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15100212I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10983 SWEET OAK ST I CONTRACTOR: HUSSEY BROS INC PERMIT NO: 15100212 I OWNER'S NAME: HAYES KENNETH M 1903 GEORGE ST I DATE ISSUED: 10/26/2015 1 OWNER'S PHONE: 4083982067 1 SANTA CLARA, CA 95054 1 PHONE NO: (408)733-6360 1 C LICENSED CONTRACTOR'S DECLARATION License Class C Z—D Lie. # tf0 ContractorV sB (0 SZAt Date P Zit 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: t. 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 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=Date nicipal Code, ecti9.18. Signature ❑ OWNER -BUILDER DECLARATION I 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: t. 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 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. Signature Date JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ REPLACE (E) FURNACE WITH (N); SAME LOCATION Sq. Ft Floor Area: I Valuation: $3802 APN Number: 32651011.00 1 Occupancc TN pe: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSP CT ON. Issued by: ��/ �S�W�,V•«'" I 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(x) 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. Owner 'rized agent: G Z � / Date J 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 1 understand my plans shall be used as public records. Licensed Professional VV, qj"., CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 T ORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 - building(d.)CUDeriino.org ❑PLUh,mLNG 54MECKANTICAL DELECTRiC?? Ell, iISCELLA_NEEpUS aa, PROrCT A.DDP_Ess W e oak s� ON ER NAME P ]v � 4 W3� F - 7� �� _ I✓=Z I I < �� t s 060 •,LO►.. STREETADDRFS5C n °► � S w• 4t i o , STATE, ZJP L/�Lr 41Fb I FAX CONTACT 1 SME e vt N, s S,e I PHONE STREET ADDRESS I CITY, STATE, ZIP = px ❑ Oti?.'-k ❑ OR.,,=—_BUII.DE:t ❑ Otir^-1:R.4,C. i 40VrF/:CT0R ❑CO?-P4CTORAGZN7 ❑ ARCH ECT ❑ ENGWE—ER ❑ DE tLOPEt ❑ j_�/,�T CONTRACTOR NA br-_ ( LIMN't �LWR 11 ss ((�� I LI �;SE�-lYE �� I BUS. LIC = COMPANY NAIL V ss -e E N S /Z VC Iq kv 5S e lD irS.LJ � I F.AX STREET ADDRESS A b 1 Gi O J' / 5 1I � STAX,/ /1 n X, 4 4 l SIJ � s 'VFf 733-63Gd ARCHITECT/ENGD\°EERl ATE I LICENSE NUMBER I BUS. LIC R CONIPP?dY ?\ 4ME E-MAIL I FAY, STREET ADDRESS CITY, STATE, ZIP PZ; USE OF CFD or DU -PL X Eli✓L'LTI-rAhu.Y PROJECT IN R'ILDLA?El Y:S ,ZD I PROTECT LN ❑ YES B u �L G: ❑ CFDI URBAN' LNI'ERFACE APak ❑ NO FLOOD ZONE ❑ No I IS THE BLDG AN ❑ � _S EICHLER Homm ❑ NO DESCRIPTION OF WORK _I 411 U'rKac e_ n ©uo I V TOTAL VALUATION: :1 EI�TED ti By my signature below, I certify to each of the following: I= the property owner or authorized agent to act on the property owner's behalf. I have read this zpplication and the information I hav rovided is correct. I have read the Description of Work and verify it is accurate. I agree to comply Nvith all applicable local ordinances and state laws relating to a construction. I authorize representatives of Cupertino to enter the zbove denriTr property for inspection purposes. Signature of Applicant/Agent: Date: �-` SL-PPLEh1ENTAL LN'FORvIATION REQUIRED c IT_ _\`Y A-fEPMisc,4pp_2011.doc remised 06/21/11 CITY OF CUPERTINO 15100'aR, F -M-7 FEE ESTIMATOR- BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 10983 Sweet Oak St DATE: 10/26/2015 REVIEWED BY: PAUL UNITS APN: 326 51 011 BP#: *VALUATION: 1$3,802 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: # PENTAMATION FURN/AC PERMIT TYPE: A WORK Replace E furnace with (N); Same Location SCOPE Suppl. Insp Fee APPLIANCE / EQUIP TYPE FEE ID ('lurrrls. Plan, Check QTY UNITS BP FEES [rillPermir Fee Furnace, Forced -Air 1MFR=<100 'Mier 1;lec. Insp.Ll I 1 # $143 Permit F'ee: Suppl. Insp Fee PME Unit Fee: $143.00 PME Permit Fee: $48.00 Construction Tax: Administrative Fee: (ADMIN $45.00 Work Without Permit? 0 Yes Q) No $0.00 TOTALS: Travel Documentation Fee: ITRA VDOC $143.00 Strong Motion Fee: 1BSEISMICR 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 only an estimate. Contact the Dent for addn'l info_ FEE ITEMS (Fee Resolution 11-053 Ef: 711/13) Mech. Plan Check 10._01hrs $0.00 ('lurrrls. Plan, Check fJec..Plan Chock Mech. Permit Fee: IMPERMIT Plumb. Psrmir Fee: [rillPermir Fee Other Mech. Insp. 0.0 hrs $48.00 Other I'lumh lnsp 'Mier 1;lec. Insp.Ll I rwb. 17:sp. Fee L:lec. Insp. 1,e, - 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 only an estimate. Contact the Dent for addn'l info_ FEE ITEMS (Fee Resolution 11-053 Ef: 711/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: S'uppl. PC Fee PME Plan Check: $0.00 Permit F'ee: Suppl. Insp Fee PME Unit Fee: $143.00 PME Permit Fee: $48.00 Construction Tax: Administrative Fee: (ADMIN $45.00 Work Without Permit? 0 Yes Q) No $0.00 Advanced Planning Fees: Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg; Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $285.50 $0.001 TOTAL FEE: $285.50 Revised: 10/01/2015 CERTIFICATE OF COMPLIANCE CHR -ALT 02-E Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 1 of 3 ) I Project Name: 10983 Sweet Oak I Date Prepared: 2015-10-26 A. General Information MR -ALT -02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented, use one MR -ALT -02 document for each dwelling unit. 01 Project Name 10983 Sweet Oak 02 Date Prepared 2015-10-26 03 Project Location 10983 Sweet Oak St. 