13060095 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20199 SUISUN DR CONTRACTOR:AAA FURNACE&AIR PERMIT NO:13060095
CONDITIONING
OWNER'S NAME: NEIL EVANGELISTA 1712 STONE AVE DATE ISSUED:06/12/2013
OWNER'S PHONE: 6696662466 SAN JOSE,CA 95125 PHONE NO:(408)2934717
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL O COMMERCIALE]
License Class / fT Lic.# q C S0� �j REPLACE(E)A/C UNIT,SAME LOCATION
Contractor AAI�rA'k(e Date 2 W l 7
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:$4232
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:36928014.00 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 WITHIN 180 DAYS O T 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 DAYS F AS ALLED 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 ate
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
9.1u��
gn/gn RE-ROOFS:
I nature 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 Date:
Signature of Applicant:
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)
HAZARDOUS MATERIALS DISCLOSURE
I,as owner of the property,am exclusively contracting with licensed contractors to
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 aCertificate 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
f Health&S
Heaaode,Secti25505 53,and 25534.
I have and will maintain Worker's Compensation Insurance,as provided for by the / 11
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:"` l l
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
i MEP
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT , 8'UILDING DIVISION (
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 , FAX(408)777-3333 building(cDcupertino.org misc
CURERT Q \
.. PLUMBING _CHAMCAL ELECTRICAL ❑MISCELLAdIOUS
FROJECI'ADDRES32D`0[a cly)vl� APN.Y -3 k 9 � 0/ y
OWNERNAMEM�r�i�. X01 s-'1�1 POcI—cow-
FAX
CONTACT NM43 PHONE E-MAJL
STREET ADDRESS. CITY,STATE, ZIP FAX
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v ❑ OWNER ❑ OWNER-BUILDER Q OWNER AOENT CONTRACTOR 0 CONTRACTOR AGENT ❑ ARCHrtECT ❑ ENowm Q DEVELOPER ❑ TFNAM
CONTRACTOR NAME 111 N . �t/�(�cAce LICENSE Nt?Fp�Ei�(n�' L1C(^ rn a BUS.LIC{QV
COMPANY NAME j`(r`n ,^.Y�V�\� Eft �/`V ` U(/tJ FV�`�/
S'1 t=ADDRESS wS i c- STTE,ZTPv 1 AQ UV
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ARCF=CTlENU1NZER NAME 1 LICENSE NUMBER BUS.Uc 1
COMP ANY NAMB E-MAIL FAX
STREET ADORE33 CITY,STATE,Zip ?H `
USE OF SFD or Duplex ❑ Multi-Family PROJECT IN WILOLAND FROJECT'.N
STRUCTURE; El COmlIlerClal URBAN[X7WACE AREA C3Yes ❑ No FLOOD ZONE 0 YC3 O NO
DESCRIPTION OF WORK \ 1 dv\'� �n r
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TOTAL VALUATION: 2 W
By my signature below,I certify to eac of a followifig: am the property owner or authorized agent to act on the property owner's behalf. I have read this
applicatiomand the information I have rovi ed is come I have read the Description of Work and verify it is accurate. I agree to comply with all applicable IOW
ordinances and state lawn relating to b ildi nswcti I autho 'ze representatives of Cupertino to enter thc0bWjdcntiflj8 property for inspection purposes.
Signature of Applicant/Agent: Date: r'
SUPPLENIENI INFORMATMON REQUIRED
htEPhfvcApp 2011.doe revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 20199 SUISUN DR DATE: 06/12/2013 REVIEWED BY: MELISSA
APN: 369 28 014 BP#: I "VALUATION: 1$4,232
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION FURN/AC
USE: p PERMIT TYPE:
WORK REPLACE E A/C UNIT SAME LOCATION
SCOPE
APPLIANCE/EQUIP TYPE FEE ED QTY UNITS BP FEES
A/C Units (<=10K cfm) 1BREMAIR 1 # $67
TOTALS: $67.00
w@ �, 'ME
wg
Moll Ed$
4a ,
Mech.Plan Check 0.0 hrs $0.0.0 Phrmb,Plan Check Elec.Plan Check
Mech.Permit Fee: 1MPERMIT Plumb.Permit Fee: I lec•. Permit
Other Mech.Insp. Li
0.0 hrs $45.00 Oilier Plumb Insp. 011ier Elco.Insp.
