11010123 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19735 MERRITT DR CONTRACTOR:AIR QUALITY HEATING& PERMIT NO: 11010123
AIR
O1'"ER'S NAME: CAROL WU 720 NORTHRUP ST DATE ISSUED:01/24/2011
SAN JOSE,CA 95126 PHONE NO:(408)293-7138
O'vv ivER'S PHONE: 4086791588
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class C, W Lic.# ` MECH r RESIDENTIAL r COMMERCIAL r
Contractor 47,11— Date
JOB DESCRIPTION:REPLACE FURNACE AT SAME LOCATION(GARAGE)
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. Sq.Ft Floor Area: Valuation:$3700
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 anc Type:
Occupancy
permit is issued. APN Number:31635009.00 P Y YP
APPLICANT CERTIFICATION
I certify that I have read this application and state that the abov ' ormation 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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION.
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 sou regulations per the Cupertino Municipal Code,S tion Issued by Date' �r2
9.18.
S;--ature Date
RE-ROOFS:
❑ All roofs shall be inspected prior to any roofing material being installed.If a roof is
OWNER-BUILDER DECLARATION
installed without first obtaining an inspection,I agree to remove all new materials for
I hereby affirm that I am exempt from the Contractor's License Law for one of inspection.
the following two reasons:
I,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(Sec.7044,
Business&Professions Code) ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code).
HAZARDOUS MATERIALS DISCLOSURE
I hereby affirm under penalty of perjury one of the following three
I have read the hazardous materials requirements under Chapter 6.95 of the
declarations:
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 Municipal Code,Chapter 9.12 and the Health&
performance of the work for which this permit is issued. Safety Code,Section 25532(a)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
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued. Health&Safety Code,Sections 25505,25533,and 25534.
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 Owner or authorized agent:
Compensation laws of California. If,after making this certificate of exemption,I Date:
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. CONSTRUCTION LENDING 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 I have read this application and state that the above information is Lender's Name
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 Lender's Address
n the above mentioned property for inspection purposes.(We)agree to save
mnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
costs,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
Licensed Professional
9.18.
Signature Date
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
ELI] Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: PoePERMIT# Z
OWNER'S NAME: PHONE# -ISS
GENERAL CONTRACTOR: BUSINESS LICENSE#
ADDRESS: CITY/ZIPCODE:
*Our municipal code requires all bus' esses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors an complete the following information:
V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/ Carpeting
Linoleum /Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
CITY OF CUPERTINO
5 ITEMS OF 16 PERMIT RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31635009.00
DATE ISSUED. . . . . . . : 01/24/2011
RECEIPT #. . . . . . • • • : BS000012552
REFERENCE ID # . . . : 11010123
SITE ADDRESS . . . . . : 19735 MERRITT DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CAROL WU
ADDRESS . 19735 MERRITT DR
CITY/STATE/ZIP CUPERTINO, CA 95014-2406
RECEIVED FROM MATTHEW T FARBER
CONTRACTOR MATTHEW FARBER LIC # 22791
COMPANY AIR QUALITY HEATING & AIR
ADDRESS . . . . . . . . . . : 720 NORTHRUP ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95126
TELEPHONE . . . . . . . . : (408) 293-7138
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC- NEW_BAL-
__ -- -----
--------
0.00 1. 00 0 .00
1BCBSC VALUATION 3, 700 . 00 1 .00 0 .00 0 .50 0 .00
1BSEISMICR VALUATION 3, 700.00 0 .50
1MFR=<100 UNITS 1. 00 126 . 00 0 .00 126 . 00 0 . 00
1MPERMITFE FLAT RATE 1. 00 42 .00 0 .00 42 . 00 0 .00
1TRAVDOC FLAT RATE 1.00 42 .00 0. -- 42 .00 ------ -- --
TOTAL PERMIT
211.50 0 . 00 211.50 0 . 00
VOICE ID DESCRIPTION
VOICE ID DESCRIPTION ____________________________
----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
' e
Prescriptive Certificate of Compliance: Residential CF-IR-ALT
Residential Alterations Page 1 of 5
Project Name: Climate Zone# #of I tories
General Information WCA<Z- Fl t,l
Site Address: 5r MCV44 tl— D it– Enforcement Agency: Date: _ u�
Building Type ingle Family []Multi Family Circle the Front Orientation:N,E,S,W,or degrees
Conditioned Floor Area(CFA): Project Type: Alterations Envelope Fenestration Roof DkHVAC
Replacement or Chane Out Duct Replacement 0 Water Heater
NOTE:This form is not to be used for Newly Constructed Buildings or Additions
Insulation Values For Opaque Surfaces(for Furring use the Mass and Furring Strips Construction table below)
Assembly Alteration
Opening of framed cavity alone–Alterations that involve the opening of the framed cavity of a wall, ceiling,or floor must install the
mandatory minimum insulation value per§150 for the altered assembly.Fill in Columns A–C and enter mandatory insulation value in Column H.
