10090233 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21530 RAINBOW DR CONTRACTOR:ABC COOLING&HEATING PERMIT NO: 10090233
OWNER'S NAME: ROBERT MC LOSKEY
31845 HAYMAN ST DATE ISSUED:09/24/2010
'NER'S PHONE: 4082530452
HAYWARD,CA 94544 PHONE NO:(510)471-8181
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r— ELECT F PLUMB r
License Class C 3 6.c to LI,.# 3 IR Z 3` j MECH RESIDENTIAL COMMERCIAL
Contractor ABC CCV 1< < e7►gi Date ? �4 ��
JOB DESCRIPTION:NEW AC UNIT 4 TONS/13 SEER RATING W/40 AMP
I hereby affirm that I am licensed under t e provisions of Chapter 9 CIRCUIT
(commencing with Section 7000)of Division 3 of the Business&Professions REPLACING 8 DUCTS.ADDING DUCTS(2)TO KITCHEN&
Code and that my license is in full force and effect. LIVING ROOM
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 Valuation:$13510
permit is issued. Sq.Ft Floor Area:
APPLICANT CERTIFICATION anc Occu Type:
I certify that I have read this application and state that the above information is APN Number:36638021.00 occupancy YP
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, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Si Date 2 1 > Issued by Date:
Date: /✓2�t'��!
gnature
O -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
I,as owner of the property,or my employees with wages as their sole compensation installed without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code) Signature of Applicant: Date:
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
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the
I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(x)should I store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,[
Health&Safety Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I nn st Owner autho ' d a ent:
forthwith comply with such provisions or this permit shall be deemed revoked. Date: ki �U
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
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 relati ng I hereby affirm that there is a construction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
+-'-mnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
and expenses which may accrue against said City in consequence of the
gating of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR--BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN: B*1 ;
*VALUATION: $13,510
*PERMIT TYPE: Mechanical PermitN CHECK TYPE: Alteration /Addition / Repair
PRIMARY PENTAMATION 1 RMAP2USE: SFD or Duplex i„�: PERMIT TYPE:
WORK
SCOPE
PAPPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
(<=10K cfm) 1BREMAIR 1 # $63
Furnace, Forced-Air
1MFR=<100 1 # $126
Heating System 21 MR 1 # $63
TOTALS: $252.00
Mech.Plan Check 0.0 hrs $0.00 1 r rlarj,. 'r,,t
Mech.Permit Fee: IMPERMIT 'i �'� P �Ez Fc F.T�c 1'r>f�,(r Vc,
EFI--
Other Mech.Insp. 0.0C)r�3ef Pt.�r,r,�7,fr��> Inst,
�hrs $42.00
NOTE: These fees are based on the preliminary information available and are only an estimate. Contact the De t or addn7 info,
FEE ITEMS (fee Resolution 09-051 Eff. 7i1%70) F1E.E QTY/FEE
MISC ITEMS
P/an Ctrsc: Fe”
Srpp/. P 'Fete
-
PME Plan Check: $0.00
I'crinit Fcc:
Srippl, Irrsp 1:cc
PME Unit Fee: $252.00
PME Permit Fee: 142.00
C"fm.wr action Tax
"ic:oustical
Work Without Permit? 0 Yes No $0.00 '
Travel Documentation Fee: ITRAVDOC ; 42.00
Strom;Motion Fee:
$1.35 Select an Administrative Item j
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $:338.35 $0.00 TOTAL FEE: $a68.35
