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13120040R CITY. OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10510 CULBERTSON DR CONTRACTOR: AAA FURNACE & AIR PERMIT NO: 13120041 CONDITIONING OWNER'S NAME: MCCUTCHEON DAVID AND KAREN TRUSTEE 1712 STONE AVE DATE ISSUED: 12/04/2013 OWNER'S PHONE: 4088651723 SAN JOSE, CA 95125 16, PHONE NO: (408)2934717 ❑ LICENSED CONTRACTORS DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL pZLicense Lic. # CO U REMOVE AND REPLACE FURNACE IN SAME LOCATION Class Contractor V (✓ k" Date 44 I hereby affirm that I am licensed under the provisions of 6apter 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 performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $1866 have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 37533001.00 Occupancy Type: 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 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 FRO CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Issued by: Date: 124k> granting of this permit. Additionally, the applicantunderstands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section RE -ROOFS: 9.18 Signature Date Z' 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 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 Cod on 505, 2 3 nd 25534. Section 3700 of the Labor Code; for the performance of the work for which this Owner or autho ed agent: 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 CONSTRUCTION LENDING AGENCY 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 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 thatthe 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 Dam CUPERTINO GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 1 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 0() (408) 777-3228 • FAX (408) 777-3333 • building(cD-cupertino.org V MISC � J PROJECT ADDRESS IMI C) r I A t jQ fA6 I (1(� V0 APN # -375- 5 j32 not OWNER NAME V�A/I W �71A � �!� PHO 2,3 E -"MAIL, STREET ADDRESS (/� CUt IVB ` C T FAX CONTACT NAME P E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OwNER-Bun.DER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME j 11/ , {� /[I � LICENSE NUMBER -� j /��J/ "j LIC CIO BUS. LIC # iir'OI� COMPANY NAME ` E-MAIL FAXFAX STREETADDRESS �j (f2 ��j�/�/J � CITOTj1i M 15In,F" AM ��. % i ARCHITECT/ENGINEERNAME LICENSENUMBER r ' �,(y� BUS. LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF -4@-8Pft, DUPLEX ❑ MULTI -FAMILY PROJECT IN WILDLAND ❑ YES - PROJECT IN ❑ YES IS THE BLDG AN ❑ YES BUILDING: ❑ COMMERCIAL URBAN INTERFACE AREA FLOOD ZONE- 8-N9�-EICHLER HOME? ` 5 NA - j A� DESCRIPTION OF WORK �- % l ViA!I 1 c TOTAL VALUATION: By my signature below, I certify t ach o follow g: I am the property owner or authorized agent to act on the owner's behalf. I have read this application and the information have pro ed is co ect I have read the Description of Work and verify it isaccu ate. I agree to comply with all applicable local ordinances and state laws relati g to build g con tion. I authorize representatives of Cupertino to enter the ab e,�id t((ified property for inspection purposes. Signature of Applicant/Agent: Date: ( 1� SUFKENVTAL INFORMATION REQUIRED MEPMiscApp_2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 1,0510 culbertson dr DATE: 12/04/2013 REVIEWED BY: Mendez APN: BF#: -VALUATION: $1,866, *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY PENTAMATION FURN/AC USE: SFD or Duplex PERMIT TYPE: WORK remove and replace furnace in same location SCOPE ............... .. . ... . Mech. Plan Check 0.0 hrs $0.00 Plumb, Plan Check Elec. Plan Check Mech. Permit Fee: 1MPERMIT Plumb. Permit Fee: Elec. Permit lee: Other Mech. Insp.0.0 hrs $47.00 Other