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13080238 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 889 BETTE AVE CONTRACTOR:PELLE HEATING&AC PERMIT NO:13080238 INC OWNER'S NAME: BALAKRISHNAN SAKTHIDHARAN 3751 D CHARTER PARK DR DATE ISSUED:09/03/2013 OWN R'S PHONE: 4087686535 SAN JOSE,CA 95136 PHONE NO:(408)978-7060 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL License Clas ® Lic.4 qV9,522 4. . ADD(N)A/C UNIT IN SIDE YARD AREA Contractor G &Yl— Date I hereby affirm that I am licensed under the provisio s of&pter 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:$4650 h and will maintain Worker's Compensation Insurance,as provided for by ection 3700 of the Labor Code,for the performance of the work for which this APN Number:36927053.00 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 F A ALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, 9�3 costs,and expenses which may accrue against said City in consequence of the �3 granting of this permit. Additionally,the applicant understands and will comply I Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: SignaVe 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 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 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,Sectio 5505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized age Date: .7//,/-7 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 MEP* .. I : COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION .. 10300 TORRE AVENUE•CUPERTtNO, CA 95014-3255S C Om ' CU�ERTINO (408)777-3228 FAX(408)777-3333•buildingCa�cupertino.org ^ PLUMBING.` . EIMECHANICAL EIELEcTRiCAL nMISCELLANEOUS PROJECT ADDRESS r APN# 6 9 — d S ' 6 OWNER NAME: AN PHONE 7MAEL40t1_6b('2 STREET ADDRESS rfY I FAX CONTACT NAME K f PH NE V MAII STREET ADDRESSi-o FCTIY,ST TEZIP C1394K ❑OWNER ❑�OWNER-BUILDER ',13OWNER AGENT 13CONTRACTOR ❑CONTRACTOR AGENT 11ARCHITECT ❑ENGINEER ❑ DEVELOPER 0-TENANT . CONTRACTOR NAME . LI $� LIC SE TYPE BUS.LIC#Z�5y3 COMPANY NAME MAIL •� job`n e4- F y STREET ADDRESS t' C Y ST Z P PH0 ��o ' ABC NAME UV()�' LICENSE NUMBER BUS.LIC# COMPANY:, I+ E-MAIL FAX STREET/ADDRESS;! j CITY,STATE,ZIP PHONE USE OF 4[DUPLBX ❑•_MULTI-FAMILY PROJECT IN WIJALAND ❑ YES 17g;0JECTIN ❑YES IS THE BLDG AN ❑.YES BUILDING•:,.: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLD ❑NO EICHLER HOME? t3 NO DESCRIP}iONOFV`'ORK Ale, J• J. TOTAL'VA4UA770�V� � I�� By;>ry signature low,Icertjfy to each of the following: I am the property owner or authorized agent to n perty o s f. I have read this apglicatlott hnd le iriformatroa I have p ide&is correct. I ve read the Description of Work and verify it is accurate. I a mply with all applicable locate ordpances and'state laws relating`to bui in onstructi :Zaun.,i representatives of Cupertino to enterthe above-identified property for inspection purposes. ignatureicant/AgentDate: 0 i SUPPLEMENTALWORMATION REQUIRED I+ is i r i MEPMiscApp_ Ol Ldoc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 889 BETTE AVE I DATE: 08/30/2013 REVIEWED BY: MELISSA APN: 369 27 053 BP#: *VALUATION: 1$4,650 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: p PERMIT TYPE: WORK ADD N A/C UNIT IN SIDE YARD AREA SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES A/C Units (<=10K cfm) 16REMAIR 1 # $70 et TOTALS: ° $70.00 Mech.Plan Check 0.0 hrs $0.00 Plumb.Plan Check Elect.Plan Cheek Mech.Permit Fee: IMPERMIT Plumb.Permit Fee: Elec. Permit F-e: F,,, er Mech.Insp. 0.0 hrs $47.00 Other Plumb Insp: E17- Other Dec.Insp. Ljh.Insp. free: I Plumb. hrsp. Fee: I Elec.Insp.Fee: 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 prefimina information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl. .P(..'Fee PME Plan Check: $0.00 Penni[Fee: Suppl, Insp Tee PME Unit Fee: $70.00 PME Permit Fee: $47.00 Construction Tax: Administrative Fee: 1ADMIN $44.00 Work Without Permit? ® Yes (j) No $0.00 ,Advanced Planning Fees: Travel Documentation Fee: ITRAVDOC $47.00 A Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item 131.dy Stds Commission.Fee: 1BCBSC $1.00 1,7W ` $209.50 $0.00 3 aTozAL-62 $209.50 Revised: 07/01/2013 INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning Systems,Ducts and Fans (Page I of 2 Site Address: Enforcement Agency: Permit Number: g g �'! Space Conditioning Systems Heating Equipment Duct Efficiency Location Equip (AFUE, (attic, Type ARI #of etc.)',' crawl- Heating Heating (package- CEC Certified Mfr.Name Reference Identical (>_CF-1R space, Duct Load Capacity heat um and Model Number Number' Systems value 4 etc.) R-value Btu/hr (Btu/hr Cooling Equipment Efficiency Duct Equip (SEER Location Type and EER) (attic, (package #of 1,3 crawl- Cooling Cooling heat CEC Certified Mfr.Name ARI Reference Identical (>_CF-1R space, Duct Load Capacity um and Model Number Number 2 Systems value)4 etc. R-value (Btu/hr) (Btu/hr) ay"l o--� da S� 1.If project is new construction, see Footnotes to Standards Table 151-B and Table 151-C for duct ceiling alternative compliance. 