15020152 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10632 LA RODA DR CONTRACTOR:ATLAS-TRILLO HVAC PERMIT NO: 15020152
OWNER'S.NAME:
SAN JOSE,CA 95125 PHONE NO:(
fl LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
REMOVE AND REPLACE FURNACE IN SAME LOC.
License Class Li..`#
Contractor A-11 CL STK 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:$1700
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:36933016.00 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 WITIIIN 180 DAYS 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 DAYS FR 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
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: 7
with all non-pont source regulations per the Cupertino Municipal Code,Section
918.
RE-ROOFS:
Signature Dat 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
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
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,Sec s, 505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: 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
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
GENERAL',PERMIT APPLICATION
MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION "
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 1vrr``1
CUPERTINO ( ) FAX(408)777-3333•buildingCcDcuoertino.org (�" MISC
408 777-3228•' � 1
❑PLUMBING ❑MECHANICAL [:]ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS APN#
Aeq
STREET ADDRESS CITY,STATE, FAX
CONTACT NAME ( PHONE E-MAIL
ao
STREET ADDRESS ) CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENTZ—coNm
CTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
LICENSE NUBE 2� LIBUS.LICONTRACTOR NAME
F1f(
COMPANY NAME ` E-MAIL / �7C FAX
STREET ADDRESS Iq CITY,STATE,ZIP L �. /��2J PHONE C 6_ Gf
(7 U �./L-),
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 IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUHDING: ([]'COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER OME? ❑ NO
DESCRIPTION OF WORK
P� c
TOTAL VALUATION: REGEICrEDBY <- w3p�� a
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information It
___Ne provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relaticonstruction. I authorize representatives of Cupertino to enter the above-id en'fled roperty,for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL QUIRED ,: OFFICE
W
oYERHE COUNTER
STANDARD
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114AJOR�
MEPMiscApp_201 1.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10632 la rodaDATE: 02/27/2015 REVIEWED BY: Mendez
APN: BP#: *VALUATION: 1$1,700
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition /Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: FURN/A�
WORK remove and replace furnace in same loc.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced-Air 1MFR=<100 1 # $143
TOTALS: $143.00
J
Mo. ux.
€.K
..-._
Mech.Plan Check 0.0 hrs $0.00 Phimb. Plum('heck FT I,lec.P/an Check
Mech.Permit Fee: 1MPERNIIT Plydmb. Permit Fee, I lec Permit fee:
Other Mech.Insp. 0.0 hrs $48.00 Other Plumb lnsp. Li I EJr't,ea -Ac_In IEl
Llech, Insp, Fee: Plumb. hisp. lee: Glec.lyzsxz Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Thesefees are based on the prelinmdina information available and are only an estimate Contact the Dept/or addn'l info,
FEE ITEMS OW Resolution 11-053 Elf. 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check 17ee:
.Suppl. P(:`Fee
PME Plan Check: $0.00
1'et•mil F'ee:
P'e e
PME Unit Fee: $143.00
PME Permit Fee: $48.00
(Onstruction Tax:
Administrative Fee: IADMIN $45.00
Work Without Permit? ® Yes (j) No $0.00
Ildvanced Planning Fees:
Travel Documentation Fee: ITRAVDOC $48.00
Strom Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
Nu O` AL FEE•
$285.50 $0.00 a $285.50
Revised: 02/14/2015
STATE OF CALIFORNIA
ALTERATIONS - HVAC
%add`
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-1R-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
0 Setback
❑ 5 t System
❑Condensing Unit
SEER
❑ R -8' (CZ 16) Ducts
s ft
q
(if not already
HSPF
❑ R -6 (all CZ's) Plenums
present, must
uri nace
❑ Lineset
EER
❑ R -5 or R7.5 Lineseta
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
fo 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 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 >_ 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
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-M ECH-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 L15% 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.
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% ", 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 p mi piication.
Res onsible Designer Name:
R ib nu 'gnature:
Date Signed:
License:
^ `�
Company: r
Addres
�i �
City /State /Zip:
Pho
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For assistance or questions reSyding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300