14060066 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10744 ALDERBROOK LN CONTRACTOR:PELLE HEATING&AC PERMIT NO: 14060066
INC
OWNER'S NAME: ROBERT MCQUEER 3751 D CHARTER PARK DR DATE ISSUED:06/11/2014
OWNER'S PHONE: 4083662895 SAN JOSE,CA 95136 PHONE NO:(408)978-7060
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑
ADD A/C UNIT TO SFDWL
License Class ` 120 Lic.4 �0�9F
P<'Contractor t� 2//,4p /04"1'y' Date 60/_
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:36920045.00 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 1 DAYS OF1PERMIT 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 F AS CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, f /
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18.
RE-ROOFS:
Signatur� �_ i'Date �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)
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. 1 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 5,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agenty io
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
9 18.
Signatu f'! ate
GENERAL PERMIT APPLICATION u MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 MISC
CUPERTINO (408)777-3228•FAX(408)777-3333•buildinaCa cuoertino.ora , 11V1J'
❑PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS' L I APN#r4 n�J�
OWNER NAME 1 N� 'swo'Itcl5 ( E-MAIL
STREET ADDRESS I()-+-Q L W I�ITY, 4& qis®i FAX
CONTACT NAME 94f6j 4U D -1SJI�[A J Ie AIL ZjL
STREET ADDRESSyIwD C A
eWjt / 0- I ' T /
11 OWNER 11 OWNER-BUILDER
❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME n I LICFS� I LICE TYPE
ENS BUS.LIC#
COMPANY NAME p- E-MAIL 4,69 9 ( ,no
STREET ADDRESS�.nc+�_w � �•}�1�• e Y STA E,ZIP ,� ^�I�� P Q,q� y��
ARCHITECT/ENGINEER NAME 1, I LICENSE NUMBER BUS.LIC
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF O SFD or DUPLEX ❑ MULTI-FAMILY I PROJECT IN WILDLAND ❑❑ YES I PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: COMMERCIAL /� URBAN INTERFACE AREA ��,uONO FLOOD ZONE ❑NO EICHLER HOMES ❑NO
►,[�
DESCRIPTION OF WORK M � �s1rR/ 4.
TOTAL VALUATION: /'1 Y 1 ('1 I RECEIVED-11,
By my signature below,I i,..IJJI i� ify�Vto each of the following: I am the property owner or authorized agent to act`on'lbeTre s e alf. I have read this
application and the information I have p vided is correct. I h r d the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to bui ng c nstruction. I uthor' a epresentatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: N Date: �PIIO /Iy
SUPPLEMENTAL INIVkMATION REQUIRED OFFICE USE ONLY
WW ❑ OVER-THE-COUNTER
E ❑ EXPRESS
❑ STANDARD -
❑ LARGE
a
❑ MAJOR
r�
MEPMiscApp_201 Ldoc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10744 alderbrook In DATE: 06/11/2014 REVIEWED BY: Mendez
APN: BP#: *VALUATION: 1$5,000
*PERMIT TYPE: Building Permit I PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Duplex PENTAMATION FURN/A
USE: PERMIT TYPE:
WORK add a/c unit
SCOPE
J
Mech.Plan Check 10.0 I hrs $0.00 Plrimb. Phin('hec t,
Mech.Permit Fee: IMPERMIT Plrt:rii;. Ptsmit 1 cr: I„.r
Other Mech.Insp. 0.0 hrs I $47.00 Other PlUmh•hasp. Utln s'l:r"<: i.-,t: Li
, . , .. Phinib, InSp, /'ve ,,:.i
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 preliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (F,(-,e Resolution 11-053 Eff. 711113) FEE QTY/FEE I MISC ITEMS
Plan Check Fee: $0.00 0 # Mechanical
Suppl. PC Fee: Reg. ® OT 0.0 hrs $0.00 $70.00 IBREMAIR A/C Units (<=10K cfm)
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:Q Reg. 0 OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $47.00
F i
Administrative Fee: IADMIN $44.00
Work Without Permit? Yes 0 No $0.00 G
Advanced Planning-Fee: $0.00 Select a Non-Residential E)
Travel Documentation Fee: ITRAVDOC $47.00 Building or Structure
J�
Stronp- Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item
Bldp- Stds Commission Fee: IBCBSC $1.00 J
_ ry'� _B ` ],5, TOTAL FEE: I 209.50
s: C7 A? r :<. $139.50 $70.00 $
Revised: 10/01/2013
STATE OF CALIFORNIA
MANDATORY MEASURES SUMMARY: RESIDENTIAL
CEO-MF-1R(Revised 0$108) CALIFORNIA ENERGY COMMISSION
Mandatory Measeres Summary MF-1R
Residential (Pale 1 of 3)
Site Address: En rcement Agency: bate:
NOTE: Low-rise residential buildings subject to the Standards must comply with all applicable mandatory measures listed,
regardless of the compliance approach used More stringent energy measures listed on the Certificate of Compliance(CF-18,
CF-1R-ADD, or CF-1R-ALT Form)shall supersede the items marked with an asterisk(*)below. This Mandatory Measures
Summary shall be incorporated into the permit documents and the applicable features shall be considered by all parties as minimum
component performance specifications whether they are shown elsewhere in the documents or in this summary. Submit all
applicable sections ofthe MF-.IR Form with plans.
