14050105 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22441 CARNOUSTIE CT CONTRACTOR:ATLAS-TRILLO HVAC PERMIT NO: 14050105
OWNER'S NAME: JAIRAMAN SHANBRASHEKSAR 1965 KYLE PARK CT DATE ISSUED:05/16/2014
OWNER'S PHONE: 5104495662 SAN JOSE,CA 95125 PHONE NO:(408)286-8931
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL
( � REMOVE AND REPLACE FURNACE AND INSTALL A/C
License Class "�n Lie.#
Contractor�i'C 111 S l<'�' �d DattN6 INe
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:$5000
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:35603027 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 WITBIN 1 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter p�
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS O, LAST CALLED INSP CTI 7
indemnify and keep harmless the City of Cupertino against liabilities,judgments, (,/
costs,and expenses which may accrue against said City in consequence of the Issued b / Date: r ��
granting of this permit. Additionally,the applicant understands and will comply y'
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18. �
5/fa
RE-ROOFS:
Signature Date J l 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:
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)
1,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,Sec 25505,25533,and 25534.
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 � MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION /V\
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408) 777-3228•FAX(408)777-3333•buildina(a.cunertino.orp `� MISC
ICUP tR`C'ChCO
❑PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑`MISCELLANEOUS
PROJECT ADDRESS /n/ •�47: 1 I APN#
OWI IERNAME J 1 �� ,. (/ [`/ lam( _ F--MAULhD 14
V v
V
STREETADDRESS CITY FAX
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑ OWNER ❑ OlAlt&M-BUILDER ❑ OWNER AGENT17
ONIRACTOR ElCONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER E] DEVELOPER ❑TENANT
CONTRACTOR NAME ' LICENSELICENS - BUS.LIC k
ASS; n l 2-;
COMPANY NAME E-MAIL FAX
STREET ADDRESSj6f(,,,C.
l V • CITY,STATE,ZI1„
ARCHn=/ENGINEERNAME LICENSE NUMBER- J( BbS.LIC#
COMPANY NAME E MAII FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
ge
USE OF ❑SFD or DUPLEX MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD 7.01E ❑NO EMBLER HOME? ❑NO
DESCRIPTION OF WORK �• /f/�am_ L
l �
12
-04
0-71
TOTAL VALUATION: ET '
- r, As
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the prege�er's eh lf. I have read this
application and the information I hay provided is correct. I have read the Description of Work and verify it is accurate. I to comp y v�th all applicable local
ordinances and state laws relating to ,,provided
co truction. I authorize representatives of Cupertino to enter the above-i ntified pr perty f r inspection purposes.
Signature of Applicant/Agent: _.�� Date: 1
SUPPLEMENTAL INFORMATIQN— REQUIRED y
: R---10 .
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WEMEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 22441 carnoustle ct DATE: REVIEWED BY: Mendez
APN: BP#: "VALUATION: $5,000
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY PENTAMATION FURN/AC
USE: SFD or Duplex PERMIT TYPE: A
WORK remove and replace furnace and install a/c
SCOPE
�t
Mech.Plan Check Fo.0 hrs $0.00 Phlwb_ Plan t:iRc 1;Ye _I'r �btecic
Mech.Permit Fee: IMPERMIT
Other Mech.Insp. 0.0 hrs $47.00 other Plumb fnsrr- ED
LI''!'e'`
-I��c!�_l;aa/�. <'��. Phvi�h. Irrs�z Ercc
NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These fees are based on the preliminary information available and are only an estimate. Contact the De t or addn'l info,
FEE ITEMS(Fee Resolution 11-053 Ef 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 �� # Mechanical
Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $139.00 IMFR=<100 Furnace,Forced-Air
PME Plan Check: $0.00 F1 # Mechanical
Permit Fee: $0.00 $70.00 IBREMAIR A/C Units(<=10K cfm)
Suppl. Insp.Fee: Reg. 0 OT O,Q hrs $0.00
T_=
PME Unit Fee: $0.00
PME Permit Fee: $47.00 -T=
Couvritclion Tff.
Administrative Fee: ]ADMIN $44.00 0
Work Without Permit? ®Yes (F) No $0.00 G
Advanced Planning Fee: $0.00 Select a Non-Residential G
Building or Structure 0
Travel Documentation Fee: 1 TRAVDOC $47.00 i
Strop Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission.Fee: IBCBSC $1.00
11
01
OTALS.: $139.50 $209.00 TOTAL FEE: $348.50
rt, :
Revised: 04/01/2014
HVAC ALTERATIONS ENERGY COMPLIANCE FORM
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
ALBERT SALVADOR, P.E.,C.B.O.,BUILDING OFFICIAL
CUPERTihl0 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildina(ftupertino.oro
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 f>
• 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 $5,000 per violation or suspension/revocation of a contractor's license.
2008 BUILDING ENERGY EFFICIENCY STANDARDS (Title 24,Part 6)REQUIREMENTS
E\TCLUDE:
I. Heating equipment must have a minimum 78%AFUE(Exception: Wall &floor furnaces; room
heaters).
2. Central air conditioners&heat pumps less than 65,000 Btu/hr must have a minimum 13 SEER.
3. Newly installed or replaced ducts must have a minimum insulation value of R-4.2.
4. A setback type thermostat(24 hr clock with four set points) is required for all alterations.
5. New or replacement ducts must meet the mandatory requirement of Section 150(m).
• All joints and openings in the HVAC system must be sealed.
• OnIy UL 181, UL 181A, or UL 18113 approved tapes or mastic shall be used to seal duct
openings.
• Connections of metal ducts and the inner core of flex ducts shall.be mechanically fastened.
Flex ducts must be connected using a metal sleeve/coupling.
• FIex ducts that are suspended must be supported every 4 ft. max for horizontal runs with no
more than 2" of sag between supports and 6 ft. max for vertical runs.
6. The CF-6R-MECH-04 must be completed and signed by the installing contractor. The Inspector
will collect this form and verify that the model numbers are the same as the installed equipment.
2008 Residential Compliance Forms.doc revised 04/10/12
Simpered Prescriptive Certificate of Compliance:2flfl8 Residential HYACAIieratiotts CR-1R-ALT-AYAC _.
Cfirsate Zona 1 and 3-7
Site Address: EnforcenerdAgency: Daie:;;x Perini!;#
2 w- C '
Conditioned Duca insulation
EqUipmentTyp'l List Iv€htiiiniEfl}icien Floor Area re Theitriostnt
Paekagei3¢Umt - `' � " fiver 40$of
Furnace E COP Served by system added&ii placed in Q Setback
door Coil SEER HSPF= (If nar already prrsart,rias!be
densiimg
Unit DEER E3 Resistance -If unconditioned space hidtaakdJ
L?ther,•-
E3 R 6 (CZ I,3-SJ
L F-quipmeut Type:Choose the equipment being uistalled;if more than one:system,use another CF-I R-AI.T-iW_AC.fw each system.
2-Minimum Equipment Effidencies:13 SEER,78%AFUE,7.7HSP,F for typical residential systems.
Contractor(Ddcameutation Author's/Responsible Designer's Declaration Statement)
• I testify that this Certificate of Compliance documentation is accurate and coi6l:cte.
• I am eligible under Division 3 of the California Business and Professions Code to adept responsibility for.the design identified on this
Certificate of Compliance.
• I certify that the energy features and performance:specrfications 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 fesiures 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 approgal,with time permit
application. _
Name: Signature: �!
Company: /
1
Address jq l('i/_ LW
(f_ License:
A
City/StatelZip: � Phone: .
2008 Residential Compliance Forms.doc revised 04/10/12
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