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13050153 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21421 MILFORD DR CONTRACTOR:TFF HEATING AND AIR PERMIT NO:13050153 CONDITIONING OWNER'S NAME: MURAI TOM AND ROBERTA 299 CORNING AVE DATE ISSUED:05/21/2013 OWNER'S PHONE: 4088292648 MILPITAS,CA 95035 PHONE NO:(408)786-8120 U LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIALS License Class G — Za Lic.# 3 S REPLACE EXISTING FURNACE AND DUCTWORK&ADD Z / A/C TO Contractor /q-CDate REAR OF SFDWL 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:$8310 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 APN Number:32641106.00 Occupancy Type: permit 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.I agree to comply with all city and county ordinances and state laws relating WITHIN0 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for;inspection purposes. (We)agree to save 180 DA M LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Issued by: Date: 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. RE-ROOFS: Signature Date z /3 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 1,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 HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: 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 and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534. Section 3700 of the Labor.Code,for the performance of the work for which this Owner or authorized agent: Date: 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If,Stter making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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. ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 �O CUPERTINO (408)777-3228-FAX(408)777-3333-buildincl(cDeuoertino.or4 MISC �3 ❑PLUMBING MECHANICAL ❑ELECTRICAL [:]MISCELLANEOUS PROJECT ADDRESS Z' �yt✓YO�� fl APN# -/ i I O(-n OWNER NAME �kS9N /t'OM v � PHONE L-kof �Z ,may E-MAIL STREET ADDRESS S A A^ CITY, STATE,ZIP G✓ �T�� v FAX CONTACT NAME I PHONE E-MAIL STREET ADDRESS /� = CITY,STATE, ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME T ✓� r LICENSE NUMBER �� LICENSPEC4 �� BUS.LIC# COMPANY NAME E-MAIL -,yam FAX t� I i'r �• /V8 �3� �y STREET ADDRESS � �_ CITY,STATE,ZIP ��/� � PHONE ARCHITECT/ENGINEER NAME l• , LICENSE NUM r BUS.LIC# COMPANY NAME E- FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑S LEX ❑ MULTI-FAMILY PROJECT IN WHALAND ❑ 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: Q 13 j�, v RECEIVED Y By my signature below,I certify to each of the following: I am the property owner or authorized agent to actt roperty 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 ac rate. I agree to comply with all applicable local ordinances and state laws relating to building cons n. I authorizerepres Cupertino to enter the above-identified roperty fo inspection purposes. Signature of Applicant/Agent: Date: Z 3>- SUPYL�E-MEN =WFORMAT4eriTREQUIRFD OFFICE USE ONLY WW ❑ OVER-THE-COUNTER r" ❑ EXPRESS k U ❑ STANDARD zU a ❑ LARGE a ❑ MAJOR MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 21421 milfrod dr DATE: 05/21/2013 REVIEWED BY: Mendez 191APN: BP#: "VALUATION: $8,310 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair. PRIMARY SFD or Du lex PENTAMATION FURN/AC USE: p PERMIT TYPE: WORK re lace existing furnace and ductwork& add a/c to rear of sfdwl SCOPE P „ d w �m� y;E, w� y — n Mech.Plan Check 0.0 hrs $0.00 Phanb.Plan Check Elec:..Plan Check Mech.Permit Fee: 1A PERMIT Plumb.Peamit Fee: Elec.Permit Fee.: rOther Mech.Insp. 0.0 hrs $45.00 Other Plumb Insp. Other Elec.Insp, Insp.Fee: Plumb. lass/�.Fee: Elec.Insp.Fee. EiLd NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These fees are based on the prelimina information available and are only an estimate Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Mechanical Supp/.PC Fee: (E) Reg. ® OT 0.0 I hrs $0.00 $133.00 IMFR=<100 Furnace,Forced-Air PME Plan Check: $0.00 = # Mechanical Permit Fee: $0.00 $67.00 1BREM4IR A/C Units(<=1OK efin) Suppl. Insp.Fee:Q'Reg. ®OT . _o hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $45.00 Cont-fiction :Tax: Administrative Fee: IADMIN $42.00 Work Without Permit? ® Yes No $0.00 Advanced Planning Fee.. $0.00 Select a Non-Residential Travel Documentation Fee: ITRAVDOC $45.00 Building or Structure ®, Strong Motion Fee: 1BSEISMICR $0.83 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 -a $133.83 $200.00 .°" $333.83 Revised: 04/29/2013 Simplified Prescriptive Certificate of Compliance:2008 Resirfenfhd HVACAIterations CF-IR-ALT-HVAC Climate Zones f and 3-7 Size Address: Ettforcewnt Agency: Date Perrnit il:.:: ZI�IZI �w�t-Q� fl2- Gv Pe-9--1---�c: Conditioned Duct insulation Equi prow Type' '1:4 A dim`Efficien Plooi Area requirement Thermostat Pack ceed Unit p.>� over 40 8 of ducts � �� L1E G� COP ,r by system ' added or ie cxd in !a!'aetback Indoor Coil ;� 8 HSPF— �sf un oned space (Taot alreadypr-ag mast be Condensing Unit ®EER ®Resistance /So 0 6 (CZ I,Spa txatatled) E3 Other • 1.Equipment Type:Choose the equipment being installed;if more than one_systent,use another CF-1 R-ALT-HVAC for each system 2.Minimum Equipment Efficiencies:13 SEER,7S%AFUE,7.7HSPF for typical residential systems. Contractor(Documentation Author's/Respon:sible.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: `Oi.►` �v—;--�LK-J Signature: Company: Date: Address: 2� Gblts`ti./L y4�/� License: 1/17350 City/State/Zip: C y p r;�� Phone: 4108 99 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 CUPERTtNO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333•buildinga-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 P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: Z LA ZI r-As-t_f-p P_A PERMIT'#,:; OWNER'S NAME: �1 1�11fZ-�L PH TE# y� 99�o —81 ZD GENERAL CONTRACTOR: BUSINES&LICENSE# ADDRESS: Z_q g eol s SSb3 CITY/ZIPCODE: *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 SUBCONTRACTORS HAVE OBTAINED A,-CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information::..' 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 CUPERTINO QIJ+tdsng pepartment COMMUNRy � , AY 2013 evItDINELOPMENT G UMSION-CU ERTiRT ENT NO REVIEWED F Ft CODE COMPLIANCE This ON ® job site plans and specifications Revlevv By: 1� during construction MUST be kept at th changes or alterations on sam nlawful t0 e erefrom, without a or to deviate a any The>� pproval from the Building official. be held two ng of this l be an specifications OT permit or cations Siigt t , YLO'1' PL�r Of any p ions of an approval of t,3e vial, By tY O.dinajgce or 3trvn CHECKED BY Y�/ r PLANNING DEPT. 0 P�r DATE off Wo-- Lf-oxp oz- 9 150 z-9150G -�c