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14050087CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21063 CHRISTENSEN DR CONTRACTOR: VALLEY HEATING & PERMIT NO: 14050087 COOLING OWNER'S NAME: PEARLMAN DALE L AND DARA B 1171 N 4TH ST DATE ISSUED: 05/13/2014 OWNER'S PHONE: 4089961459 SAN JOSE, CA 95112 PHONE NO: (408)294-6290 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL E] REPLACE (E) FURNACE & A/C UNIT, SAME LOCATIONS _ ` # f C/0/ License Class Licc./. / Contractor c ` 1 l/1_ Date f !/2ul [ 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 performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $6395 1 have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 32654005 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 DAY LED 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: 3 granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section RE-ROOFS: be inspected to roofing material being installed. If a roof is 9 18. Date �V J (� Signature All roofs shall prior any 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 & Safety Code, Sections 505, 25533, and 25534. ` ��/ �/ `y Section 3700 of the Labor Code, for the performance of the work for which this 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 /00 MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildina(o)cupertino.org MISC ❑ PLUMBING ❑ MECHANICAL ❑ ELECTRICAL ❑ MISCELLANEOUS PROJECT ADDRESS I U 6"3 C k ` n D - I APN # _57 OWNERNAME Qom / I/y- ` PI�{Dj - L -C ( b - � l L. C E MAII. STREET ADDRESS I G i % / L � 1 �S`� l '1 CITY, STATE, ZIP_ / PHONE E-MAII CONTACT NAME ��. `�/ " t STREET ADDRESS / /Al./ CITY, STATE, ZIP �¢ Gjr Z �(❑BAR [CFIIT'ECf FAX CTOR ❑ CONTRACTOR AGENT ❑ ENG11,MR ❑ DEVELOPER ❑ TENANT ❑ OWNER ❑ O/-BURDER ❑OVR MAGEN7 LCIM WNER CONTRACTOR NAME i/ _' , „ ()L /` LICENSE NUNMER 2_f�(/� LICENSE TYPE Q / �j� S. LI B v 4 0 Z L U l Z.� COMPANY NAME �I r, Tl C�� I. 7 E MAII FAX STREET ADDRESS / V CITY, STATE, ZIP ��- � /1 �J ( J `rJ (� PHONE (� r7 ! �P ZC( V ARCHTTECT/ENGWEER NAME AM/ LICENSE NUMBER BUS. LIC 9 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ MULTI-FAMQ Y PROJECT INWIIALAND ❑ YES BUILDJNG: ❑ COMMERCIAL URBAN nnERFACE AREA ❑ NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO IS TIM BLDG AN ❑ YES EICHLER HOME? ❑ NO DESCRIPTION OF WORK /7 Ale - TOTAL VALUATION: r -g_ WNW K By my signature below, I certify to each of the following: I am the property owner or authorized ag p I . application and the information I have provided is .correct. I have read the Description of Work and verify it is ace agree mply vrith al a le local ordinances and state laws relating to bu9lg construction. I th representatives of Cupertino to enter the abova led inspection purposes. Signature of ApplicanUAgent: Date: SUPPLEMENTAL INFORtMATION REQUIRED = M oF�cE�s�z��-10� aNEWoLzsTx` z'l� ��TA3VD� MEPA&cApp 2011.doc revised 06/21/11 CITY OF CUPERTINO ill � iii FFF. FCTTMATnR — HOLDING DIVISION APPLIANCE / EQUIP TYPE 21063 CHRISTENSEN I DATE: 05/13/2014 REVIEWED BY: MELISSA 19dADDRESS: APN: 326 54 005 BP#: *VALUATION: 1$6,395 xPERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex I PENTAMATION FURN/AC I PERMIT TYPE: USE: Furnace, Forced -Air 1MFR=<100 WORK REPLACE E FURNACE & A/C UNIT SAME LOCATIONS # $139 SCOPE PME Unit Fee: APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES Phwib. Plur1 Check A/C Units (<=10K cfm) 1BREMAIR Permit Fee: 1 # $70 ONU.