14050106 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21853 WOODBURY DR CONTRACTOR:ONE HOUR HEATING PERMIT NO: 14050106
AND AIR
OWNER'S NAME: LOU RICHARD C AND CAROL C 1400 PETALUMA HILL RD DATE ISSUED:05/16/2014
OWNER'S PHONE: 4082349300 SANTA ROSA,CA 95404 PHONE NO:(707)545-1800
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL F] COMMERCIAL F]
/�' REMOVE AND REPLACE FURNACE &A/C UNIT
License ClasCU C2-0 Lic.# �Z 0 ���-//�
Contractor Date
I hereby aff that I m licensed under the provisions of Chapter 9
(commen g 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:$13198
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:32645046 00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT 5FR
WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHINYS OF P RMIT 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 DAYLAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ,,nn
costs,and expenses which may accrue against said City in consequence of the Issued by: Date (X.,
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18.
f - 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
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,Secti 5,25533,and 25534. 57- !
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized age Date " 6`�
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 ME P
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 b` MMM I S C
(408) 777-3228•FAX(408)777-3333•buildinaacupertino.org
CU p E2TINO V
❑PLUMBING
❑MECHANCAL P ❑ELECTRCAL ❑MISC
ELLAN
EOUS
PROJECTADDRESS2l8,53 wo JNvKl APN# ^Ll 5- /q0-
OWNTERNAMEA(Cha✓ L`ovE-MAIL
STATE,ZIP FAXS�D 7 08 CUITYP✓t��0 �5Gly I
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
[3 OWNER '❑ OWMM-BUMDER 1-3OWNERAGENT ❑ CONTRACTOR El CONTRACTOR AGENT E] ARCHITECT ❑ENGINEER 13DE\JEL.OPER ❑TEN.SNT
CONTRACTOR NAME LIG BUS.LIC#
cjjg vGCUY Eq/
COMPANYrAME E-MAIL
FAX
S ADD STAVE ZIP�r/f 1 �7 �Stl,U / l C/7'r 1,
r/oPHONE
j(112tr h ff ►'G� J
ARCHJTECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANYNAME F MAIL FAX
STREET ADDRESS CTTY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT INWMDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BX=ING: ❑COMMERCIAL URBAN DTIERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK J.G
TOTAL VALUATION: 8 I2$CEB1 g _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 owner's behalf. I have read this
application and the information I have prod 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 bliaiKung traction: I authorize representatives of Cupertino to enter the above-identified roperty for inspection purposes.
Signature of Applicant/Agent:. Date: ` r
LE NTTAL INFORMATION REQUIRED MWoP s1 ii
F
�'
Mi
� JU'RESS v
15�
: STAI\DARD = `
p v-_
7.ARU _ - �:
A1tEPMisc.4pp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
W.PERMIT
DDRESS: 21853 woodbury DATE: REVIEWED BY: Mendez
BP#: EVALUATION: $13,198
PE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Duplex PENTAMATION FURN/AC
USE: p PERMIT TYPE: i
WORK remove and replace furnace &A/ C unit
SCOPE
r4"
R
;sem .
Mech.Plan Check 0.0 hrs $0.00 f htnih. Plan(-`hc,-h
Mech.Permit Fee: IMPERMIT Plumb. Pe f fn`r%''C r Pc r;
Fther Mech.Insp. 0.0 hrs $47.00 001 r Plumb 7rup. Lj
PhVilk InsI). Fet!.
