13110168 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22963 LONGDOWN RD CONTRACTOR:DESIGN HEATING&AC PERMIT NO: 13110168
OWNER'S NAME: PANDE JYOTI P AND TANUJA1820 BASS LAKE AVE DATE ISSUED: 11/26/2013
OWNER'S PHONE: 4093661425 TURLARE,CA 93274 PHONE NO:(559)688-3776
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL0
License Class G Lic.# ? 7 REMOVE AND REPLACE FURNACE
Contractor Date /I 2 6-.b0
I hereby a in 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
fect
ormance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$3800
ve and will maintain Worker's Compensation Insurance,as provided for by
ion 3700 of the Labor Code,for the performance of the work for which this
APN Number:34240016.00 Occupancy Type:
mit 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 DA OM LAST CALLED INSPECTION.
indemnify and keep:harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said Cityin cons uence of the
granting of this permit. Addit onall the applicant understands and will comply Issued by: Date: p
with all non-point source regulat' s Cupertino Municipal Code,Section
9.18.
/ RE-ROOFS:
Wigdattite ` t ate " 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 isnot 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 Ar Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupe o 'cipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25 ,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this ,}
Owntl,oaiz d agent Da
permit is issued. a
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 ofCupertino 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 r v
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 0
(408)777-3228•FAX(408)777-3333•building(c�cupertino.Org '1 MISC
CUPIERTINO t�
❑PLUMBING RMECHANICAL ❑ELECTRICAL 1 [—]MISCELLANEOUS
PROJECT ADDRESS aDj4 CA I /J 7APN I
OWNER NAME Tho PHONEL/ _ 1q)_
� E-MALtcq ILSTREET ADDRESS � CITY, S ATE,ZIP l+� /!./ FAX
CONTACT NAMEPHONE `E-MAIL
�G ��✓e.l I� )�ooS
STREET ADDRESS / L CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUELDER ❑ OWNER AGENT XONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME / LICENSENUMBEI{,76�� LICE TY E BUS.LIC#
Y /
COMPANY NAME , EMAIL FAX
x `
Q J-7
STREET ADDRESS
�t1 y^l ` , . /f+a k �v CITY,STATE,ZIPSI_r CI 3-7 7 7 PHO -Y �D -
ARCHITECT/ENGINEER NAME LICENSE NUMBER 7 O` BUS.LIC#
COMPANY NAMEE MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX MULTI-FAMILY PROJECT IN WBALAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK
s G,, w►l �J L(4VI CAI-C
dw
fi ;.
TOTAL VALUATION: 3 $�` �� ,rs��p W �
a, e ..
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on1he proowner's behalf. I have read this
application and the information I have provided is.c ct. I have read the Description of Work and verify itis accurate. I agree to comply with all applicable local
ordinances and state laws relating to building cons on. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature ofApplicant/Agent: Date'. NO
SUPPLEME INFORMATION REQUIRED r o�ici us>or 4
* w' ,�YERTHFCOUNT�R - -
aO
MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 22963 longdown rd DATE: 11/26/2013 REVIEWED BY: Mendez
APN: BP#: `VALUATION: 1$3,800
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Duplex PENTAMATION FURN/A
USE: PERMIT TYPE:
WORK remove and replace furnace
SCOPE
I 'NOR
a
�W �-- - 4
0
Mech.Plan Check 0.0 hrs $0.00 Plwnb.Plan Check Ek>c.flan Check
Mech.Permit Fee: 1WEIMT Ptumh.Permit Feer Flec. Permit Fee:
Other Mech.Insp. 0:0 hrs $47.00 Other Plumb Insp. Other Elec.Insp.
F-71 I
1lfech_Insp, Fee: Plumb. Insp. Fee: Elec.Insp.Fee:
NOTE:This estimate does not includefees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Thesefees are based on the prefindna information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 E,f. 7/1113) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 1 I # Mechanical
Suppl.PC Fee: (j) Reg. '� OT0:0 hrs $0.00 $139.00 IWR=<100 I Furnace,Forced-Air
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee1q Reg. 0 OT O,Q hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $47.00
Consttztction Tax:
Administrative Fee: IADMIN $44.00
Work Without Permit? ®Yes (E) No $0.00 G
Advanced Planning Fee: $0.00 Select a Non-Residential 0
Travel Documentation Fee: ITRAVDOC $47.00 Building or Structure
i
Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item
Bldiz Stds Commission Fee: IBCBSC $1.00
$139.501 $139.00 ^x TUTAL E $278.50
Revised: 10/01/2013
HVAC ALTERATIONS ENERGY COMPLIANCE FORM
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
C U P E RT I N.0 10300 TORRE AVENUE•CUP ERTI NO, CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildina(d.=Dertino.orQ
WREN 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 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
Simplified Prescriptive Cerditeate of Compliance:2008 Residential HYACAlterations. CF-1R-ALT-HVAC
Climate Zones 1 and 3-7 -
McAddrecs: Enfor eney: Dale ;,:r Permit.
Conditioned Duct insolation
Pip-ent T i isi h iaiiiin`£fticiert floor Ani' T leadiml
Ftunace Unit
C4P Over 4118 of ducts"
®AFUFfp Setback
Serve&by system added orreplactd in
Indoor Cog [ SFkR HSPF Wtivialreadypresent muff be
Condensing Unit 13 EER 0 Resistance /YO° sf unconditioned space, -
Other I®R 6 (CZ 1,3-5)
1.Equipment Type:Choose the equipment being installed;if more than one system,use another CF-IR-ALT-HVAC for each sys`tem.
2.Minimum Equipment Efficiencies.13 SEER,78%AFUE,7.7HSPF for typical residential systems.
Contractor(Documentation Amthar's/Responsible Desiper's Declaration Statement)
• I certify that this Certificate of Compliance documentation is accurate and coihplete.
• I am eligible under Division 3 of the California Business and Professions Code to nompt responsibility for the design identified on this
Certificate of Compliance.
• I certify that the energy features and performance specifications for the design identified m this Certificate of Compliance conform to the
requirements of Title 24,Parts I and 6 of the California Code of Regulon.
• The design features identified on this Certificate of Compliance are consistent with the info=zdon documented on other applicable
compliance forms,worksbeets,calculations,plans and specifications submitted to the enforcement agency for approval with the permit
application. _
Nacre:
Company ate-
,/� `>yr ,.1�1 �, �. D ,. l �—�l>- -;)-c,-(3
Address /�� J .7 S�n, S u k /c L, nse. 7 7 3
City/Smmzip: Pine: eft T3 :Ls o
2008 Residential Compliance Forms.doc revised 04110112