Replacement of entire assembly–Replacement of an entire wall,ceiling,or floor assembly requires the installation of Component
Package-D insulation values in Table 151-C. Fill in Columns A–J.
Opaque Surface DetailS For the furred.portioned of Mass Walls see Furring Strips Construction Table below.
A B C D E F G H I J
Proposed See Note Standard Values From JA4 Table
Framing Thickness, Framed Continuous JA4 Proposed
Tag/ Assembly Name Material Spacing, U- JA4 Table Cavity Insulation Assembly Assembly
IDS or Type 2 and Size or Other' factor° Numbers R-value6 R-Value? Row/Col8 U-factor9
Note:For furred assemblies,accounting for Continuous Insulation R-value,see Page JA4-3 and Equation 4-1. For calculating furred walls use the Mass and
Furring Construction table below.
1.For Tag/ID indicate the identification name that matches the building plans.
2.Indicate the Assembly Name or type:Roof/Ceiling, Walls,Floors,Slabs, Crawl Space,Doors and etc...Indicate in column G the Frame
material and Size:For Wood,Metal,Metal Buildings,Mass,enter 2x4,2x6, or etc... see JA4 for other possible frame type assemblies.
3. Enter the thickness for mass in inches or Spacing between framing members enter; 16"or 24"OC;or Other for all other assembly description
such as Concrete Sandwich Panel,Spandrel Panel,Logs,Straw Bale Panel and etc....
4.Based on the Climate Zone;enter the equivalent U factor found in JA4 Table based on the R-Value from Table 151-B, C, or D
5.Enter the Table number that closely resembles the proposed assembly.
6. Enter the R-value that is being installed in the wall cavity or between the framing;otherwise, enter "0".
7. Enter the Continuous Insulation R-value for the proposed assembly;otherwise,enter "0".
8.Enter the row and column of the U factor value based on Column F Table Number and enter the Assembly U factor in Column J
9.The Proposed Assembly U factor, Column J,must be equal to or less than the Standard U factor in Column E to comply.
Furring Strips Construction Table for Mass Walls Onl
A I B I C I D I E F G H I J I K L M
Proposed Properties of Masonry and Concrete Added Interior or Exterior Insulation
Walls From Reference in Furring Space from Reference
Joint Appendix Table 4.3.5,4.3.6,4.3.7 Joint Appendix Table 4.3.13
N
U
U^„ �a >'^„ Final
Assembly < o .? '� d0 a W 2
Mass Name or JA4 Table ;, ? c Assembly
Thickness Type' Number' > x ° ¢ > U-factor Comment
A'74t+�1 .��� Ems°,,, , ,a��A , .�. .��,,�€
March 2010
2008 Residential Compliance Forms
Prescriptive Certificate of Compliance: Residential CF-IR-ALT
Residential Alterations Page 2 of 5
Project Name: Climate Zone# #of Stories
Mass and Furring Strips Construction(footnotes)
1.Indicate the type of assembly to include;Hollow Unit Masonry Walls,Solid Unit Masonry,Solid Concrete Walls,Etc. Additional assemblies can
be found Reference Joint Appendix JA4.
2. This is the U-Factor based on the thickness of the assembly in inches.
3. The R-value of the insulation to be added on the interior or exterior of the assembly.
4. The Calculated R-Value is the R-value of the furred out section of the assembly.
-6.The Final Assembly is calculated using Equation 4-2 or Equation 4-4of the Reference Joint Appendix JA 4. The equation is the inverse of Column
added to Column 1. Column K is the inverse from column J.
7.Insert the calculated U-actor value on to the Opaque Sur ace Details in Column J
FENESTRATION PROPOSED AREAS
Replacing window alone—Replacement windows shall meet the U-Factor and SHGC Value requirements of Component Package D in
Table 151-C. The Total Fenestration and West facing Area requirements are not applicable.
rl Adding 50ft2 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.
E] Adding more than 50ft2 of window 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 Allowed Area Table on Page 2 of the CF-IR-ALT
Orientation
Fenestration Type and Frame (North,East, PropsedAreal Maximum Maximum NFRC or Default
Window,Glass Door or Skylight) South,West (ft') U-factor"s SHGC""° Values
1.Fenestration area is the area of total glazed product(i.e.glass plus frame). Exception: When a door is less than 50%glass, the fenestration
area may be the glass area plus a "2 inch frame"around the glass.
