15120174CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11041 FfRETHORNE DR
CONTRACTOR: GOSAL HEATING & AIR
PERMIT NO: 15120174
CONDITIONING
OWNER'S NAME: SHAW KATHLEEN K
34492 TORREY PINE LN
DATE ISSUED: 12/21/2015
OWNER'S PHONE: 4082489004
UNiON CITY, CA 94587
PHONE NO: (510)441-2318
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
REMOVE AND REPLACE FORCED AIR FURNACE, SAME
License Class 2ll Lic. # / 92 y
LOCATION
Contractor / C',4L Date 1 Z ' 2 t 2e
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:
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
erformance of the work for which this permit is issued.
Sq. Ft Floor Area:
Valuation: $2650
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: 32344013.00
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 FROM LAST CALLED INSPECTI N.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
1
//��Jgrnting
"� Date: l�(
of this permit. Additionally, the applicant understands and will complyssued
by:T-tIULV
with all no int source regulations per the Cupertino Municipal Code, Section
9.18,
Signature Date / L 2 l ZL! S
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.
❑ 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
1, 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)
1, 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(x) 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 compliance with the Cupertino Municipal Code, Chapter 9.12 and
i have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Se.tai us 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date: / 2 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
1 hereby affirm that there is a constriction 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. 1 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
CUPERTINO-
W4
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPh/iENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 9501A 3255
(408) 777-3228 • FAX (408) 777-3333 • build! no(c cuDerino.org
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USE OF PD or DUPLEX ❑ 1JI LTI-i,4Lffi Y PRO ECT LN VIILDLAI.D ❑ Y: -:s
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DESCP.IPTION OF t%rORK
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TOTALW-LUATION:
By my signature below, I certify to each of the following: I ant the propel owner or authorized agent to act on the grope. owner's behalf. I have _
application and `he i-afornation I have provided is correct. I have read the Description of'Work
and verify it is accurate. I agree to comply;vith all applicable local
ordinances and state Iaws relating t uilding construction. I authorize representatives of Cuue. Lino to enter the above -identified property for ins nec lion purposes.
Si�matere of App �
Date: 12— ° .2
SUPPLEMENTAL IAI. ITTFORvIA OI\ REQUIRED
mzmgL
h,1'EP.A sc, ,Dp_2011.doe revised 06/21/11
CITY OF CUPERTINO 151-gor14
FEE ESTIMATOR — BUILDING DIVISION
191 ADDRESS 11041 Firethorne Dr
FEE ID
DATE: 12/21/2015
REVIEWED BY: PAUL
APN: 323 44 013
BP#:
I EJ("".
*VALUATION: $2,650
*PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
#
$143
PENTAMATION FURN/AC
PERMIT TYPE:
WORK
Remove and Replace Forced Air Furnace,
Same Location
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
A,"ujnb, ""heck --F
QTY
UNITS
BP FEES
I EJ("".
Furnace, Forced -Air
1 MFR=<l 00
Z -1,11c'. -I. Insp,
Ll I
1
#
$143
PME Unit Fee:
$143.00
PME Permit Fee:
$48.00
C . olis NWHW A':
Administrative Fee: (ADMIN
$45'00
Work Without Permit? 0 Yes 0 No
$0.00
TOTALS:
Travel Documentation Fee: I TRA VD OC
1 $143.001.
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 only an estimate. Contact the Dept./or addn'l in/o.
FEE ITEMS (1,ee.Resq1ution.11-053 L,ff.7/'1113)
Mech. Plan CheckRohrs $0.00
l
A,"ujnb, ""heck --F
MISC ITEMS
IMech. Permit Fee: IMPERMIT
Phorth. A;,rm;z Fee:
I EJ("".
Other Mech. Insp. hrs $48.00
Fo-ol
O�h��i- 1.1 fh-v,,.
"I
Z -1,11c'. -I. Insp,
Ll I
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 only an estimate. Contact the Dept./or addn'l in/o.
FEE ITEMS (1,ee.Resq1ution.11-053 L,ff.7/'1113)
FEE
QTY/FEE
MISC ITEMS
PME Plan Check:
$0.00
PME Unit Fee:
$143.00
PME Permit Fee:
$48.00
C . olis NWHW A':
Administrative Fee: (ADMIN
$45'00
Work Without Permit? 0 Yes 0 No
$0.00
Travel Documentation Fee: I TRA VD OC
$48.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item.
Bid;
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 -IR -ALT -HVAC) (Page 1 of 1)
Site Address: / / 6 / 7W 0A%/. YC •
Enforcement Agency:
Date Prepared:
Permit#:
Equipment Type
Equipment Efficiency
New: Ducting, Plenums, Lineset
Required R -value
Conditioned
Floor Area (sq ft)
Thermostat
❑ Packaged System
❑ Evaporator Coil
Sia AFUE
COP
L9 -R-'6 (CZ 1,3-7) Ducts
Served by system
❑ Setback
❑ Split System
❑Condensing Unit
SEER
p
❑ R-8' (CZ 16) Ducts
8 sq ft
(If not already
E Furnace
❑ Lineset
EER
HSPF
❑ R-6 (all CZ's) Plenums
❑ R-5 or R7.5 Lineset'
\
present, must
be installed)
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. AVpe'rm- itrapphicati-orxthis
fi iq'gtallo�d B'elfllle` out'' y . an - 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'
CF1R-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
CF113-ALT-02-E
space but less than All New Ducts'
CF2R: MECH-20-HERS
CF3R: MECH-20-HERS
Installer Req 'red to: Duct leakage (< 15% or, < 10% to outside, or seal all accessible leaks)
L'�" 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.
3 R-5 0." 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.
Responsible Designer Name:
Responsible Designer Signature:
Date Signed:
%Z- .111
License:
Q(2L%
Company:
Address:
City/State/Zip:
Phone:
For assistaAce or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300