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15010073CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7548 ORANGE BLOSSOM DR CONTRACTOR: DG HEATING & AIR PERMIT NO: 15010073 CONDITIONING OWNER'S NAME: SAN JOSE, CA 95125 PHONE NO: (408) 978-1411 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL CHANGE OUT (E) FURNACE & A/C UNIT, ALONG WITH License Class Lic. # % Gid ASSOCIATED DUCT WORK, SAME LOCATION ContractorD6 Date l_/ ?2 '/ 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: $10255 Iave 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: 36611064 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 DA IT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter ALLED INSPEC IO upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS 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: granting of thi ermit. Additionally, the applicant understands and will comply y' with all non of t source regulations per the Cupertino Municipal Code, Sectio 9 18. // RE -ROOFS: rat __ Date �'' �'J!S 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. 1 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 Pe pertmo Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, 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 CUPERTINO GENERAL PERMIT APPLICATION �1 EP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 0 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 / � misc (408) 777-3228 • FAX (408) 777-3333 • building akupertino.org \ ❑ PLUMBING 9PffiCHANICAL []ELECTRICAL ❑ MISCELLANEOUS PROJECT ADDRESSlTO_"(% Q� TIVS rh L r, S C Q �Q APN # .3 OWNERNAME �t jy K TI�A V J STREET ADDRESSSTATE, ZIP FAX SLA CIT CEO TY,O P I NL) CA qs-t) CONTACT NAME _ PHONE I I E-MAIL _ I L_kU STREET ADDRESSSTS CITY, STATE, ZIP FAX 10 �0 COntim 9 t�Ls-G D K r� SU S G4 C1 S) )'a ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR AQONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENS NUMBER _ LICENSE TYPE BUS. LIC # F 2 C 31 5Zpsl COMPANY NAME E-MAIL FAX ''(✓Yo t-l��j-�-INoCr 1glfL �OhJO►Tt0 !N� 'D�1-YL'�71N6Nv ,�L@G STREET ADDRESS CITY, STATE, ZIP PHONE i !MITI f Clv nw.,cwrija t _fit_ 'Tr t tlt 4 --qo,cTT-r-) ,F CA ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF SFD or DUPLEX ❑ MULTI -FAMILY PROJECT 1N WHALAND ❑ YES PROJECT IN ❑ YES IS THE BLDG AN ❑ YES BUILDING: ❑ COMMERCIAL URBAN INTERFACE AREA ❑ NO YODZONE ❑ NO EICHLER HOME? ❑ NO C_ DESCRIPTION OF WORK P 1 �A4F,�Ga-rAyr r, (')tSJ1�C,t_-X_ TOTAL VALUATION: �� l v ✓ _ C / U �3 By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the propeKy o s behalf. I have read this application and the inform�toi d is correct. I have read the Description of Work and verify it is accura ee to comply with all applicable local ordinances and state laws Date: SUPPLEMENTAL INFORMATION REQUIRED MEPMiscApp_2011.doc revised 06/21111 CITY OF CUPERTINO FORM FF,F, VIRTIMATOR - BUILDING DIVISION imADDRESS: 7548 ORANGE BLOSSOM DR DATE: 01/13/2015 REVIEWED BY: MELISSA APN: 366 11 128 BP#: -VALUATION: $10,255 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY or Du lex p PENTAMATION FURN/AC ISFD PERMIT TYPE: USE: $72 WORK CHANGE OUT E FURNACE & A/C UNIT ALONG WITH ASSOCIATED DUCT WORK SAME SCOPE LOCATION APPLIANCE / EQUIP TYPE FEE ID Mech. Plan Check 0.0 hr $0.00 QTY UNITS BP FEES Other Plump 7rrsp. Ch1te7 :,'s -c- ln'Vpl EL j A/C Units (<=10K cfm) 1BREMAIR 1 # $72 Furnace, Forced -Air 1MFR=<100 1 # $143 PME Unit Fee: $215.00 PME Permit Fee: $48.00 CPsti'vcII.o) 7 7,41,v: 1 1 Administrative Fee: 1ADMIN $45.00 Work Without Permit? 0 Yes (E) No $0.00 TOTALS: Travel Documentation Fee: 1TRAVDOC $215.00 Strong Motion Fee: IBSEISMICR v , Plumb. 1'lon Cheek1°aec. !'/tan Check Mech. Plan Check 0.0 hr $0.00 Mech. Permit Fee: IMPERMIT Numb. PCI -M;( Fee: 1"Iec- NrP i Fc"' Fther Mech. Insp. 0.0 hrs $48.00 Other Plump 7rrsp. Ch1te7 :,'s -c- ln'Vpl EL j fagt�. <<�� 111w0. hasp. Fee. l_k'(.M s Fee. NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public wortcs, rzre, sanuazy Sewer District, ocnooa D' Th s are based on the relimina information available and are onl an estimate. Contact the Dept or addn'l info. zstrzct, etc . ese ee FEE ITEMS (Fee Resolution 11-053 Eff. 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: SGdppl, PC /"ee PME Plan Check: $0.00 �'ca•rrtit h�'c�: PME Unit Fee: $215.00 PME Permit Fee: $48.00 CPsti'vcII.o) 7 7,41,v: 1 1 Administrative Fee: 1ADMIN $45.00 Work Without Permit? 0 Yes (E) No $0.00 Aciv anc°e d Tlanv /zing P�es: . Travel Documentation Fee: 1TRAVDOC $48.00 Strong Motion Fee: IBSEISMICR $1.33 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 3 a - $358.33 $0.00 TOTAL FEE: $358.33 Revised: 01/06/2015 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 -IR -ALT -HVAC) (Page 1 of 1) Site Address: E forcement A envy: Dat I Prep ed: Permit#: Equipment Type Equipment Efficiency New: Ducting, Plenums, Lineset Required R -value Conditioned Floor Area (sq ft) Thermostat ❑ Packaged System ❑ Evaporator Coil AO AFUE COP -6 (CZ 1,3-7) Ducts Served by system ❑ Setback ❑ Split System q�ondensing Unit (3 SEER ❑ R -8t (CZ 16) Ducts 1.4 ) h 5q ft -–'—� (if not already T_ HSPF ❑ R-6 (all CZ's) Plenums present must urnace QLineset EER ❑ R-5 or R7.5 Lineset3 I I 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. .7". HVAC Changeout/Repair Required Compliance Documents to be left on site for Final: Can include new ducting All Equipment, CFI11-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 112. 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' 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) ❑ 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 2 350 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. New Ducting over 40 feet Required Compliance Documents to be left on site for Final: Adding or replacing ducts in unconditioned CFIR-ALT-02-E CF2R: MECH-20-HERS space but less than All New Ducts' 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. s 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 perr7ftlppplication. Company: 1 Address: �y) DLI '�I City/State/Zip: Q � ( (a Phone: ro 1 F `it la 2 t� rn I Sia N ,-FvSE&t qU�'s 9 q, L 1 a) a For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300 CUPERTFNO 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(aocupertino.org Permit No. 150100 3�- 3 Address 0✓v /' 4e_ AlOS'Sorn k # of Alarms Smoke: Carbon Monoxide: l PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CE ICATE �� HAS BEEN rSIGNED AND RETURNED TO THE BUILDING DIVISION 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 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. 1 have read and agree to comply with the terms and conditions of this statement Owner (or Owner Agent's) Name: �^ /l Signature................................................................... Lic.#...................................... Date: ................... Smoke and CO form.doc revised 03/18114