2.Enter value from Component Package D Requirements in Table 151-C.
3.Actual fenestration products installed and as indicated in CF-6R-ENV Form shall be equivalent to or have a lower U factor and/or a lower
SHGC value than that specified on the CF-1 R ALT Form.
4.Submit a completed WS-3R Form if a reduced SHGC is calculated with exterior shading.
5.If applicable at this stage enter "NFRC" or NFRC Certified windows or are CEC "Default"valuesfound in Table 116-A or B.
ALTERED FENESTRATION ALLOWED AREAS (Complete if more than 50ft2 of fenestration is added)
A B C D E F G
CFA of Allowed Existing Allowed
Entire %of Fenestration Area Fenestration Area Proposed Area
a
Dwelling CFA Z,s Area4 Removed Area Added A x B) (E-D)+C
Total Fenestration >
Areae ft
West Fenestration Area
(Required In >
CZ's 2,4&7-15
1, The Proposed West Fenestration Area includes West-sloping skylight area and any other skylight area with a pitch less than 1:12.
2. Enter 20%when no West orientation restriction or 15%when West fenestration is being installed in Climate Zones 2, 4, &7-15.Note that the
maximum allowed fenestration can only be 5%of the CFA as indicated in Column F. Column G must be equal to or less than Column F.
3. In climate zones 2, 4, 7-15,no more than 5%of the CFA is allowed for west facing glazing.
4.Existing Fenestration area must be counted toward the maximum allowed 15%or 20%of the whole building and calculated in Column G. The
Proposed Area must be less than or equal to Column F.
5.Enter the fenestration removed as part of the alteration if any in column D.
6.Enter the Fenestration area that is being added as part of the alteration.
2008 Residential Compliance Forms March 2010
Prescriptive Certificate of Compliance: Residential CF-IR-ALT
Residential Alterations Page 3 of 5
Project Name: 0/6" L uAk Climate Zone #of Stories
ROOFING PRODUCTS(COOL ROOFS)§1510912
When the area of exterior roof surface to be replaced exceeds more than 50%of the existing roof area,or more than 1,000f?,whichever is
less,the new roofing area must meet the roofing product"Cool Roof"requirements of§152(b)IHi,152(b)IHii,or 152(b)IHiii.
Check applicable alternative or exception below if the roof alteration is exempt from the roofing product "Cool Roof'requirements.Note:If any
one of the alternatives or exception below is checked, the Aged Solar Reflectance and Thermal Emittance requirements for roofing products in
§118(1)are not applicable.Do not fill table below.
LJ Cool Roofs Not Required in Climate Zones 1-12, 14,and 16 with a Low Sloped. Less or 2:12 pitch.
Cool Roofs Not Required in Climate Zones I through 9 and 16 with a Steep-Sloped Roofs(pitch greater than 2:12)and product unit weight less
than 5lb/ft2.
Alternatives to§152(b)1Hi and§152(b)Hii,Steep-slope roof(pitch>2:12)
E] Insulation with a thermal resistance of at least 0.85 heft•°FBtu or at least a 3/4 inch air-space is added to the roof deck
over an attic;or
Existing ducts in the attic are insulated and sealed according to§151(f)10;or
El In climate zones 10,12 and 13,with 1 ftZ of free ventilation area of attic ventilation for every 150 ftZ of attic floor area,and
where at least 30 percent of the free ventilation area is within 2 feet vertical distance of the roof ridge;or
Building has at least R-30 ceiling insulation;or
Building has radiant barrier in the attic meeting the requirements of§151(02;or
Building has no ducts in the attic;or
Q In climate zones 10,11,13 and 14,R-3 or greater roof deck insulation above vented attic.
Exception to§152(b)1Hiii,Low-slope roof(pitch<_2:12)
Building has no ducts in the attic.
Other Exceptions
Roofing area covered by building integrated;photovoltaic panels and solar thermal panels are exempt from the below Cool Roof criteria.
Roof constructions that have thermal mass over the roof membrane with at least 25 lb/ftZ is exempt from the below Cool Roof criteria.
Note:If no CRRC-1 label is available,this compliance method cannot be used,use the Performance Approach to show compliance,otherwise,
Check the applicable box below if Exem t from the Roofing Products"Cool RoofRequirement:
Roof Slope Product Weight Product Aged Solar Thermal
CRRC Product ID Number < 2:12 >2:12 < 51b/ft2 > 5lb/ft2 Type 2 Reflectance3'4 Emittance SRI
0 0 E
El 0
13
U_
® El 13 0
1. The CRRC Product ID Number can be obtained from the Cool Roof Rating Council's Rated Product Directory at www.coolroo s.om1products/search.php
2.Indicate the type ofproduct is being used for the roof top,i.e.single ply roof,asphalt roof,metal roof,etc.
