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14030013CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7921 BELKNAP DR CONTRACTOR: AAA FURNACE & AIR PERMIT NO: 14030013 CONDITIONING OWNER'S NAME: HOMER L AND JACQUELYN FLETCHER 1712 STONE AVE DATE ISSUED: 03/05/2014 OWNER'S PHONE: 4082579106 SAN JOSE, CA 95125 PHONE NO: (408)293 -4717 0 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] REPLACE (E) FURNACE, SAME LOCATION License CIass�2 Lic. # I 2 O t Contractor f---J CND CC. Date I hereby affirm that I am licensed under the provisions of hapter 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 erformance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $3100 I ave and will maintain Worker's Compensation Insurance, as provided for by N APN Number: 36208041 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 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 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, / //Lf costs, and expenses which may accrue against said City in consequence of the Issue Date: 3 granting of this permit. Additionally, the applicant understands and will comply al t source regulation per the Cupertino Municipal Code, Section !with / ROOFS: being installed. If a roof is ature ate (fir / All roofs shall be inspected p r to any roofing material 1 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 deft the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain co Dance with the upertino 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 performance of the work for which this the Health & afety Code, Sections 505 5 3 , and 25534. Owner or authorized agent: 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 G Na RAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT-,11UILDING DIVISION WEP 103.00 TORRE AVENUE - CUPERTINO, CA 95014 -3255 (408)7 77-3228 - FAX (408) 777 -3333 , building @cupertino.org `V`YA \� MISC .Trixorkir, [.-.:�rWAKnrnt f7vi RrT•RI('AL 7MISCELLANEOUS PROJECT ADDRESS —) 9p 21 11 KpiVIp CA 09:1 VC, 7AM 3 r.,7— D AS - O OWNER HAS � PH 2-61• -II�0 E-MAIL MT= ADDRESS 1Ci. 2 ( � �WAV0 1 P � V p— C ST �1� � - I J✓j `+ FAX CONTACT' NAME PHONE E -MAIL STREET ADDRESS i• MY, STATE, ZIP FAX • ❑ OWNER Q OWNBR•SUILDER Q OWNER AGENT '-G ONTRACroR ❑ CONnACrOR AGENT ❑ ARCKrECT Q ENOMEER Q 06VELOPER Q TWANT CONTRACTOR NAME f. f A V-aiido p LICENSE NUMHERj w i T7e7N G ?� BUS. UC i COMPANYNAMB fVV I "N� 1 (�A e•� Vl STREET ADDRESS 1'112 5 i-l�(1G Crrvmiosc ovGu, -2c13 - .q71"1 ARCF{rrtcvZNOTNMR NANM LICENSE NUNMER BUS. LIC COMPANY NAME E -MAf1 FAX STREET ADDRESS CM, STATE, ZIP PHONE USE OF eSFD or Duplex ❑ Multi - Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN DTIERPACE AREA ❑ Yes ;;--iVO FLOOD ZONE O Yes le No DESCR7nON OF WORK VIO( "Q (Ay)d t*16j (e fV n MC-e TOTAL VALUATtoN: 00 By my signaturb below, I eeriify to each of the Rflong: l am the property owner or authorized agent to act on the property owner'3 behalf. I have read this application and the information I ha videt. •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 boil ing c n, I authorize representatives of Cupertino to enter the above id✓en�tifi property for inspection proposes. Signature of Applicant%gent: Date:, 2.2 - S LEFY NTAL INFORMATION REQUIRED hBPWwcApp_2011.doe revised 03116111 CITY OF CUPERTINO Fw--NR7 FFT, ESTIMATOR - BUILDING DIVISION I& ADDRESS: 7921 BELKNAP DR DATE: 03/05/2014 "VIEWED BY: MELISSA APN: 362 08 041 1 BP#: *VALUATION: 1$3,100 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: I PENTAMATION I PERMIT TYPE: FURN/AC WORK REPLACE (E) FURNACE, SAME LOCATION SCOPE APPLIANCE / EQUIP TYPE FEE ID PbolA Plan Check QTY UNITS BP FEES Ak,'. Furnace, Forced-Air A 1MFR=<100 lm p 1 # $139 PME Unit Fee: $139.00 PME Permit Fee: $47.00 TIA F Administrative Fee: IADAffN $44.00 Work Without Permit? 0 Yes 0 No $0.00 TOTALS: Travel Documentation Fee: ITRAVDOC $139.00 Strong Motion Fee: IBSEISAffCR NOTE. This estimate does not include fees due to other Departments (4e. Planning, Public Works, tire, Sanitary Sewer District, acnoot M f �f' 1 Th—, — .