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These fees are based on the prelimina information available and are onl an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/131 FEE QTY/FF MISC ITEMS
Plan Check Fee: $0.00 I ' I # Mechanical
Suppl.PC Fee: (F) Reg. 0 OT T 0.0 hs $0.00 $139.00 IMFR=<1o0 I Furnace,Forced-Air
PME Plan Check: $0.00 = # Mechanical
Permit Fee: $0.00 $70.00 1 IBREMAIR A/C Units(<=10K cfm)
Suppl. Insp.Fee-.(E) Reg. ® OT 0,0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $47.00
{"rf�asrJ r,rctir�er �''ir�:
Administrative Fee: (ADMIN $44.00 0
Work Without Permit? 0 Yes Q) No $0.00 0
Advanced Planning Fee: $0.00 Select a Non-Residential E)
Travel Documentation Fee: I TRA VDOC $47.00 Building or Structure ,
Strony Motion Fee: IBSEISMICR $1.32 Select an Administrative Item
Bldy,Stds Commission.Fee: IBCBSC $1.00
MISS
5 TOALS } $140.32 $209.00 TOTAL FEE: $349.32
Revised: 04/01/2014
HVAC ALTERATIONS ENERGY COMPLIANCE FORM
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
GUPERT[N0 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•building(cDcupertino.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
• 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.$5,000 per violation or suspension/revocation of a contractor's license.
2008 BUILDING ENERGY EFFICIENCY STANDARDS (Title 24,Part 6)REQUIREMENTS
INCLUDE:
L Heating equipment must have a minimum 78%AFUE (Exception: Wall &floor furnaces; room
heaters).
2. Central air conditioners&heat pumps less than 65,000 Btu/hr must have a minimum 13 SEER.
3. Newly installed or replaced ducts must have a minimum insulation value of R-4.2.
4. A setback type thermostat(24 hr clock with four set points) is required for all alterations.
5. New or replacement ducts must meet the mandatory requirement of Section 150(m).
• All joints and openings in the HVAC system must be sealed.
• Only UL 181, UL 181A, or UL 18113 approved tapes or mastic shall be used to seal duct
openings.
• Connections of metal ducts and the inner core of flex ducts shall.be mechanically fastened.
Flex ducts must be connected using a metal sleeve/coupling.
• Flex ducts that are suspended must be supported every 4 ft. max for horizontal runs with no
more than 2"of sag between supports and 6 ft. max for vertical runs.
6. The CF-6R-MECH-04 must be completed and signed by the installing contractor. The Inspector
will collect this form and verify that the model numbers are the same as the installed equipment.
2008 Residential Compliance Forms.doc revised 04/10/12
5r
f.
qMpnfied Prescriptive Certificate of Compliance:2068 Re'sldenfidB— VACAlteratiotts CF-1R-ALT-1TVAC 7 _
Ciitsa Zones 1 and 3-7
McAd&m:1=00 r 8 3 (,moo ckJ b y EnforcemerrlAgency: r.#
r
Conditioned Duct insulation
E=ioment 'Iwtm;rniar4+'$fsyed` ' F1oorAiea" I�"rmosat'::3
PaekagedUnit /V
.� ;.�
A ID � Over 4tT 8 of dans
Indoor Cot? �HSPF S ed by system added orraglaced inetbacdt
sf Un span.., ° trust be
Condensing Unit ®F.EIt Resistance 4R66 (CZ I,3-3)
Usher:.
1.Equipment Type:Choose the equipment being installed,if mora than one system,use another CF-1 R-ALT-FIVAC.for each system.
2.11rnimam Equipment Efficiencies:13 SEED 78%AFUE,7.7HSPF for typical residential systems.
Contractor'(Documentatioa Author's/Responsible Designer's Declaration Statement)
• I certify that this Certificate of Compliance documentation is accutate and complete.
• 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 l and 6 of the California Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with the infonvation documented on other applicable
compliance forms,worksheets,calculations,plans and specifications submitted to the enforcement agency for approval with the permit
application. `
Name �f sf G P2 SitaGut:
Company: a n e h.C3l/✓ . h en 1�<lr' j�G? t f Date ! f
l�fo� PeaI/�,G h r�i r� License.
CitylStatefLip: �-1 �(n kCiS.0 Ct.-,Oq Sy-v Phone: -7c'7, Sr-L( 0 C7
2008 Residential Compliance Forms.doc revised 04/10/12