13080055CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:. 21116 FREEDOM DR
CONTRACTOR: AAA FURNACE & AIR
PERMIT NO: 13080055
CONDITIONING
OWNER'S NAME: HOMEOWNER'ASSOC COMMNS OF CUPRTN
1712 STONE AVE
DATE ISSUED: 08/07/2013
OWNER'S PHONE: 4085591977
SAN JOSE, CA 95125
PHONE NO: (408)293-4717
JOB DESCRIPTION: RESIDENTIAL El COMMERCIALE]
®" LICENSED CONTRACTOR'S DECLARATION
Class L'Y� Zf Lic. # % i
**CLUBHOUSE**REPLACE 2 (E) FURNACES & 2 (E) A/C
License
UNITS, SAME LOCATIONS (1ST & 2ND FLOORS)
Contractor A /-/� t A .1 f H Z c -L_ Date
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: $12600
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 32653034.CLUBHSE
Occupancy Type:
Section 3700 of the Labor Code, for the performance of the work for which this
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 FRO C D 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
Iss e: I ( 3
granting of this permit. Additionally, the applicant understands and will comply
y:
with all non -point source re ons per the Cupertino Municipal Code, Section
9:18.
Signature Datea'_ ?-13
RE -ROOFS:
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 isnot intended or offered for sale (Sec.7044,
Business & Professions Code)
1, 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
Section 3700 of the Labor Code, for the performance of the work for which this
the Health & Safety Code, Sections 25505, 2 ,and 534.
Owner or authorized agen� 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, 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 inconsequence 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
Q NIE P
COMMUNITY DEVELOPMENT DEPARTMENT-18UILDING DIVISION VO
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 O
(408) 777-3228 • FAX (408) 777-3333 • buildinQ0 cupertino.orq
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STREET ADDRESSV712-
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ED OWNER ❑ OWNER -BUILDER ❑ OWNER AGNJ,@'C0NTRACrOR ❑ CONTRACTOR AGENT ❑ ARcmrrECT ❑ ENGINEER ❑ OgvELoPER ❑ TENANT
CONTRACTOR NAME 4dLa f=t � f,n/j a Ce
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SiTUMT ADDRESS
CITY, STATE, ZIP
PHONE
USE OF --@-3FD or Duplex ❑ Multi-f7;
STRUCTURE: ❑ Commercial
JECT IN WILDLAND
AN DrTERFACE AREA ❑ Yes C
PROJECT P1
FLOOD ZONE ❑ Yes 9
DESCRUMON OF WORK
1�° 2 &AIJMOnd 2- MC Cond WI
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TOTAL YALUATION: 000,00
13y my signature below, I cerfify to e f the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the informadon I ve pr ided is L 1I have read the Description of Work and Yerify it is accurate. I agree to comply with all applicable local
ordinances and state laws reladn to buil ng co n. I authorize representatives of Cupertino to enter the b Ye- entified property for inspection purposes.
Signature of Applicant/Agent: Date: I✓ _.
5U#LL=tAL INFORMATION REQUIRED
0
MEPMurApp1011.doc revised 03116/11
--� CITY OF CUPERTINO
1PU'U TQT7•M A TnR — RTTTT .DINE DIVIRION
ialADDRESS:
21116 FREEDOM DR (CLUBHSE)
DATE: 08/07/2013
REVIEWED BY: MELISSA
UNITS
APN: 32653034.CLUBHS
BP#:
A/C Units (<=10K cfm)
`VALUATION:
1$12,600
*PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY Commercial Building
USE:
Furnace, Forced -Air
PENTAMATION FURN/AC
PERMIT TYPE:
WORK
REPLACE 2 E FURNACES & 2 E A/C UNITS SAME LOCATIONS 1ST & 2ND FLOORS
SCOPE
$278
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
A/C Units (<=10K cfm)
1BCAIRHA
2
#
$278
Furnace, Forced -Air
1MFR=<100
Suppl. Insp Fee
2
#
$278
PME Unit Feer
$556.00
PME Permit Fee:
$47.00
C'onslruction I,ax:
Administrative Fee: IADILIIN
$44.00
Work Without Permit? ® Yes (j) No
$0.00
TOTALS:
Travel Documentation Fee: ITRAVDOC
$556.00
Strong Motion Fee: 1BSEISMICO
Mech. Plan Check 10.0 1 hrs
Mech. Permit Fee: 1
Other Mech. Insp. F-0-01hrs
I.11ech. Insp. Fee:
$0.00 Plumb. Plan Check
ERMIT Plumb. Permit Fee:
$47.00 Other Plumb Insp.