Revised: 9/22/2010
CITY OF CUPERTINO
7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36638021. 00
DATE ISSUED. . . . . . . : 05/24/2010
RECEIPT #. . . . . . . . • : BE000011554
REFERENCE ID # . . . : 1C090233
SITE ADDRESS . . . . . : 27.530 RAINBOW DR
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER ROBERT MC LOSKEY
ADDRESS . 2:,530 RAINBOW DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM J:3FF RAINEY
CONTRACTOR . . . . . . . : G3RALD UNRUH LIC # 24643
COMPANY . . . . . . . . . . : A3C COOLING & HEATING
ADDRESS . 31845 HAYMAN ST
CITY/STATE/ZIP . . . : HkYWARD, CA 94544
TELEPHONE (510) 471-8181
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- -------------
---------- ----------
---------- ---
1BCBSC VALUATION 13, 510. 00 1 .00 0 .00 1. 00 0 .0
1BREMAIRHA NO.UNITS 1. 00 63 .00 0 .00 63 . 00 0 .00
1BSEISMICR VALUATION 13, 510. 00 1.40 0. 00 1.40 0 .00
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
1MRRAA UNITS 1. 00 63 .00 0 .00 63 .00 0 .00
1TRAVDOC FLAT RATE 1. 00 42 .00 0 .00 -----42_00 ------0_00
------ --- ----------
TOTAL PERMIT 338 .40 0 .00 338.40 0 .00
METHOD OF PAYMENT AMOUNT -- -
REFERENCE NUMBER
----------------- ---------------
CREDIT CARD 338 .40 VISA
----------------
TOTAL RECEIPT 338 .40
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
--------
------ -------------------
__ _
--
-- ----------
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
502 FINAL PLUMBING ENERGY 503 FINAL MECHANICAL ENERGY
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Is Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: 2-1 G7 PERMIT# 6't-3
OWNER'S NAME: rR Y PHONE# 25 3
GENERAL CONTRACTOR:/��Cfe BUSINESS LICENSE#
ADDRESS: 3 ' CITY/ZIPCODE:
*Our municipal code requires all businesses working ir.the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY SINSPECTION(S)ORS HAVE OBTAINED AHCITY OF CUPERTINO
UNTIL THE
GENERAL CONTRACTOR AND ALL S CO
BUSINESS LICENSE.
I am not using any subcontractors: Sign Date
Please check applicable subcontr rs and complete the following information:
BUSINESS LICENSE #
SUBCONTRACTOR BUSINESS NAME
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
2-,Lf� J6
qe ontrac or Si ure
Date
Prescriptive Certificate of Compliance: Residential CF-1It-Ai,r i
ResidentialAltercNiuus (Parc 1 ales) +
Project Name: Climate Zone# #u�Slorics
ALA
General Inl'ormation
Site Address: e.J r Enforce nent Agency: YNO Date:
1111ildillgType V`Si ingle Family ❑Multi f=amily Circle lhs FrunLOrientation:N.v.S.W.ordoPrccti_
Pn�jcct type: Alterations ❑Envelope❑Fcnestrntion ❑Roof 2 IIVAC
C.olkllllOned Fluor Area(CI:A): _ Rc Ittc:enwnt or Chan c Out ❑ Duct Rc tlaccntonl ❑\beater I leata-
NOTE:Thh;form is nol to be usedfor Newly Constructed Buildings.1rAddidons
Insulation h2lltces For Opaque Srtlfrrces(far hiu7•int'use the ra/crs.v an l pill-rip r/;.31rips Cemistruc•tion lei No hel0lN
\xxenthl)',�Itcrxlion
❑ppcnin arllamed envity alone :Ilarcr/ivlterlurl htvalrc lhenp0ringoflhe,licnnec(cavilrOJ'rt wall,crilin��,a1-,/loorinrrsl in.elerllllm
H.
lnnnrlulol r utinlnrluu ins'uluJinn vrrltrc per+l iA,lbr the ul[crtarl etnhl'.1711 in(nlunnrs a-( canal enter nuurdnlory in.+trhrriun rultrc in C'olutnn
❑Replacement of entire assembly Neplucemenl r;l an entire wall,i-eiling,urfloor•avvemblw requires the irts•rcrllnliun nl'C'Ornpunent
Nwka pe-1)ui.cululian"allies ill 1 mile. 151-C. Fill in C"OhliMIN A J.
