13050160 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20199 PACIFICA DR CONTRACTOR:ABS HEATING&A/C PERMIT NO:13050160
OWNER'SNAME::BHUPINDERKHATTRI 334 SHAMROCK DR DATE ISSUED:05/22/2013
OWNER'S PHONE: 6502246646 CAMPBELL,CA 95008 PHONE NO:(408)238-7178
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL[] COMMERCIAL
License Class G�'�2 Lic.;# �g�l� REPLACE FURNACE&A/C UNIT,.ADD ADDITIONAL A/C
Z UNIT TO EAST SIDE OF SFDWL
Contractor//c3„�r //¢/W Date_
I hereby affirm that I am licensed under the provisions;of Chapter 9
(commencing withl,Section7006)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 self-insure for Worker's
Compensation as provided for by Section 3700 of the Labor Code,for the
perfbirnaiice of the work for,which this permit is issued. Sq.Ft Floor Area: Valuation:$10000
I have and will maintain'Workers Compensation Insurance,as provided for by
Section 3700 of the;Laboi Code for the performance of the work for which this APN Number:36929011.00 Occupancy Type:
permrt;is issued.
APPLICANT CERTIFICATION
I certify,that I have read this application and state that.the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct!II`agree to comply.with all city'and county ordinances and state laws relating WITHINtAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorizerepresentatives of this city to enterupon the above mentioned propertyfor inspection purposes. (We)agree to save 180' M LAST CALLED INSPECTION.
indemnify and keep,harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrueagainst said City in consequence of the
granting of this permit! Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
� RE-ROOFS:
Signature' Date 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.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner of the property,or my employees with wages as their sole compensation,
will dolthe work,'and tbe,!structure,islnot intended or offered for sale(Sec.7044,
Business&Professions Code)
I,as owner of the,p;operty,ism exclusively,contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec 7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
jCalifornia Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm undfr penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
III Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will,maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation;as provided,for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for,which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and.
I have acid will maintain YVorker's Compensation Insurance;as provided for by the Health&Safety Code,Sections 25505,25533,and 25534.
Section 370Q of the jlabor Code,Ilfor the performance of the work for which this
permit t!is issued. l ;! III 11,1:!H L Owner or authorized agent: Date
I certify that in thepetfor�nanc,.q of the,work for which this permit is issued,I shall
not eiijoy an per oin any lantilso as to become subject to the Worker's
n m CONSTRUCTION LENDING AGENCY
Compe sation�laws of Callifprnia l I after making this certificate of exemption,I
�I IIII I,,. �; ,II !
bec ,
loml subject to th'1Wdrker s Com(�ensation'provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwitb;coiriply with isuph('provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
(III I ,ISI r 111.: 1
APPLICANT CERTIFICATION Lender's Address
I certify,thaiii 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,end hereby authorize representatives of this city to enter
upon the:above Merl ned property forlinspection'purposes.(We)agree to save ARCHITECT'S DECLARATION
indeimiify and keep harness the Citylof Cupertino against liabilities,judgments,
costs,acid expense,s(which.may accrue against said City inconsequence of the I understand my plans shall be used as public records.
granting'of this permit Additionally;)the applicant understands and will comply
with M non point spurce regulations-per,the Cupertino Municipal Code,Section Licensed Professional
9.18.
II
Signature Date
II I.iIli
it
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION r n�
10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 b lv
CUPERTINO (408)777-3228•FAX(408)777-3333-buildino(a.cupertino.ong 00� MISC
❑PLUMBING U MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS �j >�rG�' / APN#/,:,7�pt I
OWNER NAME �� P14 /_ li0 1 /_e E-MAIL
STREET ADDRESS CITY,STATE,ZIP A�7✓�(�� FF
CONTACT NAME PHONE G E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER(
LICENSE TYPEr BUS.LIC It
COMPANY NAME ,
STREET ADDRESS JG CITY,STATE,ZIP
ARCHITECT/ENGINEER NAME LICENSE NUMBER r BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑ YES IS THE BLDG AN ❑ YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK
TOTAL VALUATION: / RECEIVED BY:
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the broperty 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 to wilding co truction. I aut,4orize representatives of Cupertino to enter the a ove-iden'led.property for inspection purposes.
