14010072 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19720 AUBURN DR CONTRACTOR:AAA FURNACE&AIR PERMIT NO:14010072
CONDITIONING
OWNER'S NAME:
SAN JOSE,CA 95125 PHONE NO:(408)293-4717
JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
13 LICENSED CONTRACTOR'S DECLARATION REMOVE AND REPLACE FURNACE IN EXISTING AREA
License Clas -1+3 Lic.#
Contractor A ��� �� Date O �i
I hereby affirm that I am licensed under the.provision 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:$2979
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:31635019.00 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 DAY 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
Issued by: Date:
granting of this permit. Additionally,the applicant understands and will comply
with all int source re uI t'ons per the Cupertino Municipal Code,Section
9.
r �j a' / RE-ROOFS:
Signature Date G T 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
1,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 maintaincomplian
permit is issued. ZD
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
9.18.
Signature Date
0,F-N.ERAL PERMIT APPLICATION M t p
COMMUNITY DEVELOPMENT DEPARTMENT44U,ILDING DIVISION, /I/
'A M.1.1.1 11
103,00 TORRE AVENUE CUPERTINO, CA 95014-3255
• 408 777-3333 •Ly ldinO�CUDerllnO.Orq \
S C
CURE iki 41 tYf-H.0 (408)777-3228 FAX( )
r
•..
PLl1iV�TNG MCHAMCAL ELECTRICAL NIISCELLA OUS.
PROJECT ADDRESS loll 20 ftv a m pn1 c APN
OWNER NAME
rG�2� Dnp e� oft FAX
STREET ADDRESS
CONTACT NAME PHONE E•MA1L
STREET ADDRESS cCITY,STATE, ZIP FAX
.
• ❑OWNER ❑ OWM. -BUILDER ❑ OWNER AOENT--ffl-ONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHr=7 ❑allomn ❑ DEVELOPEERR(�❑TENANr
K ^ .�f^'^�� LICENSE NUI'aER L[CEN BUS.WC
CONTRACTOR NAME 'v' �(`/� (�I-U'p 1 •°��ip�,/�'-(,JU
COMPANY NAME �/�/►r1(P s'"�`A' F`-'T�./V"Z���
sTnEET ADDRESS 0,125 206'4't 11
ARC-TrECTIENODMIk NAME
LICENSE NUMBER BVs.UC 1
COMPANY NAME E-MAIL FAX
ST •
•
REET ADDRESS =Y,VATS,ZIP PHONE
PROJECT IN USE of or Duplex ❑- Multi-Family PROJECT w WILDLAND Yes p No C] No
STRIJCRiRE: ❑ Cort] =ial URBAN DMRFACE AREA C] FLOOD r INE ❑ `rte
DESCUMON OF WORK: D nd ict
TOTAL.vu•UA`IiOr: t ,
i3y my sigriaN>ti below,i cerfify to each of the following: a e property owner or authorized agent ro act on the property ovmer's behalf. i have read this
application and the information I hs provi d is correct I ,I read the Description of Work and verify it is accurate. I agree to comply viitlt all applicable local
ordinances and statclaws relating building ;CQ
o'ze representatives of Cupertino to enter the above-iden:: ied�r petty for inspection purposes.
Signature of Applicant/Agent: Date; �-
sUPPLEMENTAL Ti`TFO M;7 ION REQUMD
MBPMueflPP2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 19720 Auburn ave DATE: 01/13/2014 REVIEWED BY: Mendez
APN: BP#: "VALUATION: 1$2,979
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY PENTAMATION
USE: SFD or Duplex -7PERMIT TYPE: FURN/A
WORK remove and replace furnace in existing area
SCOPE
If WN ta
"IN
Em
zx v
.. .,n , M _� � � w _ ..
Mech.Plan Check 0.0 his $0.00 PlumL Plan Check Elec.Plan Check
Mech.Permit Fee: IMPERMIT Plumb.Permit Peep: Elec.Permit Fee:
Lhther Mech.Insp. 0.0 hrsOther Plumb Insp. C.)ther Elec.Insp.
