13110067 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10450 IMPERIAL AVE . CONTRACTOR:CONDITIONED AIR PERMIT NO:13110067
OWNER'S NAME: ANTONIO WONG 1701 LITTLE ORCHARD ST DATE ISSUED:11/12/2013
OWNER'S PHONE: 4089967888 SAN JOSE,CA 95125 PHONE NO:(408)291-2220
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL L1 COMMERCIAL
License Class G"-Zy Lic.# 16 Z REMOVE&REPLACE(E)FURNACE&A/C UNITS,SAME
��tdtlrr y Date / L LOCATIONS
Contractor
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
0performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$10200
/1 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:35719089.00 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 WITfIIN 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 D LA ALLED 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: 2La
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
2 RE-ROOFS:
Signature Date �� �Z �j 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
1,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,Sections 25505,2 nd 2 4.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent:
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 soas 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 M E P
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION o0
10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 \1
-3228•FAX(408)771-3333-buildingna cupertino.org misc
CUPERTIINO
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USE OF -SLSFD ar DUPLEX ❑ MULTI-nzzy PROJECT IN WII D[AT ID El YES PRFLOOD Z W [3YES Is TELE HLDO AN ❑YES
BUILDING: 13COMMERCIAL URBAN INTERFACE AREA O FLOOD ZONE J9-N0 ETCHI FR HOME? { NO
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By my signature below,l certify to each of the following: I am the property owner or au prized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct.j have read the Description o£Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relatin�tobbWnlcdim
thorizer Sentatives of Cupertino to enter the abov-iden' ed pro erty for insp pu(@Signature of Applicant(AgenC' - Date. 2
SUPPLEMENTAL'TNFORMA'TION REQUIRED OFFICE USE ONLY
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MEpMwa4pp 2011.doc revised 06121111
CITY OF CUPERTINO
FEE.ESTIMATOR—BUILDING DIVISION
Ila ADDRESS: 10450 IMPERIAL AVE DATE: 11/12/2013 REVIEWED BY: MELISSA
APN: 357 19 089 BP#: *VALUATION: $10,200
*PER.MIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION FURN/AC
USE: PERMIT TYPE:
WORK REMOVE& REPLACE (E)FURNACE &A/C UNITS SAME LOCATIONS
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
A/C Units (<=10K cfm) 16REMAIR 1 # $70
Furnace, Forced-Air 1MFR=<100 1 # $139
TOTALS: a, r $209 00G
_
Mech.Plan Check "00 $0.00 Plumb.Plan Check Elec.Plan Check
Mech.Permit Fee: IMPERMIT Plumb.Permit Fee. Dec. Permit Fee:
r,Otherhrs $47.00 Mech.Insp. Other Plumb Insp. Other Elec.Insp. Li 0.0
h.Insp. Fee: Plumb. Insp.Fee. Elec.Ins"),Fere:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). These fiW 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 ..7/1!13) FEE QTY/FEE MISC ITEMS
Plan Check Pee:
Syppl..PC Fee
PME Plan Check: $0.00
Permit Fee:
.S`upp/.Insp I,ee
PME Unit Fee: $209.00
PME Permit Fee: $47.00
Construction Tax:
Administrative Fee: IADAffN $44.00
Work Without Permit? ® Yes iq No $0.00
Advanced Planning Fees:
Travel Documentation Fee: ITRAVDOC $47.00
Strong Motion Fee: IBSEISMICR $1.02 Select an Administrative Item
131dy Stds Commission Fee: IBCBSC $1.00
$349.02 $0.00 . 5a OL FEES $349.02
Revised: 10/01/2013
HVAC ALTERATIONS ENERGY COMPLIANCE FORM
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
CUPERTIN.0 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•building aacugertino.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 $5,000 per violation or suspension/revocation of a contractor's Iicense.
2008 BUILDING ENERGY EFFICIENCY STANDARDS (Title 24,Part 6)REQUIREMENTS
I1�TCLUDE:
1. Heating equipment must have a minimum 78%AFUE (Exception: Wall &floor furnaces; room
heaters).
2. Central air conditioners &heat pumps less than 65,000 Btu/hr must have a minimum 13 SEER.
3. Newly installed or replaced ducts must have a minimum insulation value of R-4.2.
4. A setback type thermostat(24 hr clock with four set points) is required for all alterations.
5. New or replacement ducts must meet the mandatory requirement of Section 150(m).
• All joints and openings in the HVAC system must be sealed.
• Only UL 181, UL 181A, or UL 181B approved tapes or mastic shall be used to seal duct
openings.
• Connections of metal ducts and the inner core of flex ducts shall.be mechanically fastened.
Flex ducts must be connected using a metal sleeve/coupling.
• Flex ducts that are suspended must be supported every 4 ft. max for horizontal runs with no
more than 2"of sag between supports and 6 ft. max for vertical runs.
6. The CF-6R-MECH-04 must be completed and signed by the installing contractor. The Inspector
will collect this form and verify that the model numbers are the same as the installed equipment.
2008 Residential Compliance Forms.doc revised 04/10/12
a .
Smplified Prescriptive Certificate of CompUance:2008 Residenturt HVA CAIierations CF-IR-ALT-HVAC
Cfunate Zones I and 3-7 -
,iite.4ddress i Enforcemetsf AgetteP: Daf, Perrrrit.'
Conditioned Duct insulation
Egui=ent TYTel `'Iasi irncien" floor" ' " , Thermostat
ackaggd Unit
tainace Over 408 of dads
!.� COPeiback {: ,
Saved-by system added orreglaced in
door Coil HSPF_ (ff Rot already present must Ee
Condensing Unit g EER E3 Resistance sf unconditioned space,
M Other ®3t 6 (CZ I,3-3)
1.Equipment Type:Choose the equipment being installed;if more than one_systern,u'see another CF-IR-ALT--HVAC for each system.
2.11Imimum Egaipment Efficiencies:13 SEER,7$%AFUF,7.7HSPF for typical resideatia?systems.
Contractor(Documentation Author's/Responsible Designer's Declaration Statement)
I certify that this Certificate of Compliance documentation is accurate and complete
- I am eligible under Division 3 of the Califorruia Business and Professions Code to accept responsibility for the design identified on this
Certificate of Compliance.
• I certify that the energy features and perfoimance:specificatims 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 infonaation documented on other applicable
compliance forms,worksheets,calculations,plans and specifications submitted to the enforcauent agency for approval with the permit
application. _
Name: �1 f L Signature:
Company r 1 .h Date l 1.1. ,—r
Address: �'�G License
Z n yys/co z
City/Stateizip: Hca v� a SG.. ,�_. =.� � Phone: U�. 29 / 2 Z 2,70
2008 Residential Compliance Forms.doc revised 04/10/12