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1408001435 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS:, PLEASANTON, CA 94588 PHONE NO: (925) 4444444 10 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL REPLACE (E) FURNACE & A/C UNITS ALONG WITH 7 License Class �Z'�% Lic. # SUPPLY DUCTS, SAME LOCATIONS 5 II-- I Contracto . t�f6e, X�1 0A S Date 9 --q 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: $14217 I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 3421209f; 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 PERNIIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 18 ERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter F LED INSPECTION. upon the above mentioned property for inspection purposes. (We) agree to save 180 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Issue Da Ll granting of this permit. Additionally, the applicant understands and will comp with all non -point source regulations per the Cupertino Municipal Code, Section 9 18. ` ROOFS: installed. If is Signatur Date any r a roof All roofs shall be inspected prior to any roofing material being 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 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 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 CONSTRUCTION PERMIT APPLICATION �O COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPEKTINO (408) 777"3228 FAX (408) 777-3333 • buil ingQc4Derflno.om PRO75CTADDRESS SSS' ''''Ny (� S7REET ADDRESS MY, STA . 22 FAX CONTACT NAiW PHONE 6MATL S'TR23TADDRESS CTlV,STATE, 21P FAX ❑ OWNPB ❑ 0Wr—g )3tM,0Rt O OWMAGM KCONPRACTOR 0MIlCYORAGBNT ❑ AScHREcT ❑ ENGwm ❑ umLOFBR ❑ -nvANT CONTRACTOR NAHffi — (!tA c2na'1210(lylil - LTCBNSQ eTt LICENSB TYPT? BUS. LIC N COMPANYNAME (�/y� STREErADPRESB n Cf1Y,STA7Fi, %i "7 PFION6 ARCHI M.ENOMM&NAW LIMMNUMSER BT14 C 7 CONFANXNAME 54AII.' FAX STW= ADDRESS COY, STAm, zm PHONE DPSCRngM OP WORK 1 I I I I Use I TATE I OCC. I SQ.1'T. I VALVASTON(s) 1 I A" I AREA l I NWS, I BATTIROOM ICTTCI�i R5MODELARBA I REMODRLARBA I AEMODH.AReA AREAI TOTALDEMPOACHAREA I OARAGGAREAAODBTACH ❑ATTACH B1dgApp 2011.docrevised06121/11 e�e7m�oe a�A� CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS -,10" SALEM AVE DATE: 08/04/2014 REVIEWED BY: MELISSA APN: 342 12 097 BP#: *VALUATION: $14,217 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY PENTAMATION FURN/AC USE: SFD or Duplex PERMIT TYPE: WORK REPLACE E FURNACE & A/C UNITS ALONG WITH 7 SUPPLY DUCTS SAME LOCATIONS SCOPE APPLIANCE / EQUIP TYPE FEE ID — __ _. _ QTY/FEE QTY UNITS BP FEES Furnace, Forced -Air 1MFR=<100 1 # $143 A/C Units (<=1 OK cfm) 1BREMAIR 1 # $70 PME Unit Fee: $213.00 PME Permit Fee: $48.00 j. Administrative Fee: ]ADMAN $45.00 Work Without Permit? ® Yes (E) No $0.00 TOTALS: Travel Documentation Fee: ITRA VDOC $213.00 Strong Motion Fee: IBSEISMICR Mech. Plan Check"00 $0.00 Plzrnib. P111 Cheek Mech. Permit Fee: IMPERMIT Plumb. Permit Fee: r1her Mech. Insp. 0.0 hrs $48.00 Other Plumb 1rup. h. lrzs> . 14;er: Plumb. hrslr. Fee: i?tlrrr 1k... Lml" " L_ 1,lec. irisp. FIe: rv__y._ c';-- r 7s....., Q—,., Wctr;rt Rrhnnt NOTE: This estimate does not inetuaejees aue to urner uepurtmeata twc....�,�•..••s, - -�•� - -- _, _________, _ n_ci_ �.t ,. »h. ca t. r'nntnrt tho nent for addn't info. District, etc.). [nese ees are oaseu un ane reurrts aur FEE ITEMS (Fee Resolution 11-053 Elf.' 7/1/13) ....,......�,».--»�-� FEE — __ _. _ QTY/FEE -•-- ---- --- MISC ITEMS Plan Check P1 Cffe: sliPpl. PC I'tre PME Plan Check: $0.00 PME Unit Fee: $213.00 PME Permit Fee: $48.00 Administrative Fee: ]ADMAN $45.00 Work Without Permit? ® Yes (E) No $0.00 furanced Phrrining Fees: Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICR $1.85 Select an Administrative Item Bldg, Stds Commission Fee: IBCBSC $1.00 t: $356.85 $0.00 TOTAL FEE: $356.85 Revised: 07/10/2014 3y'8,8SSS OFOAUFMILA ERATiONS - HVAC CE FICATE OF COMPUANCE CRRALT-03-1! Al ons - HVAC a 1, 3 to 7 and 16 (formerly CF-iRALT NVAC) ' (Page 1 of 1) Ad cement Data spared: Permit Eq Ipment Type. EMdency New: ousting P/anvms, Llrram R uVed Rvalue diff Flool Alva ft Thermostat 0 P goad System Coll tFRJE�p 