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name 10983 Sweet Oak 07 Zip Code 95014 08 Dwelling Unit Conditioned 960 Installing Installing Installing Floor Area (ft2) Location or Area by this SC ducted containing system Number of space conditioning entirely new 09 Climate Zone 4 10 (SC) systems in this dwelling 1 component? components? feet of ducts? duct system? unit. Alteration Type B. Space Conditioning (SC) System Information 01 02 03 04 05 06 07 08 09 10 Is the SC Installing a SC System SC System CFA served system a refrigerant Installing new SC Installing Installing Installing Identification or Location or Area by this SC ducted containing system more than 40 entirely new entirely new Name Served System (ft2) system? component? components? feet of ducts? duct system? SC system? Alteration Type System 1 Location 1 960 Yes No Yes No No No Altered space conditioning system C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)iDiib) This section does not apply to this project. Registration Number: 215-A6370317A-000000000-0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance OCT 2 6 2015 Registration Date/Time: 2015-10-26 11:34:38 HERS Provider: CalCERTS Report Version: 2013-1.006 Report Generated: 2015-10-26 11:34:34 Schema Version: 0.555SDD CERTIFICATE OF COMPLIANCE CF111-ALT 02-E Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 2 of 3 ) D. Altered Space Conditioning System (Sections 150.2(b)1E and F) 01 02 03 04 05 06 07 08 09 10 11 12 Heating Cooling System Heating Altered Heating Minimum Altered Cooling Minimum Required New or Identification System Heating Efficiency Efficiency Cooling Cooling Efficiency Efficiency Thermostat Replaced New Duct or Name Type Components Type Value System Type Components Type Value Type Duct Length R -Value Central gas Gas furnace Central split No cooling This field or This field or This field or This field or System 1 furnace AHU AFUE 0.8 AC component section is not section is not Setback section is not section is not altered applicable applicable applicable applicable Reauired Documentation: CF2R-MCH-01-E - Space Conditioning Systems Ducts and Fans -Duct insulation requirement for new plenums: R6. CF2R-MCH-20-H & CF3R-MCH-20-H — Duct Leakage testing required when heating or cooling components are installed in ducted systems, or when more than 40 ft of duct length is replaced. -Leakage rate compliance: 5 15%, or 5 10% leakage to outside, or seal all accessible leaks. CF2R-MCH-25-H & CF3R-MCH-25-H Refrigerant Charge Verification required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15). CF2RCF3R-MCH-23 & CF3R-MCH-23 Air Flow z 300 CFM/ton required when MCH -25 is required. Exceptions: -Duct systems registered with HERS provider as previously sealed are exempt from MCH -20 Duct Leakage Testing requirements. -Heating-only systems and Air Handler/Furnace changes do not require verification of Air Flow MCH -23, or Refrigerant Charge MECH-25. -Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH -20 Duct Leakage Testing requirements. E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)iDiia and 150.2(b)1E, F) This section does not apply to this project. F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)iC) This section does not apply to this project. Registration Number: 215-A6370317A-000000000-0000 Registration Date/Time 2015-10-26 11:34:38 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-10-26 11:34:34 Schema Version: 0.555SDD CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 3 of 3 ) Documentation Author's Declaration Statement 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Hussey, Steve Company: Signature Date: HUSSEY BROS INC 2015-10-26 11:34:38 Address: CEA/ HERS Certification Identification (if applicable): 903 GEORGE ST City/State/Zip: Phone: SANTA CLARA CA 95054 408-733-6360 Responsible Person'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 Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible designer). 3. 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 California Code of Regulations. 4. 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. 5. 1 will ensure that a registered copy of this Certificate of Compliance shall be made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a registered copy of this Certificate of Compliance is required to be included with the documentation the builders provides to the building owner at occupancy. Responsible Designer Name: Responsible Designer Signature: Hussey, Steve 7 _.'(it'��'`%�� Company : Date Signed: HUSSEY BROS INC 2015-10-26 11:34:38 Address: License: 903 GEORGE ST 675669 City/State/Zip: Phone: SANTA CLARA CA 95054 408-733-6360 Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document, and in noway implies Registration Provider responsibility for the accuracy of the information. Registration Number: 215-A6370317A-000000000-0000 Registration Date/Time: 2015-10-26 11:34:38 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-10-26 11:34:34 Schema Version: 0.555SDD