Plumb. !lisp. Fee:
Elec. Plan Check
Elec. Permit lee:
Cather Elec- Insp.
Elec. Insp. Fee:
7.
NOTE: This estimate does not include jeer true to other uepartments (r.e. rtanntng, ruouc rrurn3, rare,-ure-uly UGIYGI LULL LVL, YL LLvvL
Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/12)
FEE
QTY/FEE
MISC ITEMS
Plan Check Feer:
Suppl. PC Fee
PME Plan Check:
$0.00
Permit Fee:
Suppl. Insp Fee
PME Unit Feer
$556.00
PME Permit Fee:
$47.00
C'onslruction I,ax:
Administrative Fee: IADILIIN
$44.00
Work Without Permit? ® Yes (j) No
$0.00
Advanced Planning? Fees:
Travel Documentation Fee: ITRAVDOC
$47.00
Strong Motion Fee: 1BSEISMICO
$2.65
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
Fr4ef
$697.65
$0.00
! Gql..� 9..:a, w .A: 3.i.3'd�rsi�
$697.65
M Revised: 07/01/2013
Prescriptive
Project Name;
ate of•Compliance: Residential
r
►C SYSTEMS - HEATING
Minimum
Heating -Equipment Efficiency Distribution
vna and (".anacitv".) ( \FUE or HSPF Type and Location
CF -1R -ALT
Pae 4 o If 501
Climate Zone # # of Stories
actor- iping Configuration
Insulation Thermostat (Central, Split,
R -Value Type Space, Packa a or H
1. Indicate Pleating Type (Central Furnace, .Wall Furnace, Heat pump, Boiler. Electric Resistance, etc.)
2: Electric resistance treating 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 rime-Nmiring device not exceeding 30 minutes). See §151(b)3 exception.
3. Refer to the HERS Verification section on Page 4 of the CF - I R-,ILT Form for additional requirements and check applicable boxes.
4. Indicate Type or Location (Ducts. Hydr•onic in Floor, Radiators, etc.)
HVAC SYSTEMS - COOLING
Minimum Configuration
Efficiency Duct or Piping
Insulation Thermostat (Central, Split,
Cooling Equipment (SEER/EER or Distribution R.Value T e S ace, Packa e or H dronic
Tvoe and CavaeitY�•- COP) T e and Location CPX d
1. Indicate Cooling Type (A/C. Heat pump, Evap. Cooling, etc)
2. Refer to the HERS Verification section on Page 4 of the CF- IR -ALT Form Jor• additional requirements and check applicable bores.
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 opropane f fired, and may not exceed 10 gallons. Hot water pipe insulation from the DHW hearer to the kitchen(s) and on all underground
r•
hot water pipes is re uired in all com onent packa es in all climate zones. External Tank
Tank E
Water Heater Type/Fuel Distribution Type Number In Energy Factor or Insulation
Tv�e (Standard, Recirculatin )
' system Ca aciry ( al) Thermal Efficienc R -Value
1. indicate Type (Storage Gas, Heat Pump, Instantaneous, etc.)
2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of §1 SO(n). The Prescriptive requisements do
not allow the installation of a recirculating water heating system Jor single dwelling units.
3. The external water heatingtank and pipes shall be insulated to meet the re uirements a 150
SPECIAL FEATURES The enforcement agenev should pay special attention to the Special Features specified in this checklist below.
These items may re vire written usti tcation and documentation ands ecial veri tcation.
•
NEW. ROOF ASSEMBLY - Radiant Barrier
` The radiant barrier requirement of 151( 2 does nota i to roof alterations.
Slab Edge (Perimeter) Insulatfon W 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 re uired for all heated -slabs all Climate Zones, See details in Table 1 18-A of the standards.
in
Raised Slab Insulation ❑ YES 0 NO
YES: In Climate Zones 1, 2; 11, 13, 14 & 16, R48 insulation is required; in Climate Zones G2;& 15,:R-4 is required..under com onent Pa
Thermal Masswse.the:Perfonnance A roach.
To obtain Compliance Credit for the installation oftherrn'ai mass.,:,:
Registration Number: Registration DarelTime:
2008 Residential Compliance Forms
HERS Provider:
August ZO