14060084 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20630 CLEO AVE CONTRACTOR:ONE HOUR HEATING PERMIT NO: 14060084
AND AIR
OWNER'S NAME: AMINA NAZIR 1400 PETALUMA HILL RD DATE ISSUED:06/13/2014
OWNER'S PHONE: 4085806886 SANTA ROSA,CA 95404 PHONE NO:(707)545-1800
FJ' LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL ❑
,1 REMOVE AND REPLACE A/C LIKE FOR LIKE
License Class C Z Lic.# �! G"'1
Contractor Date r 9 pq
I hereby m th am licensed under the provisions of Chapter 9
(comm cing 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:$8580
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:36231041 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 DAYS FR77 ST CALLED 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 1'-
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:
Signature Date ( •13 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,Sectio 55059 25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized ag t: Date:
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
` EP
GENERAL PERMIT APPLICATION �
v COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408) 777-3228• FAX(408)777-3333•building alcuoer ino.ora j � i
e U�•fr S`C'I hC 0
PLUMBING ❑1,=ANIC4L ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS 20 0b Cleo ave I APN 4�0 2 31 L4) .60
OWNS 'Abffi (4 M V J(A Nr P Oh u Z' o .6 Q I E Wim,
S `ETA 1C l e o a V C FAX
CONTACT NAh E I PHONE E-1J°II
STREET ADDRESS CITY,STATE,ZIP I FAX
❑ OVT�t Q mir LAGENT ❑ COkTRACTOR ❑coimuCTORAGE?QT ❑ ARCcBTECT ❑ENGTN—R ❑ DEVELOPER ❑Tc INT
CONTRACTOR NAl✓.E LICENSE JBER I LICENSE TYP I BUS.Ll °��1
OCf O G O 6 11
COIvLDP TY I E-}✓aAIL I FAX
law i l�PGrI� a I�
ST¢TE,ZIPS PHOAE
ARCbTrECT(ENGINZEERNAME LICENSENUJ✓IBER I BUS.LIC
COMPANY ATAA E E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑sm.,DUPLEX ❑ muui-FAMII.Y I PROJECT IN WILDLAND ❑ YES ( PROIECT 3N ❑YES I IS THE BLDG AN ❑YES
BLIII. n4e. ❑CO1J,NIERCIAL URBAN 11,7MFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑ NO
DESCRIPTION OF WORK lqce 2
TOTALVPLUATION: tE�TED3� � 3� 5
By my signature below,I certify to each of the following: I am the proper'y ovner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provid orrect. I have read the Description of Work and verity it is accurate. I agree to comply vrith all applicable local
ordinances and state lams relating to bu• ng cc ion. I authorize representatives of Cupertino to enter thea
entified propems for inspection purposes.
S i mature of Applicant/Agent: Date: �� 3 �7
PLEh E1\TTAL INFORMATION REQUIRED =
- OFFICE��SE-M F
_ -�1-
.
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1vjEPh1isa4pp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 20630 cleo ave DATE: 06/13/2014 REVIEWED BY: Mendez
APN: BP#: "VALUATION: 1$8,580
t,PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: FURN/A
WORK remove and replace a/c like for like
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
A/C Units (<=1 OK cfm) 1BREMAIR 1 # $70
TOTALS: $70.00
Mech.Plan Check "00 $0.00 Plwnb.Phin Chef:
,:
Mech.Permit Fee: IMPERMIT F'Iumh. 1 c:rr tir Pee" If<<c t'<�r.r.��, r c
Other Mech.Insp. 0.0 L!jj
Other Pl m7)frfV?. Omer°l ice.i,:s}-.
-fEui. jnrp. t cz: Phvilb. h7 p. 7` c: 1-<:r:.[;i,. E r c':
NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Theseees are based on the prelimina information available and are only an estimate. Contact the De t or addh7 info.
FEE ITEMS (Fee Resolution 11-053 E f 7/1/13) FEE QTY/FEE MISC ITEMS
Ph rr
PME Plan Check: $0.00
S",wr,l. X117:> > Fc,
PME Unit Fee: $70.00
PME Permit Fee: $47.00
Cr3ta.o'I'tch.0` 1 '
Administrative Fee: ]ADMIN $44.00
Work Without Permit? ® Yes 0 No $0.00
'filti'unc:e l'1<rnxain F'ces:
Travel Documentation Fee: ITRAVDOC $47.00
Strong Motion Fee: IBSEISMICR $0.86 Select an Administrative Item
Bldp,Stds Commission.Fee: 1BCBSC $1.00
MIN, I
ArSs $209.86 $0-00[1 '
0.00 TOTAL FEE $209.86
e .n
Revised: 04/01/2014
HVAC ALTERATIONS ENERGY COMPLIANCE FORM
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E.,C.B4O., BUILDING OFFICIAL
CUPERTIN0 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333•building aacupertino.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 i7
• Relocation of an existing HVAC unit
• Adding or replacing more than 40ft ducting in unconditioned space
BUSINESS AND''ROFESSIONS 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:
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
Simplified Prescriptive Certificate of Compliance:2008 Residential HVA CAl erations. CF-IR-ALT-HVAC
Clirnate Zones 1 and 3-7
sheern Enforcexent Agency: D Perrnft A
o C(e 01Ue '��3
Conditioned Duct insulation
..
entt T ' ' ... rhe mosEat
Packaged unit Aver 40 8 of ducts'
13 Furnace b AFUE: COP ed by s}stem added or regl6ced in e
,12 Indoor Coil SEIIt ®HSPF J/( ,/) (Ifnotulrraaypresau.crust be
EA Condensing Unit EER ®Resistance ���sf unconditioned space
Other
®R 6 (CZ 1,3-3)
-
1.Equipment Type:Choose the equipment being uistalled;if more than one_system,use another CF-IR-ALT-HVAC for each systan-
2.Afin num 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 13ushiess 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 approval with the permit
application.
Name: P e Pi Signature:
Company r-`/ �v"✓. Y IQa1��1� lCr f l� Daze
Address qcv:.: ptl , 't vWl� Y 1 l(�.. License: C
C /State/Z/ ip: vz-(� CS d Phone: �J • �� S
2008 Residential Compliance Forms.doc revised 04110112