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15100173I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 19756 WHEATON DR CONTRACTOR: PERMIT NO: 15100173 OWNER'S NAME: JYOTISEN MODYCEL,a. ���5 ������ �Y� DATE ISSUED: 10/21/2015 OWNER'S PHONE: 4087263535 ' , �i�tN c%�E �A %�� I PHONE NO:�oB t �� 735I ❑ LICENNSED CONTRACTOR'S DECLARATION License Class / () Lic. # ( "I Contractor I ` 91 o ' " ' E Date 10 VR5 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: 1. 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 Action 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 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 p2nnit. Additionally, the applicant understands and will comply with all non -point urce a dations per the Cupertino Municipal Code, Sec ion 9.18. Signature Date Ibi Zl , ❑ OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1 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: i. 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. 1 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. 3. 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 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ REMOVE AND RELOCATE FURNACE TO ATTIC; INSTALL A/C; REPLACE (11) DUCTS AND (2) RETURNS WITH R6 INSULATION. Sq. Ft Floor Area: I Valuation: $1793 APN Number: 31628003.00 1 Occupancy "Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: �c�N 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. Owe o ori agen : —Date: 10 IJ 2A I j C 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 �iu CUPERTINO GENERAL PERMIT APPLICATION COMMiUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (-,/,o 8) 777-3228 • FAX (408) 777-3333 • buildinc(a-�cuoedino.org j �l / 7-3 PLU]IvG L!NCIIs\ICAL ❑ELECTRICAL ❑A�SCELLAI\OUS PRor_cr .4DDREss W 5(D W hepiD n Wr 0Pv'1\'ER NAIJ_E I v z` V l M od PHo,,z- OAUP 3S 3 5 E-ML4 7 STREET ADDP.ESS `y�' �M � /f� I�1 /� n CITY, STATE, ZIP I FAX COI;IACT K/iU,EsW � PHONB gobQ oQ -),35 I E-1vL4 L STREETfi.DDRESS Q/'� �/� %� 0,10V\fe CITY,STATE, ZIP FAX E3Oti'ma ElOR'1\'EP.-BUILDER ❑ORI ER AG T �01\TRACTOR 11C01TR4CTORAGMI7 13.1-RCH ECT ❑ ENGL ..R ❑ nz LOPER ❑ ENYL\? 1 CONT n A/ 1 i` x) % LJi,/t VVI , V�, l/ LICE SE LhER %a�(L� "I v l e( BUS. LIC C01J2.41 Y hP 1�,E- i I Vwe' � K I E MAI>�ir r �� F.4X STREET r �j Q}� CITY, STATE: ZIP OCLq [W,509 12GO A-RCI-DT=CT/ENGD'=R NAME — LICENSE NIU1,1MER I BUS. LIC I COMPANYNUlm E-MAIL I FAY, --- STRET ADDRESS _ CITY, STATE, ZIP — I PHONE USE OF SIJ or DUPLEX ❑ 14I LTI-FAhffi Y PROT CT LN V 1LDLAJ D ❑ YES PROJECT LN ❑ -m B=NG: ❑ com-1,=CI4IURB ? P TER> ACE ARE4 F D Z 1 0 IS Ti -2 BLDG AN ❑ yES I EICF?LER HOME? ❑ NC MFPMisc.4pp_2011.doc revised 06/21/11 M-7 CITY OF CUPERTINO R� FEE ESTIMATOR- BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 19756 WHEATON DR DATE: 10/21/2015 REVIEWED BY: SEAN UNITS APN: BP#: *VALUATION: 1$15,793 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: SFD or Duplex # PENTAMATION PERMIT TYPE: FURN/A WORK REMOVE AND RELOCATE FURNACE TO ATTIC; INSTALL A/C' REPLACE 11 DUCTS AND 2 SCOPE RETURNS WITH R6 INSULATION. APPLIANCE / EQUIP TYPE FEE ID 1,1111 b. Plan Check QTY UNITS BP FEES l ler. Permit Fee: A/C Units (<=10K cfm) 1BREMAiR Other lilec. Insp.Li 1 # $72 Furnace, Forced -Air 1MFR=<100 V Styppl. Insp Fee 1 # $143 PME Unit Fee: $215.00 PME Permit Fee: $48.00 t "onstt-uc tion Tax: Administrative Fee: IADMIN $45.00 Work Without Permit? 0 Yes E) No $0.00 TOTALS: Travel Documentation Fee: ITPA VDOC $215.00 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, eta). These fees are based on the preliminary information available and are only an estimate. Contact the Dent for addh 7 info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13,] Mech. Plan Check0.0 hrs $0.00 1,1111 b. Plan Check Elec. Plan Check Mech. Permit Fee: IMPEWVWT Plumb. Permit hie l ler. Permit Fee: Other Mech. Insp. 0.0 hrs $48`..00 other Plumb Insp. Other lilec. Insp.Li hasp. Tee. '_Iec. Insp. 1•ee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, eta). These fees are based on the preliminary information available and are only an estimate. Contact the Dent for addh 7 info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13,] FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl. PC Fee _T7 PME Plan Check: $0.00 Permit he'c: Styppl. Insp Fee PME Unit Fee: $215.00 PME Permit Fee: $48.00 t "onstt-uc tion Tax: Administrative Fee: IADMIN $45.00 Work Without Permit? 0 Yes E) No $0.00 Advanced Planning Fees: Travel Documentation Fee: ITPA VDOC ✓ $48.00 Strong Motion Fee: IBSEISMICR $2.05 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $359.05 $0.00 TOTAL FEE: 1 $359.05 Revised: 10/01/2015 STATE OF CALIFORNIA ALTERATIONS - HVAC CEC-CFIR-ALT-03-E (Revised 06/14) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE CFIR-ALT-03-E Alterations - HVAC CZ 1, 3 to 7 and 16 (formerly CF -1R -ALT -HVAC) (Page 1 of 1) Site Address: f , f 4cn_ _�Y Enforcement Agency: Date Prepared: Permit#: ( Cf —75 -p I Equipment Type Equipment Efficiency New: Ducting, Plenums, Lineset Conditioned Thermostat Required R -value Floor Area (sq ft) ❑ Packaged System NTEvaporator Coil AFUE COP R-6 (CZ 1,3-7) Ducts Served by system ElSetback ❑ Split System lKondensing Unit SEER ❑ R-8' (CZ 16) Ducts sq ft (If not already ❑ Lineset HSPF ❑ R-6 (all CZ's) Plenums present, must L�rr urnace EER 11R-5 or R7.5 Lineset' 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_ g2. 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) tl: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 Pequirement: 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 (:<_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. I 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 permit application. Rensible Designer N t Respo le ner Sign Date Sign d: License: f n rn s4rJ V� l l MmKapAddress: UTI-� i� I ZS sc,�2 City/State Zip sl �2i� P For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300