14100020CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7840 JEANETTE CT
CONTRACTOR: VALLEY HEATING &
PERMIT NO: 14100020
COOLING
OWNER'S NAME:
SAN JOSE, CA 95112
PHONE NO: (408)294-6290
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑
—C_ „ �� /`�
License Clasps ci Lic. #
REMOVE AND REPLACE FURNACE
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V U I If_:" �" e4 f",/ " Cy�Date / �l
Contractor t
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
Sq. Ft Floor Area:
Valuation: $4157
performance of the work for which this permit is issued.
ave and will maintain Worker's Compensation Insurance, as provided for by
ection 3700 of the Labor Code, for the performance of the work for which this
APN Number: 36217035 00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT E S IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WIT 180 DAYS OT 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 DA ALLEDINSPEC ION*
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
/t�
granting of this permit. Additionally, the applicant understands and will comply
Issued by: Date:
with all non -point sou regulations per the Cupertino Municipal Code, Section
918.
RE -ROOFS:
Signature Date ( r ((
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-
atethe
I hereby affirm that I am exempt from the Contractor's License Law for one of
thefollowing two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1, 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, Seeds 5505, 25543,ynd 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date: ( 0,1f11
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
NERAL PERMIT APPLICATION MEP
COMNUNI—i Y DEVELOPI>>ENT DEPAR i IdiENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 ` \
(.•08) 777-3228 - FAX (!03) 777-3333 - building g0,cunei-fino.ora M I S\
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USE OF ❑ -sm or DUPLEX Ct muLTI-FA2 ffi.Y PROTECT DZ WILDLA-MD ❑ YES I FROM= A ❑ YES
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By ny sig _ ±re belo;a, I c tL`y to each of the iollO;vL:�: I zn u,e ?rope_ y o;;•aer or au ho izad ��ent to 2ct en :e grope.:o;anefs behalf. I have read thus
application and the information I have provided is correct I have read the Description of v,%ork and veaij it is acMXEta. I ag.*ee to compIy w th all applicable local
Ordinances and S_ie 1a s rel atUlg to buL • conS uma on. I author•-^ Sent'u`iV es of Cupe;tinO to enter the ebov e --i dentil'�ed oro -per'), for LS_eC On -D -,s--s.
Sigma Ure ofApplle-vii aPnt: Dc a Ul
SUPIAI.LNYORhfiATION REQUID
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NOW Wiz_= OW
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hi-',-E.Phjisc, pp_ 0JJ.doc revised 06121111
CITY OF CUPERTINO
Fm -M FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 7840 jeanefte ct
FEE ID
DATE: 10/03/2014
REVIEWED BY: Mendez
UNITS
APN:
I BP#:
*VALUATION: 1$4,157
*PERMIT TYPE: Mechanical Permit
1: IC(_
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
$143
PENTAMATION FURN/AC
PERMIT TYPE:
WORK
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
Phinib. Cheel,
QTY
UNITS
BP FEES
2'er!'71f
Furnace, Forced -Air _d
1MFR=<100
1: IC(_
Fe(:.
#
$143
PME Unit Fee:
$143.00
PME Permit Fee:
$48.00
Tax:
Administrative Fee: (ADMIN
$45.00
Work Without Permit? 0 Yes 0 No
$0.00
TOTALS:
1
A
Travel Documentation Fee: ITR,4VDOC
$143.00 1
1
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the Dreliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 711113)
Mech. Plan Check 0,0 hrs $0.00
Phinib. Cheel,
1'kv3 Ch,ck
Mech. Permit Fee: IMPERMIT
11himb. 1'ermiF Fee.,
2'er!'71f
Other Mech. Insp.0-0
1 hrs $48.00
1 1
Other Phwnb fns,p.
1: IC(_
Fe(:.
I [111011b, 111sp. Vve..
$0.00
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the Dreliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 711113)
FEE
QTY/FEE
MISC ITEMS
Plan P, C�0:
SvrP1_P('! lf'ce
PME Plan Check:
$0.00
PME Unit Fee:
$143.00
PME Permit Fee:
$48.00
Tax:
Administrative Fee: (ADMIN
$45.00
Work Without Permit? 0 Yes 0 No
$0.00
i V0, ees.,
"iu' Plorming F
A
Travel Documentation Fee: ITR,4VDOC
$48.00
Strom; Motion Fee: IBSEISMICR
$0.54
Select an Administrative Item
131dy Stds Commission Fee: IBCBSC
$1.001
$285.541
$0.00 TOTAL FE
$285.54$285.54
Revised: 08/20/2014
STATE OF CALIFORNIA
ALTERATIONS - HVAC
0
CEC-CF1R-ALT-03-E Revised 06/14 GALIFURNIA LM-KGY GUMMISSIUN
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:
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
L)AFUE
COP
❑ R-6 (CZ 1,3-7) Ducts
Served by system
❑ Setback
❑ Split System
❑ Condensing Unit
SEER
❑ R-8' (CZ 16) Ducts
S-0 0 sq ft
(If not already
HSPF
❑ R-6 (all CZ's) Plenums
present must
J <Furnace
❑ Lineset
EER
❑ R-5 or R7.5 Lineset3
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.
1. HVAC Changeout/Repair
Required Compliance Documents to be left on site for Final:
Can include new ducting
All Equipment,
CF1R-ALT-02-E
Condenser Unit, Evaporator Coil,
CF2R: MECH-01, MECH-20-HERS
Air Handler/Furnace
CF3R: MECH-20-HERS
Installer Requirement: Duct leakage (:5_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 ❑ 3. 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'
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:5 6%, Fan Efficacy,(.58W/CFM), Air Flow >_ 350 CFM/ton (or Standards Table 150.0-C / D alternative)
❑ 3. All New Duds 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: Dud 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'
CF2RMECH-20-HERS
CF3R: MECH-20-HERS
Installer Required to: Duct leakage L<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.
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
tC. t
Address:
Ci State/Zip:
Phone:
for assistance or question regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE - �
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
CUPERTINO
(408)777-3228•FAX(408)777-.3333•building Dcupertino.org
Permit No.
Address -7C� J_e Qfl e4^2 Com... #of Alarms Smoke: Carbon Monoxide:
it,inn's
�.� PE 'C� � ', TO'T' E�,���LEI�A�D�CUMPFSTEDITNTILTHIS CE�'�IFICATE
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 X X
bedroom(s)
On ever level of a dwelling unit including basements X X
Within each slee in 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 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
Owner(or Owner Agent's)Name:
...... ...........................................................Date:,/CJ`' ....
Sinature...................................................................Lic.# ......................................Date: ...................
Smoke and CO form.doc revised 03/18/14