Plumb Insp. Other Elec. Insp. tlech. Insp. Fee:Plumb. Insp. fee: Elco. Insp Fee: NOTE: This estimate does notinclude fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School iho dont far addn'1 info. District, etc). These fees are basea on me reuttunur FEE ITEMS (Fee Resolution 11-053 Eff. 7%1%13) Plan Check Fee: tr oasv.. �. �•�� FEE »••- - - QTY/FEE - --- MISC ITEMS $0.00 1 # Mechanical $139.00 IWR=<I00 Furnace, Forced -Air Suppl. PC Fee: Q Reg..0 OT 0:0 PME Plan Check: hrs $0.00 $0.00 Permit Fee: Supp/. Insp: Fee:Q Reg. ®OT r 070 hrs $0.00 $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 Construction Tax: Administrative Fee: 1ADMIN $44.00 Work Without Permit? ® Yes iq No $0.00 Advanced Planning Fee_ $0.00 Select a Non -Residential Building or Structure 0 Travel Documentation Fee: ITRAVDOC $47.00 Strona Motion .Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $139.50 $139.00 a $278.50 Revisea: 1 utu, tzu, o (, ," P '? K -t ) r V�- r Prescriptive t Residential A Pro)ectN42— Bance: Residential CF -1R -AL Pae 4of f )imste Zone {} # of Stories OW y HVAC SYSTVVIS - HEATING Configuration Minimum Duct.ulatipi�rig Thermostat (Central, Split, Efficient Distribution Insulation fjl!—� ce Heating'Equipment y J R -Value T e T e and Ca act _') (�FUE or HSPF T e and Location !.Indicate Hearing Type (CenrraI Furnace, .Wall Furnace, Heat pump, Boiler. Electric Resistance, etc. 2: Indicate resistance hearing is allowed only in Component Package C, or except where electric heating is supplemental (i.e., if tots( capacity < 2 KW or 7,00" Bru/hr electric heating is controlled by a time•1imiling device not exceeding 30 minutes). See �1SI(bJ3 exception. 3. Refer to the HERS Verification section on Page 4 of the CF 1 R•ALT Form for additional requirements and check applicable boxes. 4. Indicate Type or Location (Du(-ts. Hydronic in Floor, Radiators, etc.) HVAC SYSTEMS - COOLING Minimum Configuration Efficiency Duct or Piping Thet�nostat (Central, Split, tribution Insulation Cooling Equipment (SEER/EER or R_Value T e S ace, Packa a or H dronic Type and Capacity"' COP) :T: nd Location 1. indicate Cooling Type (A/C. Heat pump Evap: Cooling, etc) . 2. Refer to the HERS Verification section on Page 4 of rhe CF. IR -ALT Form Jot additional requirements and check applicable boxes. 3. Indicate Type or Location (Ducts, H dronic in Floor, Radiators, etc.) WATER HEATING aters and Lis( water heaters and boilers for borh•dome.r:lic hot w Hot (D ep'J pe insulation fadam the DHW hearer to the kitchen(s) land o all undergrouheaters Irnwt nd gas or propane fired, and may nor exceed SO gallons P hot water pipes es is re wired in all corn. on�racka es in all climate zones. External Tank Number in Tank Energy Factor or insulation Water Heater Type/Fuel ion Type Capacity (gal) Thermal Efiicienc R -Value' _,? Qvarem 1. Indicate Tvpe (Storage Gas, Hear Pump, Instantaneous, etc.) ?. Recirculating vstems serving multiple dwelling Rhea incl system for single dwelling unasmenrs of §1 SO(n). The Prescriptive requiseme>tzs � not allow the installation of a recirculating water g 3. The external water heatin tank and i es shall be insulated to meet the re uirements o !SO SPECIAL FEATURES The enforcement agency should P ands special lalttertion to tion.e Special Features specified in this checklist below• These items mav're. ;tire written 'usti rcation NEW R00F ASSEMILY - R'adiant Barrier ` The radiant barrier re uirement of I S l ( 2 does nota .y to roof alterations. Slab Edge (Perimeter) Insulation O YES CJ, R-7 insulation is required. YES: in Climate Zone 16 in Component Packages D, Heated Slab insulation YES C3 NO YES: Slab ed a insulation re uired.for all. heated.siabs in alI Climate