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14110083CITY OF CUPERTINO BUILDING PERMIT .,, BUILDING ADDRESS NANO}' CT CONTRACTOR: A & H HEATING PERMIT NO: 14110083 OWNER'S NAME: SAN JOSE, CA 95110 PHONE NO: (408)279-0722 P LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E]COMMERCIAL ❑ REMOVE AND REPLACE FURNACE IN SAME LOC. License Class C-70 Lic. # &6 t%e(iZ Contractor " tt L 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 Sq. Ft Floor Area: Valuation: $2700 erformance of the work for which this permit is issued. 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. Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMITE WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITN 1 DAYS OF PERMIT ISSUANCE OR HI 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 F ST 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 Issued by: Date: granting of this permit. Additionally, the applicant understands and will comply with all non -point source re Mations per the Cupertino Municipal Code, Section 9 18. t^ l' 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, ctions 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: J 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 CONSTRUCTIONNDING 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 puraoses. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 CUPEKTINO CITY OF CUPERTINO FURNACE/AC PERMIT APPLICATION FORM APN # 35gi 15 032- U' Date: ��_ �� IL/ Builder Ad ss: aver , may C, r ° 0 14 4. 0e, Fax #: (/Q5 27 9161-7 Contractor License M Cupertino Business License M Z- 0 qtj z 126 -?9 Contact: Phone M 968 2% � a 7 2 Z D04e— Fax #: 273 161% Building Permit Info: Elect ❑ Plumb ❑ Mech Residential' Commercial Ll Job Description: �t4#-e rp s4me, tociqvoq For Residential Installations: Attic El floor floor ® 2nd floor ❑ Adhere to minimum setback requirement For Commercial Installations: Replacement same weight ❑ Additional weight (structural. calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval RegmimA4 El Co of Project: Type of Construction (Usage Class): 2--? 6 6� Strapped H On Platform Bonded -0 New Location Replacement, Project Size: Express Standard -0 Large 0 Major Valuation: Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. -Z 67516/08 CITY OF CUPERTINO ww_ FEE ESTIMATOR — BUILDING DIVISION APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced -Air 1MFR=<100 1 # $143 TOTALS: $143.00 Mech. Plan Check 0.0 hrs $0.00 1'lnnih. I'lcan Cnee/. i'v7 (h Mech. Permit Fee: IMPERMIT 1�m" i l';": Other Mech. Insp.0.0 hrs $48.00 Other PIvrnb fnv). Orhe"r 1_i'-;(_ h?sp. lush. I'lumb. hup. Fee: l s". Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public works, Pire, sanitary sewer Vistrict, school atn I Th.— foot — h ad nn thn nroliminare infnrmadnn availahle and or& nnly an oWimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) ADDRESS nancy ct DATE: REVIEWED BY: Mendez APN: BP#: *VALUATION: 1$2,700 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: SFD or Duplex $0.00 PENTAMATION PERMIT TYPE: FURN/A Al WORK remove and replace furnace SCOPE APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced -Air 1MFR=<100 1 # $143 TOTALS: $143.00 Mech. Plan Check 0.0 hrs $0.00 1'lnnih. I'lcan Cnee/. i'v7 (h Mech. Permit Fee: IMPERMIT 1�m" i l';": Other Mech. Insp.0.0 hrs $48.00 Other PIvrnb fnv). Orhe"r 1_i'-;(_ h?sp. lush. I'lumb. hup. Fee: l s". Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public works, Pire, sanitary sewer Vistrict, school atn I Th.— foot — h ad nn thn nroliminare infnrmadnn availahle and or& nnly an oWimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 supyn/. 1"/Isp fee PME Unit Fee: $143.00 PME Permit Fee: $48.00 Administrative Fee: IADMIN $45.00 Work Without Permit? ® Yes 0 No $0.00 ,'1LPl'C1/iC.