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11050081CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10325 FARALLONE DR I CONTRACTOR: COLD CRAFT INC PERMIT NO: 11050081 OWNER'S NAME: UNDERWOOD PHILIP G AND MARCIA OWNER'S PHONE: 4082575781 MCA--- LICENSED CONTRACTOR'S DECLARATION License Class `2�37Lic. # c � 6 HT - Contractor -Contractor ` ,c) )J -1kC- ' Date 5— 1_0 ~� I hereby affirm that I am licensed under the provisions of Chapter 9 (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 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 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 upon the above mentioned property for inspection purposes. (We) agree to save 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 with all non -point sourc er the Cupertino Municipal Code, Section 9.18. _ Signatu Date – / OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, 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, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I certify that in the performance of the work for which this permit is issued, I shall 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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 upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, ^sts, and expenses which may accrue against said City in consequence of the ,ting of this permit. Additionally, the applicant understands and will comply _„th all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date. 181 LOST LAKE LN DATE ISSUED: 05/12/2011 CAMPBELL, CA 95008 PHONE NO: (408)374-7292 JOB DESCRIPTION: RESIDENTIAL C1 COMMERCIAL INSTALL A/C UNIT AT SFDWL Sq. Ft Floor Area: I Valuation: $6496 APN Number: 36931013.00 1 Occupancy Type: PERMIT EXPIRES WORK IS NOT STARTED WITH S OF PERMIT ISSUANCE OR 180 D RO LAST CALLED INSPE TIO 1 Issued Date: I RE -ROOFS: 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 inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A” OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. / Owner or authorized agent: J Date: S l6 f CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 MIS(408) 777-3228 • FAX (408) 777-3333 • buildina(@cupertino.org CUpERTINC? ❑ PLUMBING MECHANICAL ❑ ELECTRICAL [:]MISCELLANEOUS PROJECT ADDRESS APN # /� n ✓( 1 ,(J OWNER NAM P ONE E-MAIL Z STREET ADDRESS IC)3 g� /,_� � /�� ITY, ST TE, ZIP 0 W\ 1 y FAX CONTACT NAME Y ! PHONE o `E' -MAIL C�t.-b v Q- — STREET ADDRESS CITY, STATE. ZIP FAX R ❑ OWNER -BUILDER ❑ OWNER AGENTC� ONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT C N RACTOR N E ep, } e y, p LIC NSE NUMBER �03 183-7 LICENSE TYPE io �za cab BUS. LIC # Co i 3 7 MPA Y NAM M E-MAIL Cd �� FAX STREET ADDRESS j� % Z:_0,5 7L Y, STATE, ZIP (� / PHONE - .74_ ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF FD or Duplex STRUCTURE: ❑ COtI1IIlerClal N WILDLAND URBAN INTERFACE AREA ❑ Yes ❑ NO PROJECT IN FLOOD ZONE ❑ Yes ❑ No DESCRIPTION OF WORK L hL�L j:1) -Ad TOTAL VALUATION: �! J-�' CCVJJ RECEIVED BY r By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating t u ding construction. horize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: I �' SUPPLEMENTAL INFORMATION REQUIRED a�>»ICE�py MEPMiscApp_201 1. doc revised 03/16/11 INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning Systems, Ducts and Fans Pae 1 of 2 Site Address: / o Sas %aa -4t-) r, Q C>,—. IEnforcement Agency: Permit Number: Space Conditioning Systems Heating Equipment Cooling Equipment Equip°,�, Type (package�'AC heat um �j �� e V Certified Mfr. Name and Model Number ARI Reference Number z # of Identical Systems Duct Duct Location (attic, crawl- space, etc. Duct R-value(Btu/hr) Cooling Load Cooling Capacity Btu/hr Efficiency Location c Xis%/ Equip (AFUE, (attic, Type ARI # of etc.)I' 3 crawl- Heating Heating (package- CEC Certified Mfr. Name Reference Identical (>_CF -IR space, Duct Load Capacity heat um and Model Number Number 2 Systems value 4 etc.) R -value Btu/hr Btu/hr oI fIpc U 0 Cooling Equipment Equip°,�, Type (package�'AC heat um �j �� e V Certified Mfr. Name and Model Number ARI Reference Number z # of Identical Systems Efficiency (SEER and EER) 1' 3 (>_CF -1R value)4 Duct Location (attic, crawl- space, etc. Duct R-value(Btu/hr) Cooling Load Cooling Capacity Btu/hr c Xis%/ l 1. Ij project is new construction, see r ootnotes to 3tanaaras tante t j t -n ana hate Oji -u jur uuct cetung utterrtutt ve compliance. 