2.ARI Reference Number can be found by entering the equipment model number at http://`vww.aridirectory.org/ari/ac.php# 3.Listed efficiency on this page must be greater than or equal(>_)to the value shown on the CF-IR form. 4. When CF-IR is reference it also applicable to the CF-IR, CF-JR-AA or CF-IR-ALT ALL BOXES MUST BE CHECKED TO BE A VALID FORM ❑ §110-§113:HVAC equipment is certified by the California Energy Commission. ❑ §150(h):Heating and/or cooling loads calculated in accordance with ASHRAE,SMACNA,or ACCA. ❑ §150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of§112(c). ❑ §1500)2:Pipe insulation for cooling system refrigerant suction,chilled water and brine lines meets minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entirely in conditioned space. 2008 Residential Compliance Forms August 2009 .INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning Systems,Ducts and Fans (Page 2 of 2 Site Address: Enforcement Agency: Permit Number: Ducts and Fans §150(m):Duct and Fans ❑ 1.All air-distribution system ducts and plenums installed,sealed and insulated to meet the requirements of CMC Sections 601,602,603,604,605 and Standard 6-5;supply-air and return-air ducts and plenums are insulated to a minimum installed level of R-4.2 or enclosed entirely in conditioned space. Openings shall be sealed with mastic,tape or other duct-closure system that meets the applicable requirements of UL 181,UL 181A,or UL 181B or aerosol sealant that meets the requirements of UL 723. If mastic or tape is used to seal openings greater than 1/4 inch,the combination of mastic and either mesh or tape shall be used;and ❑ 1.Building cavities,support platforms for air handlers,and plenums defined or constructed with materials other than sealed sheet metal,duct board or flexible duct shall not be used for conveying conditioned air. Building cavities and support platforms may contain ducts. Ducts installed in cavities and support platforms shall not be compressed to cause reductions in the cross-sectional area of the ducts. ❑ 2D.Joints and seams of duct systems and their components shall not be sealed with cloth back rubber adhesive duct tapes unless such tape is used in combination with mastic and draw bands. ❑ 7.Exhaust fan systems have back draft or automatic dampers. ❑ 8.Gravity ventilating systems serving conditioned space have either automatic or readily accessible,manually operated dampers. ❑ 9.Protection of Insulation.Insulation shall be protected from damage,including that due to sunlight,moisture, equipment maintenance,and wind.Cellular foam insulation shall be protected as above or painted with a coating that is water retardant and provides shielding from solar radiation that can cause degradation of the material. ❑ 10.Flexible ducts cannot have porous inner cores. DECLARATION STATEMENT • I certify under penalty of perjury,under the laws of the State of California,the information provided on this form is true and correct. • 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction,or an authorized representative of the person responsible for construction(responsible person). • I certify that the installed features,materials,components,or manufactured devices identified on this certificate(the installation) conforms to all applicable codes and regulations,and the installation is consistent with the plans and specifications approved by the enforcement agency. • I reviewed a copy of the Certificate of Compliance(CF-1R)form approved by the enforcement agency that identifies the specific requirements for the installation: I certify that the requirements detailed on the CF-1R that apply to the installation have been met. • I will ensure that a completed,signed copy of this Installation Certificate shall,be posted,or made available with the building permit(s)issued for the building,and made available to,the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. _ Co y e: (Install g S boontr/motor or General Co7actor or ilder/Owner) R s nsib a Person's Name: Respons =on's Signature: rt CS Licenser a�t`ee Posi"on W Com p( tl ): 2008 Residential Compliance Forms August 2009 Nft-lw I./L!,,L(nl . a < I / v l N -:):,- `Y\ I." P/A- j +• j .:yx t , ,, ,,, •�w�a,y"'iacwa."a ,y. COfvlly a iiY pRl !f- i uJ r c r , � s d r This`,`at ofjob E I QE>> r s UI z?Ietr r .-:^� r � IYl o.i} � tlla 2frCYn,Vv!'d1UU'G ap,.,t-ov-I i€Uff€1F1C T1oStPinPinn'ofthi Dia ! vE �. a 4. s O W }. _ held, _U I;.N-MllIL UY �t fry q;iovaic O"k(11 rtLi$' !-! I V Z '} " of any g3Y „4 is of y JrinQnce or 1— Q _ r LU o h rE3 CL c O P RrJIT NO. CLr .. { i 1 4: ! d _ 3 C"� S� i J i i s fi DATE' � � .c.:s.a•nt}r�C,N.,3+•If't'g",,�a.r 1.�,x,r,W,^I_:3tur x-K rc as,r r�r- tlt�.ti.�' ��7 'sa.r .i *R4 �•���� suwc,w+ ar$a sAG,�nu. fF' s k...,�.