13100154 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10436 N PORTAL AVE CONTRACTOR:ROCHA'S COMPANY PERMIT NO: 13100154
OWNER'S NAME: SIROHI RAJ K AND ANKUR 2191 MONTICELLO AVE DATE ISSUED: 10/24/2013
OWNER'S PHONE: 4088397957 SAN JOSE,CA 95125 PHONE NO:(408)593-7405
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL
License Class�� Lic.# Z REMOVE AND REPLACE FURNACE AND ADD A/C ON
RIGHT
Contractor / Date `Z SIDE OF SFDWL
I hereby affirm that I am lic nse rder 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:$12150
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:31629013.00 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 ZOM LAST CALLED INSPECT
IO
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. dditionally,the applicant understands and will comply Issued by: Date:
with all non-point so regulat" per th pe o unicipal Code,Section
9.18.
RE-ROOFS:
Signature Date _ 5 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)
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
1 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 Cu rtino nicipa , hapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 505, 5 ,a
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized
permit is issued. Dat
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
10 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 \b misc
CUPERTINO (408)777-3228• FAX(408)777-3333•building ftupertino.org
❑PLUMBING ❑MECHANICAL ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS /p y�6 /V. ✓i'0.�'%A L tl. APN x 5tU �t
OWNERNAME ��'/`7 J _S /�'�iy/ PHONE
STREET ADDRESS �� (�j �(/ ���//�L G! CITY, STATE,ZZIP 6 L/!'C //�� C' FAX
Y 5-0"ey
CONTACT NAME /�� ✓ S(,�CCffi PHONEgra E-MAIL _5/x 7 ,£'
STREET ADDRESS �V /76xjf/-1 %G' CITY,STATE,ZIP L�LI�C fel/��J « ASO fid FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC k
COMPANY NAME E-MAIL FAX
46�L , 11
STREET ADDRESS / _ CITY,STATE,ZIPS- PHONE
ARCHTTECT/ENGINEER NAME LICENSE NUMBER J BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ MULTI FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑ NO
DESCRIPTION OF WORK /J
TOTAL VALUATION: � -7 Q �� RECEIVEDY "A� Y'
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the RVperty owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply withal]applicable local
ordinances and state laws relating to building V71
on. I authorize representatives of Cupertino to enter the above 6 e Ified roperty for inspection purposes.
Signature of Applicant/Agent: , Date: ��
SUPPLEMENTAL INFORMATION REQUIRED -'
, OFFICEUSEONLY .,.;
J YER T> ovrirEx
y� �
MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10436 n portal ave DATE: 10/24/2013 REVIEWED BY: mendez
APN: BP#: 'VALUATION: 1$12,150
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION FURN/AC
USE: p PERMIT TYPE:
WORK remove and replace furnace and add a/c on right side of sfdwl
SCOPE
x
Mech.Plan Check0.0 hrs $0.00 i'lturrl>. Plan flee. 1'1m Chcck
Mech.Permit Fee: 1 NIPERMIT F t arab. Pcmil P
LerMech.Insp. 0.0 hrs $47.00 Oihc�r I'lond"Iny Unccl Lift. (PSI, t`i'e: Pharuh. h%sl;, hey- 17cc_laatp. I',-pec
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Theseees are based on the prelimiina information available and are only 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 F7 # Mechanical
Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 $139.00 1MFR=<100 I Furnace,Forced-Air
PME Plan Check: $0.00F-1 -1 # Mechanical
Permit Fee: $0.00 $70.00 IBREMAIR A/C Units(<=10K cfm)
Suppl. Insp.Fee-.0 Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: _T_T $47.00
Constrcrcfion Tax.
Administrative Fee: (ADMIN $44.00
Work Without Permit? 0 Yes (E) No $0.00 0
Advanced Planning Fee: $0.00 Select a Non-Residential
Travel Documentation Fee: ITRA VDOC $47.00 Building or Structure
Strong Motion Fee: 1BSEISMICR $1.22 Select an Administrative Item
Bldg�Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $140.22 $209.00 TOTAL FEE: $349.22
Revised: 10/01/2013
HVAC ALTERATIONS ENERGY COMPLIANCE FORM
L' COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTtNO
(408)777-3228 • FAX(408)777-3333• buildinarcDcupertino.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 bem een 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
V
Simplified Prescriptive Certificate of Compliance:2008 Residential HVA C Alterations CF-IR-ALT-HVAC
Climate Zones I and 3-7
Sue Address: Enforcanenl Agency: Dater., Permit
dd
Conditioned Duct insulation
ent T ' I isi Ivlmimum Efficiency2 floor Area rc Tbeimostat, ,
Packaged Unit {aver 40 8 of ducts'
®AFUE COP Served by systemadded or replaced in Setback
Indoor Co�7 �' bt� ®HSPF_ ,1�W sf unconditioned space "or rdready prueKt a ust be
Condensing Unit ®EER ®Resistance �R 6 (CZ 1,3-5) °
Other �
L Equipment Typo Choose the equipment being installed;if more than one system,use another CF-IR-ALT-HVAC for each system.
2.&).anima Equipment Efficiencies:13 SEER,78%AFUE,7.7HSPF for typical residential systems.
Contractor(Documentation Author's/Responsible Designer's Declaration Statement)
0 I certify that this Certificate of Compliance documentation is accurate and Mete.
• 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 feahurs identified on this Certificate of Compliance are consistent with the info +'on documented on other annlicable
compliance forms,worksbeets,calculations,plans and specifications submitted to the en ent ag for app the permit
application. _
Name: L Si- --
Company: Dater
Address: - Lloer=:
dG
City/State/Zip: j' S Phone:
2008 Residential Compliance Forms.doc revised 04110112
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