2. ARI Reference Number can be found by entering the equipment model number at http://www.aridirectory.orglarilac-php# 3. Listed efficiency on this page must be greater than or equal (>_) to the value shown on the CF -1 R form. 4. When CF -IR is reference it is also applicable to the CF -IR, CF -IR -AA or CF -IR -ALT LL BOXES MUST BE CHECKED TO BE A VALID FORM § 110-§ 113: HVAC equipment is certified by the California Energy Commission. § 150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA, or ACCA. § 150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of § 112(c). § 15W)2: Pipe insulation for cooling system refrigerant suction, chilled water and brine lines meets minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entirely in conditioned space. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning Systems, Ducts and Fans (Page 2 of 2 Site Address: / f Enforcement Agency: Permit Number: e.52 -15i ,® is Ducts and Fans §150(m): Duct and Fans ❑ 1. All air -distribution system ducts and plenums installed, sealed and insulated to meet the requirements of CMC Sections 601, 602, 603, 604, 605 and Standard 6-5; supply -air and return -air ducts and plenums are insulated to a minimum installed level of R-4.2 or enclosed entirely in conditioned space. Openings shall be sealed with mastic, tape or other duct -closure system that meets the applicable requirements of UL 181, UL 181A, or UL 181B or aerosol sealant that meets the requirements of UL 723. If mastic or tape is used to seal openings greater than 1/4 inch, the combination of mastic and either mesh or tape shall be used; and ❑ 1. Building cavities, support platforms for air handlers, and plenums defined or constructed with materials other than sealed sheet metal, duct board or flexible duct shall not be used for conveying conditioned air. Building cavities and support platforms may contain ducts. Ducts installed in cavities and support platforms shall not be compressed to cause reductions in the cross-sectional area of the ducts. ❑ 2D. Joints and seams of duct systems and their components shall not be sealed with cloth back rubber adhesive duct tapes unless such tape is used in combination with mastic and draw bands. ❑ 7. Exhaust fan systems have back draft or automatic dampers. ❑ 8. Gravity ventilating systems serving conditioned space have either automatic or eadily accessible, panually operated dampers. ❑ 9. Protection of Insulation. Insulation shall be protected from dance°,Qencal,,�.,;` g th nlight, mc'sture, equipment maintenance, and wind. Cellular foam insulation sha pP to am it �d oating that is �°� � Idl. water retardant and provides shielding from solar radiatio at can �lause^'ie ra t rt 0 ❑ 10. Flexible ducts cannot have porous inner cores.''3,�, . c, *► ��+,�j AF � s t DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). • I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. • I reviewed a copy of the Certificate of Compliance (CF -1R) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -1R that apply to the installation have been met. • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. 2008 Residential Compliance Forms August 2009 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC Climate Zones 1 and 3 - 7 ac'ht4 Site Address: 03 r r4//0».s? P'a Enforcement Agency: Date- s—�—ii Permit #: Conditioned Duct insulation Equipment Type' List Minimum Efficiency2 Floor Area requirement Thermostat ackaged Unit urnace AFUE COP BServed by system Over 40 It of ducts added or replaced indoor ®Setback be Coil Unit t SEER EER HSPF 13 Resistance �Lsfunconditioned space (Ifnot already present, must installed) ondensing ®R 6 (CZ 1, 3-S) ther /. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -1 R -ALT -HVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) • I certify that this Certificate of Compliance documentation is accurate and complete. • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. • I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 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 compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application. Name: �® Signature: Company: Date: Cold UA -P:; s C . 5-- c1- l Address: IS 1 4-05 + L4_1 License: 6_51337 City/State/Zip: Phone: Y08 -3 74-9 a-9 9- 2008 Residential Compliance Forms March 2010