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14020101CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20378 CLAY ST CONTRACTOR: SANDIUM PERMIT NO: 14020101 OWNER'S NAME: SAN JOSE, CA 95134 PHONE NO: (408) 894-9072 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ Q ` n License Class c_2,0 Lic. # C>O� FURNACE REPLACEMENT S SR`" �(q tL� Contractor Date 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 Compensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $5000 performance of the work for which this permit is issued. 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: 36938027 00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is IS NOT STARTED PERMIT EXPIRE7OFPE correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 D YIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enterupon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROED 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 Issued by: Date: 69" with all non -point source regulations per the Cupertino Municipal Code, Section RE -ROOFS: 9 18. / 2` t� 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 Signature of Applicant: Date- atethe I hereby affirm that I am exempt from the Contractor's License Law for one of thefollowing 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 & Safety Code, Sect' s 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: 1 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 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 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 r� GENERAL PERMIT APPLICATION � COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION \6 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 FAX (408) 777-3333 • buildino(a)cupeltino.org �U 1/1t.fCI+S.S A T.TT!' A T MT:T 1YrTPMAT- MMTSCELLANEOUS MEP MISC PROTECT ADDRESS �9 S-7 2 C S -E, I APN # OWI'zERNAME STREET ADDRESS „ _ �� a �v CITY, STATE, ZIP I FAX CONTACT NAME PHONE E-MAII STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER '❑ Ow', -M -BUILDER .❑ OVJNERAGEI.T ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENcmTTEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAMEM._ p i LICENSENUMBE LICENSE TYPE BUS. LIC# COMPAATY NAME ( inti E-MAIL FAX STREET ADDRESS ? ` !/ +. CITY, STATE ZIP\ /► J ") �13 PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER. BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ mumi-FAmmy BUILDING: ❑ COMMERCIAL PROJECT INWILDLAND ❑ YES URBAN IN*rMFACE AREA ❑ NO PROTECT IN ❑ YES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO DESCRIPTION OF WORK TOTAL VALUATION:, Pit - 10100-11 By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to bui ' construction. I authorize representatives of Cupertino to enter the abo�e-i entifie property for inspection purposes. Signature of Applicant/Agent: Date: - 119/14 SUPPLEMENTAL INFORMATION REQUIRED '��mOFETCEdISE-0'�Ty�-'" a W-. IO?R 11S msU '1§5i WARD• Zc � MEPMiscApp_201 Ldoc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 20378 clay st FEE DATE: 02/19/2014 REVIEWED BY: Mendez APN: BP#: *VALUATION: 1$5,000 *PERMIT TYPE: Mechanical Permit 111,w lA. P/ana t.7hc:rG PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: Fee: IMPERMIT PENTAMATION FURN/A PERMIT TYPE: WORK furnace replacement hrs $47.00 SCOPE t}t/res I<<cr. I; YP' aiccta. In -sly. t'r�' APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced -Air 1MFR=<100 1 # $139 TOTALS: $139.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School ni.ctrirt_ Ptr )_ These fees are haled on the nreliminary information available and are only an estimate. Contact the Dept for addn 7 info. FEE ITEMS (Fee Resolution 11-053 E(f.' 711113) FEE QTY/FEE MISC ITEMS Plan Mech. Plan Check0.0 hrs $0.00 111,w lA. P/ana t.7hc:rG Mech. Permit Fee: IMPERMIT P/e;m/,. Pe'-init Fee: Other Mech. Insp. 0.0 hrs $47.00 CJtl;c>r 1 iatrtll� Tres/�. t}t/res I<<cr. I; YP' aiccta. In -sly. t'r�' Phwib. F-ee ties tnst� l ,e: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School ni.ctrirt_ Ptr )_ These fees are haled on the nreliminary information available and are only an estimate. Contact the Dept for addn 7 info. FEE ITEMS (Fee Resolution 11-053 E(f.' 711113) FEE QTY/FEE MISC ITEMS Plan ti'uppl. PC Fee PME Plan Check: $0.00 Pe'-init Fee: ,Supp/. 11.1sp, Fee PME Unit Fee: $139.00 PME Permit Fee: $47.00 Administrative Fee: IADMIN $44.00 Work Without Permit? ® Yes 0 No $0.00 Plarmim, Fees: Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldy, Stds Commission Fee: IBCBSC $1.00 $278.50 $0.00 TOTAL FEE: $278.50 Revised: 01/15/2014 Z • 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 • building aC-cupertino.org 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 She AddressG9�� . EnforcemersfAgency: Daie . ' Permit P.,, Conditioned Duct insulation Equir,mentType, {" l:YItI1lIFi13ni'F.tfiCren .., .FlOOI'Asea Tr: •_ •: Thermostat—' P Unit , : vrnace ' QQ //� A {t� GOP HIISPF J ` r Sewed by system Over 4U 8 of ducts; _ . added or replaced in .. ., .— [� Setba;u:dt Indoor Coil (3SEER s�Jc7 sf imponditionedspa Griotatreadypr=M4mustbe Condensing Unit ® EER Resistance R 6 �� 3 insta71edJ Ovier . 1. Equipment Type: Choose the equipment being installed; ifmom than one_system, use another CF -1 -ALT-HVAC for each system 2. Afinimum Equipment Efficiencies: 13 SEER, 78%AFUE, 7.7RSPF for typical residential systems. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) • I certify that this Certificate of Compliance documentation is accurate and conapiete. • 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 design featiurs identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms, worksbeets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application, _ . Name / fly, Q q�! City/StatwZip: <CA q < 1 151Phone: 2008 Residential Compliance Forms. doc revised 04/10/12 Address SST.! vsr SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building ftwertino.orp tJc%f FILE La ? Permit No./'-?'C126/0,'/ PURPOSE This affidavit is a self- certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections are required. GENERAL INFORMATION Existing single - family and multi- family dwellings shall be provided with Smoke Alarms and Carbon Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds $1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and /or Carbon Monoxide Alarms be installed in the following locations: AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the bedroom(s) X X On every level of a dwelling unit including basements X X Within each sleeping room X Carbon Monoxide alarms are not required in dwellings which do not contain fuel- burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated. In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for alarms which must be connected to the building wiring. As owner of the above - referenced property, I hereby certify that the alarm(s) referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes. The alarms have been tested and are operational, as of the date signed below. l have read and agree to comply with the terms and conditions o his statement ' In a , Si nature ............ ........ ............................... Date:<.�..� ...... .Z . ...... Contractor Name: Signature.................................... ............................... Lic.# ....... ............................... Date: ................... Smoke and CO form.doc revised 03118114 ly