14010159CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 18931 BARNHART AVE
CONTRACTOR: CALIFORNIA DELTA
PERMIT NO: 14010159
MECHANICAL INC
OWNER'S NAME: MIKE SHENG
6056 E BASELINE RD STE 155
DATE ISSUED: 01/29/2014
OWNER'S PHONE: 5134133879
MESA, AZ 85206
PHONE NO: (866) 692-5273
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class C ` Z !� Lic. # `
FURNACE REPLACEMENT
n c/
Contracto Date 7�
I hereby aff gat 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
performance of the work for which this permit is issued.
Sq. Ft Floor Area:
Valuation: $1646
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 37509021 00
Occupancy Type:
Section 3700 of the Labor Code, for the performance of the work for which this
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 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 T 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
Date: �
granting of this permit. Additionally, the applicant understands and will comply
Issued by:
with all non-point source regulations per the Cupertino Municipal Code, Section
RE-ROOFS:
be inspected to material being installed. If a roof is
9 18.
-
Date
Signature
All roofs shall prior any roofing
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
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 maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the of the work for which this
the Health & Safety Code, Sections 255 33, and 25534.
" 29 l
performance
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
CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
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
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 FAX (408) 777-3333 • buildingolcupertino.org \ V \
xAG�AITT!A7 rmPrTRIrAT. I (MISCELLANEOUS
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CONTA NAME / % !'
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ADDRESS
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ElOWNER ❑ OINWER-BUILDER ❑ 0INWERAGENTf CONTRACTOR �CONTKACTORAGENT ❑ ARCHITECT 11ENCTIN R 13 DEVELOPER ❑TENANT
"�07 R NAME `�
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LICENSE NUMBER
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LICEN E TYPE
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BUS. LIC #
CO NAME
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E-MAIL
FAX
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CITY, STATE, ZIP
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PHONE
AR.CHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX ❑ MULTI-FAMII.YPROTECT
BUILDING: ❑ COMMERCIAL
IN WII.DLAND ❑YES
URBAN INTERFACE AREA El NO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORKCy S /
Win
TOTAL VALUATION`:�LVED W
9 sVe.ssr-a•?»dm - 'makes_ . `rug-
By my signature below, I ertify to each of the following: I am the property owner or authorized agent to act on the RLif I have read this
application and the information I have provided is.correct. I have read the Description of Work and verify it is te. I agree to com with all applicable local
ordinances and state laws relating to building cons on. I authorize representatives of Cupertino to enter the above -i en I perty-fo 'nspection purposes.
Signature of Applicant/Agent: Date:
-----SUftUX9F,AL INFORMATION REQUIRED
�� F>scE zISI1nLs
ME
�ATiDARD
MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
Ituffm RTTTT n1NP 11IVICI(1N
APPLIANCE / EQUIP TYPE
i• Ly iv i
-
QTY
UNITS
ADDRESS: 18931 barnhart
DATE: 01/29/2014
REVIEWED BY:
1MFR=<100
BP#:
*VALUATION:
$1,646
APN:
.Supp/. Insp Fee
*PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
SFD or Duplex
PME Unit Fee:
PENTAMATION FURN/AC
PERMIT TYPE:
USE:
$47.00
Consiruction Tax:
WORK
furnace replacement
Administrative Fee: 1ADMIN
$44.00
SCOPE
Work Without Permit? ® Yes (j) No
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
Furnace, Forced -Air
1MFR=<100
1
#
$139
Permit .I* ee:
.Supp/. Insp Fee
PME Unit Fee:
$139.00
PME Permit Fee:
$47.00
Consiruction Tax:
Administrative Fee: 1ADMIN
$44.00
Work Without Permit? ® Yes (j) No
$0.00
TOTALS:
i
<� - s
..
$13900
Strong Motion Fee: IBSEISMICR
Mech. Plan Check 0.0 hrs $0.00 P&rsrb. Alun Check Elect. Plan Check
Mech. Permit Fee: 1MPERMIT Plumb. Pe'r'mit Pee: hlec. Permit Pee:
Other Mech. Insp. 0.0 hrs$47.00 Other Plumb Insp. u Other Elec. Insp. u
Altech. Insp. Fee: Plumb. Insp. Fee: Glee. Insp. Fee:
avnTF• This octisnoto dnoc not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
bd 41.Z' 'na in ormation available and are onl an estimate. contact the ue r or aaan i in u.
hese ees are as on a re
�tstrter, etc.). Timt
FEE ITEMS (Fee Resolution 11-053 E . 7/1113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
Sup1)1. PC Fee
PME Plan Check:
$0.00
Permit .I* ee:
.Supp/. Insp Fee
PME Unit Fee:
$139.00
PME Permit Fee:
$47.00
Consiruction Tax:
Administrative Fee: 1ADMIN
$44.00
Work Without Permit? ® Yes (j) No
$0.00
Advanced Planning Fees:
i
Travel Documentation Fee: 1TRA VDOC
$47.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
.
. $278.50I�..
Bldg�Stds Commission Fee: IBCBSC
fix$§141
_.
$1.00
$
Revised: 01/15/2014
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 • buildinaecupertino.orct
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
Site Addr
Enjorcemem Aim -y:
Da
Conditioned
Duct insulation
Equipment r
last ht'mr —E enC -
- -1 I1 k6i
Packaged Ufut
]9 Furnace
AFUB/
8Served
CUP
�IISPF_
by system
Over 44 fl of ducts`
added or ieplacxd in
[.Setback
Indoor Coil
Condensing Unit
SER �'
13EER
O Resistance
sf conditioned
space
{Ificotalreadypreserxt must be
R 6 (CZ 1, 3-S)
Other .
1. Equipment Type: Choose the equipment being installed; if more than one_system, use another CF -1 R -ALT -HVAC for each system_
2. Minimum 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 Complian= documentation is accurate and complete.
• I am eligible ander 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 desiga features identified on this Certificate of Compliance are consistent with the information documented on other applicable
compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit
lication.
m y c /
Date:.
License:
City/Statelzip: 2
Phone: -Q
2008 Residential Compliance Forms.doc revised 04110112