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14090126 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20248 NORTHWEST SQ CONTRACTOR:AIR QUALITY HEATING PERMIT NO: 14090126 &AIR OWNER'S NAME: FIANCE FLORENCE S 720 NORTHRUP ST DATE ISSUED:09/19/2014 OWNER'S PHONE: 4089105787 SAN JOSE,CA 95126 PHONE NO:(408)293-7138 Gds LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL REPLACE FURNACE,ADD A/C UNIT License Class �CIA— Lie.# ContractorDate I hereby affirm that I am licensed uer 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 aevve and will maintain Worker's Compensation Insurance,as provided for by to Section 3700 of the Labor Code,for the performance of the work for which this APN Number:31639046.00 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 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 ROM LAS 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 q 1q .1q.- 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 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 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this 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 mpim Iff E P CO>UMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION a" ` 10300 T ORRE AVENUE• CUPERTINO, CA 95014-3255 (408) 777-3228•FAX(403)777-3333•buildln0l-CUDe fino.oro mist; U� ❑PLUNy3ING ❑ ELECTItICa.L ❑hSSCELLKNBOUS PROM-M ADDRESS �f I F3N 1 U ✓ ��-� OVTh=Pli�lr G/�/ I PnO,�.• qly , 59?,-7I E-1J°II STR:.'=?FT�DP.cSS i �"TA�ij I FAX I'," CO viACT N�r PHONE I E-1J4II c�=:�ADDR SS CITY S I FAX OJ tv�t: ❑ OR?v -3L�TD ❑ DP7I zRACE?7 ❑ COI.TTRACTOR ❑C01\i SCTORAGENT ARG—"--CT ❑ gmr7--K - .,X-T CGI�iP 0. I LICF1. I� nz I LI S' I BUS.LIC E-1,QJL ST ccI .CITY A7-£,ZIP PH hi AA V 3"P7ZO ARCF:TTECtr..NGI,--z—x 1JL I LICeTTSENuMSER. I BUS,LIC' CONPi FNYXAI—m I E 1JpII, I FAX STREET ADDRESS I CITY,STATE,ZIP PH B USE orrr or LzX DuP ❑ MJLII-FAMII Y P&0JB=N WIIAElYE LAND YFS PROJECT R" ❑ S IS T nt BLDG kV ❑ 1 rS BUIIALNG: p CON�]JFmCLA.L I t�T�BANN-1=- ACE AREA p NO I FLOOD ZAI� ❑NO I -rlc=- xo1J,E? ❑ NO 11 DESCRIPTION OF WORK TOTAL V.AT UA 110\1: - By my siva«re below,I certify to each of the follo:;.,:ng: I Fun tteprope-ty owner or authoriztd astnt to act on the prope o)Amur s behalf. I have read thds application and the info:nation I hav provi is cor ect I have read the Description of Work and verify it is acc+sate. I aa*ee to comply With all applicable local ordinances and state laws rclatine to d' e I authorize representatives of Cupertino to enter t5e above-identiflprope,_ for ^spection purposes. S i satire of.4_palican"Agent: Date: JUIPPLEMENITAL 11 OR_NL&TION REQ UJD 1-5 _- 1✓FPAdiscApp 2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION kDDRESS: 20248 n west sq DATE: 09/19/2014 REVIEWED BY: Mendez PN: BP#: *VALUATION: 1$5,000 94PERM TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: PERMIT TYPE: WORK re lace furnace add a/c unit SCOPE YOM- x' Mech.Plan Check 0.0 hrs $0.00 111,twb. flat/(hec.'k Lie'% 1'11,i;?Check Mech.Permit Fee: IMPERMIT Numb, Perm27 Fee: tec rt'her Mech.Insp. hef v. Plumb fn . C1;h��r t;le�c_1bas1:,. El h Ittp1 Fcc 0.0 hrs $48.00 (hTha nb. Insp, Fee: NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Theseees are based on the prelimina information available and are onl an estimate. Contact the Dept-for addn'1 info. FEE ITEMS (Fee Resolution 11-053 E f 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 I J # Mechanical Supp/.PC Fee: Reg. ® OT0.0s $0.00 $143.00 IMFR=<100 Furnace,Forced-Air PME Plan Check: $0.00 = # Mechanical Permit Fee: $0.00 $72.00 1BREMAIR A/C Units(<=10K cfm) Suppl. Insp. Fee: Reg. 0 OT 0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $48.00 :,,rFst?a t?t3at "'IlLv. Administrative Fee: 1ADMIN $45.00 Work Without Permit? 0 Yes (j) No $0.00 G Advanced Planning Fee: $0.00 Select a Non-Residential G Travel Documentation Fee: 1TRAVDOC $48.00 Building or Structure , Strong Motion Fee: 1BSEISMICR $0.65 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 01 $142.651 $215.00TOTAL $ FEE: 357.65 Revised: 08/20/2014 STATE OF CALIFORNIA ALTERATIONS - HVAC 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-1R-ALT-HVAC) (Page 1 of 1) Site Address: Enforcement Agency: Date Pr are Permit#: 4L Equipment Type Equipment Efficiency New:Ducting,Plenums,Lineset Condi io d Thermostat Required R-value Floor Area(sq ft) ❑ Packaged System aporator Coil AFUE COP ❑R-6 (CZ 1,3-7)Ducts Served by system