131201374
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7799 LILAC WAY
CONTRACTOR: RELIABLE AIR
PERMIT NO: 13120137
MECHANICAL
OWNER'S NAME:
SAN JOSE, CA 95136
PHONE NO: (408) 266-7267
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
Cl c�j/ f
`( J Q
REPLACE (E) FURNACE, SAME LOCATION
License Class Lic. # J !'
ADate
Contractor
I hereby affirm that I am licensed under the provisions Cha ter 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
Sq. Ft Floor Area:
Valuation: $3200
performance of the work for which this permit is issued.
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: 35904011.00
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 F 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
I Date: iS 1/73
grannthist. Additionally, the applicant understands and will comply
withr regulations per the Cupertino Municipal Code, Section
918.
Date
RE -ROOFS:
installed. If is
Sign
All roofs shall be inspected prior to any roofing material being a roof
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)
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 Pay Area Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compI* a wit upertino Municipal Code, Chapter 9.12 and
the Health & Safe Cod 25505 53 anidr 5534.
I have and will maintain Worker's Compensation Insurance, as provided for by
,
Date:
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 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 ; V
10300 TORRE AVENUE CUPERTINO, CA 95014-3255 n M'
(408) 777-3228 • FAX (408) 777-3333 • building(D-cupertino.org
rl .. n r,, ..r 7rCl . A ATrr A T 17 PT T: rTT2 Tr A I. I—( MISCELLANEOUS
MEPMiscApp_2011.doc revised 06/21/11
PROJECT ADDRESS
a C
APN #
OWNER NAME `
-
&MAIL.
STREET ADDRESS
C / - ,
CITY, STATE, ZIP. FAX
CONTACT NAME
PHONH E MAIL
STREET ADDRESS
CITY, STATE, ZIP
:5 v -J S-9 S P
FAX
❑ OWNER ❑ OWNER-BumDER
❑ OWNER AGENT ONTRACrOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME (_ (
( �-
`
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
COMPANY NAMEV C`
% �� %� ( vL ^
( MAIL I „ r n _ f
(}C•,ITY,
(_AX
STREET ADDRESS,-`
STATE ZlI'P` �j�� 2 S
(
PHONE
ARCHITECTIENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX
BUILDING'. ❑ COMMERCIAL
❑ MULTI -FAMILY
-
ALOJECT IN WI DLAND ❑ YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK P
(kin, C C,
TOTAL VALUATION:
wear
x:
By my signature below, I certify to each of the follow' g: I am the property owner or authorized agent to aetlKlFe property owner's behalf. I have read this
application and the information
a provided is ect. I have read th escription of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relat
to of Cupertino to enter the ab ve�,idgntified property for in ection purposes.
C
Signature of Applicant/Agent:
Date: L/
SUPPLEMENTAL INFORMATION REQUIRED s or FICETISE oNr5�.
W M-7 VFR TH)rCOUNTER� .
MEPMiscApp_2011.doc revised 06/21/11
�� ���� CITY OF CUPERTINO
1 'P11 FF.F. FQTIMATnR — RITII.DING DIVISION
APPLIANCE / EQUIP TYPE
ADDRESS: 7799 LILAC WAY
DATE: 12/18/2013
REVIEWED BY: MELISSA
UNITS
APN: 359 04 011
BP#:
*VALUATION:
1$3,200
%PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Du lex
p
$139
PENTAMATION FURN/AC
USE:
PERMIT TYPE:
WORK
REPLACE E FURNACE SAME LOCATION
SCOPE
$139.00
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
Furnace, Forced -Air
1MFR=E100
1
#
$139
Per-rnit .Fee:
Suppl. Insp Fee
PME Unit Fee:
$139.00
PME Permit Fee:
$47.00
Conswuction Tax:
FA
Administrative Fee: IAD111IN
$44.00
Work Without Permit? 0 Yes No
$0.00
TOTALS:
��
$139 00
k
?
Mech. Plan Check 10.0 I hrs 1$0.001 Plumb. Pluri Check
Mech. Permit Fee: 11PERMIT I I Plumb. Permit Tee:
Other Mech. Insp. 1 0.0 1 hrs 1 $47.001 Other Plumb Insp.
:Mech. Insp. Fee
Plumb. Insp. Tet::
Elec. Plan Check
Elec. Pear -mit Fee.,
Other (glee. Insp.
Elec. Insp. Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. (Manning, runllc worlrs, rlre, aamraly newer utslricl, acnout
•n._ _ X_ L.. _..a .. IL .. -i.* ..-i'----#:---.,-.I"blo and Oro Only nn nctim itn l-antart tho Dont for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
Suppl. P(.' F (,e
PME Plan Check:
$0.00
Per-rnit .Fee:
Suppl. Insp Fee
PME Unit Fee:
$139.00
PME Permit Fee:
$47.00
Conswuction Tax:
FA
Administrative Fee: IAD111IN
$44.00
Work Without Permit? 0 Yes No
$0.00
Advanced Planning Fees.-
ees:Travel
TravelDocumentation Fee: 1TRAVDoC
$47.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
1
Bldg Stds Commission Fee: IBCBSC
$1.001
ry M
$278.501
9:a )1
$0.001$
278.50
Revised: 10/01/2013
CUPERTINO
HVAC ALTERATIONS ENERGY COMPLIANCE FORM
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building a(-cupertino.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 18113 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
Site Addrew
Enforcement Agency:
rrte ,- _ Pernrit #:
- _
Conditioned
Duct insulation
Equinment TVM1
last hfmimtim Mcien '
Floor Area
'thermostat
Packaged Unit r
urnace
AFUEZ'/
COP
�HSPF—
Seruzd by system
Over 44 R of ducks` `
added orreplaced in
Setbacdt
must
Indoor Coil
Condensing Unit
[SE
® EER
® Resistance
L sf
unqpadifioned space
(CZ 1, 3-S)
taieadypresdu, be
aj1
Other
,
1. Equipment Type: Choose the equipment being installed; if more than one system, arse another CF -1R -ALT -HVAC for each system.
2. Armimam Equipment Efficiencies- 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems.
Contractor (Documentation Author's /Responsible Designer`s Declaration Statement)
• I certify that this Certificate of Compliance documentation is accurate and complete.
• I am eligNe 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 perfarmance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24, Parts 1 and 5 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 a enfor t agency for approval with the permit
applicationA,_
Name:Signatiue:
Ol
Company: //�� pp
Date-,, � <
Address:
CJ_
License: � G�
City/State/Zip:
G
Phone:
l
2008 Residential Compliance Forms.doc revised 04110112