DESCRIPTION
Building Envelope Moasures:
§I 16(a)1: Doors and windows between conditioned and unconditioned spaces are manufactured to limit air leakage.
4116(a)4: Fenestration products(except field-fabricated windows)have a label listing the certified U-Factor,certified Solar Heat Gain Coefficient
(SHGC),and infiltration that meets the requirements of§10-111(a).
§117: Exterior doors and windows are weather-stripped;all joints and penetrations are caulked and sealed.
§118(a): Insulation specified or installed.meets Standards for Insulating Material. Indicate type and include on CF-6R Form.
§I 18(i): The thermal emitiance and solar reflectance values of the coot roofing material meets the requirements of §I 18(i)when the installation of
a Cool Roof is specified.on the CF-1R Form.
*§150(a): Minimum R-19 insulation in wood-frame ceiling or equivalent U-factor.
§I50(b): Loose fill insulation shall conform with manufacturer's installed design labeled R-Value.
*§150(c): Minimum R-13 insulation in wood-frame wall or equivalent U-factor.
*§150(d): Minimum R-13 insulation in raised wood-frame floor or equivalent U-factor.
§150(f): Air retarding wrap is tested,labeled,and installed according to ASTM E1677-95(2000)when specified on the CF-1R Form.
§I50(g): Mandatory Vapor barrier installed in Climate Zones 14 or 16.
§150(1): Water absorption rate for slab edge insulation material alone without facings is no greater than 0.3%;water vapor permeance rate is no
greater than 2.0 petinlitich and,shall be,protected from.physical damage and UV light deterioration.
Fireplaces,Decorative Gas Appliances and Gas Log Measures:
§150(e)IA: Masonry or factory-built fireplaces have a closable metal or glass door covering the entire opening of the firebox.
§150(e)1B: Masonry or factory-built fireplaces have a combustion outside air intake,which is at least six square inches in area and is equipped
with a with a readily accessible,operable,and tight-fitting damper and or a combustion-air control device.
§150(e)2: Continuous burning pilot lights and the use of indoor air for cooling a firebox jacket,when that indoor air is vented to the outside of the
building,are prohibited..
Space Conditioning,Water Beating 40#PluMbing Svstem Measures:
§110-§113: HVAC equipment,water heaters.,showerheads,faucets an d all other regulated appliances are certified by the Energy Commission.
§113(c)5:'Water heating recirculation loops serving multiple dwelling units and High-Rise residential occupancies meet the air release valve,
backflow "v0ntio11,,pump isolation valve,and recirculation loop connection requirements of§I13(c)5.
§115: Continuously gurning pilot fights are prohibited for natural gas:fan-type central furnaces,household cooking appliances(appliances with an
electrical supply voltage connection with pilot lights that consume less than 150 Btu/hr are exempt),and pool and spa heaters.
§150(h): Heating and/or cooling loads are calculated in accordance with ASHRAE,SMACNA or ACCA.
§,150(i): Heating systems are equ4ped with thermostats that meet the setback requirements of Section 112(c).
§150G)IA: Storage gas water heaters ratedwith an Energy Factor no greater than the federal minimal standard are externally wrapped with
insulation having an installed thermal resistance of R-12 or greater.
§1500)1B: Unfired storage tanks,such as storage tanks or backup tanks for solar water-heating system,or other indirect hot water tanks have R-12
external insulation.or R-16 internal insulation where the internal insulation R-value is indicated on the exterior of the tank.
§1500)2: First 5 feet of hot and cold water pipes closest to water heater tank,non-recirculating systems,and entire length of recirculating sections
of hot water pipes are insulated per Standards Table 150-B.
§1500)2: Cooling system piping(suction,chilled water,or brine lines),and piping insulated between heating source and indirect hot water tank
shall be insulated to Table 150-8 and Eauation 150-A.
§1500)2: Pipe insulation for steam hydronic heating systems or hot water systems>15 psi,meets the requirements of Standards Table 123-A.
2008 Residential Compliance Forms August 2009
. 1
Simplified Prescriptive Certificate of Compliance:2008 Residential HVA C Alterations CF-IR-ALT-HVAC
Climate Zones 1 and 3-7
Site Address: Enjor ement A envy: Dat : I Permit#f:
Conditioned Duct insulation
Equipment Type' List Minimum EfTiciencyZ Floor Area requirement Thermostat
D Packaged Unit Over 40 ft of ducts ,
•Furnace D AFUE D COP Served by system added or replaced in �etback
•Indoor Coil OSEER D HSPF sf unconditioned space
_ (!f not already present,must be
Condensing Unit D EER D Resistance ❑R 6 (CZ 1,3-S) installed)
D Other
1.Equipment Type:Choose the equipment being installed;if more than one system,use another CF-1 R-ALT-HVAC for each system,
2.Minimum Equipment Efficiencies: 13 SEER,78%AFUE,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 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 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 enforcement agenc for approval with the permit
application.
