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12100176CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: 10380 IMPERIAL AVE CON TRACTOR: CALIFORNIA DELTA PERMIT NO: 12100176 MECHANICAL INC OWNER'S NAME: NARAYAN VEN'KATARAMANl& KAMAN 6056 E BASELINE RD STE, 155 DATE ISSUED: 1 0124 /2 0 1 2 OWNER'S 1'I TONE: 4083431047 MESA. A'/, 85206 rDONE SO: (866)692-5273 ❑ LICENSED CON"FRACFOR'S DECLARATION r r PERMIT �Q �— 2 ���� BUILDING INFO: BLDC ELECT PLUMB License Class Lic. H O r r r Contractor Date /D- 2Y1� AIECII RESIDENTIAL COAIAIERCIAI, lhcrcb trn arlamlicensed under the provisions of Chapter JOB UESCRI PTION:REPL\CB17URNAC17 AND AIR CONDrrIONING AT SAME (commencing with Section 7000) of Di, ision 3 of the Business & Professions LOCATION Code and that my license is in full force and effect. 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. I have and will maintain Worker's Compensation Insurance, as provided for by Sq. Ft Floor -Area: Valuation: $6187 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 35719096.00 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 state 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 die 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:.�;lam Uatr.��-z L(� Signature Date ❑ ON'NF,R-BUILDER DECLARATION RF; ROOFS: 1 hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed. Ira roof is the following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for 1, as owner of the property, or my employees with wages its their sole compensation, inspection. Will do the work, and the structure is not intended or offered for sale (Sec.7044. Signature of Applicant. Dale: Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). ALA- ROOF COVERINGS TO BE CLASS "A" Olt BE ITER 1 hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSLIRIS I have and will maintain a Certificate 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. I will nhaimain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Cade, Chapter 9.12 and the health & I have and will maintain Worker's Compensation Insurance, as provided for by Safety Code, Section 25532(x) 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 permit is issued. comm umants as defined by the Ifay Area Air Ou:dity \la tagenient District I trill I certify that in the performance of the work for which this permit is issued, 1 shall maintain compliance with the Cupertino Municipal Code. Chapter 9.12 and the Beallh & Safety' Code. Sections 25505, 25533, and 25534. not employ any person in any manner so as to become subject to die Worker's Compensation laws of California. If, after making this certificate of exemption, 1 Ott'ne aft ized • nt:_ `,-- become subject to the Worker's Compensation provisions of the Labor Code, I must Date:_ forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY API'I,ICAN''I' CIiR'1'IFICA'ITON I hereby of irnt that there is a construction lending agency for the performance of work's I eenify that I have read this application and state 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 accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply ARCI I I'hECI" S DECLARA'T'ION 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 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC CF -IR -ALT -HVAC Sire Address: Enforcement Agency: Dare: Permit N: Conditioned menti e1 List Minima Efficient t •Floor Area Duct insulation requirement Thermostat Oui Packaged UnitOver Furnace DAME COP 0 40 R of ducts added or ❑ Setback ' El Indoor Coil SEER 1SPF Served by system Z2jjO 5( replaced in unconditioned space (/fnor alreadypreseni, Lj Condensing Unit ❑ EER _ E]Resistance ❑ R 6 (C% 2 and 9) must be