30421 APPL•ICANTTO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY A 1
CITY OF CUPERTINO BUILDING-ELECTRICAL PERMIT NO. 30421
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BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MECHANICAL `l/
BUILDING PROJECT'IDENTIFICATION
BUILDI�D`&!5/ OOa/y�(/, SANITARYNO. APPLICATION SUBMITTALDATE
OWNER'S AVV((//�9 PHONE:T1 CONTRACTOR'S NAME: LIC NO.
Ick- ti N/C CONTROL#
Clulf. NGINMR: LIC NO: ADDRESS: F-1
CON'fnCT: yyHON' BUILDING PERMIT INFO
Vic*
ry I �`.I�^ ❑ Consultant Fees Paid by Applicant(Initial) BLDG ELECT PLUMB MUCH
i rpyn/V( —D Z ❑ ❑ ❑ ❑
LICENSED CONTRACNR'S ULCLARA'IION QTY ELECTRIC PERMIT FEE
ogz1 hereby affirm,mar I am licensed ender provisions of chapter 9 commencing JOB DESCRIPTION
U10, with Sexamn]aWbf Division 3 ofthe Business and Professions Code,and my license is
1 w. in full force and effect. PERMITISSUANCE
f
5 F License Class Lic,p
FDWL ❑KITCHEN REMODEL
r[a „)UU
a Date Contractor APPLIANCES—RESIDENTIAL ❑ADDITION ❑PLUMBING RE-PIPE
ARCHITECT'S DECLARA'I'[ON PANELS ❑MULTI-UNIT ❑STRUCTURAL.
z p�2 7a - I understand my plans shall be used as public records MODIFICATION
O unFc UP'fU 2W AMPS a0 ❑INTERIOR ❑CHIMNEY REPAIR
FH Licensed Prnfeesbml 201-IOOOAMPS IMPROVEMENT
�d a$D❑� OWNER-BUILDER ifi firm the
RATION OVER IWO AMPS - ❑BATH REM06EIJREPAIR ❑DFMOLI'I']ON
da{IWz�1 a I hereby aliirm that 1 ora exempt Gam the Cnnlructnre License Law for the
�Lx O L U following resent.(Section 7031.5,Nmi....nd Professions Code:Any curer county SIGNS ELECTRICAL ❑OTHER
W R t F' which topuires a permit to conswct,alter,improve,demolish,or repair any structure
_Wi} primmit,ovashoe,alm requires theupplietan for such penni0o filesaignedstatemeo SPECIAL CIRCUIT/MISC.
S that he is Iicensad pursuant to the Pori of the Caricatures License Low(Chapter 9
W^p0 (commencing with S¢tion7")of Division 3 ofthe Business and Professions Code)m TEMP.METER OR POLE INST. COMMERCIAL,
as
Ii L as C that he is exempt therefrom and me basis for me alleged exemption.Any violation of [I NEW BLDG/ADDITION [I DEMOLITION
u• Section 7031.5 by any applicant for a permit subjects the applicantto a civil penalty of POWER DEVICES
rN of mom'ban five hundred dollars($500).
❑TENANT ❑FOODSERVICE
�ZQ ❑1,as owner of the property,or my employees with wages as their sole compensation, SWIMMING POOL ELECT RIC IMPROVEMENT
will Jo the wmk,anddracurmre isnot intandednroffeted rustic(Sec 70,4.Business ❑OTHER
x G and Professions Cole:The Contractor's License Law does not apply to an owner of OUTLETS—SWITCHES—171XI URES
property who builds or Improves thereon,and whn does such work himself or Ihrnngh
his own employees,provided that such Impmvenmms are not intended or offered lin NEW RESIDLNf1A1,ELECTR SQ UC
sale If,however,the buiidingorimprovenamit xsold within one yearof completion,the SQ.FY FLOOR AREA S/SQ,FT.
trbuiteer will have the burden minoring that he Jid not build or improve for put-
owner
ve irritate.).