Name:C�`�� � I Signature:
Company: - L Date:
� r
Address/� - I&V License: 009 1 VT
City/State/Zip: `SAM . -y) _ Phone:
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE CF-611-MECH-04
Space Conditioning Systems,Ducts and Fans (Pagel of 2)
Site Address: Enforcement Agency: Permit Number:
IOW AldMh Mk&W,?, I �
Space Conditioning Systems
Heating Equipment
Duct
Efficiency Location
Equip (AFUE, (attic,
Type ARI #of etc.)1.3 crawl- Heating Heating
(package- CEC Certified Mfr.Name Reference Identical (�CF-I R space, Duct Load Capacity
heat pump) and Model Number Number z Systems value)° etc.) R-value (Btu/hr) (Btu/hr)
I
Cooling Equipment
Efficiency Duct
Equip (SEER Location
Type and EER) (attic,
(package #of 1,3 crawl- Cooling Cooling
heat CEC Certified Mfr.Name ARI Reference Identical (?CF-IR space, Duct Load Capacity
Pump) and Model Number Number Systems value)° etc.) R-value (Btu/hr) (Btu/hr)
1. If project is new construction,see Footnotes to Standards Table 151-B and Table 151-C for duct ceiling alternative
compliance.
2.ARI Reference Number can be found by entering the equipment model number at http://ivww.aridirectory.orglari/ac.php#
3.Listed efficiency on this page must be greater than or equal(>_)to the value shown on the CF-1 R form.
4. When CF-I R is reference it is also applicable to the CF-1 R, CF-IR-AA or CF-I R-ALT
F A 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.
L §150(i):Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of§112(c).
NAf❑ §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
INSTALLATION CERTIFICATE CF-6R-MECH-04
Space Conditioning Systems,Ducts and Fans (Page 2 of 2)
Site Address: E orcement Agency: Permit Number:
Co" . I �u0
Ducts and Fans
§I50(m):Duct and Fans
❑ 1.All air-distribution system ducts and plenums installed,sealed and insulated to meet the requirements of CMC
Sections 601,602,603,604,605 and Standard 6-5;supply-air and return-air ducts and plenums are insulated to a
minimum installed level of R-4.2 or enclosed entirely in conditioned space. Openings shall be sealed with mastic,tape
or other duct-closure system that meets the applicable requirements of UL 181,UL 181 A,or UL 181 B or aerosol
sealant that meets the requirements of UL 723. If mastic or tape is used to seal openings greater than 1/4 inch,the
combination of mastic and either mesh or tape shall be used;and
❑ 1.Building cavities,support platforms for air handlers,and plenums defined or constructed with materials other
than sealed sheet metal,duct board or flexible duct shall not be used for conveying conditioned air. Building cavities
and support platforms may contain ducts. Ducts installed in cavities and support platforms shall not be compressed to
cause reductions in the cross-sectional area of the ducts.
❑ 2D.Joints and seams of duct systems and their components shall not be sealed with cloth back rubber adhesive
duct tapes unless such tape is used in combination with mastic and draw bands.
❑ 7.Exhaust fan systems have back draft or automatic dampers.
❑ 8.Gravity ventilating systems serving conditioned space have either automatic or readily accessible,manually
operated dampers.
❑ 9.Protection of Insulation.Insulation shall be protected from damage,including that due to sunlight,moisture,
equipment maintenance,and wind.Cellular foam insulation shall be protected as above or painted with a coating that is
water retardant and provides shielding from solar radiation that can cause degradation of the material.
❑ 10.Flexible ducts cannot have porous inner cores.
DECLARATION STATEMENT
• 1 certify under penalty of perjury,under the laws of the State of California,the information provided on this form is true and correct.
• 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction,or an authorized
representative of the person responsible for construction(responsible person).
• 1 certify that the installed features,materials,components,or manufactured devices identified on this certificate(the installation)
conforms to all applicable codes and regulations,and the installation is consistent with the plans and specifications approved by the
enforcement agency.
• 1 reviewed a copy of the Certificate of Compliance(CF-IR)form approved by the enforcement agency that identities the specific
requirements for the installation. I certify that the requirements detailed on the CF-I R that apply to the installation have been met.
• 1 will ensure that a completed,signed copy of this Installation Certificate shall be posted,or made available with the building
permit(s)issued for the building,and made available to the enforcement agency for all applicable inspections. 1 understand
that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to
the building owner at occupancy.
Company Name: (Installing SutIRT tra=or Generaj Contractorpr Builder/Ownner)/j
.ei , f"i kA7
Respon ible Person's Na ✓ Respon le P son's Signat
Yi
0.CS License: I Date Signed- h Company itle):
b` D,t ,•%R 179 �1// _",
2008 Residential Compliance Forms August 2009
P COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DINAGION-CUPERTINO
APPROVED
This set of plans and specifications MUST be kept at the
job site during construction. it is unlawful to make any
�/ �� �/✓r�� changes or alterations on same, or to deviate
therefrom, without approval from the Building uifICial.
The Stamping of this plan and specifications SHALL NOT
be held to permit or to be an approval of the violation
of a r visions of any City Ordinance or State Law.
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