13090113CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 6017 BOLLINGER RD
CONTRACTOR: CALIFORNIA DELTA
PERMIT NO: 13090113
MECHANICAL INC
OWNER'S NAME: KHAJA RIAZUDDIN AND RIAZUDDIN ASMA
6056 E BASELINE RD STE 155
DATE ISSUED: 09/16/2013
OWNER'S PHONE: 6502450714
MESA, AZ 85206
PHONE NO: (866) 692-5273
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class Za Li,. # 2�& Y
REMOVE AND REPLACE HVAC
��''0
Contractol �'l<Date
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
performance of the work for which this permit is issued.
Sq. Ft Floor Area:
Valuation: $2871
LN e and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 37538002.00
Occupancy Type:
ction 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 FAOM LAST 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
f 142 �• ��
�`�
Issued b y' Date
granting of this permit. Additionally, the applicant understands and will comply
with all non-point source gulations per the Cupertino Municipal Code, Section
9.18. ,
/
Signatu Date 9 r –L
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
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 M icipal Code, Chapter 9.12 and.
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 2550�3,and255
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized age 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 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
CUPERTINO
GENERAL PERMIT APPLICATION �� M E P
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(a�cupertino.orcl MIS
❑PLUMBING
MECHANICAL
❑ELECTRICAL
U
PROJECT ADDRESS `O/�
v
/
NAME
LICENSE NUMBER
yyyMIISCELLANEOUS
OWNER NAME ,(
E-MAIL
FAX
P NE _
/
E MAH.
STREET ADDRESS
PROJECT IN WHDLAND ❑ YES
URBAN INTERFACE AREA ❑ NO
y
FAX
CONTACT NAME // -
,-/y
PHO
E-MAIL
STREET ADDRESS
CITY_S ATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ARCONTRACTOR ❑ CONTRACTOR AGENT
❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
C CTO NAME
i- n - l7.
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�cd�+lC��
LICENSE BER
LICENS TYPE
00
BUS. LIC #
E-MAIL FAX
or/
EET ADDRESS -
rCARCFUTECT/ENGINEER
CTT�Y/, STATE, ZIP
NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY
BUILDING: ❑ COMMERCIAL
PROJECT IN WHDLAND ❑ YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN
EICHLER HOME? ❑ O
DESCRIPTION OF WORK IP C, C�
TOTAL VALUATION:
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the pdoperty owner's behalf. I have read this
application and the information I have provided is c I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buildin n. I authorize re r to enter the above-ide tifieedd property /for inspection purposes.
Signature of Applicant/Agent: Date: / s�`
INFORMATION REQUIRED
MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
1711711 . F.4ZT1M A TnR — RTTTT .DINE T)TVI4ION
imlADDRESS:
6017 BOLLINGER RD
DATE: 09/16/2013
REVIEWED BY: MELISSA
APN: 326 43 005
BP#:
"VALUATION:
1$2,871
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
0.0 1
PENTAMATION FURN/AC
USE:
PME Plan Check:
PERMIT TYPE:
WORK
REMOVE AND REPLACE HVAC
SCOPE
$0.00
Mech. Plan Check 10.0 1 hrs $0.00 .Plumb. Plan Check
Mech. Permit Fee: 1MPERMIT Plumb. Permit Fee:
Other Mech. Insp. 0.0 hrs $47.00 Other Plumb Insp.
Alech. Insp. Fere: Plumb. Insp. Fee:
F.lec. Plan (..heck
Ffec. Permit roe:
Other floc. Insp.
Elec. Insp. Tee:
NOTE: This estimate does not inehtde fees due to other uepartments (Le. manning, ruouc worKs, Lire, aunuury ocwer "13truz, ours—
�.._ _ 7% s t.. -11 ... sL , ,/:... .,f niinn nunilnblo n»d nro nnhy not octimato_ Cantact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E f 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
= #
$70.00
Mechanical
1BREMAIR A/C Units (<=10K cfm)
Suppl. PC Fee: E) Reg. Q OT
0.0 1
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Supp/. Insp. FeeQ Reg. Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$47.00
Construction Tera:
Administrative Fee: 1ADMIN
$44.00
0
Work Without Permit? ® Yes Q No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
(E)
Travel Documentation Fee: I TRAVDOC
$47.00
Strong Motion. Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg- Stds Commission Fee: IBCBSC
$1.00
...