imialled) Lj Other I. Equipment Type: Choose the equipment being installed; if inure than one system, use another CF -I R -ALT -HVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEER, 78%AFUE, 7.71ISPF for typicnl residential systems. ITERS VERIFICATION SUMMARY Listed below arc four HVAC alteration Options. The installer decides what work is being done,and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall be left on site for final inspection end u copy given to the homeowner. At final, the inspector verifies that the work listed on this Form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF -6K and rcgislcmd CFAR forms (no hand filled CF-4Rs allowed) are filled out and signed. Beginning October], 2010, o registered copy of the CF -1R and CF -6R shall also be on site for final inspection. 1. HVAC Changeout Required Forms: • All HVAC Equipment replaced CF -6R forms: MECH-04, MECI I.21 -HERS and (for split systems) MECII-25-ITERS CFAR forms: MECII-21 and (for split systems) MECII-25 • Condenser Coil and/or � CF -6R fomas: MECII-2I-I1ERS and (for split systems) MECH-25-HERS • Indoor Coil and/or CF -4R forms: MECII-21 and (for split systems) Ml -1 -CH -25- • Furnace• For Split Systems: Duct leakage < 15 percent; RC, CCA> 300 CFM/ton, TMAII For Packaged Units: Duct leakage < 15 percent Exempted from duct leakage testing if: ' ❑ I. Duct system was documented to have been previously sealed and confirmed through HEKS verification, or 2. Ductsystems with less than 40 linear feet in unconditioned space, or 3. Existin ducts stems are constructed, insulated or sealed with asbestos ❑ 2. New FI VAC System I Required Forms: ' • Cut in or Changeout with new ducts: (all I CF-61kforns: MECII-04, MECH-20-HERS and (for split systems) MECII- 25 -HERS new ductin read all new a ui menl CFAR forms: MECII-20 and (for split systems) MECIf-25 ' For Split Systems: Duct leakage <6 percent; RC, CCA> 300 CPM/ton, TMAI1. For Packaged Units: Duct leakage < 6 percent ❑ 3. New Ducts with Replacement Required Forms: • Includes replacingor installing all new CF -6R forms: MECH-PI, MECH-20-11FRS,and (for split systems) MECH-25:ARY outdoor condensi ducting and/or outdong unit CF -4R forms: MFCH-20 and (for split systems) MECH-25U La and/or indoor coil and/or Furnace. Not all ®X=M equipment chap ed.' For Split Systems: Duct leakage <6 percent, RC, CCA> 300 CFM/tori, •NIA II CLOD For Packaged Units: Duct lcaka a <6 ercenl FPTFM 4. New Dueling over 40 fee[ Required Forms: "Jill • Includes adding or replacing mon: than 40 CF -6R forms: MECH-04, MECH-2I-ITERS linear feet of duct in unconditioned space. CF -4R fomes: MECH-21 C01— For splits steno or packaged units: Duct leakage < 15 percent EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos. Contractor (Documentation Author's Atesponsible Designer's Declaration statement) I certify that this Certificate of Compliance documentation is accurate and complete. Sfm'jJ • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this,i3efnfc to a of Compliance. ? •r-.� • I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of fide 24, Pans I 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 cam fiance forms worksheets calculations, plans ands ci6cations submitted to the cnforcemant acne fora mvul wit ¢iron. Name: ^ —q vo Signature , Compan/yam Date: Z /7 ,ten.` ' 2 - ddmss:� License: - !��//� S / CI/Simer%ip, _� ,� O Phone. 