Las owner of the property,an exclusively Prefi ting with licensed contractors i- TOTAL"3 3
aroma des not (Sec.o an owneBusir
of tad properly
who but ds or)imphs,roves
esnfmoon, ted Z Z S
come Lew arcs not apply to an owner of property who builds or improves thereon,and Ql'Y. ERMIT PEE 6 9 3
' who contracts for such projects withncomcacmr(s)licensed TomorrownNContracContractor'so Contractor's 1110"1 Pap
❑1 am exempt under Sec. B&P C for this reason
Licence Law' PERMIT ISSUANCE
Owner
ALTER—DRAIN& —WAIL ) VALUATION
nate
WORKER'S COMPENSATION DECLARATION RACK FLUW PROD? .DIIVI , ^� Q Q O
I hereby affirm under penalty tf perjury one of the following declarations: J
I bltvo end will nminmin aCenlficma tel'Cnroennoaulfpal -ireurefor Worker's C(au,u DRAINS—PLO Ot REA,GOND. STORIES 'TYPE CONSTRUCTION
count,use provided for by Section 3700 of the Lubar Code,for the performance it the
work for which this permit is issued. FIXTURES—PE AI' r
n 1 have and will maintain Workers.,Compen.valion Insurance,as required by Section 7
37M of the Labor Code.for the performance of the work for which this permit is issued GAS—LA.SYSTV IN (LETS OCC GROUP APN
My Workers,Compenmcarrier num
tim Insurance carr and Policy ber are:
Carrier. Policy Na.: GAS—EA.SYSTEM-O :R :A �+�•I D S
CL•RI'IFICATE OF"XHNI PITON FROM WORKERS'
COMPENSATION INSURANCE GREASEBNDUSTRL WASTE INTERCEPT
(This section need not he completed if the permit is for one hundred dollars lS iot) - p PLANCHECK FEE BUILDING DIVISION FEES
I
or less.)certifth
y at mike performance of me work for which this permit is issued,1 shall P
GREASETRAP ZC
not emto n person in an manner so as to become subject the Workera Cron SEWER—SANITARY—STORM A IXI
P Yu any a 1 pin- ENERGY FEF.
,� Xulinn Laws of California.Date WAT[R HFB'fER W I LT: R
Applicant - GRADING FEE
y NOIICE TO APPLICANT:If,after making thh Cerfiftaw of Exemption,you should WATER SYSTEM/I'RPA'1'INC
F become subject to the Worker's Compensation provisions of the Labor Code,you mustN 1111.1 FBI� forthwith comply with such porchionsor this Permit shall he,deemed revoked IC
WATER SERVE
0
.a7. z CONSTRUCTION LENDING AGENCY NEW RESIDFMIAL PLMR. SQ.FT. PAID
UQ I herebywhich
isscomwnion len ding agency fanhe perfonnance of Date Rn p .
E•' the work for which this pemdt is issued(Sec.AN],Ci,C.)
O U Lender's Name (YfAL:
Lender's Address TOTAL: 3
H0. 1 certify that 1 have read this application and state that the have information is BUILDING FEE
N correct.I agree to comply with all city and county ordinances and state laws relating to QTY. MECHANICAL PERMIT FEF;
U z building construction,and hereby authorize representatives ofthis city manner upon the SEISMIC FEE
sr abavctmnlienod property for inspersion pmpusex. ..
(We)agree ur save,iudannlfy and keep harmless the City of Cupertino against PERMIT ISSUANCE ELECTRIC FEE rh
!n
mubilitiw,judgments,costs and expenses which may in any way acerae against said City ALTER OR ADD TO MUCH. - N
scyucace ofthe granting of this permit. PLUMBING FEE
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNTP(TO IO.WUCFM)
SOURCE REGULATIONS, MECHANICAL FEE
AIR HANDLING UNIT(OVER IBM)CFM) CONSTRUCI'IONTAX
Signamrco(ApplicanVCanancurr Dare EXHAUST HOOD(WIDUCry No-
HOUSING MITIGATION FEE'
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material HEATINGUNIT(TO 100.000 BTU)
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 2553$x)? HEATING UNIT(OVER 100,000 I1'TU)
[3 Yes ❑No VENTILATION PAN(SINGLE RESID) PAID
Will.meapplicant ter future handingocenpunt use egnipment or devices which Date Resciaa
t haeatdous air contaminants as defined by the Bey Area Air Qualify Management BOILER—COMP IMP 011 IfN1,000 B'IV)
rid^
H'AL:
❑Yee []No BOILER—COMP(OVER II111,00RTU)
Ihave read the interactions materials requirements under Chapter 6.95 of the Cull AIRCONDITIONER ISSUANCE DATE
fomix Health&Safety Cone,Secure,25505.8533 and 25530.1 toderstoW that if the NEW RESIDENTIAL MECH. SQ.UT.
building dues not currently have a tenant,that if is my respatlsibility,to a rify the occupant
of the requirements wman mus he met norn,iamance of a Cenificate of Occupancy.
