07020012CITE' OF CUPFR1 EN U
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
19925 STEVENS CREEK BLVD
OWNER'S NAME:
MATTESON REALTY
)NE:
ARCHITECT/ENGINEER:
i p z0 LICENSED CONTRACTOR'S DECLARATION
V F I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and in license is
,a„ in full force and effect L
vj Licenac Class d Lam•
t Dale Contractor
ARCHITECTS DECLARATION
i W < 1 understand my plans shall be used as public records
>yU
Gy Licensed Professional
y OWNER - BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractors License Law for the
00 following reason. (Section 7031.5, Business and Professions Code: Any city or county
<%P which requires a permit to construct, alter, improve, demolish, or repair any structure
J— y prior m its issuance. also requires the applicant for such permit to file a signed statement
= Z < that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
l-- (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
i that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars ($500).
❑ 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
and Professions Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for sale. If,
however, the !wilding or improvement is sold within one year of completion, the owner.
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ 1, as owner of the property. am exclusively contracting with licensed contractors to
construct the project (Sec. 7044. Business and Professions Code:) The Contractor's U.
ccnse Law does not apply to an owner of property who builds or improves thereon, and
who contracts for such projects with a contractors) licensed pursuant to the Contractor's
License Law.
❑ I am exempt under Sec. B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
.7
W
Qr Q
az
U
�F
OU
Uz
] I have and will maintain a Certificate of Consent to self4sum for Worker's Compen-
sation, 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 required by Section
3700 of the Labor Code, fee the performance of the work for which this permit is issued.
My WorkafMantualsatiion dance carrier and Policy number ate:
Carrier NI %, %-- —�' Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100)
or less.)
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 Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name
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, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, costs and expenses which may in any way accrue against said City
in consequence of the tu�r F� i _t ng of this permit.
e nor tre I1h1nP C'f*Mn ANn WiLL—rr*IPLY WITH ALI1NON:P `0INT
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
❑ Yes o
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
District? — -//
❑ Yes Lj'tstt
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safcty Codc, Sections 25505, 25533 and 25534.1 understand that if the buildi g
does not currently have, a tenant, that it is my responsibility to notify the occu+ of )he
Owner or authorized
MATTESCN REALTY
1 LAGOC N
INSTALL NEW A/C UNIT
Sq. Ft. Floor Area
316210E 9 .
Issued b
Re -roof.
Type of Roof
PERMIT NO.
07020012
PERMIT ISSUE DATE
SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECT PLUMB
Job Description
uatlon
$7700
Required Inspections
All roof 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.
Signatul e of Applicant
All roof coverings to be Class "B" or better
Date
CI� Of�
CUPEkTINO
CITY OF CUPERTIN(
FURNACE/AC
PERMIT APPLICATION FORM
APN # ...
Date:
Building Address: ..,
BUILDING
Owner's Name: e
� a
hone #:
Contractor: � -Q�11one:
n, , ��
License 7,71:
Contact: Phone:
Cupertino Business License #:
A/C Unit > 10,000 cfin
MECHANICAL
Building Permit Info:
�CMech
Bldg ❑ Elect ❑ Plumb ❑
A/C Units <= 10, 000 efin
Job Description: R F
BREMRECEPT
Residential ❑ Commercial
ELECTRICAL
BSEISMICRE
For Residential Installations:
BUILDING
Attic ❑ 1St floor ❑ 2 °d floor ❑
BSEISMICOM
Adhere to min set back requirement ❑
BUILIDNG
For Commercial Installations:
EPERMITFEE
Replacement same weight ❑ Additional weight (structural calcs) ❑
ELECTRICAL
Structural Calculations required for new installation ❑
MPERMITFEE
New installation Planning Approval Required ❑
MECHANICAL
Cost of Project: Type of Construction:
Occupancy group:
Plumbing Permit Issue
PLUMBING
Strapped ❑ On Platform ❑ Bonded ❑
Sq.Ft. Floor Area:
New Location ❑ Replacement ❑
BUILDING
Qty. if
Applicable
Fee ID
Fee Description
Fee Group
BENERGY
Energy
BUILDING
BREMFURN
Furnace
MECHANICAL
BREMACOVER
A/C Unit > 10,000 cfin
MECHANICAL
BREMAIRHAN
A/C Units <= 10, 000 efin
MECHANICAL
BREMRECEPT
Rec tl, Switch & Outlets
ELECTRICAL
BSEISMICRE
Seismic Fee Res
BUILDING
BSEISMICOM
Seismic Commercial
BUILIDNG
EPERMITFEE
Elee Permit Issuance
ELECTRICAL
MPERMITFEE
Mech Permit Issuance
MECHANICAL
PPERMITFEE
Plumbing Permit Issue
PLUMBING
%
BPERMFEE
Bldg Permit Fees
BUILDING
BPLANCHK
Plan Check Fee
BUILDING
BPGAS
Gas Piping System Fee
PLUMBING
BUSLIC
Business License
BUILDING
CITY OF
CUPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777 -3228
Fax (408) 777 -3333
Building Department
JOB ADDRESS n
PERMIT #
OWNER'S NAME:' _ cs�� �c
PHONE #
GENERAL CONTRACTOR .