tback ❑R-8' (CZ 16)Ducts s ft (/ nat already lit System ondensing Unit SEER HSPF ❑R-6(all CZ s)Plenums ` q present,must Furnace neset EER ❑R-5 or R7.5 Lineset3 be installed) HERS VERIFICATION2t, ARY 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. W.HVAC Changeout/Repair Required Compliance Documents to be left on site for Final: Can include new ducting All Equipment, CFIR-ALT-02-E Condenser Unit,Evaporator Coil, CF2R:MECH-01,MECH-20-HERS Air Handler/Furnace CF3R:MECH-20-HERS Installer Requirement:Duct leakage(S.15%or,<10%to outside,or seal all accessible leaks) Exempted from duct leakage testing if: ❑1.Duct system registered with HERS provider at previously sealed,or 112.There is less than 40 linear feet of duct in unconditioned pace,or ❑3.Existing duct systems are constructed,insulated or sealed with asbestos(list manufacture date of building New HVAC System Required Compliance Documents to be left on site for Final: All new equipment and All New Ducts' CF1R-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 2 350 CFM/ton(or Standards Table 150.0-C/D alternative) 1:13.All New Ducts with Replacement Required Compliance Documents to be left on site for Final: Includes replacing or installing All New CF1R-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. 114.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,<109 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. 2 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. 3 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. Responsible D er Nam Respo esigner Signature: Date Sig d: Licens 1 `Y �� 7 ompany: dress: City/State/Zip: Phone: ailvit —' ft" Ze 3 For assistance or estions regarding the Energy Standard contact the Energy H ne at:1-800-772-3300 NORTHPOINT HOMEOWNERS ASSOCIATION PROPERTY MODIFICATION NOTICE Please indicate below which modification(s) are planned for your property. Provide brochure(s) if possible and a copy of any proposal(s), including the contractor's license number. Any modification not expressly listed herein, or not conforming to the restrictions and requirements listed herein for that modification will require an Architectural Review Application to be submitted to the Grounds and Architectural Committee and the Board of Directors for approval. Satellite Dish installation has a separate form to be completed and submitted for approval. Modification Restrictions and Requirements K Air conditioning unit Unit will be designed for quiet residential use. Unit will be located within the enclosed yard of the property. There will be no part of the unit visible to common areas. Installed by a licensed contractor. Replacement window/ Must be same size aperture and Sliding door location of existing window or sliding door. Any necessary touch-up painting is the responsibility of the Homeowner. Installed by a license contractor. Garage door Must be windowless and in conformity with general architectural style of the complex. Repainting to conform to exterior color scheme is responsibility of the Homeowner. Installed by a licensed contractor. Any damages caused to property as a result of modifications will be the homeowner's responsibility. All prohibitions, restrictions, conditions, and rights of the Association enumerated under Article V of the amended and restated Covenants, Conditions and Restrictions of the Northpoint Homeowners Association are applicable to modifications Contained herein. City permits may be required. Please Print Homeowners Name(s): v0-€� S. i'1AA1CcC-- Property Address: Z-d.14-ff 4M2wti-� Phone: 4g-gq,� _ 1jVj Date of Notification: Date of Completion: l 1 Homeowner has 6 months to complete the designated modifications and is responsible for notifying management upon project completion. OffiRC9 Use Only Notification received by: Date: app ved by: Date: Form adopted 8/10/1999 Revised 5%00 l.� CU PrRTIN0 BUilding Department SEP 14 2014 REVIEWED FOR CODE C,Otvlf'!JARICE ._m,.Reviewad.$y- AO 1 Fi. I C Alto q 8y plq I r r_,OMMUNITY i. F '_LOPMENT CEPA T TF c D P BUILUIIN ! I':'ISION - CUPERTI ^;s set of pla�is ! spec iicatior a I �. ;J site during 1Ct!Jrl. It IS .i.', tv m-ake .wy EAx: changes or gilt .rations on s3.l 5-O,(,(^AitC7 *(-'P.'mn)� t:,- f1C) l)fiic al. The Stamping ,-:; ,:an _HALL NCT �,,e held to perri,,t _ to bt a , a�--p f ary prov!s!i;n� any ty C�r,�� -e �r -t , t La.% BY - — l v1 c —._ - DATE --- --- [�Lc� l PERMIT #4 c� �,eJC�rr C6 �•I