14060085 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22231 BITTER OAK ST CONTRACTOR:ONE HOUR HEATING PERMIT NO: 14060085
AND AIR
OWNER'S NAME: ABBURI SRINIVAS AND SUKHAVASI MEENA 1400 PETALUMA HILL RD DATE ISSUED:06/13/2014
OWNER'S PHONE: 4084763485 SANTA ROSA,CA 95404 PHONE NO:(707)545-1800
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL ❑
/� _A10 REMOVE AND REPLACE FURNACE AND A/C LIKE FOR
License ClasU 6 ZU Lic.4 ``ZV / LIKE
Contractor Date
I hereby affir at I am lice ed under the provisions of Chapter 9
(commend ith Section 7000)of Division 3 of the Business&Professions
Code and at 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:$9464
I have and will maintain Worker's Compensation Insurance,as provided for by
5l8ection 3700 of the Labor Code,for the performance of the work for which this APN Number:32651021 00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPI WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 YS OF &+RMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter Cj
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FRO ST ALLED 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 Issued b ~s Date:
granting of this permit. Additionally,the applicant understands and will comply y'
with all non-point source regulations per the Cupertino Municipal Code,Section
918. _.
2 RE-ROOFS:
Signature Date �3 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,Sections ,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this - 3-
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
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.
Signature Date
GENERAL PERMIT APPLICATION 1
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION MEP .
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 t\�
(408) 777-3228•FAX(408)777-3333•building cJ1cuoerino.ora mist;
curytAtI tea
❑PLUMBING ❑MECHAI\TIC-AL ❑ELECTRICAL ❑MISCELLANEOUS
PROT-a ADDRESS 223 ) 14e e o� i j I
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CONTACT NATI E (; C , I PHONE E-IJiAII
STREET ADDRESS CITY,STATE,ZIP FAX
❑ ORTEJt ❑ OWI�LBUMDM ❑ OWI.c-RA M17 ❑ co-N ucm ❑CONIRACTORAmvT ❑ AR== ❑ENG�rt,R ❑ D1'U,OPER ❑TENZA"TI
C01-TPACTORNAMELICENSENU1Ju3F$.� \ I LICIEO C � I BUS.LIC
CO TY ?4NE - Vv- h ea4iH I E-MAIL [ lJ FAX
FET AD S /,y/Vl p- h t�( ! I STAlE ZIP CA.4 Cjq l `1 L I v-7 C�l7
ARCHITECT rENGNTERINAAME U/` LICBNSE NUMBER V I BUS.LIC n
CONPAN'Y NAME E-MAIL FAX
STREET ADDRESS CRY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ M n-FAMI Y PROJECT IN WIIALAND ❑ .ms PROJECT IN ❑YES IS TIM BLDG AN ❑1iS
BX Dn.C: ❑COVII RCIAL I URBANIN=ACEAREA ❑ No FLOOD ZONE ❑No EICHLERHOME? ❑ No
DESCRIPTION OF WORK -Qj v- via c e t- /C —7 , L. k-e P�,, l e
K
TOT,11WLUATION: b I REC�TVEDBY x�
By my sig-nature.below,I certify to each of the following: I am the property oti mer or authorized agent to act on the property ovmer's behalf. I have read this
application and the information I have Prov Is forrect. 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 bu' ng co ion. I uthorize representatives of Cupertino to enter the above,identified pro
per-ty for inspection purposes.
SiMatureofApplicant'Agent Date: !
SUP I�rTAL INFORMATION REQLJ=D
InKamc '
JO?RESs
5111114 �a
MEP Rsc4pp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 22231 bitter oak DATE: 06/13/2014 REVIEWED BY: Mendez
APN: BP#: EVALUATION: $9,464
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION FURN/AC
USE: p PERMIT TYPE:
WORK remove and replace furnace and a/c like for like
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
A/C Units (<=1 OK cfm) 1BREMAIR 1 # $70
Furnace, Forced-Air 1MFR=<100 1 # $139
TOTALS: $209.00
t
11 W1
Mech.Plan Check 0.0 hrs $0.00 1'/runb.I'lon ChecA L:iec,Plat?Check
Mech.Permit Fee: ]MPERMIT 1'IWm1;. Pe:rm��r I'ee: J.J ec Permit Fee,
rther Mech.Insp. 0.0 hrs $47.00 Chher Plumb trap, [:j Cit/rer'Lh::. Irrsp'
Itzi}J. l e e: f hw)b. Ins). Fee: /_Jcc Ins":"..1"'c>
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These ees are based on the preffinina information available and are only an estimate. Contact the Dept for addn'l info,
FEE ITEMS (Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS
Plant Chcck Fee:
ttFrltl. 1'(` ;t"
PME Plan Check: $0.00
Pel'aait
PME Unit Fee: $209.00
PME Permit Fee: $47.00
L.'ons77'vchIOn 72'a :
Administrative Fee: ]ADMIN $44.00
Work Without Permit? ® Yes 0 No $0.00
- cf�catl<c�j I'r'c;nf,tr'rr�; Fires:
Travel Documentation Fee: ITRA VDOC $47.00
Strom;Motion Fee: IBSEISMICR $0.95 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
$348.95 $O.00 TOTAL FEE: $348.95
Revised: 04/01/2014
HVAC ALTERATIONS ENERGY COMPLIANCE FORM
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O.,BUILDING OFFICIAL
GUPERTtNU 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333•building -cupertino.org
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:
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
EIF, {..
Simplified Prescriptive Certificate of Compliance:2008 Residential HVACAiterations. CF-IR-ALT-FfVAC
Cranste Zona I and 3-7
SAeAddress: e �G F EnforcenrerrtAgertcy: D ,[ Permit:#:;..
X2231 6i {� ;
Conditioned Duct insulation
EquipmentType, IaSEMT,iimiiriEfriMeti Floor Asea" re Tlierniostat `
Packaged Unit
XW Furnace AFUE:Z b13 COPsetback
(served by added or replaccd in
Indoor Coil '` SEER PISPF (If noratreadypreseru must be
Condensing Unit ®EER 13 Resistance S unconditioned space. .
Other -
E3 R 6 (CZ 1,3-3) •
1.Equipment Type:Choose the equipment being installed;if more then one_system,use another CF-1R-ALT-HVAC for each system.
2.INfinimum Equipment Efficiencies:13 SEED 78%AFUE,7.7HSPF for typical residential systems.
Contractor(Documentation Author's/Responsible Designer's Declaration Statement)
• I=tify that this Certificate of Compliance documentation is accurate and complete.
• I am eligible under Division 3 of the Califirnia 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 infonnation documented on other applicable
compliance forms,worksbeets,calculations,plans and specifications submitted to the enforcement agency for appro-:al with the permit
application.
Name: P SSS C.e e Signature-
Date:
ignature:
Company
v✓. L1Pf�h �� tr /
Okle
1_ Date
Address /'/"(L License:�JZ O l
Citylsme/Zip: SQ A SA to ��Z"V Phone t! 7 S''` 5 � O
2008 Residential Compliance Forms.doc revised 04110112