Opaque Surface Details For the furred porlionecl of V7ass\\!t Its sec Purring strips Coosiraction Tahle below.
A 13 (
1'ro rased s'-`•."'"P titanInrd Values From JA4 Table
Framing • Thicknuss. Frtuned C:ontinuuus JA J Pntpuxcd
I'ug.i Assenihly Mime Millerial Spacing, l- IA4 Table ,
avity InSnitlllon Asselnhly Asscmbl•
II), or•11 c1- undSize'' urUlhcrt lileor' Number` R-value" R-Valuer C'ellVuhrc i lator
I ffy�
N•'ate:/i1)Jnrredusxemhlle.c,ucculntige,liu('on/iruruuv hcvulaliun R-value,•ve•Puge,1.44-3 and A'qualiew 4-1. 1 ire c•ulelilatirrg lit)v-ecl u•al/s use the Ahiss aad
Ful-ring Cimstruc•unn mble bell,,
1./-ill'7'1),!'11.)illetiecile the trlellliliCUl/all lrartre theo incitclex the buddi 1E,plulls.
2.Indicate rhe:Lavemhh IVante or t byre:Rogl'C'eiling,. It4r/Ls,Floors,S lobs,C rOwl Space,!)ours and etc.,.Indicate the!i ante type and,Si=c:l or'
IPorrd,;\Jelal,d•letcrl Buildings.A-friss,enter ?.cd,Zr(,orate...seed•W for other pos'sible,Ji'arete tree assemblies.
3, t=iller the ihicknesr fa•mass in hrches or Spocinsr between framing ntemherx enter: 16"or 24"0C.-ur 01her,1or 11N other cissembll,descriplient
such as Concrete Scurchvich Panel, Ypa idrel Panel.Logs,Slaw Belle Panel and etc....
1.Based on the Climate lane;elder tlm 5'icrrtdurd li factor from Tabhr 151-B.C or 1),Jit•ucwh diferent crssembli NOM&or n7x.
5.Anter the Table number that closely resembles the proposer!assetmi/v.
G, tinier the R-ver/1)e that is heilrg irrslcrlled ht the wall cavity or behvr all the,terming.ullrenvise,enter
7. !•:neer the Cominnuus hlsulalion R-vulue fur the proposed mmenibl olhenvis•e,enter "fl"
R,1:1)101-rhe raw rnrd column o/7he 1.1-ltclor value based ort Colton)?i•Table Number cr7d enlor the Auenihir l;jtrclur in C'uhurtn J
9.I he Proposed.issenibly ti-ilclOr, C'OlunnlJ,luuxl be equal 11)or le v;Ihua the Slandurrl U-wtur ill('oluntn!:10('01111)6%
Furring Strips Cunstructiun Tabic ror.lass Walls Only
A I3 (' 1) IS It G II 1 I K I, 111
I'roporcd Properties orMasonrg and Concrete Added interior or Emerior Insulation
!fulls From Reference in Furring;Spree from Reference
.loins;1 r tendis Table 4.3.5,4.3.6,4.3.7 Ioint A t endix"ruble•1.3.13
Final
h Assembly '
N-lass V;unc or Jr\3'I;thk rt r c? $ 4 7tf_'
I'hickncsst I Ivy 1-c' Kumhcr' i ll-lacuna C nntenl
_ . . .. _�
RuoislraNanNumber: _!registration 9ale,'lmo: ___, HERS Provider:
? ('J8 li'esidenlicrl C'omplivac'c�FW-ills :ter�rti.rt 200J
Prescriptive Certificate of Compliance:Residential CF-IR-ALT
ResitlenlialAl(erations (Pane 4 of 5)
Project Name: ' � Climate Zone# #of Stories
1.1 VAC SYSTEMS-11 EATING
\linimum Duct or Piping C'unligurlliun
I leating liquipntent 1:17Muncy Distribution In5lllallinn Thernwstat (Central.Split.
e and C'a mcil+ "` (A1: 11;,or I ISI'P) v e and Loeut on' It-lfuluc 'r' c S�acc,I'aektt,e or I Ndronie)
1 i
530,om
1.lnrliculu lleuling,7i71e I('enla•ul 1•iu'llot.e. Irul/!•irt•nuce,!lent pump Boiler,hlectl•ic Reeistrulce,etc.)
