13120138 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10678 FARALLONE DR CONTRACTOR:RELIABLE AIR PERMIT NO: 13120138
MECHANICAL
OWNER'S NAME:
SAN JOSE,CA 95136 PHONE NO:(408)266-7267
lyq. LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
r' ' { / REPLACE(E)FURNACE,SAME LOCATION
License Class C-2-6�J�, Lic.# "�f-4L L-// 0
Contractor Date
I hereby affirm that I am licensed under the provisions of hap r 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:$3500
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:36934015.00 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 DAA' F 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 + OM 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
granting of this permit. Additionally,the applicant understands and will com eci by, Date: I Z I /3
with all non-pgwhiouIce legulations per the Cupertino Municipal Code ion
918.
RE-ROOFS:
Signatur Date ,A, 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
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
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,
wilt 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 w'h the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Cod ,Sec' s 255 , 533,an�25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized 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
918.
Signature Date
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 v
(408)777-3228•FAX(408)777-3333•building
GUPettT1E+t0 CcDcupertino.org MISC
❑PLUMBING MECHANICAL ❑ELECTRICAL ! /❑MISCELLANEOUS
PROJECT ADDRESS APN#
OWNER NAME E-MAIL
STREET ADDRESS U May, STATE,ZIP. FAX
CONTACT NAME ✓v rz PHONE E-MAIL
r
STREET ADDRESS 22610 1 81 0131:1012LC: I& CITY,STATE, 6.- FAX
El OWNER '❑ OWNER-BUII.DER ❑ OWNER AGENT CONTRACTOR 1:1 CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ED DEVELOPER ❑TENANT
CONTRACTOR NAME C LICENSEL d LICENSE TE _l BUS.LIC# r
(�
COMPANY NAME E-MAILFAX
STREET ADDRESS YL CITY, ATE,ZIP S '5-6 PHONE
r
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILt PROJECT IN WIIALAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL - URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK -4L> .4 O CA
`
TOTAL VALUATION: J��/ .,r3:3a :'..' ...:rk.....:,M -- ` w«.00 �'.�'3'�`�' f�.c x' ` �.
By my signature below,I certify to each of the ollowing: I am the property owner or authorize agent to a n the prope er's behalf. I have rea
application and the information I ha id e is.correct. I have read the Vescription of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relatin o bill nstructi tho ize repfesentatives of Cupertino to enter the above-identified6 _ opeerty�f�nspection purposes.
Signature of Applicant/Agent: Date:
S MENTAL INFORMATION REQUIRED MwazcE
MEN
a
AVER`lHECOUNT�R4
2 $ X,EPRESS s -$'
T7
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OIL s .: S;
MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 7799 LILAC IWAY DATE: 12/18/2013 REVIEWED BY: MELISSA
APN: 359 041 011 BP#: "VALUATION: 1$3,500
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION
p FURN/AC
USE: PERMIT TYPE: A
WORK �re lace a furnace same location
SCOPE
APPLIANCE/EQUIP TYPE FEE H) QTY UNITS BP FEES
Furnace, Forced-Air 1MFR=<100 1 # $139
77777
TOTALS: $139.00 A ..Mow
Mech.Plan Check: 0.0 hrs $0.00 Phctnib.Plan Check Elec.Plan Check
Mech.Permit Fee:1MPERMIT Plumb.Permit Fee: Elec.Permit Fee:
Other Mech.Insp. 0.0 hrs $47.00 Other Plumb Insp. Li Other Glee.Insp.
Alech,Imp.Fee., Plumb. Insp.Fee: Elec.Insp Fee.
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These fees are based on the prelindna information available and are only an estimate. Contact the De t or addn7 info.
FEE ITEMS(Fee Resolution 11-053,E . 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
suppl. PC F.ce
PME Plan Check: $0.00
f erinit Fee:
Sulipl. Insp Fee
PME Unit Fee: $139.00
PME Permit Fee: $47.00
Construction Tax:
Administrative Fee: IADMIN $44.00
Work Without Permit? ®Yes 0 No $0.00
Advanced Planning Fees:
Travel Documentation Fee: ITRAVDoC $47.00 A
Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
€— $278.50 $0.00 �k s' $278.50
d E _ . , a
Revised: 10/01/2013
HVAC ALTERATIONS ENERGY COMPLIANCE FORM
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
GUPERTtNO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•building aacupertino.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 i?
• 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 Certi>ltate of Compliance:2008 Residenfid HVACAIterations. CF-IR-ALT-HVAC
Cliri ate Zones 1 and 3-7
Site A ess: Enforcement Agency: Date<f= Permit#:.
N
Conditioned Duct insulation
Equipment Typel "LFist '£f cies Floor-flies rc Tbje mostat
ackaged Unit ''" Over 4t1 of darts'
,apace6 COP Seaived by system added or replaced in Se c
Indoor Coil
R Sl t IiSPF- f�,0 sf itioned space )rot already present must be
Condensing Unit OM 13 Resistance - !-� . R 6 (CZ 1,'3-5)
�Other -
1.Equipment Type:Choose tate equipment being installed;if more than one_systets,uLSe aaotber CF-1R ALT-HVAC for each system.
2.11fmimnm Equipment Efficiencies;13 SEER,78%AFUE,VHSPF for typical residential systems.
Contraetor(Documentadpq Author's/Responsible Designer's Declaration Statement)
• 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.
• 1 certify that the energy features and performatnce speaificationis for the design identified on this Certificate of Compliance conform to the
requirements of Title 24,Parts t and 6 of the California Code of Regulations.
• The design feannes identified on this Certificate of Compliance are consistent with the information documented on other applicable
compliance forms,worksheets,calculations,plans and specifications submitted en cement agency for approval with the permit
applicatiO., _ 17 A
Name: Signattae.
Company
Address / (�-/ _ ;'1 License:
CitylState2ip: lj �t/( 5 : j!` Phone:
2008 Residential Compliance Forms.doc revised 04110112