Insp.Fee: Plumb. Insp. Tee: flee.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Theseees are based on therelinmina information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS(Fee Resolution 11-053 E . 7/1/131 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 1 # Mechanical
Suppl.PC Fee: (F) Reg. ® OT 0.0 hrs $0.00 $139.00 IMFR=<100 Furnace,Forced-Air
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee-E) Reg. ® OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $47.00
Construction .Tear:
Administrative Fee: 1ADMIN $44.00 0
Work Without Permit? ®Yes (j) No $0.00 0
Advanced Planning Fee: $0.00 Select a Non-Residential 0
Travel Documentation Fee: 1TRAVDOC $47.00 Building or Structure
i
Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item
Bldg-Stds Commission.Fee: 1BCBSC $1.00
$139.50 $139.00 Via' m>M $278.50
Revised: 01/01/2014
INSTALLATION CERTIFICATE CF-6R-MECH-04
Space Conditioning Systems,Ducts and Fans (Page 1 of 2
Site Address: Enforcement Agency: Permit Number:
Space Conditioning Systems
Heating Equipment
Duct
Efficiency Location
Equip (AFUE, (attic,
Type ARI #of etc.)1.3 crawl- Heating Heating
(package- CEC Certified Mfr.Name Reference Identical (zCF-1R space, Duct Load Capacity
heat um and Model Number Number 2 Systems value 4 etc.) R-value (Btu/hr) Btu/hr
W"ore j plvJ
Cooling Equipment
Efficiency Duct
Equip (SEER Location
Type and EER) (attic,
(package #of 1,3 crawl- Cooling Cooling
heat CEC Certified Mfr.Name ARI Reference Identical (>_CF-1R space, Duct Load Capacity
um and Model Number Number 2 Systems Value)4 etc. R-value (Btu/hr) (Btu/hr
1.Ifproject is new construction, see Footnotes to Standards Table 151-B and Table 151-C for duct ceiling alternative
compliance.
2.ARI Reference Number can be found by entering the equipment model number at http://`vww.aridirectory.orglarilac.php#
3.Listed efficiency on this page must be greater than or equal(>_)to the value shown on the CF-1 R form.
4. When CF-IR is reference it is also applicable to the CF-IR, CF-IR-AA or CF-IR-ALT
ALL BOXES MUST BE CHECKED TO BE A VALID FORM
❑ §110-§113:HVAC equipment is certified by the California Energy Commission.
❑ §150(h):Heating and/or cooling loads calculated in accordance with ASHRAE,SMACNA,or ACCA.
❑ §150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of§112(c).
❑ §1500)2:Pipe insulation for cooling system refrigerant suction,chilled water and brine lines meets minimum
requirements of Table 150-B and includes a vapor retardant or is enclosed entirely in conditioned space.
2008 Residential Compliance Forms August 2009
IIQ C"
C�.1R-AZT
Prescri five Certificate of-Com liance: Residential Pae 4 of 5)
33esidentiat Alterations4 of Stories
>^)imate Zone#
ProjectName: Inn o A •` „jAa l\
'r
HVACSYSTEIVIS •HEATINGConfiguration
Minimum Ducror'i'ipirig Central,Split,
Insulation Thermostat ( p
Heating'Equipment Efficiency Distribution S ace,Packa a or H dronic)
z R-Value e
Type and Ca .act ( \.FVE or HSPF T e and Location T
ctric Resistance, etc..)
F2.
cate Hearing Type(Central Furnace,l.Wnlnace. HePackage Cof pump. Botileceeplewhere electric heating is supplemental(i.e.,iftotal capacity
ctric resistance heating is allowed onlyComponent
,• KW o.?,000 Btu/hr electric heating is controlled by a rime-i'imiting device not exceeding30minutes). See 1SI(b)3 exception.
. fer!o the HERS Verifrcativn section on Page 4 of the CF•iR-ALT Form Jbr additional requirements and check applicable boxes.
