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14080267CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10960 SANTA TERESA DR CONTRACTOR: AVA CONSTRUCTION PERMIT NO: 14080267 OWNER'S NAME: MOHAN RAM P AND SHEILA 21060 HOMESTEAD RD APT 216 DATE ISSUED: 08/28/2014 OWNER'S PHONE: 4088397575 CUPERTINO, CA 95014 PHONE NO: (408) 387-0999 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ REMOVE & REPLACE DUCT WORK THROUGHOUT License Class # g45V 3 SFDWL j-1�Lic. Contractor (.V-f ( Date !/7 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: $2500 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: 35613003.00 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 WIT B INPERMIT 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 RO AST CALLED IT N. 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 by: Date: granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section RE-ROOFS: 9.18. p Signa Date 0 ?/ 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, Section 5505, 255 3, �d�511 Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: a e: 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 PERiV1ET APPLICATION COMMUNITY DEVELOPMENT DEPARTIdiENT - BUILDING DIVISION '10300 TORRE AVENUE • CUPERTINO, CA 55014-3285 (408) 777-3228 - FAX (408) 777-3333 - building aecuDeti no.oro r-1 - F7-1=r-LTx 1,rri-eT n'PT .FrTRIf'6t. nNI.SCEU AhB0US MEP MMU ,........�_.._..... PROM-cr J-DDP=- S C 0 6 a T.�/:'v�. 1066 A ---------- — /� `�1 f?N R 95& 13 OZ.h_RI Alm w� /404A I PHOA VII� -75-7 O ' STR-- Tf.DDP.ESS{G``a.AL(C/0 -Tw, �a %/.CA1`I cm' bIATE,Zip. 0,6, � l S U j� I FAX CO viACT NF_T„tee ` 3 /f fli P3D1.a I =� ✓L(�l�7 S CO CITY, S1Ai=.ZIP I FAX E3 O -Nm ❑ OV A- 3L�3J ❑ O m -u, Ac .T�`f COMP ACTOR ❑ C01 iZt RCTDR ACTTI ❑ ARC^ C? ❑ n�t C e EID1 0? 13 CO?�iRhCTORNAN= �%� I Lcm,,'SENu-MER /ry///d 3 I LICEI�-SETYPE I BUS.LIc CON'ANY N SI✓E = ✓ida /Jl a Vvl W v`� I FAX n , rE+7J1 / STF`.."=TPJDP.ESS� � //�/. 'Tl !il/O f CI i Y, STA�� 771 Z�� t4 PHONE fiRCi>TiGIt�� RNS1J� I LiCE2'SENUI ER I BUS. LIC ig COkMNrYNAM B -W a I FAX STR.c.-T ADDRESS I CITY, STAT -r, ZIP I PHONE 'USE or ❑ SFD or DUPLEX ❑ IJ.JLn-FAMILY I MOM= W WIIAL AND ❑ YES I PP.OJE= A ❑ Y'rS BLII DING ❑ CowE?.CL4L ]TT=RFACE AREA ❑ NO FLOOD ZOIZ ❑ No I IS == BLDG IN ❑ Y rS EICT,Lm HOW 7 ❑ No ;URBAN DESCRIPTION OF WORK- TOTAL \%F I UATTON: �J (t(f MetQ=zm= ge IZECFL�B t By ny signature belota, I ce, Li.y to each of the followin; I am u,e property ov".15r or authorized a_ent to act on t t p - L owner's beha have read this application and the information I have provided is correct I have read the Description of Work and verify it is accurate. I agree p % '` all applicable local ordinances and state l€vs relating to build• cllt ^ -eprese ` ve Cupe; ino to enter the above-' '� d - ptr for ins- per poses. S i gm, of -"-_palicantIAee.^.t: Date: ge SUPPLED AT,TNrORA,TATION REQLJ=D - 02 WONex �0— AIEPhljisc.lpp 2011.doc revised 06121111 CITY OF CUPERTINO WE FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10960 santa teresa dr DATE: REVIEWED BY: 16il APN: I BP#: *VALUATION: 1$2,500 PERMIT TYPE: Mechanical Permit i PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: L PENTAMATION FURN/AC PERMIT TYPE: Al WORK DUCT WORK THROUGHOUT SFDWL SCOPE �REMOVE APPLIANCE / EQUIP TYPE FEE ID AlcT, P/,"I"? Check QTY UNITS BP FEES 010'wl� 1. 1, �t. Ins" Lj Heating System IMRRAA 1 # $72 PME Unit Fee: $72.00 PME Permit Fee: $48.00 --F-T Administrative Fee: 1,4DMIN $45.00 Work Without Permit? 0 Yes 0 No $0.00 TOTALS: A Travel Documentation Fee: ITRAVDOC $72.00 Strong Motion Fee: IBSEISMICR NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School Wvtrirt- etc )- These foin are hosed on the nreliminary information available and are only an estimate- Contact the Dept for addn 7 info. FEE ITEMS (&e Resolution 11-053 ffL 711113) Mech. Plan CheckFo .0 hrs $0.00 Phind). Plan Cheul AlcT, P/,"I"? Check FMech. Permit Fee: IMPEPMIT 11bimb. 1,ermlt 1�ee, P/On Chech Other Mech. Insp."00 L!!j 01"Ier ]'Ivmb Imp. 010'wl� 1. 1, �t. Ins" Lj phi?0. husp, Fee: F --e: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School Wvtrirt- etc )- These foin are hosed on the nreliminary information available and are only an estimate- Contact the Dept for addn 7 info. FEE ITEMS (&e Resolution 11-053 ffL 711113) FEE QTY/FEE MISC ITEMS P/On Chech !'(.' PME Plan Check: $0.00 PME Unit Fee: $72.00 PME Permit Fee: $48.00 --F-T Administrative Fee: 1,4DMIN $45.00 Work Without Permit? 