`t'G/ f"ICfY?7?7Yt�;1'e't'S`: Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 MA q $285.50 $0.00 T01?L FEE: $285.50 Revised: 10/01/2014 STATE OF CALIFORNIA ALTERATIONS - HVAC CEC-CFIR-ALT-03-E Revised 06114 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:Enforcement �0�ey � Agency: � Date Prepared: 1 /-/V- /V Permit#: Equipment Type Equipment Efficiency New: Ducting, Plenums, Lineset Conditioned Thermostat Required R -value Floor Area (sq ft) ❑ Packaged System ❑ Evaporator CoilFUE COP ❑ R-6 (CZ 1,3-7) Ducts Served by system PD Setback ❑ Split System 13 Condensing Unit SEER 13R-8' (CZ 16) Ducts �' b v s ft q (If not already HSPF ❑ R-6 (al! CZ's) Plenums , Present, must 61 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, 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 (L15% 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 < 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 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 CF311-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 CFIR-ALT-02-E space but less than All New Ducts' CF2R: MECH-20-HERS CF3R: MECH-20-HERS Installer Required to: Duct leakage (S.15% or, < 10% to outside, or seal all accessible leaks) i 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. S. The building design features or system design features identified on this Certificate of Compliance are consistent with the information Hotline at: 1-800-772-3300 CUPERTINO Address 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 • buildingalcupertino.org Permit No. I t-{ 1 1 0'9fS 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. Fe I L I have read and agree to comply with the terms and conditions of this statement ( ly ................................................... Date: Contractor Name: Signature................................................................... Lic.#...................................... Date: ................... Smoke and CO form.doc revised*03/18/14 A & H HEATING 10- 2'7_) Li & We hereby propose to furnish all material and perform all labor necessary for the following: Forced Air Heating BTMODEL# 84 Jd FR �FFIC ?,o% - _:, ,o - e -stage 2 stage variables speed- . l Wall Heater.._ _ ................................... BTU _ MODEL # A/C (outdoor unit) ........... ............ BTU MODEL # Package Unit (AIC) BTU Heat Pump Pkg (HTG) , BTU Heat Pump (outdoor unit) ............. BTU Cooling Coil - MODEL # Condenser pad Isolation pad MODEL # IT, l9N MFR MFR Crane Ft up Ft over Weight MODEL # MFR Coil case only: Size Copper tubing Level ground work Roof curb SEER PhaseNolts Air handler Condensate drain (pump if required) - Must comply i11:T,J-oral codes Drain pad Duct cleaning Duct inspection uct repairs :..'IM d IC-e_M,�KkYV� '1�ef Wt VC /=,F 61 (y 4240 Electronic Media air cleaner MODEL # MFR _ Filter box 13 po- a t> Panel upgrade Size Comments Thermostat MODEL# S If" MFR Rdrt w e& _ Electrical wiring will ovided for - mace condenser thermostat air cleaner _ Gas piping Reconne dd ne s neede econnec ven pp New _ Remove & haul away existing: f rnaceAIC -Pkg unit - duct - flue Cleanup & haul away debris Reconnect existing sheetmetal (insulate as needed) Furnish and install: filter grill - return air grill Install supply opening Install return air opening Permit Option Option Option j h Option 4 Other flue F LE NO PAINTING AND PATCHING IS INCLUDED IN THIS PROPOSAL WARRANTIES Final investment as listed includes -All labor - Equipment - Materials - Subcontractors - Warranties - Sales tax A & H Heating & AIC will provide you with 4ear parts & labor unless modified above, all new materials and equipment installed from date of completion, and will be replaced or repaired as required. You will be provided with a ( ftp ) parts only, limited warranty on furnace heat exchanger from manufacturer. You will be provided with a ( You will be provided with a years on all other parts from manufacturer. PRICE GOOD FOR56 DAYS. ) parts only, limited warranty on compressor from manufacturer. parts only, limited warranty on outdoor coil from manufacturer. TOTAL PRICE s/a '� %17 Respectfully submitted. _ A __ .