4. Indicate Type or Loca(ion(Duets. Hydronic in Floor, Radiators,etc.)
HVAC SYSTEMS•COOLING
MinimumConfiguration
Efficiency Duct or Piping Central,Split,
Insulation Thermostat ( p
Cooling Equipment (SEER/EER or Distribution 1 R_Vatue T e S ace,Packa e or H dronic
Type and Ca acit l'
app) Type and Location
1. Indicate Cooling Type(A/C. Heat pump?Evap: Cooling, etc) licable boxes.
2. Refer to rhe HERS Verification section on Page 4 of the CF-l R-,4LT Form for additional requirements and check app
3. Indicate Type or Location (Ducts, H dronic in Floor, Radiators, etc'.)
WATER HEATING
List water heaters and boilers jot both dome.r.rihtry Hot(D eWp pe inaters ai
frid dom the DHW heater to the kitchen(s)larnd o all underground b
gas a•propane fired, and may not exceed 50 gallons.
hot water pipes is re uired in all com onent packages in all climate zones. External Tank
Number in Tank Energy Factor or insulation
N
Water Heater Type/Fuel Distribution Type S stem Ca acity( al) Thermal Efcienc R-Value'
T er (Standard, Recirculatin )'
1. Indicate Tvpe(Storage Gas, Hear.Pump, (nslantaneous, etc.)
et the recirculation requirements of§150(n). The Prescriptive requirements
410
?. Recircerluting systems serving multiple dwelling units shall me
not allow the installation of a recirculating water heating system Jor single dwelling units.
3. The external water heating tank and pipes shall be insulated to meet the re Fuirements of§150 0-
cified in this checklist betow-
SPE(IAL FEATURES The enforcement agency should pav special atte tiocn tot e Special Features spe
These items.may re uire written 'usti nation and documentation and s ecial ve
NEW-ROOF ASST!;1VI1T.Y-Radiant Barrier
` The radiant barrier re uirement of, 15 l( 2 does not a- to roof alterations.
Slab Edge(Perimeter) Insulation D YES M NO
YES: in Climate Zone 16 in Component Packages D, R-7 insulation is required.
Heated Slab Insuiation O YES O NO
YES:Slab ed a insulationre uired for all heated,slabs in ali Climate Zones. See details in Table 1 18-A of the standards.
Raised Slab Insulation CI YES CJ NO
n is
YES:In Climate Zones I,2; 11, I3, IG& l6,R=8 insulatio .re,uired; in Climate Zoites f2,& 15,R>4 is re uired:undercom onentP
Thermal Mass -
To obtain Com liance Credit.for the installation of thermal mass;*Se,the:Performil A` roach.
HERS Provider:
Registration Number: Registration Date/Time:
August ZO
2008 Residential Compliance Forms
simplified Prescriptive Certificate of Compliance ZOOS Resiclen rtillYYACAlierations CF 1R-ALT-KV1
CIrricate Zonasl and 3-7
S7YeAdd{�5� ��� Enforeemertl,4gertcy: I3aiet
��CC//�� Conclitioned ,Duct insulation
entT ' i�is€?vin`Efficieri` T' iti'oorAisa rz sf�' " Ili^ osiai J
Packagul:Uq�t : . s''r Over 4tJ 8 3f dnofst" Setbar3c
.,
urnace ®
COP^T_ •Servet by system aided ari*"".1 Is
Indoor Coil SP sf unconditioned space, 'to1 a�reodypresau must be
Condensing Unit ®EER Resistance ®R 6 (CZ 1,3-5) stalld)
Other ,
i.Egtiipmeut Type•.Choose the equipment being installed;if more than one system,use another CF_I R-ALT-HVAC.for each system.
2.Mintinum Equipment E#ficleucim 13 SEER,78%AF{JE,7.7H$rF for typical residentiai:sistems.
Contractor fbocnraentation Autbor's/Responsible Des'igner's Declaratidn Statement)
• I=, fy that this Certificate of Compliance docoutentation is secinate-and cbiapiete
• 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 featu=and perfoimana•specifications for the design idtivtified on this Certificate of Complianceconform to the
requirements of Title 24,Parts I and 6 of the California Code of Regulations.
• The desigt.feau res identified on bis Certificate of Compliance are consistent with the information documented on other applicable
compliance forms,worksheets,calculations,plans and specifications.submitted to tniorcIxent agency for approval.withthe permit
Name: M011i u6 V 4Z signatwe:
Company aL'e Data.`2 25' 1.5
Address All I
City/State/Zip, (� ( O Plioiie: [
' 1
2008 Residential Compliance Fornis.doc revised 04110112