFSUNr CONTHACTORN LL E11R1. 'S2 ucwsENL,r r'1S G10 cq-3 Bvs.ucx5q,Z9y4Y wn"ANYNAAs�N GR�12 «IhN�GfG— ESQ flNaCtAl4 ./vcT F�1 `4-1) -15-73 BTRFFrADDREss, o6-ULGNRosk SaCZ CA .. 9.S-6-7 �C541�411'-6$`{S ARCH T /ENGINEER NAME LICENSE NUAMFR BUS.LIC p OOMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE.ZIP PHONE USE OP SFO wOUPIFJt ❑ MULTI-m m.Y PROJECT IN WBDLAND ❑ YFS PROInN ❑Y6 tS THE BLDG AN ❑YES BUDDING: muwmert.r URBANOIi}RPACE AREA NO FLOOD ZONENO ECIDFR HOME? 1;*o DESCRIPRON OF WORK Rad F<.6 Kc1. <et4d^T T TOTALVALUATION: ��QQ RECEIVED BY: By my signature below.I certify to each of the fall the property avraw ar authorized agent to act on the property a ces behalf. I have read this application and the iin'ormatiou 1111 ve prove correct have a Description of Work and verify it is accurate. I agree ID comply with all applicable local ordinances and state laws relating to building of Cupertino to enter rhe abaav i Properly for mspecum purposes. Signature of Applicant/Ageot: Dam: t f0 Z SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY m OVER-THFICOUNTER d ❑ CRESS Is r ❑ STANDARD u ❑ WtCE ❑ MAJOR MPPM1sc 1pp_2011.doc revised 06/21/11