Owner or omuma.ed agent Dam TOTAL:31$ SSUED BY:zgg ��_
OFFICE
INSTALLATION CERTIFICATE CF-6R
Use of this form to aatisty the nqulnmont• of the Administrative Codi 1s optional, but the Infonnallon mint be provided and posted.
2o � is 202-f6,11ES ak, CvpFIZnNO 30421
•
Site Address Permit Number
r
An installation certificate is required to be posted at the building site prior to the issuance of the occupancy
permit; this form may be used to meet these requirements. All appliance categories listed below are the actual
equipment installed. Note that the efficiency and type of the appliance installed must be equivalent or better
than the appliance specified on the certificate of compliance (Form CF-1 R). This certificate (or its equivalent)
shall be prepared and signed by the person(s) assuming overall responsibility for the appliance installation.
Refer to the reverse side of this certificate for an explanation of information required.
I, the undersigned, verify that the equipment listed in the category above my signature is the actual equipment
installed and that the equipment meets or exceeds the requirements of the Appliance Efficiency Standards.
In addition, I have verified that the equipment is equivalent to or more efficient than the equipment specified
on the Certificate of Compliance submitted to demonstrate compliance with the Energy Efficiency Standards
for residential buildings.
HVAC SYSTEMS:
Heating Equipment
Heating Equip. CEC Certified Actual Distribution Dud or Heating Load Heating
Type (Packaged Manuf.Make& Efficiency Type and Piping Before Over- Equipment
heat pump, etc) Model Number (AFUF. etc.) Location R-Value Sizing (Btuhl Capacity (8tuh)
ccetzeL �8 'FAv n o 09 It,W
L A) J�Av/ ow,v. l�
Cooling Equipment
• Cooling Equipment Actual
Type (Packaged CEC Certified Compressor Unit Efficiency Dud Duct
heat oumo. etc) Manuf Make&Model Number (SEFR) Location R•value
/Z 4
Signature, Date HVAC Subcontractor(Co. Name)
OR General Contractor OR Owner
WATER HEATING SYSTEMS
Distrib. Water CEC Certified Energy Tank Insul Internal Pilot Rated Solar/
System Heater Manuf. Make & Factor/ Volume Wrap Insul. Standby Light Input Wood
Iygg /# Model# Effic, al(g Ions) R-value HYalue Loss (%I (Btuhl kW/Btu Credits
Rho�r� PaPFPA EEMn 79 _ �� #9--? 9W,7 7f
_
FAUCETS & SHOWER HEADS:
All faucets and showerheads installed are listed in the Commissions Directory Of Certified Faucets And Showerheads,
. pursuant to Ti11e-24, Part 6, Subchapter 2, Section 111.
Signature, Date tubing Subcontractor(Co. Name)
g 7 OR General Contractor OR Owner
Insulation Certificate
- �6Ji �oo�4ak-s �� CvP�ynNo
^�Number and Street City
• /r1",
Cowry Subdivision Lat tiu,-tce:
Description of Installation
ROOF {�
Material �g1.InAa0 wT O&A C�� (k9sA Brand Name 14—P4 � P00NtYj PP40 Vez
Thickness(inches) / '' Thermal Resistance(R-Value) /r B 065,
CEILING
Batt or Blanket Type EA17S Brand Name QN6tJS 0DAWN/
Thickness(inches) v Thermal Resistance(R-Value) 7aO
Loose Fill Type Brand Name
Contractor's minimum installed weighTlb Minimum thickness inches
Manufacturer's installed weight per square foot to acheive Thermal Resistance(R-Value)
EXTERIOR WALL /t
Material Brand Name OWEOS Cad IA-16
Thickness(inches) Thermal Resistance(R-Value) Q-)3
RAISED FLOOR
Material 9A-TTS Brand Name 01A),5/45 Lb2i4t44
Thickness(inches) ¢ Thermal Resistance(R-Value) IR-/g
SLAB FLOOR
Material Brand Name
Thickness(inches) Thermal Resistance(R-Value) R- /
Width(inches)
FOUNDATION WALL
Material &175 Brand Name l9WiJS COtt//i14
Thickness(inches) 3 S Thermal Resistance(R-Value) -/3
Declaration
I hereby certify that the above insulation was installed in the building at the above location in conformance with
the current Building Energy Efficiency Standards for new residential buildings contained in Tide 24 of the
California Administrative Code.
