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13070129 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22050 REGNART RD CONTRACTOR:RESIDENTIAL HEATING PERMIT NO: 13070129 AND A/C INC OWNER'S NAME: GREGORY S YOUNG 65 CRISTICH LN DATE ISSUED:07/22/2013 OWNE PHONE: 4083660581 CAMPBELL,CA 95008 PHONE NO:4083774073 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALE] License Class_ Lic.# -7 REPLACE 2(E)A/C UNITS&2(E)FURNACE SYSTEMS, (( SAME LOCATIONS(VERIFY 20'X 20' CLEAR IN GARAGE ContracR / Date 7% Z AREA) I hereby affirm that I am licensed mule the provisio s of Ch ter 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:$25500 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:36602048.00 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 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 DAYS L 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 2 13 granting of this permit. Additionally,the applicant understands and will comply a by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. v, RE-ROOFS: Signature :,r- 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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,Sect' 255 ,25533, 5534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agen permit is issued. I certify that in the performance of the work for which this permit is issued,l shall 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 CONSTRUCTION LENDING AGENCY 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 A GENERAL PERMIT APPLICATION / MEP 10 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 O CUPERTINO (408)777-3228•FAX(408)777-3333•building(ftypertino.org M MISC ❑PLUMBING [:]MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS a2 05© ' APN# r�i ^' 2 OWNERNAME / �Q yo PHONE I/O p ✓( Ab- 59� E-MAIL � STREET ADDRESS 2;-05 O 47 l_4 CITY,STATE,ZIP O FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME�Q/J_ LICENSE NUMBER 7 0!5!5 5 LICENSE TYPE BUS.LIC# COMPANY NAME R / E-MAIL FAX STREET ADDRESS J CITY,STATE,ZIP 0^lA PHONE 41Q 9 -3?7_1- 73 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 L _ /1e�J1Cc!� 2 CC' ��nGi.C.28 f .S'g.�'Itio �OCc�/an.S i TOTAL VALUATION: 5700 RECE By my signature below,I certify to each of the following: I am the property owner or authorized agent to act o p owner's behalf. I have read this application and the information I have p ided 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 Wconstructi orize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: 7 �.n SUPPLEMENTAL INFO,OkTION REQUIRED oPFicE USE ONLY W OVER-THE-COUNTER ❑ EXPRESS U ❑ STANDARD U ❑ LARGE a MAJOR MEPMiscApp_2011.doe revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 22050 REGNART RD DATE: 07/22/2013 REVIEWED BY: MELISSA APN: 366 02 048 BP#: *VALUATION: 1$25,500 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: p PERMIT TYPE: WORK REPLACE 2 E A/C UNITS&2 E FURNACE SYSTEMS SAME LOCATIONS VERIFY 20'X 20' SCOPE I CLEAR IN GARAGE AREA) APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES A/C Units (<=1 OK cfm) 1BREMAIR 2 # $140 Furnace, Forced-Air 1MFR=<100 2 # $278 TOTALS: "_.. ..:: $418.00 \ _. a Mech.Plan Check 0.0 hrs $0.00 t horeb.Plan£:'heck Islet,T'lan,C;=<.r;{ Mech.Permit Fee: IMPERMIT I'lasrnl.flerrrr'f 1%ee: 1s?ec;.1'er mh I<10e: Other Mech.Insp. 0.0 �hrs $47.00 Other 1'hviib lnsl;. ()1hey 1',�,c,best;. l .k.fe";h.Ifnsf;. f°.y,z. I'luoib.Inv),Fee: A'Iec;. frr.�a.f Cris: NOTE.This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). Theseees are based on the prelimina information available and are only an estimate. Contact the Dept-for addn'l.info. FEE ITEMS (Fee Resolution 11-053 E . 711/12) FEE QTY/FEE MISC ITEMS Pkarr Cheek Fe:.>: Sum.)1, PC1st> PME Plan Check: $0.00 PME Unit Feer $418.00 PME Permit Fee: $47.00 Conslr ration Tay., Administrative Fee: IADMIN $44.00 Work Without Permit? ®Yes No $0.00 Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: IBSEISMICR $2.55 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $2.00 z 11 $560.55 $0.00 ��..' y, TAIEE, $560.55 � Revised: 07/01/2013 HVAC ALTERATIONS ENERGY COMPLIANCE FORM COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL CV PERTIN0 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•buildingaacupertino.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 F'orms.doc revised 04/10/12 1.` Simplified Prescriptive Certificate of Compliance:2008 Residenturl lYVACAlterations CF-IR-ALT-HVAC Climate Zones I and 3-7 S7teAddrese: Enforcement Agency. D Pertn3t:#:;_ V-�oso z� l Conditioned Duct insulation Equip-ent T hist hfmirrriiasEfficien Floor Area" re Theimosiat P Unit :' Over 40 of ducts' / OMid ace8 GOP gerved•hy system added oricplaced in [Setback Mjadoor Coil B HSPF sf unconditioned space. '(jfnot already present.mut be �r Condensing Unit ®EER Resistance E3 R 6 (CZ I,3-5) 0 Other • 1.Equipment Type:Choose the equipment being installed;if more than one_systern use another CF-IR-ALT-HVAC for each system. 2.Minimum Equipment Efficiencies-13 SEER,78%AFUF,7.7RSPF 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 spbeifications 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: Sim Company: Address: /_ - License: -70 . `) city/SuWzip gwe_lflH Phone:16,9 6 T 2008 Residential Compliance Forms.doc revised 04/10/12