Signature of Applicant/Agent: Date: "
�tpp NTAL NFORMATION REQUIRED J OFFIC SE ONLY
W OVER-THE-COUNTER
a
❑ EXPRESS
U .
w ❑ STANDARD
x
U
a ❑ LARGE
a
❑ MAJOR
MEPMiscApp_201 1.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 20199 PACIFICA DR DATE: 05/22/2013 REVIEWED BY: MENDEZ
APN: BP#: *VALUATION: j$10,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Duplex PENTAMATION FURN/AC
USE: PERMIT TYPE:
WORK REPLACE FURNACE &A/C UNIT ADD ADDITIONAL A/C UNIT TO EAST SIDE OF SFDWL
SCOPE
Mech.Plan Check 0.0 hrs $0.00 Phemb.Plan Check Elec..Plan Check
Mech.Permit Fee: IMPERMIT Plumb.Permit Fee. Elec. Permit Fee:
Other Mech.Insp. 10-01hrs $45.00 Other Plumb Insp, Li Other Elec.Insp. Li
Alfech.Insp.Fee: Plumb, Insp.Fee: Elec.Insp.Fee:
NOTE.This estimate does not include fees due to other Departments(.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Thesefees are based on the prelimina information available and are only an estimate Contact the De t or addn I info.
FEE ITEMS (Fee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Mechanical
Suppl.PC Fee: (E) Reg. ® OT 0.0 1 hrs $0.00 $133.00 IMFR=<100 Furnace,Forced-Air .
PME Plan Check: $0.00 F27 # Mechanical
Permit Fee: $0.00 $134.00 1BREMAIR A/C Units(<=10K efin)
Supp1:Insp:Fee-.0 Reg: .Q OT0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $45.00
Constratctio 7ar:.
Administrative Fee: IADMIN $42.00
Work Without Permit?' ®Yes 0 No $0.00 G
Advanced Planning Fee. $0.00 Select a Non-Residential 0
Travel Documentation Fee: 1TRAYDOC $45.00 Building or Structure
i
Strong;Motion Fee: IBSEISMICR $1.00 Select an Administrative Item
Bldgs Stds'Commission Fee 1BCBSC $1.00
$134.00 $267.00 $401.00
Revised: 04/29/2013
Simplified Prescriptive Certificate of Compliance:2008 Residential HVACAIieradens CF-IR-ALT-RVAC
Climate Zones 1 and 3-7
S7te Address: Enforcement Agency: Date: - Permit X
Conditioned Duct insulation
aruiraiient T rI,i`s-Wmmimtint'Efficien Floor Area requirement Thermostat
Packaged Unit •.:: . over 44 8 of ducts �,�
® E �P t ed• system added or replaced in t�setback
rCoil sEE'j TiSPF— Mzsf unconditioned ce fllnotalreadypreaenbmustae
leasing unit DEER' �Resistance /— . ®R 6 (CZ I,3�sj hzSWled)
0 other
1.Equipment Type.Choose the equipment being installed;if more than one system,use another CF-IR-ALT-HVAC for each system.
2.Minimum Equipment Efficiencies:13 SEER,7S%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 ofthe 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,Pacts 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
compliance forms,worksheets,calculations,plans and specifications submitted to the enforcement agency for approval with the permit
application. _
Name / Signature:
Company: Tlf�li Date;
Address: License:
City/State/Zip: Phone•
2008 Residential Compliance Forms.doc revised 04/10/12
HVAC ALTERATIONS ENERGY COMPLIANCE FORM
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
CUPERTtN4 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333•building aacupertino.org
WHEN IS A PERMIT REQUIRED
A construction permit shall be obtained from the enforcement agency prior to the erection,
construction,reconstruction, installation,relocation, or alteration of any mechanical system, except as
permitted in Chapter 1, Section 112.2 of the 2010 California Mechanical Code. Projects requiring
permits include, but are not limited to:
• New HVAC installation
• HVAC Changeout
• Replacement of furnace, coil, FAU or condenser
• Relocation of an existing HVAC unit
• Adding or replacing more than 40ft ducting in unconditioned space
BUSINESS AND PROFESSIONS CODE, SECTION 7110
Willful or deliberate disregard and violation of the building laws, including the California Building
Code, and local permit requirements constitutes a cause for disciplinary action from the Contractors
State License Board working in conjunction with the local building department. This action may
consist of fines up to $5,000 per violation or suspension/revocation of a contractor's license.
2008 BUILDING ENERGY EFFICIENCY STANDARDS (Title 24,Part 6)REQUIREMENTS
INCLUDE:
1. Heating equipment must have a minimum 78%AFUE(Exception: Wall &floor furnaces; room
heaters).
2. Central air conditioners&heat pumps less than 65,000 Btu/hr must have a minimum 13 SEER.
3. Newly installed or replaced ducts must have a minimum insulation value of R-4.2.
4. A setback type thermostat(24 hr clock with four set points) is required for all alterations.
5. New or replacement ducts must meet the mandatory requirement of Section 150(m).
• All joints and openings in the HVAC system must be sealed.
