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15020153CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7505 PEACH BLOSSOM DR CONTRACTOR: ATLAS-TRILLO HVAC PERMIT NO: 15020153 OWNER'S NAME: SAN JOSE, CA 95125 PHONE NO: (408)286-8931 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ rr�� License Class C 2� Lic.. #� �� REMOVE AND REPLACE FURNACE IN SAME LOC. Vr 1 Contractor 1� �) :r ) I Date Z I 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: $5000 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: 36611130.00 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 WITHIN 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 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 theS/ Issued by: Date: granting of this permit. Additionally, the applicant understands and will comply with all non -poi t source regulations per the Cupertino Municipal Code, Section 9 18. (�- RE -ROOFS: Signature Dat ) 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, Sectio j(15, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this yy Owner or authorized agent Date: T 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 T CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 1 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingO-)cupertino.oro ❑ PLUMBING [:]MECHANICAL [:]ELECTRICAL ❑ MISCELLANEOUS MEP MISC PROJECT ADDRESS r /J „ G / ( MAIL STREET ADDRESS CITY, STATE, ZI FAX CONTACT NAME PHOUa E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT�i�_'�CTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME e� / ' 1, L ( LICENSE NUMBEIj�j�--/ it LICENSE TYPV2 BUS. LIC # COMPANY NAME,�1 . E-MAIL "�� ` c/ ! %/L [ O , / `/' FAX STREET ADDRESS /} / CITY, STATE, ZIP PHONEjI l J 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 WJLDLAND ❑ YES PROJECT IN ❑ YES IS THE BLDG AN ❑ YES BUILDING: OMMERCLAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO EICHLER HOME? ❑ NO DESCRIPTION OF WORK 2 �y , eWf TOTAL VALUATION: REGED B \ w L v G By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property o behalf. I have read this application and the information I have vide ' rect. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to i d' ons on. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQ u' �'FICE USE O1±�Y,� D OVER THE-COIJ7ERr �+ 4. IN MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO wo FEE ESTIMATOR - BUILDING DIVISION APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced -Air 1MFR=<100 1 # $143 $143.00 TOTALS: �,, r , Mech. Plan Check 0.0 1 hrs $0.00 Plunib. Plan (`heck I,lecr. Plan Check Mech. Permit Fee: IMPERMIT Plumb. Permit Fee: Flec 1'ermit Fees Other Mech. Insp. 0.0 hrs $48.00 Other Plumb Insp. Other- Exec. Insp. Li �Wcch. Insp. Fire: 1'I7sn1b. Insp. Fee: I Zilec. Insp. Hee: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District etch These fees are hated on the nreliminary information available and are only an estimate Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 711113) 7505 peach blossom DATE: 02/27/2015 REVIEWED BY: Mendez IVAADDRESS: APN: BP#: *VALUATION: 1$5,000 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: SFD or Duplex PME Plan Check: PENTAMATION PERMIT TYPE: FURN/A WORK remove and replace furnace in same loc. SCOPE suppl. Insp Fee APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced -Air 1MFR=<100 1 # $143 $143.00 TOTALS: �,, r , Mech. Plan Check 0.0 1 hrs $0.00 Plunib. Plan (`heck I,lecr. Plan Check Mech. Permit Fee: IMPERMIT Plumb. Permit Fee: Flec 1'ermit Fees Other Mech. Insp. 0.0 hrs $48.00 Other Plumb Insp. Other- Exec. Insp. Li �Wcch. Insp. Fire: 1'I7sn1b. Insp. Fee: I Zilec. Insp. Hee: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District etch These fees are hated on the nreliminary information available and are only an estimate Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: :Suppl. P(:' Fee PME Plan Check: $0.00 Permit mit Fee: suppl. Insp Fee PME Unit Fee: $143.00 PME Permit Fee: $48.00 _F_T (:'Onslr action Tax: Administrative Fee: ]ADMIN $45.00 Work Without Permit? 0 Yes (E) No $0.00 ,Idlanced Plarming Fees: A Travel Documentation Fee: 1TRAVDOC $48.00 Strong Motion Fee: IBSEISMICR $0.65 Select an Administrative Item Bldiz Stds Commission Fee: IBCBSC $1.00 $285.65 $0.00 a TO L FEE $285.65 Revised: 02/14/2015 STATE OF CALIFORNIA ALTERATIONS - HVAC 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% / e— / j Enforcement Agency: Date Prepared: Permit #: Equipment Type Equipment Efficiency New: Ducting, Plenums, Lineset Required R -value Conditioned Floor Area (sq ft) Thermostat • Packaged System ❑ Evaporator Coil O AFUE COP ❑ R -6 (CZ 1,3 -7) Ducts Served by system C3 Setback • Split System ❑ Condensing Unit SEER ❑ R -8' (Q 16) Ducts sq ft (if not already HSPF ❑ R -6 (all CZ's) Plenums present must rnace ❑ 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 Iforrrj,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. ly�VAC Changeout /Repair Required Compliance Documents to be left on site for Final: an include new ducting II 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 ❑ 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' 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 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- MECH -20 -HERS, MECH -(23 or 24) -HERS Installer Requirement: Dud leakage < 6 %, Air Flow ? 350 CFM /ton (or Standards Table 150.0 -C / D alternative) ❑ Exempted from duct leakage testing I existing dud 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. ' 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. 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 docu ksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building per a ation. Res onsible Designer Name: Resp si a esigngr- Date Si ed: License: Company: Address: l ?G �' �' City /State/Zip. Phone: -4NIt'. -T) r � 73 r��iz� For assistance or questions regra�og the Energy Standards, contact the Energy Hotline at: 1-800-772-3300