FAX #
r
I am not using any subcontractors:,.\
Signature Date
Please check applicable subcontractors and complete the following information:
Owner/ Contractor Signature
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/ Contractor Signature
Date
1
COMMERCIAL/INDUSTRIAL INTERIOR
CITY OF IMPROVEMENTS . C.O.VER SHEET..
CUPEi�T1N0
Assessors Parcel Number:
Name of business.
4.
Project address.
Contact person. Phone.
Fax.
Current use of space.
Proposed use.
Building construction type.
Occupancy Group(s)
Occupancy Load.
Square footage of remodeled area.
Is the building equipped with: Fire sprinkles? ��%'- N; Fire alarm system? Y)- N
Number of floors in the building? On what floor(s) is work being done?
Brief description of work.
Code editions: 2001 CBC (Y - N)2001 CFC (Y - N) 2001 CMC (Y- N)
2001 CPC (Y - N)2001 NEC (Y - N)
r
}
Effective 11/1/02
APPROVED
tE w f(� CE VVIT11 1,4 CITY (Hi
Are there any chemicals/hazardous materials to be stored at site?
— . ' "'° ) (30[4'S AND
If above answer is yes, provide a list of materials and quantities.
Z
DATE
If job is involves food service, provide 3 extra plan sets for Health DepartrA� v'
n 8s set of p rs,L l4; :r °6°
4'Ie kept orl tiie (i:JI:M al e1
ul u d t Yr aI1N
�% a /,,,/ i%�
�� 1. ✓� /� Vii,
'f
�)IIl4ll' Dept, �f�
rrrrllx "r a
I C7 r I
<
p
HVf I' iNk" . "rl to
J� li( lld Y Irlll .I 14,E 1
!jf flri; I V W (li ;il` rc r�C
anv (�iCy it" 1�rl,. d "�t 4� Cr& Ile r
Commercial Plan Review Process Work BookPage -11- revised 4/28/04
O
MODELS: PU12/18/24/30/36EK , PU42EK2 , PU42EK7
PU18/24/3O/36EK1 , PU42EK21
Model
Item
PU12EK
PU18EK
PU24EK
PU30EK
PU36EK
PU42EK2
PU42EK7
OUTDOOR UNIT MODELS
PU12EK
PU18EK PU18EK�
PU24EK,PU24EKi
151.130EK PUNEKi
PU36EK,PU36EK1
PU42EKZPU42EK2i
PU42EK7.
External finish
Munsell 5Y 7/1
Power supply V, phase, Hz
208/230, 1, 60
Max.fuse size (time delay) P,
Min.ampacity A
15
11
20 20
16 16
30
20
30
22
40
27
40
28
Fan motor F.L.A.
0.65
0.75
0.65 +0.65
0.65 +0.65
0.75 +0.75
0.8 +0.8
0.8 +0.8
Model (type)
RH167NAB
RH247NAB
NH33NBD
NH41NAD
NH47NAD
NH569NXA
ZR42K3PFV
Compressor
R.L.A.
8.9
12.0
11.5
14.0
17.5
20.0
20.4
L.R.A.
29
37
54
73
87
105
109
Crankcase heater A(W)
0.11/0.12(23/28)
0.11/0.12(23128)10.16/0.17(33/39)
0.16/0.17(33139)
0.16/0.17(33139)
0.16/0.17(33/39)
0.16/0.17(33/39)
Refrigerant control
Capillary tube
Sound level dB
50
53
55
55
55
56
56
W in.
34 -1/4
34 -1/4
34 -1/4
34 -1/4
38 -3/16
38 -3/16
38 -3/16
Dimensions
D in.
11 -5/8
11 -5/8
11 -5/8
11 -5/8
13 -9/16
13 -9/16
13 -9/16
H in.
25 -9/16
33
49 -9/16
49 -9/16
49 -9/16
49 -9/16
49 -9/16
Weight lb
105
54
207
208
220
260
260
Control voltage (by built -in transformer)
Indoor unit - outdoor unit: DC12V
Name
R22
REFRIGERANT
Charge
4 Ibs 14 oz
5 Ibs 8 oz
9 Ibs 15 oz
10 Ibs 2 oz
10 Ibs 9 oz
112lbs 9 oz
11 Ibs 0 oz
Oil <Model> OZ
16 <MS -56>
16 <MS -56>
37 <MS32(N -1)>
40 <MS32(N -1)>
40 <MS32(N -1)>
49 <MS32(N -1)>
42<SONTEX200LT>
REFRIGERANT PIPING
Not supplied(optional parts)
Pipe
Liquid in.
