15080076�Au
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11652 BRIDGE PARK CT
CONTRACTOR: RESIDENTIAL HEATING
PERMIT NO: 15080076
AND A/C INC
OWNER'S NAME: ENGELMAN PNINA AND ELI
65 CRISTICH LN
DATE ISSUED: 08/10/2015
OWNER'S PHONE: 4088918396
CAMPBELL, CA 95008
PHONE NO: 4083774073
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑
7� �JcSs
REPLACE (E) FURNACE & A/C, SAME LOCATIONS
License Class Lic. #
n� /�,� t rC
Contractor Resd� I l I � l� Qd Date_Z3 � s
YTI
I hereby affirm that I am licensed under t e 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
Sq. Ft Floor Area:
Valuation: $13000
performance of the work for which this permit is issued.
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: 36652051.00
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 0EXY4MT 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 F ALLED 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
granting of this permit. Additionally, the applicant understands and will comp y
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
O /(S
RE -ROOFS:
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
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)
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 Code, Sections 25505 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
�ic �
Owner or authorized agent: /ODate:
permit is issued.
_&,/]2/,
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 APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
MEP
Imo' 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building0-cupertino.or�gMISC
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❑PLUMBING U MECHANICAL ❑ ELECTRICAL ❑ MISCELLANEOUS
PROJECT ADDRESS I I'n 5 R ✓I d O// V j� co `,r.
APN # _3(
OWNER NAME Ben Fn '1mq,^
PHONE O�_p^ I — 10
E-MAIL
bnmn �oo. C�
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STREET ADDRESS � i vs B V *(d G F „, ^ � �
CITY, STATE, ZIP C qv_ H�n o (, iJ� O' i
FAX
CONTACT NAME V I1 �n Ct)0j)in
7PHONEqob -111-4073
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E-MAIL Ve-7FAx4.8
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STREET ADDRESS (5 Cr i s ti Ch L G .n e
CITY, STATE, ZIP C b QI ( CA 95 OOg
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13OWNER ❑ OWNER -BUILDER 1:1OWNER AGENT 13CONTRACTOR ❑ CONTRACTOR AGENT 13ARCHITECT 11ENGINEER 11 DEVELOPER ❑ TENANT
CONTRACTOR NAME ResidenticU �t¢ati 4A/C
LICENSENUMBER 705554
LICENSE TYPE �
BUS. LIC#
COMPANY NAMEdential uving; Pr
E-MAIL kellq ti)resih>eaconm
FAX 409-377-US1
STREET ADDRESS ( r, Gr jr fl C� ' ^ e
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CITY, STATE, ZIP C ^ � t I, ! � q%C6
1 M " \ lI� �l w
' OQ _,3 7 j - q O� 2
PHONE 40'6_,37j -q0-1_3
V 1 J
ARCHITECT/ENGINEER 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 WILDLAND ❑ YES
URBAN INTERFACE AREA NO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK Zp I Q G' N -N r n ace A/c
TOTAL VALUATION: 13 00o RECEIVE - �^
By my signature below, I certify to each of the following: I am the property owner or authorized agent on the ope s behalf. I have read this
application and the information I have provided is correct. 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 building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date:��U/�S
SUPPLEnENTAL INFORMATION REQUIRED
OFFICE USE ONLY
❑ OVER-THE-COUNTF,R
r
t
❑ EXPRESS
v
U
❑ STANDARD
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a
❑ LARGE
❑ MAJOR
MEPMiscApp_201 1. doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
APPLIANCE / EQUIP TYPE
ADDRESS: 11652 BRIDGE PARK CT
DATE: 08/10/2015
REVIEWED BY: MELISSA
UNITS
APN: 366 52 051
BP#:
`VALUATION: $13,000
°PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: SFD or Duplex
#
PENTAMATION
PERMIT TYPE: FURN/A
WORK
REPLACE E FURNACE & A/C SAME LOCATIONS
SCOPE
` HppL Insp Fee
APPLIANCE / EQUIP TYPE
FEE ID
r'Irtmb. Plan C:`hecr`v
QTY
UNITS
BP FEES
I les. Permit Fee:
A/C Units (<=10K cfm)
1 BREMAIR
:rt,< i t.tuc- hisp LLI L
1
#
$72
Furnace, Forced -Air
1MFR=<100
` HppL Insp Fee
1
#
$143
PME Unit Fee:
$215.00
PME Permit Fee:
$48.00
Administrative Fee: IADMIN
$45.00
Work Without Permit? 0 Yes 0 No
$0.00
TOTALS:
Travel Documentation Fee: ITRA VDOC
$215.00
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 nreliminary information available and are onlv an estimate. Contact the Dept for addh7 info.
FEE ITEMS (Fee Resolution 11-053 a.' 711113)
Mech. Plan Check 0.0 1 hrs $0.00
r'Irtmb. Plan C:`hecr`v
Flee. Pleas Cheek
Mech. Permit Fee: IMPERMIT
111/11-b, Pernail Fee:
I les. Permit Fee:
Other Mech. Insp.0.0 hrs $48.00
:rt,< i t.tuc- hisp LLI L
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 nreliminary information available and are onlv an estimate. Contact the Dept for addh7 info.
FEE ITEMS (Fee Resolution 11-053 a.' 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check
icPpL PC Fee
PME Plan Check:
$0.00
Permit Fee:
` HppL Insp Fee
PME Unit Fee:
$215.00
PME Permit Fee:
$48.00
Administrative Fee: IADMIN
$45.00
Work Without Permit? 0 Yes 0 No
$0.00
Travel Documentation Fee: ITRA VDOC
$48.00
Strong Motion Fee: IBSEISMICR
$1.69
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$358.69
$0.00 TOTAL FEE:
$358.69
Revised: 07/02/2015
STATE OF CALIFORNIA
ALTERATIONS - HVAC
13
CEC-CFIR-ALT-03-E Revised 06114 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:
``7 FaY�
11V52 Bridge
Enforcement Agency:
i of cu fiino
Date Prepared:
16 /11) /is
Permit#:
sa8,00 -74
Equipment Type
Equipment Efficiency
New: Ducting, Plenums, Lineset
Conditioned
Thermostat
Required R -value
Floor Area (sq ft)
❑ Packaged System
Evaporator Coil
q AFUE
COP
❑ R-6 (CZ 1,3-7) Ducts
Served by system
❑ Setback
❑ Split System
Im Condensing Unit
Iq SEER
❑ R-8' (CZ 16) Ducts
133gsq ft
(If not already
IZS
HSPF
13R-6 (all CZ's) Plenums
present must
Furnace
11.
Lineset
EER
❑ R-5 or R7.5 Lineset3
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.
1. HVAC Changeout/Repair
Required Compliance Documents to be left on site for Final:
Can include new ducting
All Equipment,
CFIR-ALT-02-E
Condenser Unit, Evaporator Coil,
CF2R: MECH-01, MECH-20-HERS
Air Handler/Furnace
CF3R: MECH-20-HERS
Installer Requirement: Duct leakage (L15% 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 ....... Jl
❑ 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 CFIR-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
CFIR-ALT-02-E
space but less than All New Ducts'
CF2R: MECH-20-HERS
CF3R: MECH-20-HERS
Installer Required to: Duct leakage (S_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.
3 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-2%", 3.5 to 4T-2%", 5T -4'/a"
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. I 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:
License:
M5551
Welly MCDC16fl
/!'l
$ 10 ](s
Company.
Address:
City/State/Zip: Phone:
RK1 dMU H01rig ;Alc,
t -'s Ci St i ch Car12
C I I, Cit qs 408 -3 7 i- 407 3
For assistance or quistions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300