14120028CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20650 PARK CIR
CONTRACTOR: ATLAS-TRILLO HVAC
PERMIT NO: 14120028
OWNER'S NAME: NIU JIMMY C AND NANCY H
1965 KYLE PARK CT
DATE ISSUED: 12/04/2014
OWNER'S PHONE: 4083710705
SAN JOSE, CA 95125
PHONE NO: (408)286-8931
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑
APT 4 -REMOVE AND REPLACE WALL FURNACE
License Class Lie. # u 91
n
— l 1� ��i
Contractor) 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: $1700
performance of the work for which this permit is issued.
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
APN Number: 32632016.00
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
WITHI 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 DA UAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
7
costs, and expenses which may accrue against said City in consequence of the
Issued by: Date: " 1
granting of this permit. Additionally, the applicant understands and will comply
with all non -point a regulations per the Cupertino Municipal Code, Section
9 18.
RE -ROOFS:
Signature Date Ll
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.
pertino Municipal Code, Chapter 9.12 and
will maintain compliance wiMctiou505,
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized age Date: l `
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
CUPERTINO
r_]
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 �v
(408) 777-3228 • FAX (408) 777-3333 • building cDcupertino.org
I—IVT0071?TPA T nMISCF.LLANEOUS
MEP
MISC
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E] OWNER El OWNER -BUILDER ❑ OWNER AGENT ❑ CO CTOR ❑ CONTRACTOR AGENT ARCHITECT El ENGINEER ❑ DEVELOPER El TENANT
CONTRACTOR „ ( ; (
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BUS. LIC #
COMPANY NAME �L
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LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OFSFD r DUPLEX ❑ MULTI -FAMILY
PROJECT IN WILDLAND ❑ YES
AREA NO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
BUILDING: ❑ RCIAL
URBAN INTERFACE ❑
DESCRIPTION OF 6RK f „
C/ a u�
TOTAL VALUATION: $
RECEIVED
By my signature below, I certify toe of o o ing: I a the propertyowner or authorized age o act on the property owner's behalf. I have read this
it is I agree to comply with all applicable local
application and the information I Ve ovided is co ect. I have d the Description of Work an verify accurate.
ion. I author N presentatives of Cupertino to enter the above-iden i d�pr for inspection purposes.
�rty
ordinances and state laws relating t In
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Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED
I` OFFICE USE ONLY
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MAJOR
MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FVR FRTIMATOR — RITII,DING DIVISION
ADDRESS: 20652 park circle # 4
FEE
DATE:
REVIEWED BY: Mendez
APN:
BP#:
"VALUATION: 1$1,700 -�
*PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
Plan Check:
PENTAMATION FURN/A
PERMIT TYPE: A
WORK
remove and replace furnace
SCOPE
APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced -Air 1MFR=<100 1 # $143
TOTALS: z $143.00
Mech. Plan Check 10.0 1 hrs $0.00 Plumb. Plan ChecA
Mech. Permit Fee: IMPERMIT Ytt',nh. 1'erm:p 1'�<:: IsW(_'<rrs77i`
Other Mech. Insp.0.0 hrs $48;00 E iter Plumb {rup. E:1
1.
11"Iech, Iris). Fvc. I PlaxrA hisp. Fee: Ale'(_ It p,
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Nire, J'anitary sewer uzstrict, school
t]ictr.�t ot, 1 Th—, f— Oro hncoil nn tho nroliminnry infnrmatinn availahle and are nnly an estimate. Contact the DeDt for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E,ff 711/131
FEE
QTY/FEE
MISC ITEMS
Plan
Plan Check:
$0.00
Permit
I�e ami
PME Unit Fee:
$143.00
Permit Fee:
$48.00
l!PME
t�."'3siso'vct on Tax
T
-T
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? 0 Yes 0 No
$0.00
Travel Documentation Fee: ITRA VDOC
$48.00
Strom; Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg; Stds Commission Fee: IBCBSC
$1.00
_
$285.50
$0.00 �. a"r' TO-�L�iiaE"
$285.50
Revised: 10/01/2014
STATE OF CALIFORNIA
ALTERATIONS - HVAC
CEC-CF1 R -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 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
AFUE
COP
❑ R-6 (CZ 1,3-7) Ducts
Served by system
11 Setback
S It System
❑Condensing Unit
SEER
❑ R-8' (CZ 16) Ducts
s ft
q
(If not already
HSPF
❑ R-6 (all CZ's) Plenums
present, must
urnace
QJ■
IJ Lineset
EER
❑ R-5 or R7.5 Lineset3
be installed)
ERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this
orm 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.