2.1;7ec•tric•msislarrce healhig,is allou•etl(111/1'in C'olnpnnenl Package C.lir c ecl7l where ukell•ic healing is's'npplc:uleunll(i.e.,il'lulol r upr11 i(r
?1,'11'#1•.7,0110 8111-/w eleell1c•I'vomrp is c•nnb-ullecl lry a!bile-liar i ilgr device nal e-eeeeclinfi 34 minrnesl. .Vvv§15 1(W.?tweeplhln.
3.R yi-to the HERS Ytwe lieulion s•ec•tiun rill Pule 4 uf'N)e CF- R-:iLT 1•'arnt fbr•uc(cli/ionnit r-ugrrirements unci check ulgVicuhle hoxe s.
d. hulicale I17)e of LOCalioll(Ducl,P, Ilt'ch•unic in Moor, Rodiolol•.e,el .)
HVAC SYSTEMS-COOLING
M1•lininnun
l:I'Iiciuncv Duct or Piping Cont rion
Cooling i;quipnlent (SI?1•:It/[':lilt or Dislributiot. Insulation Thermostat (Central.
ol.Shlil.
1•ype and Capacity CO(') e and Loca ion' t-VUlue ('y e Splice.Puckugc or I lydronic)
CDOD
1./ndi tale C'oul(nq Type(kC,Ileal pinup.livup.C•ouflllg,etc)
�.Rei/e1-In the Ill-.RSf%er(lieolion section on Prigu d of 1he('(_/R-Q 1.r'1 in m.�n ar(c(hlortn!requirement,+unc/a tree/r uppl ic(rhl e hone.+.
3,indicate f)•lie or Loc•olioll(Duels.111,c11-onic hr l'lour. ReWhIfo s.el:.)
WATER HEATING
List avcrtel•heumrs•titre/boiler .fiir both domestic hol wine((W IP)he,(tela•curd hrc(l uric spuee hecr!(nlr. Mdiricluul cIn ellint 11//3f'Ircurlen+uucrr he
ens fir propune,(irect.noel nun•not crceec/.i11>ullult.e. Hol+Miller pipe(rnsululion front the D111Y healer to the kilc•11crll.+'1 and nn oll illydergroarlei
hol uqlter )(m.e is ree aired in fill eunrpunelrr ur<lur,,r.+in crll clinude=ones.
I•:xtcrnal'Tank
Wam.IWater T%I)e/Fuel Distributinn'I'ypc Number Ili Tank Energy hnctoror Insulation
Type, (Standard.Recirculating)2 System C a acil (gull) Thermal I•:Tliciency R-Villuct
L hulivule'l;ty)c 151oruge(icr.+. Ileru Pinup,hrsluluuneous.etc.)
2. Ree ireulcrlirl,t srs/eur.e s•ervi/rg muAil)!e dwellilig units shall nlee+!Ilia 1'ec/r•culeaioll I•equil•Cllle1mv Uf';�l54(i>i. "l he !'re.reriplire r egrrirclnenu.c Ju
not allow the lusrallulion ul'a rec•ir culu/(nl;iru/er healil>,tr.ri:slelrr•l))•:Tone rltvelllng units.
3. the cvterncll water healing tank caul )i)ec shall he(nsrrlerled lu me'.1 the ret uil-emenrs o%+$1.511(j).
