13080117 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21045 FREEDOM DR CONTRACTOR:CONDITIONED AIR PERMIT NO:13080117
OWNER'S NAME: YANAGISAWA NORIKO 1701 LITTLE ORCHARD ST DATE ISSUED:08/15/2013
OWNER'S PHONE: 4082531786 SAN JOSE,CA 95125 PHONE NO:(408)291-2220
❑ LICENSED
CONTRACTOR' DECLARATION JOB DESCRIPTION: RESIDENTIAL 11COMMERCIALE]
License Class C ` Z/a/ Lic.# l l6 ? REMOVE AND REPLACE A/C UNIT IN SAME LOCATION
Contractor C N c11�"t i aye J A(Date l �
I hereby affirm that I am licensed under the provision of C apter 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:$4000
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:32653026.00 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 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: ,N
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date X_3 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 h►surance,as provided for by the Health&Safety Code,Sections 25505,255!!�ao 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent: Date: rh
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
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
GENERAL PERMIT APPLICATION t� MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION1
10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 (�
(408)777-3228•FAX(408)777-3333• building(a�cuperdno.org V misc
CUPERTlNO 0
[]PLUMBING [Taq— ICAL ELECTRICAL ❑MISMLL�ANIEOOUS s
F-7
S C APN#��
�S
"NFA ZG I E-MAIL
� � �
TREETADDRESS CITY,STA ZIP � FAX
CONTACT NAME PHONE ccicr& E-MAIL
STREECADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BunnER ❑ OWNER AGENT WYCONTRACCOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGDJEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC#
_ � Must 6
COMPANY NAME E-MAIL FAX
�YK E
STREET ADDRESS0f% RIO
CTCV,STATE,ZIP PHONE
222
222
LICENSE NUMBER BUS.LIC#
ARCHITEMENGINEER NAME
COMPANY NAME'
EMAIL FAX
STREET ADDRESS
CITY,STATE,ZIP . ��
USE OF ❑SFDorDUPLEX ❑ MULTI-FAMII.Y PROJECT INWILDL4ND ❑ YES PROTECTIN ❑YES Is THE BLDG AN ❑YES
USE DWG• ❑sm DUPLE URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK L)e cc k Ct oy\p�
TOTAL VALUATION:
/'� �y�® RECETVED BY:_�
� V � V
01 Id 4-
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,I ha v d the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building eaestracti an repres of Cu oto enter the above-id t/ified pro for inspection pu(poses.
Signature of AppEcant(Agent- Date. ( /
ENTAL RWATION REQUIRED OFFICE USE ONLY
N ❑ OVER-THE-COUNTER
❑ EXPRESS
U
U
❑ STANDARD
U
❑ LARGE
❑ MAJOR
MEPMrscApp Z011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: DATE: 08/15/2013 REVIEWED BY: Mendez
APN: BP#: *VALUATION: 1$4,000
%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
LIM
�."501,
Mech.Plan Check0.0 hrs $0.00 .Plumb.Plan Check Elec.Plan Check
Mech.Permit Fee: IMPERMIT Plumb.Permit Fee: I fec. Permit Fee:
Other Mech.Insp. 0.0 hrs $47.00 Other-Plumb Insp. Other Elec.Insp. ET
_14ech.In,sp� Fee: Plumb. Insp.Fee: Elec.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These ees are based on the prellmina information available and are only an estimate. Contact the Dept for addn'1 in o.
FEE ITEMS (Fee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 0 # Mechanical
Suppl.PC Feer Reg. 0 OT 0.0 hrs $0.00 $70.00 1BREMAIR A/C Units(<=1OK cfin)
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $47.00
Construction Tax:
Administrative Fee: 1ADMIN $44.00
Work Without Permit? ® Yes (j) No $0.00 E)
Advanced Planning Fee. $0.00 Select a Non-Residential G
Travel Documentation Fee: ITRAVDOC $47.00 1
Building or Structure
i
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
Kip
T a� $139.50 $70.00 -
$209.50
Revised: 07/01/2013
Sfwplified Prescriptive Certifcate of Compliance:2008.Residential.HYACAlteratiotrs. CF-1R-ALT-AVA1C-
Climste Zones i and 3-7 r
Site Addr=
EnforcemewAgency: Datei
Frc a
l/D y g 'S
Conditioned Duct insulation
&Mpmenaypel L'sc'2 m.`Efficien` icor Aiea' The ostai
Packaged Unit ;r. Over 40 8 of dards' `
Furnace �.t�.�UE_ COP Served by system added orreplaced in WSetback
Indoor Cott U RSPF (fnotalreadypresort,mrut be
Condensing Unit �1,� Resistance sf unconditioned space, hwallr4
1-3 er I E3R6 (CZ 11 3S) •
1.Equipment Type.-Choose the equipment being installed;ifmore than onesystem,use anotlter CF-7R-ALT-HVAC for each system
2.Afinimum Equipment EMcienciees:13 SEER,7S%AFUF,7.7HSPF for typical residential systems.
Contractor(Documentation Author's/Responsible Designer's Declaration Statement)
• I certify that this Certificate of Compliance documentation is accivate and'compiete., ;
• I am eligible under Division 3 ofthe Califona¢a 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 idehtified 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 infonnation doc=ented on other applicable
compliance forms,worksbeets,calculations,plans and specifications submitted to the enN=ment agency for approval with the permit
application. _ 14-01
Name: f C 2 Signatrue:
Company Date:
k I t' g /f
Address: License: .s/� Z
Citylstateaip: (?Se S F Z Phone: �� ZZ 2 2v
2008 Residential Compliance Forms.doc revised 04/10112
HVAC ALTERATIONS ENERGY COMPLIANCE FORM
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
CUPERTIN0 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333•building aecupertino.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
Community Development
10300 Torre Avenue
Cupertino CA 95014
.1 Telephone(408)777-3228
Fax(408)777-3333
M OF
CUPEkTINO
, y
Buildin De artment
I j
JOB ADDRESS:
Zl i PERMIT#
.C_
OWNER'S NAME: f, Z�f1Z C PHONE# 6 l G 17FS
GENERAL CONTRACTOR Cin ck FAX# CCI�) i ?�2
8 111 �
I am not using any subca�.tr�ctors: Date
Signature.
Please check applicable su, ontractors and complete the followin information:
SUBCONT'RA OR BUSINESS NAME BUSINESS LICENSE #
Cabinets&Millwo*k
Cement Finishi#g
Electrical ' a
i
Excavation
Fencing
i
i
Flooring:Carpetin
Linoleum / Wood
Glass/ Glazingl
x
Heating
In
sulation
Landscaping
Lathing
is
Masonry
Ornamental Sheet e
Painting/ Wall' a
Paving
Plastering k
Plumbin
Roofin
Septic Tank l
Sheet Metal
Sheet Rock
Tile
Owner/Contract�pr Signature
Date