14030137 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10881 NORTHOAK SQ CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 14030137
CONDITIONING
OWNER'S NAME: GUPTA MANOJKUMAR AND VUDUTA SUNITHA 1712 STONE AVE DATE ISSUED:03/24/2014
OWNER'S PHONE: 6512107254 SAN JOSE,CA 95125 PHONE NO:(408)293-4717
LICENSED CONTRACTOR'S DECLARATION ( F
ELECT�� f BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class 2 Lic.# �j
[/�� MECH l RESIDENTIAL I— COMMERCIAL�
Contractor A() r—c> N CQ Date 2
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION REPLACE EXISTING A/C CONDENSER
(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:$4110
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
permit is issued. APN Number:31641010 00 Occupancy Type:
APPLICANT CERTIFICATION
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 PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS LAST CALLED INSPECTION.
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply
a - o.nt source re ati ns per the Cupertino Municipal Code,Section Issu Date:
r9 18.
Signatur
RE-ROOFS:
❑ OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,1 agree to remove all new materials for
I hereby affirm that I am exempt from the Contractor's License Law for one of inspection.
the following two reasons:
I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date:
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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations: 1 have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's Owner �aXnt:
Compensation laws of California. If,after making this certificate of exemption,I Date:
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and state that the above information is Lender's Name
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 Lender's Address
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply 1 understand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18 Licensed Professional
Signature Date
C --N'5RAL PERMIT APPLICATION M , P
COMMUNITY DEVELOPMENT DEPARTMENT--'#U.ILDING DIVISION
I• 103'00 TORRE AVENUE ' CUPERTINO, CA 95014-3255
(408)777-3228 ' FAX(408)777.3333 buildinGCa�cuoertino.orq �u
MISC
C U P El�T1'N'Q 1
y
PLUSONG - l'MCHANTCA.L ELECTRICAL MTSCELLA/ OVSS}/
PROJECT ADDRESS �[\[�C +� yy�� V APN 1�f 3 Of
OWNER'NAMA /�
E o�vn((JJoCCJJ 1VC-`-•'U ,Y 1 F P O —240 1�I �
srREST ADD'�99 I V9b► woa 1 cxl Uarc U� fly 01 1 FAx
CONTACT NAM PHONE EMAIL
STREET ADDRESS c CITY,STATE, Z1P FAX
' 0 OWNER Cl OWNIM-BUILOER O OWNER AGENT .Q-'CoNTP.AcToR El CONTRACTOR AGENT it ARCHrrecT Q IrNowait• 0 ouynovER ❑TENANT
CONTRACTOR NAME �kodo LICENSE NUMHEIir�,,w 1 L! SE E HUS.LIC 1 G )
COMPANY NAME V 1 e'MAlI l F
STREETADORESS 1-1r AVC° *( sT TE ' PHO 3 °+in
ARCHITECT/ENGINEER NAME LICENSE NUMBER HVS.UC F
COMPANY NAME EMAIL FAX
STREET ADDRESS MY,STATE,ZIP PHONE
USE OF SFD or Duplex ❑ Multi-Family PROTECT IN WILDLAND PROJECT Pr
STRUCTURE: ❑ Commercial URBAN wrERFACEE AREA Q Yes 2'NO FLOOD ZONE 0 YCS 2rNo
DESCRIFnON OF WORK /�, Q�� � �Q, r � r +x/i
TOTAL VALUA-n'o : oy
13y my signaturt below,T certify to sac a followings am the property owner or authorized agent to act on the pcopeity owner'a behalf. I have read this
application and the information I hay provi d is con'c •T have read the Description of Work and verify it is accurate. T agree to comply with all applicable local
ordinances and state Iaws relating t building construe uthorize representatives of Cupertino to enter the abboo, -ide 'Ted property for inspection purposes.
Signature of ApplicanVAgent: Date; ✓ 1
SUPPLE ]ENTAL 1NFORIviA 1~ION REQUIRED
MEPMucRpp_1011.doc revised X3/76/1/
INSTALLATION CERTIFICATE CF-6R-MECH-04
Space Conditioning Systems,Ducts and Fans (Page 1 of 2
Site Addre s: Enforcement Agency: Permit Number:
1��i
.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 Numbers Systems value)4 etc. R-value Btu/hr Btu/hr
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 (zCF-1R space, Duct Load Capacity
um and Model Number Number 2 Systems value)° etc. R-value tuft (Btu/hr
1.If project is neiv construction, see Footnotes to Standards Table 151-B and Table 151- for duct ceiling alternative
compliance.
2.ARI Reference Number can be found by entering the equipment model number at http:1Avww.aridirectory.org/arilac.php#
3.Listed efficiency on this page.must be greater than or equal(>:)to the value shown on the CF-IR form.
4. When CF-IR is reference it is also applicable to the CF-IR, CF-JR-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 load's 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 I50-B and includes a vapor retardant or is enclosed entirely in conditioned space.
2008 Residential Compliance Forms August 2009
8mi
Iified Preseript7ve Gerfircste of Com�liaace 2(aQ8 Resirlent�ul fIVA�Alieraiions CF �1R-ALT-AV�Cr :� _
Cie Zones l sad 3-7
,h 'erirst# "
Are Addrets � i r 1� �� ti Pl �orc�te►lf Agersc9: ':'
oho
Cou,MQn
ilU 5 g f Over 40 8 of duds'. . Se
LIndc
O SeN�bysystem �inddpor afreadyprcaa: mzui be
QeIndoor Cott Ste_ sf iresta/tu�j
densing Unit r ®EER Resistance ®R 6 (t:Z I,3-3) •
Other c Choose tilt: ent being installed;if moi a than one system,use another CF•lR-AI.T HVAC.for each system
!, wcutTyp r
2.Wmfntum E�uiptr►eat Mcieaeim 13 SEER.78%AFM
7.7ASPF for typical resideatial:systems.
Cvrctractor araentatioa Aa'thar's/Responsible Desitiser's Declarstitin$tat�uient}
• I cc tify that this Certificate of Compliance docmnentation is ecwrate end'ctiii fete: :
• I em eligrblc ander Brvision 3 of the Caiifortda Business.and Professions Code to accept respoasibilitY for the design identified.on this
Certificate of Courplinace.
• I certify that the energy features and performance spWraicadom for the design idarttiied on this Certificate Of Compliance conform to the
requirements of Title 24,Parts I and 6 of the California Code of Regulations. applicable
• The design.features identified on this Certificate of Compliance are'consistent with the information doeamented on cod=app e t
compliance forms,wotisbeets,cslculations,plans and specifications.subm*O to the en cement a enryy for app. ..al Yn PQTII1
1scatiOn. ` j Signature:
Name: �l�Y ►� uc V Q S c
s�V11NLGtC]P� Date
Company ..Ojt,lO. I
Address 1`t 1 fG P� , :�•,;�
CitylState/zip: Z
i
':!;:11' .. _i .. .. .��. •• . . 'I: E?ftp .. .. .. ..
}�` 2008 Residential Compliance Forms.doc revised 04/10/12