3. If the Aged Reflectance is not available in the Cool Roof Rating Council's Rated Product Directory then use the Initial Reflectance value from the same
directory and use the equation(0.2+0.7(pinitial—0.2)to obtain a calculated aged value. Where pis the Initial Solar Reflectance.
4.Check box if the Aged Reflectance is a calculated value using the equation above.
5.Calculate the SRI value by using the SRI-Worksheet at http://Www.enerz.ca•govltille24/and enter the resulting value in the SRI Column above and attach acopy of
the SRI-Worksheet to the CF-JR.
To apply Liquid Field Applied Coatings,the coating must be applied across the entire roof surface and meet the dry mil thickness or coverage
recommended by the coatings manufacturer and meet minimum performance requirements listed in§118(i)4. Select the applicable coating:
Aluminum-Pigmented Asphalt Roof Coating 0 Cement-Based Roof Coating Other
2008 Residential Compliance Forms March 2010
Prescriptive Certificate of Compliance: Residential CF-IR-ALT
Residential Alterations Page 4 of 5
Pro je It Name: Climate Zone# #of Stories
L Al lk
HVAC SYSTEMS-HEATING
Minimum Duct or Piping Configuration
Heating Equipment Efficiency Distribution Insulation Thermostat (Central,Split,
Type and Capacity 1.2,3 AFUE or HSPFL Type and Lgzation4 R-Value Space,Packa a or Hydronic)
(oG' TS70 Pau-51r-we- D- &`=;F7rn2lfL
1.Indicate Heating Type(Central Furnace, Wall Furnace,Heat pump,Boiler,Electric Resistance, etc.)
2.Electric resistance heating is allowed only in Component Package C, or except where electric heating is supplemental(i.e., if total capacity
<2 KW or 7,000 Btulhr electric heating is controlled by a time-limiting device not exceeding 30 minutes). See§151(b)3 exception.
3.Refer to the HERS Verification section on Page 4 of the CF-IR-ALT Form for additional requirements and check applicable boxes.
4. Indicate Type or Location(Ducts,Hydronic in Floor,Radiators, etc.)
HVAC SYSTEMS-COOLING
Minimum
Efficiency Duct or Piping Configuration
Cooling Equipment (SEER/EER or Distribution Insulation Thermostat (Central,Split,
T d Capacity"' COP) Type and Location; R-Value Type Space,Package or Hydronic)
1.Indicate Cooling Type(A/C,Heat pump,Evap. Cooling, etc)
2.Refer to the HERS Verification section on Page 4 of the CF-IR-ALT Form for additional requirements and check applicable boxes.
3.Indicate Type or Location(Ducts,Hydronic in Floor,Radiators,etc)
WATER HEATING
List water heaters and boilers for both domestic hot water(DHW)heaters and hydropic space heating. Individual dwelling DHW heaters must be
gas or propane fired. Hot water pipe insulation from the DHW heater to the kitchen(s)and on all underground hot water pipes is required in all
component packages in all climate zones.
External Tank
Water Heater Type/Fuel Distribution Type Number In Tank Energy Factor or Insulation
Ty I (Standard,Recirculating)2 System Capacity(gal) Thermal Efficiency R-Value3
1.Indicate Type(Storage Gas,Heat Pump,Instantaneous,etc.)
2.Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of§150(n). The Prescriptive requirements do
not allow the installation of a recirculating water heating system for single dwelling units.
3. The external water heating tank and i es shall be insulated to meet the requirements o 150 '.
SPECIAL FEATURES The enforcement agency should pay special attention to the Special Features specified in this checklist below.
These items may require written 'usti►cation and documentation and special verification.
NEW ROOF ASSEMBLY-Radiant Barrier
The radiant barrier requirement of§151 2 does not apply to roof alterations.
Slab Edge(Perimeter)Insulation LJVES UNO
YES:In Climate Zone 16 in Component Packages D,R-7 insulation is required.
Heated Slab Insulation 0 VES ONO
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 UVE9 NO
YES:In Climate Zones 1,2, 11, 13, 14& 16,R-8 insulation is required;in Climate Zones 12& 15,R-4 is required under component Package D.
Thermal Mass
To obtain Compliance Credit for the installation of thermal mass,use the Performance Approach.
2008 Residential Compliance Forms March 2010
Prescriptive Certificate of Compliance: Residential CF-IR-ALT
Residential Alterations (Page 5 of 5
Project Name: Climate Zo e_# #of Stories
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)1Dii and the newly installed ducts are to be insulated per§151(f)l0.
