13050197 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23017 CRICKET HILL RD CONTRACTOR:CALIFORNIA DELTA PERMIT NO:13050197
MECHANICAL INC
OWNER'S NAME: SANDIP DEB 6056 E BASELINE RD STE 155 DATE ISSUED:05/29/2013
OWNER'S PHONE: 4083983965 MESA,AZ 85206 PHONE NO:(866)692-5273
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11I
COMMERCIAL
License Class C=2 d Lic.# fll& �/ REMOVE AND REPLACE A/C AND FURNACE SAME
C 2 9 LOCATION
Contractor Date
I hereb arm 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:$6609
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:34241031.00 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 WIT 80 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 F OM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, /
costs,and expenses which may accrue against said City inconsequence 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.
ROOFS:
any r
Signature Date G 6 All roofs shall be inspected prior to y 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. 1 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 ,and 25534. r
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized age Date: Z g`
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,after 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 4�
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 ��/�
(408)777-3228•FAX(408)777-3333•buildin4(ftwertino.orp ✓ MISC
CUPERTINO
❑PLUMBING MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS ^ 3 D!/7 /y /� /_ d APN# 3 ya �l 6 3
OWNER NAME '7 C / P�� p_Sq / / EMAIL
STREET ADDRESS AQ/67 ��1� 7� CTTY ATE,ZIP �7 0 �O�J FAX
CONTACT NAME f / PHONE E-MAIL
G(�GJ� p - Z I-tJ/�D�
STOT ADDRESS CITY,STATE, ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT -aJ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CO TRACT R NAM LIC SE NUMBER LICENSE TYPE BUS.LIC#
CO ANY N E-MAIL FAX
VS ET ADDRESS _ CITY,STATE,ZIP PHONE
�'$2 / �' g PPV' .-dna
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 OF WORK / ,p
loe
TOTAL VALUATION: 9- D RECEIVED BY: 1-7
By my signature below,I cert+ to each of the following: I am the property owner or authorized agent to act on the py6peer'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 building c n. I authorizer ert_ino to enter the above-identified
Cproperty
for inspection purposes.
Signature of Applicant/Agent: Date: / 2/ 6 s-;;>
S LEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
W ❑ OVER-THE-COUNTER
❑ EXPRESS
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❑ MAJOR
MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 23017 cricket hill rd DATE: 05/29/2013 REVIEWED BY: MENDEZ
APN: BP#: *VALUATION: 1$6,609
%PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Duplex PENTAMATION FURN/AC
USE: PERMIT TYPE:
WORK remove and replace a/c and furnace same location
SCOPE
ME
Mech.Plan Check 0.0 hrs $0.00 P1....b.Plan Check Dec.Plan(:;heck
Mech.Permit Fee: IMPERMIT Plumb.Permit Fee: Elec.Permit ree:
Other Mech.Insp. 0.0 hrs $45.00 Other Plumb Asp. Other Dec.Imp. Lj
Mech, fnsp.Fee: Pfurrtb. hrsp.Fee: Elee.Insp.Tee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). These fees are based on the prefindna information available and are only an estimate. Contact the Dept/or addn7 info.
FEE ITEMS (Fee Resolution 1.1-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 F 1 # Mechanical
Suppl.PC Fee: (E) Reg. Q OT 0.0 hrs $0.00 $133.00 IMFR=<100 I Furnace,Forced-Air
PME Plan Check: $0.00 1 I # Mechanical
Permit Fee: $0.00 $67.00 IBREmAiR A/C Units(<=10K cfm)
Suppl. Insp. Fee:(j) Reg. Q OT 0.01hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $45.00
Consiruction:Tar: _T7
Administrative Fee: IADMIN $42.00
Work Without Permit? ® Yes (j) No $0.00 G
Advanced Planning Fee: $0.00 Select a Non-Residential 0
Travel Documentation Feer 1TR4VDOC $45.00 Building or Structure
i
Strong Motion Fee: IBSEISMICR $0.66 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
WOM
1 EN M_ $133.66 $200.00 �a- ® $333.66
Revised: 04/29/2013
Simplified Prescriptive Certificate of Compliance:2008 Residential HVACAIteradons CF-IR-ALT-HVAC
Climate Zones I and 3-7
Qe • Enforcement Agency: Dole: Permit#:
!7
Co�itioned Duct insulation
Ev"iment Type, 'List mum pen Floor Area requiranalt Thermostat
Packaged Unit Over 44 8 of ducts
Furnace ®AFUE_ COP • Served system ' added or replacxd in El Setback
Indoor Coil Mai HSPF atwtolrmdypreseru,must be
Condensing Unit ®EER ®Reswtazice sf unconditioned space
E3 Other ;@ R 6 (CZ 1,3-5) ,
1.Equipment Type:Choose the equipment being installed;ifmore than one_system,use another CF-IR-ALT-HVAC for each system.
2.Mnimum Equipment Efficiencies:13 SEER,78%AFIIE,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,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 forms,worksheets,calculations,plans and specifications submitted to the enforcement agency for approval with the permit
application, _
Name: .4 ,�e-I-,e// rp v p Signature:
Comp Date:
G� G d<t !� `Z
License:
del
ILI
City/Statelzip: - G E7 ;2 P J_ '2-a • . Phone: 2 4?O 7
2008 Residential Compliance Forms.doc revised 04110/12
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•buildingaacupertino.oro
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
N
JOB ADDRESS: PERMIT#
OWNER'S NAME: PHONE#
GENERAL CONTRACTOR: G, .t a BUSINESS-LICENSE#
ADDRESS: p G r f CITY/ZIPCODE: _. cs
*Our municipal code requires all businesses working in the city,to•have a City-of Cuperhno;business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SU13CONTRACTORS•.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