General Conuactor(Builder) License Number
Signature and Tide Date
Corw- /N5ULAV0-,<% 46S-44O 67-2-
• Sub-Conuactor(insulation installer) License Number
J -30 -47
slz�t MTS Bnature and Title Date
Complim¢e Forms h�D J.�nuury 1, 1995
INSTALLATION CERTIFICATE CF-6R
The following is an explanation of many of the input values required on the opposite side of this form:
HVAC SYSTEMS
Heating Equipment T e- must be one of the following:
• Furnace: Gas or oil-fired central furnaces 8 space heaters.
Boiler: Gas or oil-fired boilers.
PckoHeatPump: Packa ed central heat oumos.
Spl rHeatPum : Split central heat pumps.
RoomHeatPum : .Room heat pump.
Lr Pck HeatPum : Large Packaged Heat Pumos (265.000 Btuh output).
Electric: Electric resistance heatinq HSPF=3.413. Radiant electric resist. healinq HSPF=3.55
CombinedH dro: Reference water heater under water heating systems, below.
Refer to CEC publication "Appliance Efficiency Regulations", P400-92-029.
CEC Certified Manuf. Make & Model Number; from applicable CEC appliance directory.
Actual efficiency; from applicable CEC appliance directory.
Distrib type & location; Distnb type is "Ducts", "Piping'or both. Duct location is Attic', "Crawlspace',
'CVCcrawlspace'or-Conditioned space". Piping location is to be listed as 'Gond.'or "Uncond.".
Duct or Piping R-Value; from the Directory Of Certified Insulation Materials and/or manuf's data.
Heating Load Before Oversizing; refer to CEC -approved heading load caiculation procedure. This is the heating
load resultprior to application of the factor recommended in the bad calculation procedure for oversizes the appliance to
account for the use of a setback thermostat.
Heating Equipment Capacity; from the applicable CEC appliance directory. Note; location elevations over 2000 it
above sea level require a derating of output capacity(refer to manufacturers literature).
Cooling Equipment T o; must be one of the following:
SolitAirCond: Split sstem air conditioner.
PckoAlrCond: Packaged air conditioner.
S litHeatPum : Split sstem heat oumo.
Pck HeatPum : Packaged heat pumo.
RoomHeatPumo: Room heat pump.
LgPckgHeatPump: Large Packaged Heat Pumps(265,000 Btuh output). Substitute EER for SEER when
SEER is not available.
RoomAirCond. Room air conditioner. Min. SEER varies'
• LrgPckgAirCond: Large Packaged Heat Pumps(265,000 Stuh output). Substitute EER for SEER when
SEER is not available.
. EvapDirect: Direct Evaporative Cooling System. The SEER is fixed at SEER=11.0. The duct
condition is to be fixed at location=attic and duct insulation R.value=4.2.
Evapindirect: Indirect Evaporative Cooling System. The SEER is fixed at SEER=13.0. The duct
condition is to be fixed at location-attic and duct insulation R-value=4.2.
Refer to CEC publication'Appliance Efficiency Regulations", P400.92-029.
WATER HEATING SYSTEMS
Distributions stem t e: refer to Residential Manual for more details.
Standard: Standard POU/HWR: Point of use/Hot water recovery
Pioe Insulation: Pie Insulation RecirciNoControl: Recirculation loop with no control
RecirclTmer Recirculation loop with a timer Recirc/Demand: Recirculation loop with demand
control
Recirc1T7me+Temp: Recirc. loop with timer and temp Recirc/Tamp: Recirculation loop with temperature
control control
The table below summarizes the water heatinq system items needed by water heater type.
Input item NAECA NAECA NAECA Instant. Instant. Large Indirect
Storage Storage Heat Gas Electric Storage Gas
Gas or Oil Electric Pump Gas Boiler
Energy Factor Yes Yes Yes Yes
Pilot Input, Btu Yes Yes
Recov. Etf., fraction Yes Yes (AFUE)
Standby Loss, % Yes
Tank Volume, gal. Yes Yes Yes Yes Yes
Tank Insulation, R Yes Yes
Ext. Insulation, R Yes Yes Yes Yes Yes
Additional Information Required If Combined Hy cranio System:
Rated ftuu kBtuh Yes Yes Yes
Rated Input, kWl Yes Yes
Rec. Elf, fraction Yes