2008 Residential Compliance Forms - July 2010 CITY OF CUPERTINO F" FEE ESTIMATOR—BUILDING DIVISION APPLIANCE/EQUIP TYPE ADDRESS: 10380 imperial ave. DATE: 10/24/2012 REVIEWED BY: bobs. UNITS APN: BP#: 1a1001 •VALUATION: $6,187 *PERMITTYPE: Mechanical Permit PLAN CIIECK Tl'PE: Alteration / Addition / Repair PRIMARI SFD or Duplex USE: # PENTAMATION FURN/AC PERIIIIT TYPE: WORK sfd replace furnace with new. SCOPE Supp/. Insp 1,ee APPLIANCE/EQUIP TYPE FEE ID Phmhh. Plan Check QTY UNITS BP FEES Elec. Permit Fee: Furnace, Forced -Air 1MFR=<100 Other Elec. hhsp. 1 # $133 A/C Units (<=10K cfm) 18REMAIR Supp/. Insp 1,ee 1 # $67 PME Unit Fee: $200.00 PME Permit Fee: $45.00 Construction Tax: Administrative Fee: lAD,tfhV $42.00 Work Without Permit? O Yes (j) No $0.00 TOTALS: i Travel Documentation Fee: ITKA PDOC $200.00 Strove Motion Fee: IBSEISAIICR NOTE: This estimate does not include jeer due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sehver District, School District, etc). These fees are baser/ on the Prelitninan, information available and are only an eviinmte. Concoct the Dent for addn'l info. FEE ITEMS free Resohaion I1-053 Efi' 771112) Mech. Plan Check 0.0 his $0.00 Phmhh. Plan Check Elec. Plan Check Mech. Permit Fee: IMPERMIT Plumb. Permit Fee: Elec. Permit Fee: Other Mech. Insp. 1 0.0 his $45.00 01her Plumb Ince.El Other Elec. hhsp. . 1e.ch. hup. Fee: Phoob. htsp. Fee: Elec. Insp. Few: NOTE: This estimate does not include jeer due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sehver District, School District, etc). These fees are baser/ on the Prelitninan, information available and are only an eviinmte. Concoct the Dent for addn'l info. FEE ITEMS free Resohaion I1-053 Efi' 771112) FEE QTY/FEE MISC ITEMS Plan Check Fee: Sapp/. PC Fee PME Plan Check: $0.00 Permit Fee: Supp/. Insp 1,ee PME Unit Fee: $200.00 PME Permit Fee: $45.00 Construction Tax: Administrative Fee: lAD,tfhV $42.00 Work Without Permit? O Yes (j) No $0.00 Aelvwtced Planning Fees: i Travel Documentation Fee: ITKA PDOC $45.00 Strove Motion Fee: IBSEISAIICR $0.62 Select an Administrative Item I31de Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $333.62 $0.001TOTAL FEE: $333.62 Revised: 10/01/2012 GENERAL PERMIT APPLICATION M E 1 COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISION (408) TORRE AVENUE -) 77-33 INO, CA 95014-3255cuDerd 7 Oh w w I CUPERTINO (408)777"3228•FAX (C08)777-3333•buildinG(�a�Derino.ora oC (/ ej\a/' —/ / /17� U'bffiING . O kNICAL I�i:E=CAL L l MfISCELLAXEOUS X r I PRO=ADDRESS CPN. a o i0 3 P 0 1i? Pte,• < OWNc"R NAME :MAIL ' ST'R.E=I ADDRESS D YD — Ci1Y, STAT; ZIP I FAX P n D CONTACT NAME PHONE I E-MAIL ST Ft—= ADDRESS CTY, YTATc, ZIP FAX ❑ OWNER ❑ OWTQ-Bb=M ❑ OWNER AGENT ❑ CONTACTOR ❑ COMRACDORACENT, ❑ ARO -Tr 13 ❑ D1�P�- ❑ TENANT CONRACTOR NAI.SE LC- E R LICENSE z G IBUS. LIC ALJ COMPANY NAAE E-MA1L 2 � z -Co FAX BTR ESTI D °55 _ S QTY, STAT;- a PH -:'200-0 ARGSI7CTF_NG1N MRNAME I uC_NSc.WNSER BUS. Lick CONQiANY NAAE ' E-MAE. FAX STR=ADDRESS CITY, STATT=, ZB PHONE USE OF SFD m DMIDC ❑ MULTLFAMB.Y BU=NG: ❑COMMERCIAL ?ROT IN WZDL1ND ❑ YS PROC�IN ❑ YFS URBAN DM FACE AREA ❑ NO FLOODZONE ❑ NO IS =1 BLDG AN ❑ Y=S EICHL=R HOME? ❑ NO DESCRIPTION OF WORK ' A"e- To c c s- oL c TOTAL VALUATION: 199.0 0 O I RE -COVED BY: 7 By my sigten:re blow, I c.-rdfy m each of the `ollowing: I am the prone,y owne�otasthoriz-d agent m act on the pmpe,y owner's behalf. I have read ;his application and the information I have ptnvided is co,ecL I have read.ix Desaipdon of Work and verity it is ac=mtc. I ageq:o comply wiLh all applicable local a -direr ces and state laws relating Wbl;- ng ccnsaaction. Lau: Do U reDnsmumvcs of Cpe,ino to enter the above-identi5edap�m/pel far inspection poroses. Signature of ApnlicandAgen _ Date: /d - 2 / Z L'PPLEMEIN i AL IN7ORMATION R.EQUUI-i ED ' OFFICE USE ONLY r u m V L 12 -61 -11 -THE -COUNTER ❑ EXPRESS ❑ STANDARD ❑ LAROE ❑ MAJOR MFPMucApp_?011.doc revised 06/11/11