0 Yes 0 No $0.00 /;,ees, A Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $214.50$0.00 TOTAL EE: $214.50 I Revised: 08/20/2014 STATE OF CALIFORNIA ALTERATIONS - HVAC El CEC-CFIR-ALT-03-E Revised 06/14 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE CF1R-ALT-03-E Alterations - HVAC CZ 1, 3 to 7 and 16 (formerly CF -IR -ALT -HVAC) (Page 1 of 1) Site Address: I9rGy ��t� 6� w Enforcement Agency: Date Prepared: Permit#: Equipment Type Equipment Efficiency New: Ducting, Plenums, Lineset Conditioned Thermostat Required R -value Floor Area (sq ft) ❑ Packaged System ❑ Evaporator Coil AFUE COP 'JR -6 (CZ 1,3-7) Ducts Served by system ❑ Setback ❑ Split System ❑ Condensing Unit SEER ❑ R-8' (CZ 16) Ducts sq .t (if not already HSPF ❑ R-6 (all CZ's) Plenums present, must ❑ Furnace ❑ Lineset EER ❑ R-5 or R7.5 Lineset' be installed) HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this form is allowed to be filled out by hand:: For final inspection all.forms are to be registered (no hand filled forms allowed) and a copy left on site. 0 1. HVAC Changeout/Repair Required Compliance Documents to be left on site for Final: Can include new ducting All Equipment, CF111-ALT-02-E Condenser Unit, Evaporator Coil, CF2R: MECH-01, MECH-20-HERS Air Handler/Furnace CF3R: MECH-20-HERS Installer Requirement: Duct leakage (< 15% or, < 10% to outside, or seal all accessible leaks) Exempted from duct leakage testing if: ❑ 1. Duct system registered with HERS provider as previously sealed, or ❑ 2. There is less than 40 linear feet of duct in unconditioned space, or 113. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building ....... ❑ 2. New HVAC System Required Compliance Documents to be left on site for Final: All new equipment and All New Ducts' CF111-ALT-02-E CF2R-MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS CF3R-MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS' Installer Requirement: Duct leakage < 6%, Fan Efficacy (.58W/CFM), Air Flow ;-> 350 CFM/ton (or Standards Table 150.0-C / D alternative) ❑ 3. All New Ducts with Replacement Required Compliance Documents to be left on site for Final: Includes replacing or installing All New CF111-ALT-02-E Ducts' and one or more of the following: CF2R-MECH-01, MECH-20-HERS, MECH-(23 or 24) -HERS Condenser Unit, Evaporator Coil, Furnace CF3R-MECH-20-HERS, MECH-(23 or 24) -HERS Installer Requirement: Duct leakage < 6%, Air Flow >_ 350 CFM/ton (or Standards Table 150.0-C / D alternative) ❑ Exempted from duct leakage testing I existing duct systems are constructed, insulated or sealed with asbestos. 4. New Ducting over 40 feet Required Compliance Documents to be left on site for Final: Adding or replacing ducts in unconditioned CF1R-ALT-02-E space but less than All New Ducts' CF2R: MECH-20-HERS CF3R: MECH-20-HERS Installer Required to: Duct leakage (< 15% or, < 10% to outside, or seal all accessible leaks) ❑ Exempted from duct leakage testing I existing duct systems are constructed, insulated or sealed with asbestos. ' All new ducting R-8 required when more than 40 ft installed and R-6 when less than 40 ft installed. This includes in walls, between floors etc. ' A New Duct system is when the duct system is constructed of at least 75 percent new duct material, and up to 25 percent may consist of reused parts from the dwelling unit's existing duct system (e.g., registers, grilles, boots, air handler, plenums, duct material. ' R-5 (1" thick insulation) for linesets 1" and less. R-7.5 (1.5" thick insulation) for linesets over 1 inch. Most mfg will require Suction line Diameter with insulation as the following 1.5-2T-2%", 2.5-3T-2%", 3.5 to 4T-2%", 5T-4%" Contractor (Documentation Author's /Responsible Designer's Declaration Statement) I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Compliance is true and correct. 2. 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the information on this document. 3. That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations (CCR). 4. That the energy features and performance specifications, materials, components, and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the CCR. 5. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. sponsi �esigner Name: �� 1'Cj-�r� Respo999A� Date Signe � y License: Cnom1pannX W Address: cittlate n x ycob0 )v Phone: 6401 2-1-715 � g3—pt For assistance or questions regarding the Energy Standards, contact the Energy H6tline at: 1-800-772-3300