SPECIAL FEATURES The enlbrcenu'rrl ugenettshou(c!pasts)eeial atlenllon to the Simcicrl/iuuu es s/)r c j/iec!in ibis'c•hc•rklisi he/oar.
These ilen)s nun•reg uh•e writlen jusirilication cid documentation non s uc•ild verilicullon.
.NVW ROOT ASSEMBLY-Radiant Barrier
The radian(barrier ret uiretnent of§151(1)2 does not apply to roof ul erttions.
Slab Edge(Perimeter)Insulation O YE.S ONO
YES:In(Timate Zone 16 in Component Packages 1),11-7 insulation is required.
Ilealed Slab Insulation O YES 13 NO
ITS:Slab edge insulation required lin•all healed slabs in all C'limalt ZoncS, See(letails in'Toble I IR-A cWthe standards.
Raised Slab Insulation O YES ❑NO
yl,s:In Climate Y,ones 1.2. It. 13. 14& IG.11-8 insulation is rc tared:in C lintate Zones 12 R l5.R-4 is required under cont tortemtl Packn+e I).
Thermal Mass
To obtain(.bin litmce Credit till,lite jo.,gallutioo of Ilicrmtll nays.us:the Perlormance Approach.
Re./i.+lrulion A'rrrnher: RegIsb•alinn Vofe1'l•ime: !iliRR Prot klcr:
?1111'J
2008 Residential ComplicnllV F01-111s :Irrgrrs'I
1�
.,ct-- �u iu u..r. oar• uu u�ua_aira� or rr�.itr ar� ..ri... r ...,....... r-. ...
Prescriptive Certificate of Compliance: Residential CF-111-ALT
Rc�sidc'7ttirrl:111errrlions' (Pa 'e S of 5)
l'ro,jecl V:un e: Clirnalc Zone# #o�Storicx
HERS VERIFICATION SUM MARV 77ra enforcement agengvshould puvspacial alrenlion to ilia HERS Ucusures spec•ilied hi this
checklist helow. ;I c•onrpleled and Signed C'F--/ll Form fnr a//Ilia niers sines•spec•ifted shall he saGmined to the hirih/ing hisp ctor be%bre final
inspection.
Duct Scaling Testing t1/sRSneri/icalion is required�n Ild;meccr'utr.
❑YES IVNO YES:In Cliniata 7.onus 2 and 9-16.if more than 40 linwur feei ol'new or replacement ducts are installed in unconditioned
space.the ducts,ire(o be•scaled per§152(h)l Dii and the newly installed ducts ure to be insulated per§151(1)l Il.
❑ 1{X('iSP'I'ION:1?xistint duct systems that arc extended,which are constructed,insulated or sealed with ashestos.
❑YES LK NO YI•;S:In Climate%ones 2 and 9-ib,iI'III c exisrilit,space-conditioning systeni(I IVAC equipnicnt and dueliiIg)is replaced•the
ducts are to be suaIed per§152(b)1 Di.
❑ YES U40 Ylsti:In C'liniule zones 2 noel 9-16.if the exislint.HVAC'equipment is ruplaced(including the replacement of the air handler•
outdoor condunsing unit of a split system.c auling or hurling coil.or(lie furnace heal exchanger)the ducts:u•e to Ire
scaled per$152(h)11?.
❑ I?\('I,P'1lQN: 1)net systems Ihat arc Jac nuentcJ to have been previously scaled confirmed Ihrou}h IlERS
verification in necordance frith procedunps in the Reference Resitlential Appendix RA3.
❑ EXCEPTION: Doc(systems with ICSS than d(I linear feet in unconditioned space.
❑ 1;\('1:1''1'IOn:Existing duct systems con:tructed,insulated or sealed with asbestos.
Refrigeranty lia rge-Split System HERS veri/icalion is ri ilith•ed fi r this measure.
