14010074 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10199 RICHWOOD DR CONTRACTOR:RESIDENTIAL HEATING PERMIT NO:14010074
AND A/C INC
OWNER'S NAME:
CAMPBELL,CA 95008 PHONE NO:4083774073
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL F] COMMERCIAL
( REPLACE ALL(E)DUCTWORK WITH R8 DUCTWORK
License Class ILich# 7b�-1
4
Contractor 2 (0,Q r�1� LU Date
I hereby affirm that I am licensed under t e 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
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$5000
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:36908041.00 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 FR LED 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 comply ed by: a e: 1
with all non-point source regulations per the Cupertino Municipal Code, n
918. Z,-
18. ..
1113.N-
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.
❑ 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,
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. 1 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,
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent. 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 o MEP
[P-611 COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION x�
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTIN4 (408)777-3228•FAX(408)777-3333•building
acupertino.org \ misc
❑PLUMBING MECHANICAL [:]ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS IOIgq � Ck 00V rO APN# Aeq_ o _ O j
OWNER NAME
STREET ADDRESS�V t {�' ^ /� CITY, STATE,ZIP cuarhnO.CA I,J FAX
CONTACT NAME KQJ
I MI ei PHONEy08-371_ q073 E-MAIL
STREET ADDRESS (f r Sf Ich l�l/�/ 1 CITY,STATE, ZIP (Aq5o(�B FAX _ q PM
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME Ck U LICENSE NUMBER baJOE j5� LICENSE TYPE BUS.LIC#
COMPANY NAME C�I dCV, ( ( E-MAIL FAX _ _ 4
STREET ADDRESS 05 r<, Sti CI ton(Q CITY,STATE,ZIPLu by,i IJCfi 5 r 0b PHONES I DB ,,
ARCHITECT/ENGINEER NAME 11 tJ ("II/,' LICENSE NUMBER `�/v BUS.LI'C"(#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIFf[ONOFWORK
�/ d I c1 rV- wI i^ R q ''`Inn,cI n
TOTAL VALUATION:
By my signature below,I certify to each of the following: I am the property owner or aut agent to pertyer' F. I have read this
application and the infonnation I have provided is correct. I have read the Description of Work and verify it is accurate. I o comply with all applicable local
ordinances and state laws relating to uilding construction. I authorize represenpqves of Cupertino to enter the above idgritified property for inspection purposes.
Signature of Applicant/Agent: Date: 1 �'
REQUIRED ocl vsgJv n
9L I► o
MEPMiscApp_2011.doe revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10199 RICHWOOD DR DATE: 01/13/2014 REVIEWED BY: MELISSA
APN: 369 08041 BP#: "VALUATION: 1$5,000
*PERMIT TYPE: MechanicalPermit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION 1 RMAP
USE: pPERMIT TYPE: i
WORK REPLACE ALL E DUCTWORK WITH R8 DUCTWORK
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Other Appliance/Equip 113APPLOT 1 # $70
TOTALS: $70.00 K
ME-MEN
Mech.Plan Check 0.0 hrs $0.00 Plumb.Plan Check Elec.Plan Check
Mech.Permit Fee: 1W.ERMIT Plumb.Permit Fee: Elec.Permit Fee:
Other Mech.Insp. 0.0 hrs $47.00 Other Plumb Inst). Li Other Elee.Insp. 12
Ilech.Insp. Fe 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,eta). Theseees are based on the preffinWha information available and are only an estimate. Contact the De t or addn'l info,
FEE ITEMS (Fee Resolution 11-053 E . 711/131 FEE QTY/FEE MISC ITEMS
Plein Check Fee:
&Ipp1. PC.Fee
PME Plan Check: $0.00
Permit.,Fee: 7-1
Suppl, Insp Fee
PME Unit Fee: $70.00
PME Permit Fee: $47.00
(,onstr action Tax.; T-T
Administrative Fee: IADMIN $44.00
Work Without Permit? 0 Yes No $0.00
advanced Plcrntting Foes:
Travel Documentation Fee: 1 TRAVDOC $47.00
Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
$209.50 $0.00 <_ .� t $209.50
PAO, Revised: 01/01/2014
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
CUPERTthlO
(408)777-3228•FAX(408)777-3333•buildinaacupertino.or4
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 replaeing 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 $5,000 per violation or suspension/revocation of a contractor's license.
2008 BUILDING ENERGY EFFICIENCY STANDARDS (Title 24,Part 6)REQUIREMENTS
INCLUDE:
1. Heating equipment must have a minimum 78%AFUE(Exception: Wall &floor furnaces; room
heaters).
2. Central air conditioners &heat pumps less than 65,000 Btu/hr must have a minimum 13 SEER.
3. Newly installed or replaced ducts must have a minimum insulation value of R-4.2.
4. A setback type thermostat(24 hr clock with four set points) is required for all alterations.
5. New or replacement ducts must meet the mandatory requirement of Section 150(m).
• All joints and openings in the HVAC system must be sealed.
• Only UL 181, UL 181A, or UL 181B approved tapes or mastic shall be used to seal duct
openings.
• Connections of metal ducts and the inner core of flex ducts shall.be mechanically fastened.
Flex ducts must be connected using a metal sleeve/coupling.
• Flex ducts that are suspended must be supported every 4 ft. max for horizontal runs with no
more than 2"of sag between supports and 6 ft. max for vertical runs.
6. The CF-6R-MECH-04 must be completed and signed by the installing contractor. The Inspector
will collect this form and verify that the model numbers are the same as the installed equipment.
2008 Residential Compliance Forms.doc revised 04/10/12
Simplified Prescriptive Certificate of Compliance:2008 ResidenW HVACAIterations. CF-1R-ALT-HVAC
Comte Zones 1 and 3-7
S7teAdre : Enf, nlAg DaPM7nt.
0/ w� � P70 At
yo 10
.
CmAiti
tined Duct insulation
Equipment TyVel LISth1mimum'Etflcien - -Floor AICA rt; •, .. `.
Packaged Unit t3ver 4t)$of duds,
Furnace 13 AWE_ COP Served by system added or replaced in ' Setback
Indoor Coil [SEER ®IiSPF 41h already Present.mart be
Condensing Unit ®EER ®Resistance sf un atoned space,- insta7ledJ
1.Equipment Type:Choose the equipment being installed,if more than one_systema use another CF-IR-ALT,-HVAC for each system.
2.Yflu lmum 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 eligible 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 performance specifications 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 information documented on other applicable
compliance forms,wor3ssbeets,calculations,plans and specifications submitted to the enforcement agency for approvai.with the permit
application. _
Name: I �� Signahue:
Company: C In(. Date
l0 5 Cri ti L License: 705554f
city/stateaip: bQ L A: , . Phofle:116B.3 7 7-8073
2008 Residential Compliance Forms.doc revised 04/10/12