0 EXCEPTION: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 the existing space-conditioning system(HVAC equipment and ducting)is replaced,the
ducts are to be sealed per§152(b)IDi.
QYES []NO YES:In Climate Zones 2 and 9-16,if the existing HVAC equipment is replaced(including the replacement of the air handler,
outdoor condensing unit of a split system,cooling or heating coil,or the furnace heat exchanger)the ducts are to be
sealed per§I52(b)IE.
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.
Refrigerant Charge-Split System HERS verification is required for this measure.
rl YES NO YES:In Climate Zones 2 and 8-15,when the existing HVAC equipment 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,or the furnace heat
exchanger)a refrigerant charge measurement shall be verified per§152(b)IF.
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.
Q YES E3NO YES:In Climate Zones 10 through 15,when the existing space-conditioning system(HVAC equipment and ducting)is
replaced,the airflow and fan watt draw shall be verified per§152(b)1Ci to meet the requirements of§151(f)7B.
Documentation Author's Declaration Statement
• I certify that this Certificate of Compliance documentation is accurate and com let .
Name: Signature:
Y��
Company: A Date: iA
�
/9f/�
Address: If Applicable CEA or CEPE
(Certification#):
City/State/Zip: ww �• Phone: 7—?3-
7115
Responsible Building Designer's Declaration Statement
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design identified on
this Certificate of Compliance.
• 1 certify that the energy features and performance specifications for the building 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 building design features identified on this Certificate of Compliance are consistent with the information provided to document this
building design on the other applicable compliance fortes,worksheets,calculations,plans and specifications submitted to the enforcement
agency for approval with this building permit application.
Name: Signature:
Date:
Company:
License:
Address:
City/State/Zip:
Phone:
For assistance or questions regarding the Energy Standards,contact the Energy Hotline at:1-800-772-3300.
WWI tk"R
Grnml LEI March 2010
2008 Residential Compliance Forms
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 35 merritt dr. DATE: 01/24/2011 REVIEWED BY: bobs.
APN: BP#: *VALUATION: 1$3,700
;PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION FURN/AC
USE: I I PERMIT TYPE:
WORK replace furnace at garage location
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced-Air 1MFR=<100 1 # $126
TOTALS: 1 $126.00
Mech.Plan Check 0.0 hrs $0.00
Mech.Permit Fee: IMPERMIT or?. F("rm'i°
__LOther Mech.Insp. 0.0 1 hrs $42.00 t11i�,�?.P/ n/)1 u 0/h _�L7C(. 117s1?. Li
'A"Ch. L?;su. F ': 1'muly) 1? +1;. 1--c" 1>1Cf,.lord?. kk,
NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resohrtion 09-051 Eff. 7%1/10) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Supp/. PC'1,ce
T I 'A
PME Plan Check: $0.00
1 erinit Fc e:
.Suppl. 111sp 1'Ce
PME Unit Fee: $126.00
PME Permit Fee: $42.00
C,otz_wlrclioz Too
,1couslical 1t't'vicw
Work Without Permit? 0 Yes 0 No $0.00
Plunrih 7
Travel Documentation Fee: I TRA VDOC $42.00 A
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldiz Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $211.50 $0.00 TOTAL FEE:> $211.50
Revised: 01/03/2011
CITY OF 0i I ��
CITY OF CUPERTINO
iss FURNACE/AC
CUPERTINO PERMIT APPLICATION FORM
APN# j 0 o Date: 1117-111
Building Address: lJ _
77- PIZ-
If residential, is house an Eichler? Yes ❑ No If yes, needs planning approval.
Owner's Name: Phone#: .
Contractor: '' Phone #: Va t_Zg3._ 7 13r
k,X- 1 Fax#:
Contractor License#: �, Cupertino Business License#:
Contact: n Phone#:
Fax/e-mail:
Building Permit Info:
Elect 1Z Plumb Mech
Residential ftZ Commercial ❑
Job Description: LA- F14'� �'%�7•►,� LD C A-T-%p�
�-z
For Residential Installations:
Attic EJ 1St floor ] 2°d floor ❑
Adhere to minimum setback requirement ❑ /
For Commercial Installations:
Replacement same weight ❑ Additional weight(structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: Type of Construction(Usage Class):
3
Strapped On Platform ❑ Bonded-EEI- New Location ❑ Replacement
Project Size: Counter Express ❑ Standard ❑ Large ❑ Major ❑
Valuation:
6® a_
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the
application or if applicable,include in plan set & the sheet index.
Revised 12/06/10