14120126CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 18761 PENDERGAST AVE
CONTRACTOR: AMODERN
PERMIT NO: 14120126
CONSTRUCTION
OWNER'S NAME:
SAN JOSE, CA 95131
PHONE NO: (510) 274-8336
Q( LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
WfT"
INSTALL A/C UNIT
License Class F-11Lic. #
Contractor 14,!6?" v v Lz 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
performance of the work for which this permit is issued.
Sq. Ft Floor Area:
Valuation: $2000
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 37527034 00
Occupancy Type:
Section 3700 of the Labor Code, for the performance of the work for which this
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 1 OF 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 DAY AST 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 regulations per the Cupertino Municipal Code, Section
ROOFS:
If is
9 18.
Z� /
Signature Date J
All roofs shall be inspected prior to anyy roofing material being installed. a roof
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
Section 3700 of the Labor Code, for the performance of the work for which this
the Health & Safety Code, Sections 2550 , 25 , and 25534.
Owner or authorized 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
CONSTRUCT ON 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
CITY OF CUPERTINO
1 FF,F, ESTIMATOR — BUILDING DIVISION
ADDRESS: 18761 pendergast ave
FEE ID
DATE: 12/23/2014
REVIEWED BY: Mendez
APN:
BP#:
*VALUATION: $2,000
PERMIT TYPE: Mechanical Permit
1BREMAIR
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
p
#
PENTAMATION FURN/AC
USE:
Perm - ,,£�t,.
PERMIT TYPE:
WORK
install a/c unit
�'
I IYdFuL Ii.117. I`i`i':
SCOPE
PME Permit Fee:
$48.00
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
A/C Units (<=1 OK cfm)
1BREMAIR
�'Irartrh. Plat -r t.'/,c<i;
1
#
$72
Plum!". Permit 1W.,
Perm - ,,£�t,.
rthor Mech. Insp. 0.0
hrs $48.00
1'Lum7� �P'/-5�.7.
Oihei I
�'
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t
PME Permit Fee:
$48.00
Administrative Fee: 1ADMIN
$45.00
Work Without Permit? ® Yes 0 No
$0.00
TOTALS:
Travel Documentation Fee: 1TRAVDOC
$72.00
Strom Motion Fee: IBSEISMICR
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District etc) These ees are based on the nrefimina information available and are onlv an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711/13)
FEE
QTY/FEE
MISC ITEMS
....
01
Mech. Plan Check 0.0
hrs $0.00
�'Irartrh. Plat -r t.'/,c<i;
:-iec. Pia" � Check
Mech. Permit
Fee: 1MPERMIT
Plum!". Permit 1W.,
Perm - ,,£�t,.
rthor Mech. Insp. 0.0
hrs $48.00
1'Lum7� �P'/-5�.7.
Oihei I
�'
I IYdFuL Ii.117. I`i`i':
t
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District etc) These ees are based on the nrefimina information available and are onlv an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711/13)
FEE
QTY/FEE
MISC ITEMS
1' hvt Check Fee:
PME Plan Check:
$0.00
Permit FC'£:
sigy)1. 11?sp
PME Unit Fee:
$72.00
PME Permit Fee:
$48.00
Administrative Fee: 1ADMIN
$45.00
Work Without Permit? ® Yes 0 No
$0.00
Narming Fees:
Travel Documentation Fee: 1TRAVDOC
$48.00
Strom Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldp, Stds Commission Fee: IBCBSC
$1.00
..0
$214.50
$0.00 TOTAL FEE:
$214.50
Revised: 10/01/2014
STATE OF CALIFORNIA
ALTERATIONS - HVAC
0
CEC-CF1R-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)
r
Site Adds:
Enforcement Agency:
Date Prepared:
Permit#:
Equipment Type
Equipment Efficiency
New: Ducting, Plenums, Lineset
Conditi ned
Thermostat
Required R -value
Floor Area (sq ft)
❑ Packaged System
9( Evaporator Coil
•) AFUE
COP
06 R-6 (CZ 1,3-7) Ducts
Served by system
EJ Setback
AK Split System
I�'Condensing Unit
SEER
❑ R-8' (CZ 16) Ducts
1 7 % v s ft
q
(if not already
HSPF
❑ R-6 (all Q's) Plenums
present, must
Furnace
Lineset
EER
11R-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.
❑ 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 (:<_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
1�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 z 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 CFIR-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/tonStkdards Table 150.0-C / D alternative)
13 Exempted from duct leakage testing I existing duct sy s�e constructed, insulated or sealed with asbestos.
❑ 4. New Ducting over 40 feet
Required Com '8rtc ocuments tp be left on site for Final:
Adding or replacing ducts in unconditioned
CF1R-ALT-02- Q �V
space but less than All New Ducts'
v
CF3R: MEC S
Installer Required to: Duct leakage L15% or, < 10% to oiJEjaeZ& se acc ibl I aks)
❑ Exempted from duct leakage testing I existing dug systlihs are str ed, insulated or sealed with asbestos.
All new ducting R-8 required when more than 40 ft installed andV h s n 40 ft installed. This includes in walls, between floors etc.
' A New Dud ol system is when the duct system is constructed of aast - ere new duct material, and up to 25 percent may consist of reused
parts from the dwelling unit's existing dud syste (e.g., regist rlll sLboots, air handler, plenums, duct material.
a R-5 (1" thick insulation) for linesets 1" and less 1.5" thic instio or linesets over 1 inch. Most mfg will require Suction line Diameter
with insulation as the following 1.5-2T-2%", 2. 0 4T-2�/X 5T 8"
Contractor (Documentation Author's / ns ig ,— s c �q aration Statement)
I certify the following under penalty of perju s he Site of California:
qj
1. The information provided on this Certificate o ian is tr4Zd and correct.
2. 1 am eligible under Division 3 of the California Business 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 Designer Name:
Responsible D signer Signature:
Date Signed:
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License:
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Company:
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Adcress:
City/State/Zip:
Phone:
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For assistance or questions regarding the Energy Standards, contact4he Energy liotline at: 1-800-772-3300
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