0 1. HVAC Changeout/Repair
Required Compliance Documents to be left on site for Final:
Caninclude new ducting
All Equipment,
CF111-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 acce ' le 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 1:13. Existing duct systems are constructed, insulated or seale wit sbestos (list manufacture date of building1
❑ 2. New HVAC System Required Compliance Documents to be left on site for Final:
All new equipment and All New Ducts' CFIR-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 CF3R-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 CF1R-ALT-02-E
space but less than All New Ducts' CF2R: MECH-20-HERS
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.
2 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.
a 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%8", 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 permit appl'
Responsible DesigneWNe: Respons' a Designer Sig re:
Aa
Date Sign d:
License:
-77
C�1
23
C mpantAddress: ity/State/Zip:
�
Phone:
For assistance or questions regarding the Energy Standards, conta a Energy Hotline at: 1-800-772-3300
r
L f {
1
Patricia Garcia
From: flandersair@sbcglobal. net
Sent: Wednesday, August 12, 2015 11:16 AM
To: Patricia Garcia-, Cindy Katz
Subject: Re: 20650 PARK CIRCLE #4
Hi Pat,
Will you please reopen this permit for 20650 Park Circle #4. We will be doing the install around
September 3rd -7th and the inspection will be around that time also.
Thank you,
Marg Kazares
Office Manager
Flanders Heat & Air Systems, Inc.
East Bay (510)438-0800
Tri -Valley (925)461-3333
Santa Clara Valley (408)259-6090
On Wednesday, August 12, 2015 10:16 AM, "flandersair(d)sbcglobal.net" <flandersair(c sbcglobal.net> wrote:
Hi Pat,
We spoke yesterday regarding 20650 Park Circle, #4. You said that Atlas pulled a permit for the wall
heater in December and it has expired. Atlas never installed the wall furnace. We (Flanders Heat &
Air) are going to install the furnace in September so I would like to pay the $45 that is due. Please let
me know how you would like me to pay. Have a great day!
Thank you,
Marg Kazares
Office Manager
Flanders Heat & Air Systems, Inc.
555 Peters Avenue, Suite 255
Pleasanton, CA 94566
(925)461-3333
SMOKE I CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 a FAX (408) 777-3333 • buitdinq(a cupertino.org
Q
Address
PURPOSE
W
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 perinit is required for
alarms which must be coruzected 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:
r) \. k3j z
a
�
S[ nature........ ..°.he:.' .......................... .... .. .E.. �d``l-.W. ....... Datel .0:1
Contractor Name:
Sinature ....... ............................... ............................. Lic.#...................................... Date:...................
Smoke and COfornz.doc revised 03118114
Address
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(40a' 7777628 FAX 4c0 7�c 33 buildino(CDcupe Per
i no
40
1. Is your real property a registered historical site?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
No Go to Question 2.
2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the property or its
plumbing, installation of water -conserving plumbing fixtures is not technically feasible?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
❑ The licensed plumber's certification has beenprovided to the Building Division.
Skip the rest of the form. and sign bottom of form.
No Go to Question 3.
3. Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and signbottom of form.
o Go to Question. 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
❑ No My real property is built and available for use or occupancy after January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 do not apply. Ship the rest of the form and sign bottom of foram.
Yes My real property is built and available for use or occupancy on or before January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign
bottom of form..
d. Please check ONE of the following:
❑ My property is a single family residential real property. See Civil Code Section 1101.4.
On and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing fixtures
to be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1, 2017, all non-
compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless of whether
property undergoes alterations or improvements).
My property is a multifamily residential real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or improvements shall require non- compliant
plumbing fixtures to be replaced with water -conserving plumbing fixtures.
On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with -water -
conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or
improvements).
❑ My property is a commercial real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or improvements shall require non- compliant
plumbing fixtures to be replaced with water -conserving plumbing fixtures.
On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving
plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements).
I, as the owner or owner's agent of this property, certify under penalty of peijury that non-compliant plumbing fixtures will be
replaced prior to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101.1
through 1101.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's
installation requirements, and that the water -consenting plumbing fixtures comply with the requirements as indicated in the
table on the followina nage.
LOwner or Owner Agent's Signature:JC3 _4r 0 0��-.1ti Date:I I �,s it 7)
Upon completing and signing this Certificate, please return it to the Building Division in order to final your building permit.
SB407201 S.doc ret,ised 0826/15