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13050176 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10170 CAMINO VISTA DR CONTRACTOR:T D PERMIT NO:13050176 OWNER'S NAME: BLOCKUS MARILYN J TRUSTEE �� X DATE ISSUED:05/23/2013 OWNER'S PHONE: 40824119837L 9 PHONE NO: LICENSED CONTRACTOR'S DECLLARATION BUILDING PERMIT INFO: BLDG F ELECT r PLUMB r, License Class_ Li..# X4/41b r_11j� ? MECH RESIDENTIAL COMMERCIAL Contractor 5061al�At 44 09!!T/ Date I hereby affirm that I am licensed undelUe provisions of Chapter 9 JOB DESCRIPTION:REMOVE&REPLACE FURNACE&A/C (commencing with Section 7000)of Division 3 of the Business&Professions **SEE NOTES** 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 Sq.Ft Floor Area: Valuation:$12900 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:34214058.00 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 the '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. y Issued by: G /� �� Date: S•a 3�3 Signature �JA-0* Date ��/►�� ❑ OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Date: Business&Professions Code) 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 HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I 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 maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. 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 wnuth ed a ent: )b✓� 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 APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify 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 ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply 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 . ) oo -7� GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•buildinancupertino.ora misc ❑PLUMBING ,MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS r O R AME HONE E-MAIL. �/I1 A/ �Ioc% � r¢ .Q J u.; s S REET ADDRESS CI I Y, STATE,Z FAX 0170 / CONTACT NAME h ST�CEET ADD S\\SVV cry CITY TA ,ZIP ` F T �. jO v sir Q /car/ D_ ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT C TRACTOR yNAME LICENSE NUMBER LI NSE TYPE BUS.LIC# /USN`��i1 // [, �i� 141 OMPANY NAME E-MAIL FAX lt2 90 STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WH.DLAND ❑ YES PROJECT IN ❑ YES IS THE BLDG AN ❑ YES BUILDING: COMMERCIAL URBAN INTERFACE AREA NO FLOOD ZONE NO EICHLER HOME? NO DESCRIPTION O WO L TOTAL VALUATION: �i}Da RECEIVED BY: By my signature below,I certify to/each of t50wlx�,ng: m t e property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have proect h e read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating t ti authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: Jr- �,_3-1 SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY W OVER-THE-COUNTER EXPRESS x U w ❑ STANDARD x zU a ❑ LARGE a ❑ MAJOR MEPMiscApp_2 011.doc revised 06/21/11 CITY OF CUPERTINO 0 FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10170 Camino Vista Drive DATE: 05/23/2013 REVIEWED BY: Sean APN: BP#: *VALUATION: $12,900 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY PENTAMATION FURN/AC USE: SFD or Duplex PERMIT TYPE: i WORK Remove and replace furnace and a/c. SCOPE IN 01 Mech.Plan Check 0.0 hrs $0.00 .Plzzzzrb. Flan Check Elec.Plan Check Mech.Permit Feer IMFERMIT Plumb.Permit h"ce: Elec.Permit Fee: Other Mech.Insp. 0:0 hrs $45.00 Other Plumb Imp. Other Elec.hasp. A£c:ch.In,r)�..I ere: Plumb.Insl�.Fee: Elec.Insp.F4 e: NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These&q are based on therelimina information available and are onlyan estimate. Contact the Dept or addn'1 info. FEE ITEMS (Fee Resolution 11-053 E . 7f 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Mechanical Suppl.PC Fee: Reg. Q OT FO.0 hrs $0.00 $133.00 IMFR=<100 Furnace,Forced-Air PME Plan Check: $0.00 1 # Mechanical Permit Fee: $0.00 $67.00 IBREMAIR A/C Units(<=10K cfin) Supp/.Insp.Fee,0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $45.00 construction :Ttzv Administrative Fee: IADMIN $42.00 Work Without Permit? ®Yes Q No $0.00 L L 0 Advanced Planning Feer $0.00 Select a Non-Residential 0 Travel Documentation Fee: 1TRAVDOC $45..00 Building or Structure- Strang Motion Fee: IBSEISMICR $1.29 Select an Administrative Item... Blda Stds Commission Fee: IBCBSC $1.00 $134.291 $200.00 $334.29 Revised: 04/29/2013 vL- = z5( 9 Simplified Prescriptive Certificate of Compliance:2008 Residential HVACAIterations CF-IR-ALT-HVAC Climate Zones 1 aad.3-7 Site Address: Enforcement Agency: .Dat 'j Pemrit N. Conditioned Duct insulation ent T -Iasi h�iat Eff€cien ' -' Floor Area requirement Thermostat Packaged Unit " Over 44 R of ducts Furnace ®AF[)E COP O.Setback ®Indoor Coil [�SEER� HSPF Sets/C y system added it replaced a (Vnoralreadypresent,must be Condensing Unit ®EER ®Resistance / c?�sf unconditioned space urstaAed) 0 Other ®R 6 (CZ I.3-S) 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,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 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 forts,worksheets,calculations,plans and specifications submitted to the enforcem t agency for approval with the permit application, _ 1-77 Name: Signature: Comp Da=.� Lid ny : City/hSiate/Zip: Phone 9 qY 97t-? 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 CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333•building a(-cupertino.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 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 C U PERTI N O Fax: 408-777-3333 CONTRACTOR/SUBCONTRACTOR LIST' JOB ADDRESS: (j' M,&6 OoLPERMIT# - () OWNER'S NAME: A) 131t7CI<vS PHONE# 96 `f9 `!Z; ? GENERAL CONTRACTOR: A&0A . BUSINESS LICENSE#. ADDRESS: ®( ' AV CITY/ZIPCODE: *A t tj 9y041 *Our municipal code requires all businesses 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 SUB T ORS HAVE"-OBTAINED,A.;CITY OF C PERTINO BUSINESS LICENSE. I am not using any subcontractors: s 3 v> Signature Date Please check applicable subcontractors and complete the followinginformation -:. . 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