14020039 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10140 HILLCREST RD CONTRACTOR:A-I HEATING AND PERMIT NO: 14020039
COOLING
OWNER'S NAME: GANESH SRINNASAN 476 W TAYLOR ST DATE ISSUED:02/05/2014
OWNER'S PHONE: 4088599470 SAN JOSE,CA 95110 PHONE NO:(408)283-9915
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL F] COMMERCIAL 0
o� REPLACE(E)FURNACE,SAME LOCATION,(N)AIR
License Class 'P WC'21-D Lic.# �1/ RETURN
Contractor-6(�Ct�1ytU� �c Date .451 I`r &DUCTWORK
I hereby affirm that 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
Co pensation,as provided for by Section 3700 of the Labor Code,for the
p fonnance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$9500
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:32616003 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 IT 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 + 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 ? S
granting of this permit. Additionally,the applicant understands and will comply I 3. e:
with all non-point source regulations er the Cupertino Municipal Code,Section
91 .
RE-ROOFS:
Signatur 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
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 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&Sa ect' s 25505,25533 nd 25534.
Section 3700 of the Labor Code,for the performance of the work for which this I
Owner or authorized ag 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
9 18.
Signature Date
GENERAL PERMIT APPLICATION V
o MEP
ELI] COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 MISC
CUPERTINQ (408)777-3228•FAX(408)777-3333•building(a.cuoertino.oro v
PLUMBING rkfWZMMCAL DELECTRICAL MwscELLANEous
PROJECT ADDRESS to I (cr�5-f- " # o
O Nw'a5 I r i�y.� i J�gyS�►� PHONE .�5 !�-I ! EE-MAIL
STREET ADDRESS V-1)140 `l cl/.es zIP � ! v
CITY, �,^, FAX
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OwNER-BUILDER CI.OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHInCT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME r� J i p LICENSE NUMBEDL�'Lpsa'q LICENSE T T BUS.LIC#
COWAN + I. �J EdvfAll.elm 1��L�- G Y1'1�'f� •�.OY� FAX283.99 I �
STREET ADDRESSr n � I�, G CITY ST t t D PHO
7
ARCHITECT/ENGINEER NAME cLICENSE NUMBER J l BUS.LIC#
COMPANY NAME E-MAII, FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD w DUPLEX ❑ MULTI•PAMQ YPROJECT IN WIIALAND ❑ YES PROJECT IN ❑YES IS THE DLDG AN ❑YES
BUILDING: O COMMERCIAL URBAN DaIRFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK
L ) J O® Z'� -PL4 rvvt.c e- LO h ev�1 5 ,p I d vi�1-S
2 n tL4rv% a
TOTAL VALUATIO
By my signature below,I certify to each of the following. I am the property owner or autho gent to act on the prope 1. d this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. to comply with all applica
ordinances and state la relati b ' ' nstnrction. I authorize representatives of Cupertino to enter the a V i entifi prgperty�or i Jspaction purposes.
Signature of Applieant/Agent: Date: �L
SUPPLEWENTM INFORMATIOJ REQUIRED OFFICE USE ONLY
OVER-THE-COUNTER
❑ EXPRESS
orSTANDARD
❑ LARGE
a
❑ MAJOR
A&PMiscApp_201 Ldoc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10140 HILLCREST RD DATE: 02/05/2014 REVIEWED BY: MELISSA
APN: 326 16 003 BP#: *VALUATION: 1$9,500
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition / Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: FURN/A
WORKREPLACE E FURNACE SAME LOCATION N AIR RETURN & DUCTWORK
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced-Air 1MFR=<100 1 # $139
TOTALS: $139.00
T �jr'
Mech.Plan Check 0.0 hrs $0.00 .11hwib- Flan C/u,'ek Ch"(11
Mech.Permit Fee: 11PERMIT Ph mh' P m:f Fee
Other Mech.Insp. 0.0 hrs $47.00 01her P/tirnh Irup, E3
7__
'let h?tip' P 'c' 11171 iib. h"sp, 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 the relimina information available and are onlyan estimate Contact the Det or addn7 info.
FEEITEMS (I ee Resolution 11-053 Eff.711/131 FEE QTY/FEE MISC ITEMS
fFF
PME Plan Check: $0.00
y
PME Unit Fee: $139.00
PME Permit Fee: $47.00
Administrative Fee: IADMIN $44.00
Work Without Permit? ® Yes 0 No $0.00
Travel Documentation Fee: ITRAVDOC $47.00
Strong Motion Fee: IBSEISMICR $0.95 Select an Administrative Item
Bldg Stds Commission.Fee: IBCBSC $1.00
t $278.95 $0.00 TOTAL'FEE: $278.95
r. �r
Revised: 01/15/2014
HVAC ALTERATIONS ENERGY COMPLIANCE FORM
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•building(aa)cupertino.oro
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 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 ResldentW II VACAl ie dors. CF-IR-ALT-HVAC
Climate Zones 1 and 3-7
Site Address: EnforeememAimr-y- Dar, PaMit#:..
�o c�fo th d)C.rcs-r z�(s �Z003
Conditioned Duct insulation
EquiL.-rit'ryl-I i lii NFmimum-ET=ejicY2 Thermostat
ackaged Unit ? Uver 40:a of ducts
Furnace AFUE Q.. COP Setback
Indoor Coil SEER ®HSPF Served b3'system added it reglacsp in of vfre,*presort,must be
'.
8 Condensing Unit ®EER Resistance sf rtianed space
13
Other - R 6 (CZ 1,3-5) s
1.Equipment Type:Choose the equipment being installed,if mora than one system,use another CF-I R ALT-HVAC for each system.
2.Afinimum 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.
• 1 certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of fide 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,worksheets,calculations,plans and specifications su the enforcement agency for roval with the permit
licatiOn. _
Name q L 1-j C, G>^r ES-��b�r Sig iahue:
Compan>,,_-1a �e��
Addicss�,.7 P q� — License:
City/SfiatelZip: f� Phnue�..{�pg,� '�(
2008 Residential Compliance Forms.doc revised 04110112