13070172 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 911 LIBERTY CT CONTRACTOR:TFF HEATING AND AIR PERMIT NO:13070172
CONDITIONING
OWNER'S NAME: SYMONS JAMES J AND NANCY F TRU 299 CORNING AVE DATE ISSUED:07/29/2013
OWNER'S PHONE: 4084973805 MILPITAS,CA 95035 PHONE NO:(408)786-8120
ft NELICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL 11
License Class G—Zy Lic.# 9/ 3 5 REPLACE FURNACE IN SAME LOCATION,ADD A/C IN
/Z�1/, REAR
Contractor �� Date 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
erformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$6450
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:35611063.00 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 1�0 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 ROM 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
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:7 Z 7
with all non-point source re tions per the Cu ertino Municipal Code,Section 14
9.18.
RE-ROOFS:
Signature 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
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,
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 255 25533,and 4.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: 29
permit is issued. I..
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
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 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 /f !V
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 0�
CUPERTINO
(408)777-3228•FAX(408)777-3333•building(ftuaer ino.org MISC
❑PLUMBING �CHANICAL [—]ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS el I APN#
OWNERNAME 3v � PHONr1-/0 G-/7A+7�� E-MAII.
STREET ADDRESS A CITY,STATES,ZIPAG��
CONTACT NAME PHONE
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y,M N, ^`
STREET ADDRESS V(••Y�- CITY,STATE,ZIP O -I i F
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❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME �`_ �L,► /� �� L CENSE NUMBER/�'/7 Z f LICENSE TYPE_ ` BUS.LIC#
COMPANY NAME ' r./r�fT�J� E-MAIL �% //_ v ����a uC/ FAX
STREET ADDRESS V c_n' ' � c CITY,STATE,ZI - � u� � PHONE ZIP
&
ARCHITECT/ENGINEER NAME LICENS ER BUS.LIC# (�D
COMPANY NAME FAX
STREET ADDRESSCITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WIIALAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK
TOTALVALUATION: Lt SV t RECHI B '
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act o�ht#property 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 altrate. I agree to comply with all applicable local
ordinances and state laws relating to building co tion. I auth pr ntatives of Cupertino to enter the ove-identified property for inspection purposes.
r
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE 2WLY
OVER-THE-COUNTER
❑ EXPRESS
x
U
x ❑ STANDARD
U
a ❑ LARGE
a
❑ MAJOR
MEPMiscApp_M1.doc revised 06/21111
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING.DIVISION
ADDRESS: 911 Liberty Ct DATE: 07/29/2013 REVIEWED BY: Mendez
APN: BP#: "VALUATION: 1$6,450
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY PENTAMATION
USE: SFD or DuplexL- I PERMIT TYPE: *URN/A A
WORK replace furnace in same location add a/c in rear of sfdwl
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
A/C Units (<=10K cfm) 1BREMAIR 1 # $70
Furnace, Forced-Air 1MFR=<100 1 # $139
TOTALS: A $209.00
x
Mech.Plan Check 0.0 hrs $0.00 Phunb.Plan Check F.lec.Plan Check
Mech.Permit Fee: IMPERMIT Plumb. Permit Fee: Elec. Permit Fee:
Other Mech.Insp. 0.0 hrs $47.00 Other Plumb Insp. EIF--]- Other Elec.Insp.
R3ech.Insp.1-ee: Plumb. Insp.Fee: Eke.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). These ees are based on the prelimina information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS(Fee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
St1P1-)1. PC Fee
PME Plan Check: $0.00
Permit.Fee:
Supp 1. Itisp Fee
PME Unit Fee: $209.00
PME Permit Fee: $47.00
Construction Te 7,v.-
Administrative Fee: 1ADAffN $44.00
Work Without Permit? ® Yes 0 No $0.00
Advanced Planning Fees:
Travel Documentation Fee: ITRAVDOC $47.00
Strong Motion Fee: 1BSEISMICR $0.65 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
aINT, rs �
$348.65 _ .$0.00 $348.65
Revised: 07/01/2013
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•building gncupertino.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
Simplified Prescriptive Certificate of Compliance:2008 Residential BVACAlterations CF-IR-ALT-RVA- t.
Cfrmate Zones 1 and 3-7
Me Address: EnforcwwzdAgency:
Conditioned Duct insulation
Equipment Typei Iist14inimum Efficien ' Floor AFea Tltermosfat
�'�Unit sd/`
� p COP 4v 8 of ducts` etbacdc
PF
Indoor Coif
Sery �ed' system added or replaced in
>E�� �HS _ .lj�y (Ijoot alreadyprrsau.must be
Condensing Unit ®EER Resistance L% sf unconditioned space ;rrtea)
Other E3 R 6 (CZ 1,3-5)
1.Equipment Type:Choose the equipment being installed;if more than one-systemuse another CF-IR-ALT-HVAC for each system.
2.AImimum Equipment Efficiencies:13 SEER,7S%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 forms,worksheets,calculations,plans and specifications submitted to the enforcement agency for approval with the permit
application. _
Name: T—F-T— '` ) Signatiue:
Company "-O"J"f' —�1(t—�. --I% - Date
Address: J G� �� ��.�'✓�j �}'�.l �� License: �/��
City/StatelZip:�/LJ1� Q Phcme: O -/ g/
2008 Residential Compliance Forms.doc revised 04110112
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CUPERTINO
' _�---i ft'[1 •. Building Department iI j%G
9
REVIE VE ; FOR CODE COMPLIANCE
Reviewed By; 1j�'
CBE BY-
AN
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)FFICE Cup "11.1- -
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COMMUNITY DEVELOPMENT DEPARTMENT ENING DEFT'
BUILDING DIVISION-CUPERTINO
APPROVED WA,i„E
This set of plans and specifications MUST be kept at the
durino construction. It is unlawful to make any
ch?mges or alterations on same,or to deviate
thea corn,without approval from the Building Official.
Tho ?,~ening of this plan and specifications SHALL NOT I
b': l:'<to porrnit or to be ani approval of the violation
or ny provisions of any City Ordinance or State Law.
BYA�. ✓i.0
PE!:%i,1 F NO.
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