14060200 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21885 EATON PL CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 14060200
CONDITIONING
OWNER'S NAME:
SAN JOSE,CA 95125 PHONE NO:(408)293-4717
ICE SED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑
I �J ' 11 REMOVE&REPLACE(E)3 TON CONDENSER,SAME
License Class /) Z [ Lic.# V LOCATION
AContractor E�r"I (NA(J Date
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:$4922
1 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:32619135 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 IT 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 save4-1) L 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 Date: 3U
granting of '_ error Additionally the applicant understands and will comply _
with al
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 complian
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 LO MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION l�
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 v
408 777-3228•FAX(408)777-3333•buildin0(ftuDerlino.Org m I S
CU
❑PLUMBINGCQAL ELECTRICAL r ❑.hUSCELLANEOUS
PROJECT ADDRESS,'i '� �/S "v� �t/r 1 1" 1c c V 1 APN# /7 D l / 1 3
OWNERNAME
£-MAII
STREET ADDRESS 2A�(JS p�U C,( - o 1. 14 I FAX
CONTACT NAME PHONE E-MAM
STREETADDRESS CITY,STATE, ZIP FAX
❑ OW NM ❑ OW'NER•BUILDER ❑ O'VMTR AG!5NT CONTRACTOR ❑coi,'RACTOR AGENT ❑ ARCciI= ❑ENcaNEB ❑ DEVELOPER ❑TENANT
CONTRACTORNA1,m j-j m6(o LICENSE NUMBER1( —I( LIC ` BUS.LIC#
COMPANYN ME "1 `7V 1 �,�^�lOCe E-MAIL-M
STREET ADDRESS (/� � (�AaiA TAa ZIP I Z P `M 4-1
ARCHITECT/ENUDiEERNI LAME' LICENSENUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF .EMD or DUPLEX ❑ MULIMIAMILY PROTECT IN VIII DLAAD ❑ YES PR07ECT IN ❑YES IS THE BLDG AN ❑ YFS
B=ING ❑COA9�lERCW URBAN INTERFACE AREA �.x0 FLOOD ZONE �•I<O EICFLER HOI�?
DESCRIPTION OF WORK
,\ c
TOTAL VALUATION:
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the pro owner' alf. I have' d this
application and the information I have pro ' s correct. I have re the Description of Work and verify it is accurate. I aeree comply'Ai applicable local
ordinances and state laws relating to b 'ding co trvction. I a p s tatives of Cupertino to enter the above-ide tiff or inspection purposes.
S i gnature of Applicant/Agent: Date:
SUPPLEME TAL INFORMATION REQUIRED o s n
s
MEPAdisa4pp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 21885 eaton pl DATE: 06/30/2014 REVIEWED BY: melissa
APN: 326 19 135 BP#: *VALUATION: 1$4,922
PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY ENT ION
USE: SFD or Duplex PERMIT TYPE: FURN/A
WORK remove & replace e 3 ton condenser
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
A/C Units (<=10K cfm) 1BREMAIR 1 # $70
TOTALS: $70.00
Mech.Plan Check "00 $0.00
Mech.Permit Fee: IMPERMIT z'.%ra h. '£:Yi7?t'd te£�: _ /'e�rair I�t�t:�:
Other Mech.Insp. Fo.0 ohe= P.Ju"d, nq, Li
££1, 1?pcc' .#.. ' ft££:
1f ' 40 /'dr- �; /
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). Thesefees are based on the Prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ef.. 711113) FEE QTY/FEE MISC ITEMS
a
PME Plan Check: $0.00
pernfi�Fee:
.SL .y)L Ira.p Fec°
PME Unit Fee: $70.00
PME Permit Fee: $47.00
Administrative Fee: IADMIN $44.00
Work Without Permit? 0 Yes (F) No $0.00
r1cJ=r a£:°P ce pl,, =ire€;
Travel Documentation Fee: ITRAVDOC $47.00
i
Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
�� TOAL 209.50 0.00 TOTAL FEE
. �:. $209.50
Revised: 04/01/2014
Y--T)1'j
I CF-1R-AZT
Preseri tiye Certificate of-C:orn Bance; Residential (page 4 of 5of stories
Residential A[ter'ations . •
t)imate Zone
'Pro)ectlt�aTnet rote
Configuration
HVAC'SYMNIS- HEATING Duct OFT't'p'•ng Thermostat (Central,Split,
Minimum insulation
HcatingSquipment
Efficiency Distribution R.Vatio T e S ace,Packa a or H dronic)
T e and Ca .aci r'3'7 ( .\FVE or HSPF T e and Location
if total
nr Package C, or ercep+where electric heating is supplem�S1l(i.e..
t3eexceptioncapaciry
!.Indicate Hearing Type(Ceharal Furnace,.Wall Furnace. Hear pump, Boiler. Electric Resistance, etc-) )
2.Electric resistance heating is allowed only in Comp
,. 2 KW or 7,000 Btu/hr electric heating is controlled he CFf l R- LTting device no Form Jor addict oCnal reycgriremen stand check applicable boxes.