❑YES 9 NO 1'I•:5•In(•lima(c Runes 2 and 8-15.when thu existing I•IVAC equipmdut is replaced(including the rel lacenicnl nl'die air i
htm(Iler.outdoor condensing unit ora split system A/C or heat pump.cooling or heating Coil.or the 1111-nttee haat
exchanger)a reli•igeranl charge nicasuremert shall he verified per§152(h)l F.
Central Fan Integrated(CFi)Ventilation System and Fan Watt Draw
The venlilution ru(uirenienis oQ 1500)clo not apply it)exislin g rusi(lonlial homes,
Ducted Split Sdstems-Air Conditioners and bleat Pumps: Airflow HEl?S verl/ication is requivedJi»•this measure.
❑YES UNO YF.S:In Cliniale zones 10 through 15,when the .xisting space-conditioning systeni(HVAC equipment and dueling)is
replaced.the uirllow and fan.vutt cfraw sha I be verified per§152(b)[Ci to meet the requirements ol'ti(5I(1)711.
Documentation Author's Declaration Statement
• 1 rtifv that this Certificate of*Com pliance documentation is accurate an )+n ilete.
Nunie:
C'ompan}" . y Date.
rl I(1 G `zt 11-0
Address:2 ; .` 11'AI)plienblc❑CFA or❑(TIT
JJ (Cerli lieu l ion 4r):
City/state/zip. la
Responsible Buildi esigner's Declaration Statement t~J I
• I rani CligihlC antler Division 3 ol'lhc Calilin•nin fiusiness and Pro'essions Code to uceepl WSponsibilily I01-01C building(lusign idCntilicd on
this C•erlificale of Compliance,
• I ecrliN that(lie energy fi:alurus mal iperlorninneu spocificalions I'vthe building design identified on this Certificate ol'CumplinnCC conlurnp
to the requirenicots of"I'We 24.Parts I and G of•thC Culmornitt Cole timcgulalions, a
• The huif(ling design leadures identiliud un this Curtilicate ol'Conipliance are consistent with the inlbrnuaion providC(I Ili docunienl this
hi l(ling design on the other applicable conipliance linins.worksheets.calculutions,plans and specifications submitte(I to the enliirwnpen(
m cocv fill.;a)prowl with this building liennit applicalion.
Name: Signature:
Cont pa ny: Dille:
A(Ith'csi: I,iCCnsC:
CilylSlaicizip: Phone:
1.7)r«s.vislance or questions•regording the Erlergy Standards,contact Nie Ener,(y Hollhte til: 1-800-772-3300.
Ref;iso-ell ion A'llniber: _.. ._. ... Registration Owen7me: _._. lll;ItS Provider: .
008 Residential Gulliplianre Forms August 100 ( 1
iV
Ty OF
CITY OF CUPERTINO
FURNACE/AC
CUPERTINO PERMIT APPLICATION FORM
Date:
Building Address:
21530 RAINBOW DR.
Owner's Name: Phone#: 408 253-0452
ROBERT MCLOSKEY
Contractor: Phone#: 510 471-8181
ABC Cooling and Heating Inc.
#: 510 471-8368
Fax
Contractor License#: 382383 Cupertino Business License M
Contact: Phone#: 510 471-8181
Brenda
Fax#:
510 471-8368
Building Permit Info:
Elect e7:7:- Plumb C3'' Mech ❑
Residential 0 Commercial ❑
Job Description: REPLACE FURNACE: 80KBTU/95% AFU3 NEW AC UNIT: 4 TONS/13 SEER RATING C4 /+wi�G IZG'a�T.
`To �-1-7C.*4L ti; i+A/A
For Residential Installations: 2°d floor ❑
Attic El
1St floor FX-]
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):
k_/ _q
Strapped ❑ On Platform ❑ Bon c ed❑ New Location❑ Replacement ]
Project Size: Express ❑ Standard❑ Lar&e ❑ Ma'or❑
Valuation: 13 , 510 - 00
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 01/07/09