— h—d n" tho nratifninnry infarmatian ava;lahh, and are an/v an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 711113) Mech. Plan Check 0.0 hrs $0.00 PbolA Plan Check ("hock Mech. Permit Fee: IMPERAffT 'htfn!;_ Pe"mil h"'c' Ak,'. Lt,her Mech. Insp. Fo --ol hrs $47.00 Oiiwr Plunib frisv. lm p '4111b. [ayp. Fee: P h A", L NOTE. This estimate does not include fees due to other Departments (4e. Planning, Public Works, tire, Sanitary Sewer District, acnoot M f �f' 1 Th—, — .— h—d n" tho nratifninnry infarmatian ava;lahh, and are an/v an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 711113) FEE QTY/FEE MISC ITEMS Ma,i (hcck Fee,- Svfwl. P(_' Fee PME Plan Check: $0.00 PME Unit Fee: $139.00 PME Permit Fee: $47.00 TIA F Administrative Fee: IADAffN $44.00 Work Without Permit? 0 Yes 0 No $0.00 '164WJI"V(' Pkin"lirig Fees: Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: IBSEISAffCR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 TS 278.50, TOTALF $0.00 EE: $278-50 Revised: 01/15/2014 INSTALLATION CERTIFICATE CF -6R- MECH -04 Space Conditioning Systems, Ducts and Fans (Page 1 of 2 Site Address: Enforcement Agency: Permit Number: -1°121 a Dime .Space Conditioning Systems Heating Equipment Equip Type (package- heat um CEC Certified Mfr. Name Model Number ARI Reference Numbers # of Identical Systems Efficiency (AFUE, etc.)1.3 (z.UwIR value )4 Duct Location (attic, crawl- space, etc. Duct R -value Heating Load tu/hr Heating Capacity Btu/hr `nnpd' Cooling Equipment Equip Type (package heat um CEC Certified Mfr. Name and Model Number ARI Reference Numbers # of Identical Systems Efficiency (SEER and EER) 1' 3 (2-CF -1R value) ° Duct Location (attic, crawl- space, etc. Duct R -value Cooling Load tu/hr Cooling Capacity (Btu/hr 1. If project is neiv construction, see Footnotes to S'tanaaras I aote i o 1 -ts and i aote 1.)1 -Ljur uuci c mrig utter rtuu vc compliance. 2. ARI Reference Number can be found by entering the equipment model number at http:// www .aridirectory.org/ari/ac.php# 3. Listed efficiency on this page must be greater than or equal (>_) to the value shown on the CF-]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 §I12(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 2 rescriptivq Certificate of Compliance: 2 09Aesident al YA.ty Alterations CF-AY1 C :k lazd3 -7 Me Addr—e 9nlorcwzeW Agecy. 1 P 2— Cond'itipned in�tilation . Egnipment Type' Ft _ i Mum yeti ,. +��: ,:,Duct .� ,: sr. ' Tli.�OStat'�•.3 Package;Uuu Fusnaoe s �'' t3ver 4t18 of duds, cad in ' etbacdc Y. ® COP :. Served by system sided oriepia S indoor Coil _TSPI sf rmcondiuoned ce ,; (fhot 6�ieady prcunt crust be E3 Condensing Unit ® EER Resistance ®R 6 (CZ 13 S) � rn tither 1. Egaipxocut Type: Choose the equipmani being installed, if room than one _system, use another CF-1R-ALT,-HitAC for cacti &ystem ,.:... . 2. Minimum Equipment Efficiencies: 13 SEER, 78 %AFUE; 7.7HSPF for typical residential:systcros. Contmaor(Documentation Author's /Responsible Deftner's Declaration Statement) • I =tify that this Certificate of Compliance documentation is accurate aud'ctiiaplete: • 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 ccstify that the energy features and perlbrmanoc:sp6clifications for the design identified on ibis Certificate of Compliance conform to the requirements of Title 24, Parts I rod 6 of the California Code of Regulations. • The design .feati res ideniifred on this Certificate of Compliance are'oonsisteat with the information documented on other applicable compliance forms, worksheets, calculations, plans and specif;cations.subm teed to en t envy for appmval.,.ydth the permit licadou. ; Name: Sigaanus: Company AUl�! , p� Data,. Z 2 `�C Address: `1��L-,• r j� -.�... UP== t (1 City /State lip: MA IM 2008 Residential Compliance Forms.doc revised 04110112 X� I // �Si.l9ff Address T YL i PURPOSE 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 gncuoertino.org � FILE- ,Ap 7 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 terns and coaditions of this statement Owner (or Owner Agent's) Name: cy Si nature.... ... ... .. ............... Date: .L. Contractor me: Signature.................................... ............................... Licl ....... ...................... .......... Date: ................... Smoke and CO form.doc revised 03118114