3.Refer to the HERS Verification section on Page age4 j
4. Indicate Type or Location (Ducts. Hvdronic in Floor, Radiators,etc.)
HVAC YSTEMS -C LING Configuration
Minimum Duct or PipingSlit,r Hdronic
Efficiency Insulation Thermostat (Central, p
SEER/EER or Distribution R.Value T e S ace,Package o
Cooling Equipmentt COP) T ea
nd Location'
T e and Ca acit
I. Indicate Cooling Tvpe(A/C. Hear ptrmp?'Evap: Cooling, e(c)
Verification section on Page 4 ofthe
dF �loRs,lerc•.)orm Jor•additional requirements and check applicable boxes-
2, Refer to the HERS Ver
3, Indicate T e or Location (Ducts, H dronic in Floor,
y1rA HEATING
anon tom the DH heater to the kirchen(s)and on all underground
Gst
water heaters and boilers for botlidome.r.tic hot roarer(DNW)h eainsu! nd h�tonic space hearing. individual dwelling ONW hearers must
as
or propane fired, and may nor exceed 90 gallons. Hot water pipe External Tank
hot varer.;.: i es is re aired in all eom.onen( acka es.in all climate zones. Energy Factor or Insulation
Number In Tank R.Value3
Ca aciry
Water Heater Type/Fuel Distribution Type S stem al) Thermal Efficient
T et (Standard, Recirculatin )3
?OF do
, Heat Pump, Instairtoeous, etc.)
f i 50 n The Prescriptive requiseOw
1. Indicate Type(Storage Qa,s
2. Recir•ctrlatingsystems servingllad elling t(nijssh
aver hearinglsyseemJors single dwelling requirements
o § (I
not allow the installation of a recir•u
3. The external water heatin tank and ViD65
shall be insulated ro meet rhe re uiremenrs o i 50 .
a;
S'pECIAL
�'�,A'I'URES The enforcement agenev should pay speceaialrverrii at onhe Special Features specified in this checklist Bela"'•
These irems:mery re mire written `usri ication and documentation and s
NEW.ROOF ASSEM'LY-R'adia'nt Barrier
` The radiant barrier re.uiremant of 151( 2 dons nota to roof alterations.
Slab Edge(Perim'eter) Insulation Q YES CO NO uired.
YES;In Climate*Z.one 16 in'Component Packages D,R.7 insulation is req
ards
Heated Slab insulation O YES Q NO
YES:Slab ed e'insulation re uire.d.for all heatedslabs in all Climate Zones. See details in Tattle 1 l8-A ofre ured�under tom onent P
Raised Slap Insulation C3 YES C3 Nb
YES:In Climate Zones I,2; 11, 13, 14& 16,R=8 insulation is.re:uired; in Climate.Zones f2,& 15,R= is
' Thermal Mass the Performance A'`:.roxeh.
To obtain Com 'liance Credit.for the installation of rhertPal mass;:use','
HERS Provider: August I
Registration Dare/Time:
Registration Number:
2008 Residential Compliance Forms
.. a Cert�idate of CsmPliaucet
?,p4
8 ResiiCe 'A�Alferaions �F-'1R-ALT-AYt
]ifed Press ipt '.
CrVb,nz"C$110403-7
Er{�orcemenf A&MCF., 2 1
Sia ( ah9n ,
Coft ed
_ .c�.. _`„ .-,1'k r: •I�lPSII10518t
ent? 1V mer 41D' pk
of ducts'.. . Seth
p .;Urtzt CQ� Sirved liY system add'cd dri eA* m ' ( 4t ii madyPresa4 J1 be
Ftunace .,. _sf unconditioned•§liar Guta/Jcdl
Indoor Coa O�g��az Q R 6 (CZ 1,3-5)
densing Unit
use anolh”CF-1R-ALT-HVAC for cacti s �
9ther - ed;if more than one systan.
mcut'Type.Choose the ego3Pmsent beteg foal resideatisl:systems•
1.Egtiip 7.7HSPF'fartyp• ,
2• I nputeutE ficlour-W 13 SEER:7$%AFUF; er,s Declarstldu S
Digtateuienf)
+ ousible esn
eatatfan Au'thar s!Resp
Coufrractoe c�,ete of Cotap for.the design idmtified"on this
I om,*that this Certifi tiance dowmentatioa is Pro&ate and o ac t respottsib 3
and Professions Code�a�P .:
• I am eligible under Division 3 of the CalOw"a Business haace conform to the
C,dficate of Compliancef. and performmtx°sp��c4ons for the design identified on this Certificate"cif C=P
I ratify that the
energy uo� livable
requirements of Title 24,Parts I and 6 of the California Code of
' th the information docamestted on otht r app
ed on this Certificate of Comp• the an
I erg �5 $PP�" the.pa;mt •
The desion feat, es idettt� inns and specifications.subm',
compliance foam,worksbeets,calculations,p ^+ .
lication. D C Si'
Name: t/ D t
Company.Liccrosec '1 '(,�1
Adaresr I-I
cityist�izip:
;fir 0,-. f i•
Residential Compliance Forms.doc revised 04/10/12
CUPERTINO
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(a.cupertino.org
Permit No. IkL'V079�0
Address `[ �1as w r lo ce # of Alarms Smoke: Carbon Monoxide:
PURPOSE
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
inspections are required.
GENERAL INFORMATION
Existing single-family and multi -family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds
$1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon
Monoxide Alarms be installed in the following locations:
AREA
SMOKE ALARM
CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the
bedroom(s)
X
X
On every level of a dwelling unit including basements
X
X
Within each sleeping room
X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl
space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for
- - alarms -which must-be-connected-to-the-building-wiring.--—
As
iring. —
As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms have been tested and are operational, as of the date signed
below.
i have read and agree to comply with the terms and conditions of this statement
................ it,Lic.# ...!�'...Y........`..I ......... Date: (e13
Smoke and COform.doe revised 03/18/14