0 R-6 (CL2,3-7) Ducts C R-8' (CUR Ducts Serve �ck l9not akeady i UNt sq R HSPF 13 R-6 (all CC's) Plenums must Pr rnece O Uneset EgR D R -S or US Unesets stat. j H VEWFICATtON SUMMAYN Installer determines workto be bomplated and matchas to one of the options below. At permit application this is allowed to be Ailed ori by hand. For$nal citdn all forrni areto be stemd no hand Sled forms allowed) and a copy left on site. HVAC ChanC,6wW11apatr ft"Wi ed Compliance Deeumarts to ba lett onsite far Anal: indudaraw dood Equlpnwnt, CFIR--ALT 02-E snser Unit, Evaporator Coil, MR: MECH-01, MECH 20 -HERS At Handler/Furnace CF3R: MECH-20-HERS In ler Requlromeett Duet leakaya L&M or, j0%to artslde, or seal all accessible leaks) peed from duct leakage testing If. 1. Duct system registered with HERS praidder as prwiously sealed. or 0 2. There Is less than 40 lnearfeet of duct in unconditioned or 0 3. E�dsti duct. are ranstru Insulated or sealed with asbestos Ist manufactura date of bulldln 0 2. New HVAC9ystem Required Compliance Do taunts to be left on she for Final - All new equipment and All New Ducts CFIR-ALT-o2-E CFIR.ME04-01, MECK-204HERS, MECH-22-HERS, MECH-(23 or 20HERS fi314-MECH-20-HERS, MECH-22-HERS MECH-(23 or M) -HERS' In lar Requironrertt: Duet leakage g 69fti Fan Efficacy (58W/CFM), Air Flow Z 950 CFM/ton (or Standards Table 150,Q•C / D akernetiva) 3. All New Ducts wtth RWAke neitc RequbmW Cornpliante DewMOM to be left oa site ter Mai: I udes mpla , ng or tratallIng Al New CFIR ALT -02-E eta° and one or more ofthe follomnx. CF2R MECH-01, MEW -20 -HERS MECH423 or 24)-HMS ndenser Unl Eva ratorCatl Furneoe CF3R•�MECN-20 •HE EMECH- 23 ort HERS 1 Requlre nmb Dunt leakage r 696, Air Flow k 350 CFM/ton (or Standards Table 150.0-C D altemewe) ❑ Exrem tad from duetleakem tesan c 1 existing duct systems are constructed Insulated or sealed with asbestos. 0 a. Naw Ducft seer do feet Ratwhvd SgMfwm Dowme m to be left an Mite for final A ding or replacing ducts in unoondkkmmd CFM�T-02 CF2Rt ME+aCIt-RO�NERS s ce but lass than All New Ducts= CF-SR: MECi4-20-HERS ►n aper Requited to Duetleakage (&M or, L1096 to molds, or seal all accessible leaks) 0 Exam d fromduct leaks jW1 e"pj duct systems are constructed Insulated or sealed with asbestos. ' I new dueling R-8 required when morethan 40 ft installed and R-6 when lass than 40 ft tnstailed. This Includes In walls, between floors etc _ Naw Ductsystem Is when lire ductsyseem Is constructed of at least 75 percent new duct material, and up to 25 pertanc may consist of reused from tiro dwelling unles cdsdng.duct system (eg., registers, Bellies, boots, air handler, plenums, duct mat>ctial. (1"thickInsulation)farIinmouYandless. R 75 (1.5" thick Insulation) for ilnesets over i Inch. Most mfgwill require Suction One Diameter tlnsuirtbnastlielbl[o—v—dml—r-2T-2W,7-W-2W.3sto4r-2W,ST-W N.` C r(Dome»entwtfon.Atsthoes/AesponsMk Designer's Declaration statemem) I c artilythe following under pane ft bf perjury, underthe laws ofthe State of CalMbrnta: i The information prmrldad an this Certificate of Compliance Is true and correct. 2 1 am eligible under Division 3 of the Callforota Business and Professions Coda to accept responsibl Iky.for the information on this document. 3 That the anargyfastures and performance specifleationsfbrthe design Identified on this Certtllcate of Compliance conform to the requirements oflitle 24, Parts 1 and 6 ofthe California Code of Regulations (CCR). Thatthe energy features and performance specifications, materials, components, and manuftewred drAcas forthe building deslip or system deilan Identited on this Certl&ate of Compliance conform to the requirements of This 24, Pert S and Part 6 of the CCP - 5 The building design features orsystem des>Brrfeatdtas identified on this Cerocatgof Compliance are consistentwhh the inforrnatlon provided on other applicable compliance djurnp calculations, plans and spe dations submitted to the anforeament aoncv for apprml w M this bulliftag P ANdfi6on. HaasCoo to A J' (� ay: Adorers a I.' r (�—L�lll� Far aarismnee ar gusitiatts sprang the E w W Standadr. owtaathe EMU Bolam at: s-1300,rro-33uo