>';F' F _ Imp, Furnace, Forced -Air 1MFR=<100 tae{'_ Ins"). € C< 1 # $139 PME Unit Fee: $209.00 PME Permit Fee: $47.00 ! `oizs;o`trcrron Tcty: Administrative Fee: IADMIN $44.00 Work Without Permit? 0 Yes (F) No $0.00 TOTALS: i Travel Documentation Fee: ITRAVDOC $209.00 Strong Motion Fee: 1BSEIS1vffCR NOTE: This estimate does not include fees due to other Departments (i.e. rtanning, runuc rro�na, . ��C, �u..�•u,y mac.. �• <-•�•• ��••��• bd the relimina information available and are onl an estimate. Contact the Dept or addn 7 info. District, ete,. These =are ase on FEE ITEMS Lee Resolution 11-053 E . 711/13) FEE QTY/FEE MISC ITEMS Plan ("heck, Feer: Mech. Plan Check0.0 hr's $0.00 Phwib. Plur1 Check I:iec, Ph"In Check Mech. Permit Fee: IMPERMIT Permit Fee: Other Mech. Insp. 0.0 hrs $47.00 t Cher Plumb Insp. ONU.>';F' F _ Imp, I-I c,.. Pnrrrib. Insp. Fee tae{'_ Ins"). € C< NOTE: This estimate does not include fees due to other Departments (i.e. rtanning, runuc rro�na, . ��C, �u..�•u,y mac.. �• <-•�•• ��••��• bd the relimina information available and are onl an estimate. Contact the Dept or addn 7 info. District, ete,. These =are ase on FEE ITEMS Lee Resolution 11-053 E . 711/13) FEE QTY/FEE MISC ITEMS Plan ("heck, Feer: S'#1/t/)1, PC Fee PME Plan Check: $0.00 pEr)nit l'i'{:': stdppl, 111sp P_ee PME Unit Fee: $209.00 PME Permit Fee: $47.00 ! `oizs;o`trcrron Tcty: Administrative Fee: IADMIN $44.00 Work Without Permit? 0 Yes (F) No $0.00 i Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: 1BSEIS1vffCR $0.64 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 r M To�EE:$0.00 $3$348.64 48.64 Revised: 04/01/2014 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 cDcupertino.ora 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: I . 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 setpoints) 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 MM prescriptive Certificate of Compliant4t 2669 Residential HVACAi. n's'. C*F-IR-ALT-HVA, Zones 1 and 3 - 7 she F-forcenwaAjency- Date-& P Pernift.k., Conditioned Duct insulation EquiPme.aypd Fur Furnace E, ®COP Served system by 40 it 4dilids ad TCP deddr`�.Iacid.M� be Indoor Coil E3 Rzsis�= -If unconditionedspam. - 07)!Ot rV�pr=mt, must Condensing Unit 17EER MR 6 (CZ 11 3-3), Other 1. Equipment Type; Choose the equipment being installed; if more than one_system, we another CF -IR -ALT -HVAC for each system. 2.Armimum Equipment Efficiencies; 13 SEER, 78% AFLJF, 7.7HSFF for typical residentialsystems. Contractor (Documentation Author's /Responsible Designer's Declaration Stateizient) • I certify that this Certificate of Compliance documentation is accurate and co*lete– • I am eligible under Division 3 of the California Business and Professions Code to acoeptrespowlbility forthe design identified on this Certificate of Compliance. • 1 certify that the energy features and perfoiinance. iSpeoifi cations 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 desigri features identified on this Certificate of Compliance we consistent with the infonnation documented on other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit =lication, Name: 'S Kwllc Company: va l Address: License: city/Stmeizip. Phofie: Q. 2008 Residential Compliance Forms.doc revised 04110112