3/8
3/8
3/8
1/2
1/2
/2
1/2
size
Gas in.
5/8
5/8
5/8
3/4
3/4
H13/4
3/4
Connection
Indoors
Flared
method
Outdoors
Flared
Between the indoor
Height difference ft
Max. 130
Max. 130
Max. 164
Max. 164
Max, 164
Max. 164
Max. 164
& outdoor units
Piping length ft I
Max. 130
Max. 130
Max_ 164
Max. 164
Max. 164
Max. 164
Max. 164
Operating range
In case of the wind baffle installed.
(In case of the wind baffle is not installed, the minimum temperature is D.B. 23T)
n
a,r��, 1"
u,
Indoor intake air temperature
Outdoor intake air temperature
Cooling
Maximum
D.B.95 °F, W.B.71 °F
D.B. 115 °F
Minimum
D.B. 67 °F W.B. 57 °F
D. B. 0 °F
In case of the wind baffle installed.
(In case of the wind baffle is not installed, the minimum temperature is D.B. 23T)
n
a,r��, 1"
u,
O
MODELS: PU12/18124/30/36EK , PU42EK2 , PU42EK7
PU18/24/30136EK1 , PU42EK21
Model
Item
PU12EK
PU18EK
PU24EK
PU30EK
PU36EK
PU42EK2
PU42EK7
OUTDOOR UNIT MODELS
PU12EK
PU18EK, P1.118%
PU24EK, PU24EKs
PU30EK, PU30EK,
PU36EK, PU36EK1
PU42EK2, PU42EK2,
PU42EK7
External finish
Munsell 5Y 7/1
Power supply V, phase, Hz
208/230, 1, 60
Max.fuse size (time delay) A
15
20 20 __1
30
30
40
40
Min.ampacity A
11
16
16
20
22
27
28
Fan motor F.L.A.
0.65
0.75
0.65 +0.65
0.65 +0.65
0.75 +0.75
0.8 +0.8
0.8 +0.8
Model (type)
RH167NAB
RH247NAB
NH33NBD
NH41NAD
NH47NAD
NH569NXA
ZR42K3PFV
Compressor
R.L.A.
8.9
12.0
11.5
14.0
17.5
20.0
20.4
L.R.A.
29
37
54
73
87
105
109
Crankcase heater A(W)
0.11/0.12(23128)
0.11/0.12(23/28) 0.16/0.17(33/39)
0.16/0.17(33/39)
0.16/0.17(33139)
0.16/0.17(33/39)10.16/0.17(33/39)
Refrigerant control
Capillary tube
Sound level dB
50
53
55
55
55
56
56
W in.
34 -1/4
34 -1/4
34 -1/4
34 -1/4
38 -3/16
38 -3/16
38 -3/16
Dimensions
D in.
11 -5/8
11 -5/8
11 -5/8
11 -5/8
13 -9/16
13 -9/16
13 -9/16
H in.
25 -9/16
33
49 -9/16
49 -9/16
49 -9/16
49 -9/16
49 -9/16
Weight lb
105
54 <:,
207
208
220 1
260
260
Control voltage (by built -in transformer)
Indoor unit - outdoor unit:DC12V
Name
R22
REFRIGERANT
Charge
4 Ibs 14 oz
5 Ibs 8 oz
9 Ibs 15 oz
10 Ibs 2 oz
10 lbs 9 oz
112 Ibs 9 oz.
11 Ibs 0 oz
Oil <Model> OZ
16 <1VIS -56>
16 <MS -56>
37 <MS32(N -1)>
40 <MS32(N -1)>
40 <MS32(N -1)>
49 <MS32(N -1)>
42<50NTEX200LT>
REFRIGERANT PIPING
Not supplied(optional parts)
Pipe
Liquid in.
3/8
3/8
3/8
1 1/2
1/2
1/2
1/2
size
Gas in.
5/8
5/8
5/8
3/4
3/4
3/4
3/4
Connection
Indoors
Flared
method
Outdoors
Flared
Between the indoor
Height difference ft
Max. 130
Max. 130
Max. 164
Max. 164
Max, 164
Max. 164
Max. 164
& outdoor units
Piping length ft
Max. 130
Max. 130
Max. 164
Max. 164
Max. 164
Max. 164
Max. 164
Operating range
In case of the wind baffle installed.
(In case of the wind baffle is not installed, the minimum temperature is D.B. 23 °F)
Indoor intake air temperature
Outdoor intake air temperature
Maximum
D.B. 95 °F, W.B. 71 °F
D.B. 115 °F
Cooling
Minimum
D.B.67 °F, W.B. 57 °F
D.B. 0 °F z,
In case of the wind baffle installed.
(In case of the wind baffle is not installed, the minimum temperature is D.B. 23 °F)
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