• Only UL 181, UL 181A, or UL 18113 approved tapes or mastic shall be used to seal duct
openings.
• Connections of metal ducts and the inner core of flex ducts shall.be mechanically fastened.
Flex ducts must be connected using a metal sleeve/coupling.
• Flex ducts that are suspended must be supported every 4 ft. max for horizontal runs with no
more than 2" of sag between supports and 6 ft. max for vertical runs.
6. The CF-6R-MECH-04 must be completed and signed by the installing contractor. The Inspector
will collect this form and verify that the model numbers are the same as the installed equipment.
2008 Residential Compliance Forms.doc revised 04/10/12
Simplified Prescriptive Certificate of Compliauce:2008 Residential HVACAlterations CF-IR-ALT-FIVAC
Comte Zones l rad 3-7
Sire Address: Enforcement Agency: Date: Permit R.
Conditioned Duct insulation
Eqdpm,-nt Type' L`ue'Mmimrins'Efficien Floor Aiea requirement Thermostat, ;
—Ey& Unit Over 40 ft of ducts
�" acee Q COP Saved by system added or>eplacxd lit Setback
door Coil Q� UIiSPF— sf um tinned space (Tnoralreadypresew nrust he
�densing Unit Q EER ®Resistance R 6CZ 1,3-S
Q l 1
Other
1.Equipment Type:Choose the equipment being installed,,if more than one_system,use another CF-IR-ALT.HVAC for each system.
2.b1inimam Equipment Efficiencies:13 SEER,78%AFUE,7.7HSPF for typical residential systems.
Contractor(DocumentationAunthor'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 T and 6 of the California Code of Regulations.
• The design features identified on this Certificate of Compliance am wnsistent with the information documented on other applicable
compliance forms,worksheets,calculations,plans and specifications submitted to the enforcement agency for approval with the permit
lication. _
Name: /� /7! �/ Signature:
Company;
? Date:
Address License: �`�
Citylstate Lip: Phone: Zg `-/,7`
2008 Residential Compliance Forms.doc revised 04110112
HVAC ALTERATIONS ENERGY COMPLIANCE FORM
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
GUPERTtNC? 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333•building aacupertino.org
WHEN IS A PERMIT REQUIRED
A construction permit shall be obtained from the enforcement agency prior to the erection,
construction,reconstruction, installation, relocation, or alteration.of any mechanical system, except as
permitted in Chapter 1, Section 112.2 of the 2010 California Mechanical Code. Projects requiring
permits include, but are not limited to:
• New HVAC installation
• HVAC Changeout
• Replacement of furnace, coil, FAU or condenser
• Relocation of an existing HVAC unit
• Adding or replacing more than 40ft ducting in unconditioned space
BUSINESS AND PROFESSIONS CODE, SECTION 7110
Willful or deliberate disregard and violation of the building laws, including the California Building
Code, and local permit requirements constitutes a cause for disciplinary action from the Contractors
State License Board working in conjunction with the local building department. This action may
consist of fines up to $5,000 per violation or suspension/revocation of a contractor's license.
2008 BUILDING ENERGY EFFICIENCY STANDARDS (Title 24,Part 6)REQUIREMENTS
INCLUDE:
1. Heating equipment must have a minimum 78%AFUE(Exception: Wall &floor furnaces; room
heaters).
2. Central air conditioners &heat pumps less than 65,000 Btu/hr must have a minimum 13 SEER.
3. Newly installed or replaced ducts must have a minimum insulation value of R-4.2.
4. A setback type thermostat(24 hr clock with four set points) is required for all alterations.
5. New or replacement ducts must meet the mandatory requirement of Section 150(m).
• All joints and openings in the HVAC system must be sealed.
• Only UL 181, UL 181A, or UL 181B approved tapes or mastic shall be used to seal duct
openings.
• Connections of metal ducts and the inner core of flex ducts shall.be mechanically fastened.
Flex ducts must be connected using a metal sleeve/coupling.
• Flex ducts that are suspended must be supported every 4 ft. max for horizontal runs with no
more than 2"of sag between supports and 6 ft. max for vertical runs.
6. The CF-6R-MECH-04 must be completed and signed by the installing contractor. The Inspector
will collect this form and verify that the model numbers are the same as the installed equipment.
2008 Residential Compliance Forms.doc revised 04/10/12
CUPERTINO vol Vtos
Building Department COMMUNITY DEVELOPMENT DEPARTMENT Z-01D 139
BUILDING FiViS!C)N-cUPERTM co
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REVIEWED FOR C
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Reviewed By: 'j HO I
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