13100042 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 18841 BARNHART AVE CONTRACTOR:A-I HEATING AND PERMIT NO: 13100042
COOLING
OWNER'S NAME: AURORA PEREZ 476 W TAYLOR ST DATE ISSUED: 10/04/2013
OWNER'S PHONE: 4084179374 SAN JOSE,CA 95110 PHONE NO:(408)283-9915
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIALE]
License ClassssgVP" Lic.# L ( q�� REMOVE AND REPLACE FURNACE IN SAME LOCATION
Contractor /yl •C4 Date l g013
I hereby affirm that I am license 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:$1300
Dave and will maintain Worker'sCompensation Insurance,as provided for by
ection 3700 of the.Labor Code,for the performance of the work for which this APN Number:37516054.00 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 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 DAY 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 /
Issued by: Date:
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
9 �
RE-ROOFS:
Si at Date LD' 14 0� 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 MuniSc!*pal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health& Seon 25505, 53 and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized age 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 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 I
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 O misc
CUPERTINO (408)777-3228 -Wa�
FAX(408)777-3333•buildincupertino.org ^`�
PLUMBING YM2HANICAL DELECTRICAL MISCELLANEOUS
PROJECT ADDRESS ' L4,I J t�Ct Oe Ing /�^ APN# �J5 Cp
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OWNERNAME ,/'/�-�I�G� PHO Cg.`�[ l� EMAIL dt.! P�eZ.��d✓1CR� ►�
FAX
CONTACT NAME y- r'T -I� C' PHONE Li iQr ^��'Iry'C I��` [JM�AIL
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STREET ADDRESS r.i- l U✓' rj'(" ICTl1t' AgTEj����•C Gam- `�3-�/t�
401
❑OWNER ❑ OWNER-BUILDER D OWNERAGENT jKONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
rY. grym�a•*� �� �e.- LICENSE NUMBER��/ 809 LICENSE Tx b �BUS.L,I # 1
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ST12EE�T SS �j•�i� C� CiT AQ.I� .1f Ci /J I L'��/0 •9L
ARCHITECT/ENGINEER NAME t V r J LICENSE NUNMER C� BUS.LIC#
COMPANY NAME &MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SPD m DUPLEX ❑ MULTI-FAMILY PROJECT IN WILMAND ❑ YFS PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK
55 IL.
TOTAL VALUATION: 3W. RECEWEDBY:
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the propeity owner's behalf I have read this
application and the information I have rovided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws ret to 'ding ction. I authorize representatives of Cupertino to enter the abov ide 'fled property for inspection purposes.
Signature of ApplicanUAgent: Date:
Lftom 13
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
❑ OVER-THE-COUNM
❑ EXPRESS
v
❑ STANDARD
UUz
a ❑ LARGE
a
❑ MAJOR
MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 18841 Barnhart ave DATE: 10/04/2013 REVIEWED BY:
APN: BP#: *VALUATION: $1,300
*PERMIT TYPE: Building Permit. PLAN CHECK TYPE: Alteration/ Repair
PRIMARY PENTAMATION FURN/AC
USE: SFD or Duplex PERMIT TYPE: i
WORK remove and replace furnace in same location
SCOPE
MISS .. . f
Meeh.Plan Check 0.0 hrs $0.00 Plumb.Plant Check Elect.Plan{:heek
M2Ch.Permit Feer IMPERMIT Plumb.Permit Fee: Elec. Permit Fee:
Other Mech.Insp. 0.0 hrs $47.00 Other Plumb Imp. Other Elec.Insp.
Allech.Irish,Fce: Plumb.Insp.Fee: Elec.Insp.Fee:
NOTE.This estimate does not include fees due to other Departments(Ge.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These fees are based on the prefinWdna information available and are onl an estimate Contact the Dept for addn'l info.
FEE ITEMS(Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 1 # Mechanical
Suppl.PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $139.00 IMFR=<100 Furnace,Forced-Air
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl.Insp.Fee.0 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? 0 Yes (j) No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential
Building or Structure
Travel Documentation Fee: 1TRAVDOC $47.00 A
Strong Motion Fee: 1BSEISAHCR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
$139.50 $139.00 �����]278.LOJ
Revised: 10/01/2013
Sbnpiifled Prescriptive Ce�cate of Compliance:?Alt&:Resirtenf rri f�VRCAIlergtiorrs. CF-1R-ALT-FfVA, ;
Cfirirste Zones 1 and 3-7
Ste Address $r',1
`'C` &t n e� � EnforcementAgerrry: �O l3 'Errniti
r J ConrTiusmedDuct insular'on
alp _ s ..
ent T
r .I:rStl aitE lei] -Floor'•Area Th6ermostat' .
aehaged Unit s '± 4 er 44 fi of dna
i ....
Fun,ace AF[JE COP Seaved by"system adried ar lad m Setback
Indoor CottS1L HSP}_ (�fnoralreudypresou,rrrrst aP
Condensing Unit ®EER Resistalce
sf unconditioned space
'� [3R6 (CZ 1,3S) •
Other
1.Equipment Type:Choose the equipment being installed;if more than one_system,use another CI IR-ALT-HVAC.for each system.
2.Afinimum Equipment Efficiencies:13 SEER,78%AFUE,7.7HSPF for typical residential systems.
Coutnctor'(Documentation Author's/Responsible Designer's Declar-stion Statement)
• I certify that this Certificate of Compliance documentation is accurate and coiete.
• I am eligible under Division 3 ofthe 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 masistmt 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. V
Name: a�eA�, G/►v-iG+e4.t�vj�r signahue:
:VA Gam- i Date
Address v License:
city/stat-aip:
Fine
- i
�' 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
CUFERTtNQ 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228 • FAX(408)777-3333•buiidinaacupertino.oro
VVIIEN 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.
FIex 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