15110134CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11700 UPLAND WAY
CONTRACTOR: ATLAS-TRILLO HVAC PERMIT NO: 15110134
OWNER'S NAME: PENDERGAST FRED W AND JAN L TRUSTEE
1965 KYLE PARK CT DATE ISSUED: 11/18/2015
OWNER'S PHONE: 4085689343
SAN JOSE, CA 95125 PHONE NO: (408)286-8931
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
pp--�� -
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REPLACE (E) FURNACE & A/C UNITS, SAME LOCATIONS
License CI s a��J Lic. l7
S
ContractazqLLAS Dat
I hereby affirm that I am licensed under the provisions o Chapt 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: $9500
erformance of the work for which this permit is issued.
ave 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: 36603049.00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
pERMI S ILF RK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
i ERMIT 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 s
D INSPECTION.
indemnify and keep harmles ty of Cupertino against liabilities, ju nts
Cos d expenses which ay acc a against said City in conse of the
it. dition the Mn co
slued by: Date:
gran _og applicant understan s will ply
with all oso a ons a th Cupertino Municipal ode, S tion
-ROOFS:
9.18.
'
isRE
Signature Date
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 equip r devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by t Bay rea uality Management District I
performance of the work for which this permit is issued.
will maintain compliance 'i'tth Cu rti Mu ic' al Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, ecti ns n 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
1 )
Owner or authorized agen Date:
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
GENERAL PERMIT APPLICATIO14 MEV
� COMMUNI T Y DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 T ORRE AVENUE • CUPERTINO, CA 9501A 3255
(408) 777-3228 • FAX ('08) 777-3333 • building(c Dcuoerino•orct M; I
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By ivy signature below, I ify to each of the foll in P: the prop--ty owner or authorized agent to act on pro_ owner's beha r. - a this
application and the' ion I ave provided ' torr-ei have read the Description of \A7ork and verify it iS accurz _ mp y wi tl al (cable local
ordinances and state Iz�; s relating to u 7�' ao I t�hor = represeatztives of Cupertino to enter the zb v ide ro i inspection p ses.
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l/EPh/isc4DP_2011.doc revised 06/21/11
I
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ialADDRESS: 11700 UPLAND WAY
FEE
DATE: 11/18/2015
REVIEWED BY: MELISSA
APN: 366 03 049
1 BP4:
*VALUATION: 1$9,500
"PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
I
$0.00
PENTAMATION
I PERMIT TYPE: FURN/AC
WORK
REPLACE (E) FURNACE &A/C UNITS, SAME LOCATIONS
SCOPE
Mech. Plan Check 10.0 1 hrs $0.00 Pluj),A Plan Check I I flec-I'lar. (.'.'heak I I
Mech. Permit Fee: IMPERMIT Phorrb. Per iii Fee: Permit Fee:
Li
Oih,,,
,, Phif)?b frisp,
Other Mech. Insp. 1 0.01 hrs —,� .00
Vech.. Insp-, Fee:
Ahwtb.
(OTE. 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 Preliminarv, information available and are only an estimate Contact the Dept for addn 7 info.
FEE ITEMS (Fee Resolution.1.1-053.gff7/1113)
FEE
QTY/FEE
MISC ITEMS
PNM Plan Check:
$0.00
.Pernlil
,117
k�v
PME Unit Fee:
$215.00
PME Permit Fee:
$48.00
Administrative Fee: (ADMIN
$45.00
Work Without Permit? 0 Yes (F) No
$0.00
Travel Documentation Fee: I TRA VDOC
$48.00
Strong Motion F IBSEISMICR
$1.24
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS::
00 TOTAL
3S 58.24
Revised: 10/01/2015
STATE OF CALIFORNIA
ALTERATIONS - HVAC
M
CEC-CFIR-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 -IR -ALT -HVAC) (Page 1 of 1)
Site Address-
Eforcement A ency:
Dat Prep red•
Permit#:
Equipment Type
Equipment fficiency
New: Ducting, Plenums, Lineset
Conditioned
Thermostat
..
Required R -value
Floor Area (sq ft)
❑ Packaged System
❑ Evaporator Coil
AFUE
COP
❑ R-6 (CZ 1,3-�) Ducts
Served by system
❑ Setback
❑ Split System
ndensing Unit
SEER
❑ R-8' (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 Lineseta
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.
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 112. There is less than 40 linear feet of duct in unconditioned
space, or 113. 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:
-AII new equipment and All New Ducts'
CF113-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)
1:13. All New Ducts with Replacement Required Compliance Documents to be left on site for Final:
Includes replacing or installing All New CF111-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
CF2R: MECH-20-HERS
space but less than All New Ducts'
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.
a 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-2yV, 3.5 to 4T -2X', 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, works a s, Iculations, plans and specifications submitted to the enforcement
agency for approval with this building per it ap lic ion.
Re on ible D�Name:
Re ponsib Design
Date Sign d:
,,,
License:
C m/pan cLs,
L! hjuy�
Addr s City/State/Zip: , Phone:19P(
_
For assist fnce or questions regarding the Energy Stan(ards, contact the Energy HotAne at: 1-�0-772-3300