14050066 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10446 PRUNE TREE LN CONTRACTOR:AVA CONSTRUCTION PERMIT NO: 14050066
OWNER'S NAME: STEVENSON DUANE E AND ANN L 21060 HOMESTEAD RD APT 216 DATE ISSUED:05/09/2014
OWNER'S PHONE: 4086056428 CUPERTINO,CA 95014 PHONE NO:(408)387-0999
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
REPLACE(E)FURNACE&DUCT WORK,SAME
License ClassLic.# 4 3 LOCATION&
Contractor LP Date �j' L ADD(N)A/C UNIT IN SIDE YARD AREA
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:$8000
ave 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:31633082.00 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 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 SPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the 1
granting of this permit. Additionally,the applicant understands and will compl sued by: Date:
A y
with all non-point ufc regulations per the Cupertino Municipal Code,Section
9 18.
RE-ROOFS:
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
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
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 25505,25 33 an 5534
Section 3700 of the Labor Code,for the performance of the work for which this !�
D
Owner or authorized agent: ate:
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
918.
Signature Date
' MEP
_ GENERAL PERMIT APPLEGAT(ON
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ob
10300 TORRE AVENUE-CUPERTINO,CA 95014-3255
CU E'1�Fi�i°t ht O
(408) 777-3228•FAX(408)777-3333-buildino(cDcuoertino.org O MISC
\
❑PLUMBING IIC-AL [I ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS 10446Aum7f-� ,6wwAAo
I APN# 31 CO 33 0&5?-6c'
OWIdElttdAME j� C
Dumvil, 64
/
STREETADDRESS /�/46 /pj -r E-Mt'II FAX
. PillI �`
41
CONTACT NAME PHONE/f p� Z2 5 N! E M IL R Vt '—Cell XAL-t i Z1�1
STREETADDRESS CrrY,STATE,ZIP I FAX
❑ owNER ❑ OW1.ER-BUIIAr'2 ❑ O-AWMAGENT j�<CONIRACTOR CONTRACTORAGE2.T ❑ ARCrffIECT ❑ENGAEER ❑ DEVELOPER ❑TExkmr
CONTRACTOR NAMI'( �_ I LICENSE NUMBER q-43-643 LICENSE TYPE 15 BUS.LIC#
COMPANY NAME ` /! ,,t ,C E-MAIL I '^ fn"e- tAHFAX
TREnTADDRESS * / A^ '" AN6 STATE ZIP
ARCHITECT/ENGINEERNAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ I4IULTI-FAMQ:Y PROJECT IN WIIALAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL URBAN XIERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHI-ER HOME? ❑NO
DESCRIPTION OF WORK
DD
-010 - -
TOT.AL VALUATION:
s -.-
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property ovti s behalf. I have read this
application and the information I have provided is.correc I have read the Descri • n of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating t I ding Oatnrize of es of Cupertino to enter the above-iden' e�rerty for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFOR 1ATION REQUIREDMEN.4 of CE s �L
10
MEPMisa4pp_M1.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10446 PRUNE TREE LN DATE: 05/09/2014 REVIEWED BY: MELISSA
APN: 316 33 082 BP#: *VALUATION: 1$8,000
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition / Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: FURN/A
WORKREPLACE E FURNACE &DUCT WORK SAME LOCATION &ADD N A/C UNIT IN SIDE YARD
SCOPE AREA
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
A/C Units (<=10K cfm) 113REMAIR 1 # $70
Furnace, Forced-Air 1MFR=<100 1 # $139
TOTALS: $209.00
Mech.Plan Check0.0 hrs $0.00 .111-unh. Plan Ch(; ; F— �ia�:_ !''r':n C;n�>ck
Mech.Permit Fee: IMPERMIT Plarmb. Permit t ee�
Other Mech.Insp. 0.0 hrs $47.00 01her Ph.4rab Insp. 01/7""�/1ec_ Insp.
["'CC., 3'Irrrub. T�;sp. Fee: lsie(.Ins,.) 1-1"c..
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . Thesefees are based on the prefimina information available and are only an estimate. Contact the Dept for addn'l info,
FEE ITEMS (Fee Resolution 11-053 Eff 711113) FEE QTY/FEE MISC ITEMS
Man Check k 1''ce:
Suispl. PC 11'(�e
PME Plan Check: $0.00
Supp")). Insp Fee
PME Unit Fee: $209.00
PME Permit Fee: $47.00
CO)WI—ucr ren lz7:3:
Administrative Fee: 1ADMIN $44.00
Work Without Permit? ® Yes (F) No $0.00
'Idv('W( r l p/an is Fees:
Travel Documentation Fee: ITRA VDOC $47.00
Strong Motion Fee: IBSEISMICR $0.80 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
�K $348.80 $0.00 TOTAL FEE: $
348.80
Revised: 04/01/2014
HVAC ALTERATIONS ENERGY COMPLIANCE FORM
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
ALBERT SALVADOR, P.E.,C.B.O., BUILDING OFFICIAL
CUPERTfhtO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildinge-cupertino.org
VaUN IS A PERMIT REQUIRED
A construction permit shall be obtained from the enfofeement 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 worlcing 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
; glified Prescriptive Certificate of Compliance:2068 Residentid HVACAIieratious ._ CF-IR-ALT-INA.C _
Crusate Zones 1 and 3-7
She Address: EnforceneWAgency: �TuY : 1'ernrit:#
104,46 Q �u 1.a re_ ho � 14
Conditioned Duct insulation
Eouipme=T ] 'Lak.Nam=i EEriciefi`Y2i lbor Y)[SII i+ TbermQSiat
Padkagb&Unmt
SI
Over 44 8 4dd-
-RCOP -Served.bysystem sildedotneplaced m ,
door Cot? $$PF_ (If i�walreadYpresmr a:vst be
® sf uncondmonedspace,-
jgCondms' Unit EER 13 Resistance ®R 6
Other.
1.Equipment Type:Choose the equipment being installed;if more than one_system,use another CF-1R-ALT-HVAC for each system
2.Minimum Equipment Efficiencies:13 SEER,78%AFUF,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 com ilete.
• 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 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.features identified on this Certificate of Compliance are consistent with the information documented on other applicable
compliance forms,worksheets,calculations,plans and specifications submitted to the enforcement agency for approyal,with the permit
application. _
Name: Signature:
Company � �'`�/ Date: e, G1 `4
Address �0Obt�V /2 • 6 L�oense: 4S r�
CitylState/Zip: yb J�� Phone: g
2008 Residential Compliance Forms.doc revised 04/10/12
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