$139.501
$70.00:
-
$209.50
Revised: 08/01/2013
HVAC ALTERATIONS ENERGY COMPLIANCE FORM
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildina5cupertino.ora
WHEN IS A PERMIT REQUIRED
A construction permit shall be obtained from the enforcement agency prior to the erection,
construction, reconstruction, installation, relocation, or alteration of any mechanical system, except as
permitted in Chapter 1, Section 112.2 of the 2010 California Mechanical Code. Projects requiring
permits include, but are not limited to:
• New HVAC installation
• HVAC Changeout
• Replacement of furnace, coil, FAU or condenser
• Relocation of an existing HVAC unit
• Adding or replacing more than .40 -ft ducting in unconditioned space
BUSINESS AND PROFESSIONS CODE, SECTION 7110
Willful or deliberate disregard and violation of the building laws, including the California Building
Code, and local permit requirements constitutes a cause for disciplinary action from the Contractors
State License Board working in conjunction with the local building department. This action may
consist of fines up to $5,000 per violation or suspension/revocation of a contractor's license.
2008 BUILDING ENERGY EFFICIENCY STANDARDS (Title 24, Part 6) REQUIREMENTS
INCLUDE:
1. Heating equipment must have a minimum 78% AFUE (Exception: Wall & floor furnaces; room
heaters).
2. Central air conditioners & heat pumps less than 65,000 Btu/hr must have a minimum 13 SEER.
3. Newly installed or replaced ducts must have a minimum insulation value of R-4.2.
4. A setback type thermostat (24 hr clock with four set points) is required for all alterations.
5. New or replacement ducts must meet the mandatory requirement of Section 150(m).
• All joints and openings in the HVAC system must be sealed.
• Only UL 181, UL 181A, or UL 181B approved tapes or mastic shall be used to seal duct
openings.
• Connections of metal ducts and the inner core of flex ducts shall. be mechanically fastened.
Flex ducts must be connected using a metal sleeve/coupling.
• Flex ducts that are suspended must be supported every 4 ft. max for horizontal runs with no
more than 2" of sag between supports and 6 ft. max for vertical runs.
6. The CF-6R-MECH-04 must be completed and signed by the installing contractor. The Inspector
will collect this form and verify that the model numbers are the same as the installed equipment.
2008 Residential Compliance Forms.doc revised 04/10/12
2008 Residential Compliance Forms.doc revised 04110112
Conditioned
Dud insulation
EquipmentTyp?
i sflicien��
Ti
M-Padmgbd Unit
E3 Furnace
QSt
COP
system
Sq%pd, stem
asf
OverOfto, duns''
&I
or]
a� - i6p#cedin
Isetback
be
Indoor Coil
Condensing Unit
E3 EER
Rsistance
I W
unconditioned space
Other -
JPR6 (CZ 1, 3-5)
1. Equipment Type. Choose the equipment being installed; if more than one_system, facm, use another CP -1R -ALT HVACfor each system
2- Afinimum Equipment Efficiencies: 13 SEEP, 78% AFUE, 7.7HSP.F for typical residential systems.
Contractor(Documentation Author's /Responsible Designer's Declaration Statement)
a I cer* That this Certificate of Compliance documentation is accurate and co�lztc.
a 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.
0 1 certify that the energy feattues and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24, Parts I and 6 of the California Code of Regulations.
e The design features identified on this Certificate of Compliance are consistent with the information documented on ad= applicable
compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit
application.
Nannie:
CO y-
Zpanr,
Date.
License:
Cit31/StkeaiF-
Tbofit:
6,P111 7
2008 Residential Compliance Forms.doc revised 04110112