13080116 CITY.OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10101 UNITED PL CONTRACTOR:CONDITIONED AIR PERMIT NO:13080116
OWNER'S NAME: HELEN KWAN 1701 LITTLE ORCHARD ST DATE ISSUED:08/15/2013
OWNER'S PHONE: 4088650202 SAN JOSE,CA 95125 PHONE NO:(408)291-2220
El LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL
License Class C' Z V /ILic./#J yee S,'r6 Z— REMOVE AND REPLACE A/C UNIT IN SAME LOCATION
Contractor�f� lllrGll�ct /Tim✓ Date '51EI
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:$3200
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:32653014.00 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 DA FROM 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 'S'
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source reguI ti the Cupertino Municipal Code,Section
TZ
9.18.
RE-ROOFS:
Signature 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 withctions 2the Cupertino M mcipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Se5505 nd 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized agen Date:
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 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
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
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 L9 MEP
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION U
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
408 777-3228•FAX(408)T77-3333•buildin4CUDertino.orQ misc
CUPERTINO ( ) C�
❑PLUMBING ®'IGfECHANICAL ELECTRICAL ❑MISCELLANEOUS
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LICENSE NUMBER LICIINSE TYPE BUS.LIC#
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COMPANY NAME
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ARCEIITECTfENGINEER NAME
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COMPANY NAME'
STREET ADDRESS
CITY,STATE,ZIP PHONE
F'OJECTIN 0 YES IS THE BLDG AN 11 ym
USE OF [3 Sm or DUPLEX ❑ MULTI-FAMD.Y PROJECT IN WILDLAND ❑ NO pLOOD ZONE ❑NO IICHLERHOME? ❑NO
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑
DESCRIPTION OF WORK
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TOTAL VALUATION: 3 ZUO-D G RECE17—- IIS
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the p erty owner's behalf. I have read this
application and the information I have provided is correct j have Lead the Description of Work and ve ify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating m building cons I orize r tatives of Cupertino to enter the above-identified prop /for inspection pu{poses.
/
Signature of ApplicandAgentt' Date:
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
❑ OVER-THE-COUNTER
t- ❑ EXPRESS
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❑ LARGE
❑ MAJOR
MEPMiscApp 201 Ldoc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: DATE: 08/15/2013 REVIEWED BY: Mendez
_91APN: BP#: "VALUATION: 1$3,200
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION FURN/A
USE: PERMIT TYPE:
WORK remove and replace a/c unit
SCOPE
1
= s NIt
Mech.Plan Check 0.0 hrs $0.00 Plumb,Plan Cheek Elec.Plan Check
Mech.Permit Fee: 1MPERMIT Plumb.Permit Fee: Elec. Permit Fee:
Other Mech.Insp. 0.0 hrs $47.00 Other Plumb Inch. Lj Other I:lee.Insp,
Rlech.Insp.Fee: Plumb.Insp.Pee: flee.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 prelimina information available and are only an estimate, Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Mechanical
Suppl.PC Fee: Q) Reg. 0 OT 0.0 1 hrs $0.00 $70.00 1BREMAIR A/C Units(<=10K cfm)
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Feer Reg. Q OT 10.01hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $47.00
Construction :Tett:
Administrative Fee: IADAlffN $44.00
Work Without Permit? 0 Yes (j) No $0.00 G
Advanced Planning Fee: $0.00 Select a Non-Residential 0
Travel Documentation Fee: ITRAVDOC $47.00 Building or Structure
i
Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
$139.50 $70.00 . $209.50
w __ ..
Revised: 07/01/2013
Simplified Prescriptive Certificate of Compliance:2408 Resfrfenfid HVACAlteiations. CF-IR-ALT-FM C ,
Climate Zones l and 3-7
McAddress: EnforcemewAgency: Dat _ Permit
/d� $ S /j
Conditioned Duct ti
l
insuaon
entT r L '1v�fitn cienC - 1<lbrsr';0.irea ii Theimostat
Packaged unit s `+ Over 408 bf ducts'
13 Furnace ®AI LiE COP Served.by system " .added or=placed in etbaric
cindoor Co11 O ®HSPF_ bzjnaiaJ .. Present,mart be
ondensing Unit. ®EER E3 Rmstance sf unconditioned space.
ether
1.Equipment Type:Choose the equipment being installed;if more than one_systens,use another CF:IR-ALT-HitAC for each system
2.Mw mum Equipment E#5ciencies:13 SEER;7$%AFUE,7.7HSPF for typical residential systems.
Contractor(Documentation Author's/Responsible Designees 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,wmrksheets,calculations,plans and specifications submitted to the enforcement agency f approval with the permit
licatioa. _
Name: Signatrue:
Companyr (/ Date:.
O /-11 ("ogA
Address: License:
Zz2' v�c� /6z
City/State/Zip: OS'e•. C�: g / Z_ Phone:
"" 2008 Residential Compliance Forms.doc revised 04110112
HVAC ALTERATIONS ENERGY COMPLIANCE FORM
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
CUPERT[NQ 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•building(a)cugertino.orq
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
1
Community Development
10300 Torre Avenue
` Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
CITY OF
CUPERJINO
Building Department
JOB ADDRESS: \ ` PERMMI r#
O ` PHONE# 'a6S 092Z2-
OWNER'S NAME: i
GENERAL CONTRA ,O FAX# Cet
I am not using any subco�,trctors:
;i
Signature. Date
Please check a livab. -Su ontractors and complete the following information
SUBCONTRik&OR BUSINESS NAME BUSINESS LICENSE #
Cabinets&Mir W1 4k
Cement Finishing
Electrical
Y
Excavation
Fencing or
Flooring:Carpetin'
Linoleum/-wood
Glass/ Glazing)
z
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet etal
Painting/ Wall' a
Paving
Plastering f
Plumbing
Roofing
Septic T
L
Sheet tal
Sh ock
--------------
Tee
` Date
Owner/C n-trach r Signature