Zones. See details in Table 118-A of the standards. Q N"O [ Ralsed Slab Insulation Ca YES YES: In Climate Zones 1, 2, I i, 13, I Q & 16, R=8 insulation is re. wired; in Climate. Zoites 2, & 1 S,:R>4 .is required eom onent P Thermal Mass To obtain Com fiance Credit .for the installation of thermal mass.; t'se the Performance A roach. HERS Provider: gust ?0 Registration Number: Registran Date/Time: Au 2008 Residential Compliance Forms tio lo S pined Prescriptive Certificate of Complianeez 2tii38'Resisientttil HVACAIterations CF-iR-ALT- CAMate Zones 1 and 3 - 7 �teriddrers: En,�orceineMAgertty: 3kste ;,' �'erirlit # C;cudiu Dried ,Duct insulation Eql)• ent TYPO' , `.1:X3st men fldat .- , � iso•.. �f: .,. Paclsageci'Unit ® AFS [78 ®C£?P S ! SEty by's3 s Cover 49ft of ducts` ' Mdi f orrtp xd m ' Setback Indoor Cod ' Q, HSPF _ Ell sf tmronditioned ce , not oar r t� eO p ?sau. ,nest be t Condensing Unit ® EER esist ce ®R 6 (CZ 13 , 1. Eq.tripmeut Type: Choose the equipment being installed; if more than one system, use auother CP -1 R -ALT -HVAC. for eacb system 2. Nfiuimum Equipment E#bcimciea: 13 SEER, 78%AFUE, 7.7f1SPF for typical residential systems. Contra ctor'(Documentation Author's /Responsible Designer's Declaration Statement) • I =t fy that this CertiScate of Compliance doc=cntation is acc%m to and''Conplote • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for -the design identified. on this Certificate of Compliance. • I certify that the energy features and perfarnianee specifications for the design ideaitified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations. • The desip-lbatures identified on this Certificate of Compliance are consistent with the inf on documented on other applicable t compliance forms, worksheets, calculations, plans and spetafications submitted tot agency for approval with the permit lication. yri Name: (� u G Signature: Comp -r 1 V►'� V �ltL Lt City/State/Zip: 2008 Residential Compliance Forms. doc revised 04110/12 INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning Systems, Ducts and Fans (Page 1 of 2 Site Address:Enforcement Agency: Permit Number: 00) (,f WC. Space Conditioning Systems Heating Equipment Equip Type (package- heat um CEC Certified Mfr. Name and Model Number ARI Reference Number 2 #of Identical Systems Efficiency (AFUE, etc.)1,3 (zCF-1R value 4 Duct Location (attic, crawl- space, etc.) Duct R -value Heating Load tu/hr Heating Capacity Btu/hr 0Ar Sj1�22 a _�U,CS�� Cooling Equipment Equip Type (package heat PUMP) CEC Certified Mfr. Name and Model Number ARI Reference Number 2 # of Identical Systems Efficiency (SEER and EER) 1.3 (ZCF-1R value)' Duct Location (attic, crawl- space, etc. Duct R -value Cooling Load (Btu/lu) Cooling Capacity (Btu/hr 1. If project is new construction, see Footnotes to Standards Table 151-B and Table 1 SI -C for duct ceiling alternative compliance. 2. ARI Reference Number can be found by entering the equipment model number at http://lvwiv. aridirectory. orglarilac. php# 3. Listed efficiency on this page must be greater than or equal (>_) to the value shown on the CF -1 R form. 4. When CF -IR is reference it is also applicable to the CF -IR, CF -IR -AA or CF -IR -ALT ALL BOXES MUST BE CHECKED TO BE A VALID FORM ❑ §110-§113: HVAC equipment is certified by the California Energy Commission. ❑ §150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA, or ACOA. ❑ §150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of § 112(c). ❑ §1500)2: Pipe insulation for cooling system refrigerant suction, chilled water and brine lines meets minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entirely in conditioned space. 2008 Residential Compliance Forms August 2009