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15090113I CITY OF CUPERTINO BUILDING PERMIT I IBUILDING ADDRESS: 20650 PARK CIR 13 ONTR CTOR: FLANDERS HEAT & AIR I PERMIT NO: 15090113 I OWNER'S NAME: LICENSED CONTRACTOR'S DECLARATION License Class4 Lic.# -0- 4D Contrac Date C I hereby affirm that I am licensed under the provisions J 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: r. 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. �. 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 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is collect. 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 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 with all non -point — ) J ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: t. 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) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: r. 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. 2. 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 th� is permit is issued. s. 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 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 with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date 555 PETERS AVE STE 255 1 DATE ISSUED: 09/17/2015 PLEASANTON, CA 94566 1 PHONE NO: (925)461-3333 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ APT #2 - REPLACE (E) WALL HEATER Sq. Ft Floor Area: I Valuation: $1100 APN Number: 32632016.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DA�*"J�l YYSFROIV Y� M/L/AST CALLED INnSPEC ION. Issued b ( Date: RE -ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. or authorized agent: Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO )5�©l FEE ESTIMATOR — BUILDING DIVISION IMPAPN: DDRESS: 20650 Park Circle E Apt #2 DATE: 09/17/2015 REVIEWED BY: PAUL UNITS 326 32 016 BP#: *VALUATION: 1$1,100 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: # PENTAMATION FURN/AC PERMIT TYPE: WORK Re lace E wall heater SCOPE uppl. Insp Fee APPLIANCE / EQUIP TYPE FEE ID Plwnb. flan QTY UNITS BP FEES Elec. Permit Fee: Heater, Recessed Wall 1MRSUSHTR Ocher Ekc. lns ? 1 # $72 11)ermit Fee: uppl. Insp Fee PME Unit Fee: $72.00 PME Permit Fee: $48.00 "e iistruetion Tax: Administrative Fee: 1ADMIN $45.00 Work Without Permit? 0 Yes (F) No $0.00 TOTALS: Travel Documentation Fee: ITRA VDOC $72.00 Strong Motion Fee: IBSEISMICR NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the preliminary information available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-033 Eff 7/U13 Mech. Plan Check 0.0 1 hrs $0.00 Plwnb. flan h3 ee. 1'lan Cheek Mech. Permit Fee: 1 MPERMIT Plumb. Perrnif Fee: Elec. Permit Fee: Other Mech. Insp. 0.0 hrs $48.00 irizer Plurnb Insp. Ocher Ekc. lns ? PME Plan Check: $0.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the preliminary information available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-033 Eff 7/U13 FEE QTY/FEE MISC ITEMS °'hin Check Pc e: tJr/rl, PC 1' k"" PME Plan Check: $0.00 11)ermit Fee: uppl. Insp Fee PME Unit Fee: $72.00 PME Permit Fee: $48.00 "e iistruetion Tax: Administrative Fee: 1ADMIN $45.00 Work Without Permit? 0 Yes (F) No $0.00 a z lvanced .Planning Fees: Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00/ SUBTOTALS: $214.50 $0.00 TOTAL FEE: $214.50 Revised: 07/02/2015 ►r CUPERTINO GENERAL PERMIT APPLICATION 150°101 IJ COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - buildina(a.cupertino.org D PMU MING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLAI\TEOUS PROJECT ADDRESS APN R 6 ©'6 6y*�� OWNER NAME �M \ 1` P1101,1P E-MAIL STREET ADDRESS C , STATE, ZIP FP x CONTACT NAME PHOvB 1 � - �S STREET ADD [— / , _ \ CITY, STATE e h l �� J FAX A ❑ VANTEER ❑ OWNER -BUILDER ❑ OWNERAGM,T COI,'MA.CTOR ❑COITTRACTORAGE'T ❑ ARCHITECT ❑ ENGATEER ❑ DEVELOPER ❑ TF-NA1\'T CONTRACTOR NATj��j ,^ LICENSE NUMBER �- LICENSE TYPF� BUS. LIC r 1 COMPANY NAMi—C'� n ^S \^ V� }% , E r F I V STREET ADDRES Y CITY, STATE, ZIP )V ;lS% P ter {1 -- �� ARCHITECT/ENGA'EER NAME LICEA'SE NUMBER BUS. LIC COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX BU LING: ❑ COMMERCIAL MULTI-FATOI.Y I . PROJECT IN WIIAL.AND ❑ YES PROJECT IN ❑ 17-S I IS THE BLDG AN ❑ �' S URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ X'�0 EICHLER HOME? ❑ : i DESCRIPTION OF WORK TOTAL VALUATION: By my signature below, I certify o 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 I have 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 relating to building co ction. I authorize representatives of Cupertino to enter thea -iden ed pro erty for inspection purposes. Signature of Applicant/Agent: Date: I SUFPLEMENTAL INTFORMATION REQUIRED j� MEPMiscAPP_2011.doc revised 06121/11 STATE OF CALIFORNIA ALTERATIONS - HVAC CEC-CFIR-ALT-03-E Revised 03/15 CALIFORNIA ENERGY COMMISSION -'R=P 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#: o 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 ❑ Setback ❑ Split System ❑ Condensing Unit SEER ❑ R -8t (CZ 16) Ducts 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: 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 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. t 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 -4y8" 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. S. 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 application. Res onsible Designer Name: Responsible Designer Signature: Date Signed: License: 50a -jrCoomp(annyj:: /� / F "fin iA��. L ( Address: 565 Pe4I ��z5 City/State/Zip: � c - Phone: For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300