15040010CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20258 NORTHWEST SQ
CONTRACTOR: AAA FURNACE & AIR
PERMIT NO: 15040010
CONDITIONING
OWNER'S NAME:
SAN JOSE, CA 95125
PHONE NO: (408)2934717
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑
�]
License C_ 47 ' Lie. # / �� (
REMOVE AND REPLACE FURNACE, A/C AND DUCTS
Contractor Date
provisions o Chapter 9
i
(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: $12300
erformance of the work for which this permit is issued.
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: 31639045 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 FRO T 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: S -
granting of this permit. Additionally, the applicant understands and will comply
with all 'nt source regulati ns er the Cupertino Municipal de, Section
9.bi3.
RE -ROOFS:
Signature
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 complia ve-mith-the" Cupertino Municip 1 Code, Chapter 9.12 and
"
2
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
918.
Signature Date
0eNSRAL PERMIT APPLICATION
TY DVELOPMENT 0EPARTMENT'll JUDING DIVISION
COMMUNI (\
103n0 TORRE AVENUE CUPERTINO; CA 95014-3255 VV
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PROJECT IN WQ,DLAND PROJECT IN \
USE OF SFD or Duplex ❑ Multi-FEmily ❑ Yo No PLooc .ONE D YG9
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TOT.kL YALUATION: I ( iJV ll
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cw, I certify tb cath 6f the following: I am the property QWneT or authorized agent ro act on he propeTiy vwner't his
inlo matron I have provided is correct. •I have read the Daeripron of Work and Yc."Y t is act. ate. I agree to
Iaws reprwentarlyea Orcupertino cc ' er he . EYP iCentifieJtlfprop
Date:--
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CITY OF CUPERTINO
Tri T T CTII•M A TnR — RT TIT .'nING n1V1g10N
i0iADDRESS: 20258 norhwest sq
DATE: 04/01/2015
REVIEWED BY: mendez
APN:
BP#:
*VALUATION: $12,300
%PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE: p
PENTAMATION FURN/AC
PERMIT TYPE: i
WORK
remove and replace furnace a/c and ducts
SCOPE
Furnace, Forced -Air
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
A/C Units (<=10K cfm)
1BREMAIR
1
#
$72
Furnace, Forced -Air
1MFR=<100
Suppl. Insp P'e e
1
#
$143
PME Unit Fee:
$215.00
PME Permit Fee:
$48.00
Construction Tax:
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? ® Yes (F) No
$0.00
TOTALS:
`L ., _ , ',
$215.00
Strong Motion Fee: IBSEISMICR
Mech. Plan Check 1 0.0 1 hrs $0.00 Plumb_ Plan C'hec,k L7ec. Plan Check
Mech. Permit Fee: IMPERMIT Plumb. Permit Fee: Fslec. Perinur Fee:
Other Mech. Insp. 0.0 hrs $48.00 (.hhet- Plumb Insp.EIF-t- Other klec. Insp.
;Llech. hasp. Fee: 11771rrrb. lash. Fee'- t lec. Insp" Fee:
NOTE: This estimate does not include fees due to other Departments (tie. rianning, ruouc worKs, rtre, aunttury newer "ewer/u, oueaae
[_ __ _ - G.......1 ., sL ,. ,./:..... .. L:... nBnw nankin —d —a n"h/ na oclimato_ Cantart the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/132
FEE
QTY/FEE
MISC ITEMS
Plan Check I'ee:
Sappl..PC.I Pee
PME Plan Check:
$0.00
Perrnil F'ee:
Suppl. Insp P'e e
PME Unit Fee:
$215.00
PME Permit Fee:
$48.00
Construction Tax:
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? ® Yes (F) No
$0.00
,4dvanced Planning fees:
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: IBSEISMICR
$1.60
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
._ :. ,5
$358.60
$0.00 TO AL FEE:
_51
$358.60
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:
Enforcement Agency:
Date Prepared:
Permit #:
9V1?-/
15
Equipment Type
Equipment Efficiency
New: Ducting, Plenums, Lineset
Conditioned
Thermostat
Required R -value
Floor Area (sq ft)
❑Packaged System
Evaporator Coil
AFUE
Cep
-6 (CZ 1,3 -7) Ducts
Served by system
Setback
plit System
Condensiryg Unit
SEER
❑ R -8' (CZ 16) Ducts
A 'I sq ft
(If not already
HSPF
❑ R -6 (all CZ's) Plenums
present, must
Furnace
❑ 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
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: Dud leakage (15% or, < 10% to outside, or seal all accessible leaks)
Exempted from dud leakage testing if:
❑ 1. Dud system registered with HERS provider as previously sealed, or ❑ 2. There is less than 40 linear feet of dud in unconditioned
space, or ❑ 3. Existing dud systems are constructed, insulated or sealed with asbestos (list manufacture date of building
112. 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: Dud leakage < 6 %, Fan Efficacy (.58W /CFM), Air Flow z 350 CFM /ton (or Standards Table 150.0 -C / D alternative)
113. All New Duds 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: Dud leakage < 6 %, Air Flow 2: 350 CFM /ton (or Standards Table 150.0 -C / D alternative)
❑ Exempted from dud 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 (:5_15% or, < 10% to outside, or seal all accessible leaks)
❑ Exempted from dud 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 futures 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 clocumpqs, worksh s, calculations, plans and specifications submitted to the enforcement
agency for approval with this building permit i6plicItion.
Rqwonsible
� Desi�jnjer� Na�m�e:�
Respon �
Dat Si)gn�e1 :
Licensee:
Co
a
Address:
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City /State/Zip:
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