,ldech.Insp.Fee: Plumb. hisp.fee: Elec.Insp.Fee:
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 prelindna information available and are only an estimate. Contact the Dept for addn7 info.
FEE ITEMS(Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
PME Plan Check: $0.00
Permit Fee:
Suppl. Insp Fee
PME Unit Fee: $67.00
PME Permit Fee: $45.00
Construction Kix:
Administrative Fee: 1ADAffN $42.00
Work Without Permit? ®Yes G) No $0.00
Advanced Planning Fees:
Travel Documentation Fee: ITRAVDOC $45.00
Strong;Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item.-
Bldy,Stds Commission Fee: 1BCBSC $1.00
r 1 O'1 200
$200.50 $0.00 .505 £ $
Revised- 04/29/2013
CF-1R-ALT
Prescriptive Certificate of Compliance: Residential pa e 4 of 5)
Residential Alterations =Stories
Climate Zone#
Project Name: q S 1S
HVAC SYSTEIVIS-HEATING Configuration
Minimum Duct or Piping
Heating Equipment Efficiency Distribution Insulation Thermostat (Central,Split,
Type and Ca aci i.2.) ( \FUE or HSPF) Type and Location R-Value T e Space,Package or H dronic)
1.Indicate Heating Type(Cent-al Furnace,.Wall Furnace. Heat pi.imp, Boiler, Electric Resistance, etc.)
2.Electric resistance heating is allowed only in Component Package C, or except where electric heating is supplemental(i.e., if total capacity
�• , < 2 KW or 7,000 Btu/hr electric heating is controlled by a time-limiting device nor exceeding 30 minutes). See§151(b)3 exception.
3.Refer to the HERS Verification section on Page 4 of the CF-IR-ALT Form Jor additional requirements and check applicable boxes.
4. Indicate Type or Location(Ducts. Hvdronic in Floor, Radiators, etc.)
HVAC SYSTEMS-COOLING
Minimum Configuration
Efficiency Duct or Piping g
Insulation Thermostat (Central,Split,
Cooling Equipment (SEER/EER or Distribution
Type and Capacity'-2 COP) Type and Location R-Value T e Space,Packa e or H dronic
1. Indicate Cooling Tvpe(A/C. Heat pump, Evap. Cooling, etc)
2. Refer to the HERS Verification section on Page 4 of the CF-t R-,4LT Form Jor additional requirements and check applicable boxes.
3. Indicate-Type or Location (Ducts, H dronic in Floor, Radiators, etc.)
WATER HEATING
List water heaters and boilers for both domestic hot water(DHW)heaters and hydronic space heating. Individual dwelling DHW heaters must b,
gas or propene f fired, and may not exceed 50 gallons. Hot water pipe insulation from the DHW heater to the kitchen(s)and on all underground
hot water pipes is required in all com onent packages in all climate zones. External Tank
Water Heater Type/Fuel Distribution Type Number In Tank Energy Factor or Insulation
Te' (Standard, Reeirculatin )2 System Capacity(gal) Thermal EfficiencyR-Value;
1. indicate Type(Storage Gas, Heat Pump, instantaneous. etc.)
2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of§150(n). The Prescriptive requirements do
not allow the installation of a recirculating water heating system for single dwelling units.
3. The external water heating tank and pipes shall be insulated to meet the requirements of§1506).
SPECIAL FEATURES The enforcement agency should pay special attention to the Special Features specified in this checklist below.
These items may require written justification and documentation ands ecial verification.
NEW.ROOF ASSEMBLY-Radiant Barrier
The radiant barrier requirement of; 151( 2 does not ap roof alterations.
Slab Edge(Perimeter)Insulation C1 YES 0 NO
YES: in Climate Zone 16 in Component Packages D, R-7 insulation is required.
Heated Slab Insulation D YES O NO
YES:Slab edge insulation required for all heated slabs in all Climate Zones. See details in Table 118 A of the standards.
Raised Slab Insulation O YES O NO
YES: In Climate Zones I,2, 11, 13, 14& 16,R-8 insulation is required; in Climate Zones 12.& 15,R-4 is required under component PackO
Thermal Mass
To obtain Compliance Credit for the installation of thermal mass,;use.the:Performance Approach.
Registration Date/Time: HERS Provider:
Registration Number: August 20
2008 Residential Compliance Forms