13110058 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23614 OAK VALLEY RD CONTRACTOR:VALLEY HEATING& PERMIT NO:13110058
COOLING
OWNER'S NAME: SHARON PARKER 1171 N 4TH ST DATE ISSUED:11/12/2013
OWNER'S PHONE: 4085178937 SAN JOSE,CA 95112 PHONE NO:(408)294-6290
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL U COMMERCIALE]
License Class
Lic.#� e R'PLACE(E)FURNACE&A/C UNITS,SAME LOCATIONS
--�
Contractor Dat% 7--
/
I hereby affirm that ram 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
joav
mpensa' n;as provided for by Section 3700.of the Labor Code,for the
ance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$9300
e 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:34257021.00 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 ERMIT 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 T 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 Iss Date
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source r tions per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature 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.
[IOWNER-BUILDERDECLARATION
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 Cuper' nicipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent Dat,,/—Z'
permit is issued. T
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 CO TRUCTION 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.)
Lenders 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 0
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 \\ misc CUPERTINO (408)777-3228•FAX(408)777-3333•building(a)cupertino.org \�
❑PLUMBING []MECHANICAL [:]ELECTRICAL ❑MISCELLANNEOUS
PROJECT ADDRESS 21m11,e0,,4APN#
'z — G— :?- 1 v/�2i
OWNER NAME v NE !/ E-MAIL
STREET ADDRESS CITY, ST E,ZIP FAX
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAMEl LICENSE NUMBER LICENSE TYPE BUS.LIC#
COMPANY NAME0
E-MAIL FAX n
STREET ADDRESS CITY,STATE,ZIi Z PHONE NE �ijj�
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# �r
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN=LAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING. ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK
TOTAL VALUATION:
By my signature below,I certify to each of the following: I am the property owner or authorized agent t is
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree t�p plI applicable oca —
ordinances and state laws relating to g construction. I authorize re es-6f"Cupertino to enter the above-identified erty for inspection purposes.
Signature of Applicant/Agent: Date: 3
PPLERENTAL INFORMATION REQUIRED '
�OFFICFTJSEONLY
� .� N,
�; �
�VER{THECOUIjTERy
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1=I�I'AR-r 'I e
MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 23614 OAK VALLEY RD DATE: 11/12/2013 REVIEWED BY: MELISSA
APN: 342 57 021 BP#: *VALUATION: 1$9,300
%PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: FURN/A
WORK REPLACE E FURNACE &A/C UNITS SAME LOCATIONS
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
A/C Units (<=10K cfm) 1BREMAIR 1 # $70
Furnace, Forced-Air 1MFR=<100 1 # $139
TOTALS: $209.00 ¥r'
E1' gas , _ - z TpS'ads f- a
fib �' . ` .k.:r.':
Mech.Plan Check F070 hrs $0.00 Plumb.Plan(hcxk Alec.Plan Check
Mech.Permit Fee: IMPERMIT Plumb.Permit Fee: Elec. Permit Fee:
FOther 0.0 Mech.Insp. hrs $47.00 Other Plumb Insp. Ohher Elec.Insp,Insp. Fee: Plumb. Insp.Fee: Dec.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 relimina information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ef. 7/f Ij131 FEE QTY/FEE MISC ITEMS
Plan Cheek Fee:
Supp 1. P('Fee
PME Plan Check: $0.00
lle rl"nit.ee:
Suppl. hasp 1 ee
PME Unit Fee: $209.00
PME Permit Fee: $47.00
('onslruction Tax:
Administrative Fee: IADMIN $44.00
Work Without Permit? . 0 Yes No $0.00
Advaneed Planning fees;
Travel Documentation Fee: 1TRAVDOC $47.00 A
Strom Motion Fee: IBSEISMICR $0.93 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
ksv $348.93 $0.00 $348.93
Revised: 10/0112013
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•buildinaecuoertino.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 ENTERGY EFFICIENCY STANDARDS (Title 24,Part 6) REQUIRENIENTS
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
F ip • " CF-1R-ALT-HVAC 3
S� ii�ed Prescn .rave certificate of Com Bance•2048 Resirfenfirrl HYACAIierations
Cfsmate?eves 1 and 3-7 --
Me Address: � EnforcemeroAgency: Date:-.,__ Persnit:P::>„ ;
Conditioned Duct insulation r
en1T r I:�i'stMmi�im�fncien= Floor Area" .' re ' _ Thomostat,.=,
acked'Unit-
Over 4014&16W`'
AFUE CSP Served'by system added or iiphced.in etba
w
Cott �SF ` �/�'��ondensing Unit
Condensing Unit Besistaztce ��'6= —sf unconditioned space
3.Equipment Type:Choose the equipment being installed;if more than one system,use aaodicr CF]R-ALT-l3VAC for each system
2.Afiinimam Equipment Efficiencies 13 SEER,78%AFUE,7.7HSPF for typical residential systems.
Coutractor(Documentation Author's/Responsible Designer's Declaration Statement)
• 1 certify that this Certificate of Compliance documentation is accurate andcoriihete. - -
• I am eligible ander Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this
Certificate of Compliance.
• 1 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 3 and 6 of the California Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent 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. _
Name: ��__. Signattns: -_
Company Date
Address: License: rd
CitylsiatelZip: l Phone:
2008 Residential Compliance Forms.doc revised 04/10/12