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13030001 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7762 ROBINDELL WAY CONTRACTOR:FLANDERS HEAT&AIR PERMIT NO: 13030001 SYSTEMS,INC OWNER'S NAME: MC DOW ELL PETER E AND ANNE E 555 PETERS AVE STE 255 DATE ISSUED:03/01/2013 OWNER'S PHONE: 4083710705 PLEASANTON,CA 94566 PHONE NO:(925)461-3333 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB F License Class Lie.#/� X MECH r RESIDENTIAL r COMMERCIAL Contractor 14 F1491164', �7`" Date 5-1 I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REMOVE AND REPLACE FURNACE (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:$1575 1 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 permit is issued. APN Number:36223008.00 Occupancy Type: APPLICANT CERTIFICATION 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Issued by: Date: 3• •��`-- 9.18. 1Q Signature Dale—�3 RE ROOFS: ❑ OWNER BUILDER DECLARATION 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 1 hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sce.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(x)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health Safety Code,Sections 25505,25533,and 25534. 1 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 Ow r hori e at ens Q_ �� Compensation laws of California. If,after making this certificate of exemption,I Date:��•J become subject to the Worker's Compensation provisions of the Labor Code,I 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 work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18, Licensed Professional Signature Date MEPMueAPP_2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 7762 Robindell Way DATE: 03/01/2013 REVIEWED BY: Sean 10 APN: BP#: 3 *VALUATION: $1,575 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: PERMIT TYPE: WORK Remove and replace furnace. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $133 TOTALS: $133.00 Mech.Plan Check 0.0 hrs $0.00 P/wnh.Pian Check Mech.Permit Fee: 1MPERMIT P/u,nh. Perntil F'--le Other Mech.Insp. 0.0 hrs $45.00 Odher Phimh Insp. Other[iii.r,Irs]). ;tfech. rnsp. Fe : Phnnb.bap.Fee: Elca Insp. Fee. NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These ees are based on the prellmina information ayailable and are only an estimate. Contact the Dept for addn I info. FEE ITEMS (Fee Resolution 11-053 Eff 711112) FEE QTY/FEE MISC ITEMS Plun Check Fee: 'Sup/71. PC Fee PME Plan Check: $0.00 Permit Fee, Suppl. hasp Fee PME Unit Fee: $133.00 PME Permit Fee: $45.00 Cun.srruefion Tax: Administrative Fee: 1ADM/N $42.00 Work Without Permit? O Yes (E) No $0.00 t l:acre,d Phtnnilxg Fees: Travel Documentation Fee: ITRA VDOC $45.00 Strong Motion Fee: IBSE1SAffCR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 'f SUB�TUTAI S,:' $266.50 $0.00 TOTAL FEE: $266.50 Revised: 01/01/2013 IlY 1L1ATax tj TION CERTIFICATE CW6R:1KEC$-04 S 4ee1' od'ditionin Systems,Ducts and Fans vr;' a e 2 of 2 Site Addressor- -- . -.. forcementA envy. Permit Number. bI QJ elUJ 0jKj li r n � Ducts and Fans §150(m):Duct and Faus R 1.All airdistn'bution system dudt's and plehuius installed,sealed and insulated to meet the requirements of CMC Sections 601,602,603,004„605 and Standard 6-5;supply-air and return-au ducts and plenums are insulated to a minimum installed level-of R 4,2kor enclosedientirely in conditioned space. Openings shall be sealed with mastic,tape or other duct-dlosure system that meets the,14pplicable requirements of UL 181,UL 181A,or UL 181B or aerosol sealantthatmeets the requirement of U 723: If mastic or tape is used to seal openings greater than 1/4 inch,the mbinanon of mastic and either mesh or tape shall-be used;and -1.Building.cavities;supportplatfotms for:sir handlers,and plenums defined or constructed with materials other sealed sheet metal,duct board or flexible duct shall not be used for conveying conditioned air. Building cavities and support platforms may contain dudts. Ducts installed in cavities and support platforms shall not be-compressed to cause reductions in the cross-sectional area of the ducts. 2D.Joints and seams of duct systems and their components shall not be sealed with cloth back rubber adhesive duct tapes unless such tape is used.in combination with mastic and draw bands. 7.Exhaust fan systems have back draft or automatic dampers. Allyq 8.Gravity ventilating systems serving conditioned space have either automatic or readily accessible,manually erated.dampers. 9.Protection of Insulation.Insulation shall be protected from damage,including that due to sunlight,moisture, /equipment maintenance,and wind.Cellular foam insulation shall be protected as above or painted with a coating that is ater retardant and provides shielding from solar radiation that can cause degradation of the material. 10.Flexible ducts cannot have porous inner cores. DECLARATION STATEMENT • I certify under penalty of perjury,under the laws of the State of California,the information provided on this form is true and correct • I'am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction,or an authorized representative of the person responsible for construction(responsible person). • I certify that the installed features,materials,components,or manufactured devices identified on this certificate(the installation) conforms to all applicable codes and regulations,and the installation is consistent with the plans and specifications approved by the . _.. .. .. enforcement agency,., .. .,:. '.. .. • I reviewed a copy ofthe Certificate of Compliance(CF-1R)form approved by the enforcement agency that identifies the specific requirements,for the iastallatiQa.;I,certify.that thcrequirements.detailed.on the:CF-1R that apply to the.installation have been'met. • Iwill ensure,thatacompleted,; igpet}copy,,ofthisIustallationCerlifcateshalLbe.posted;or made available with the building permit(s)issued for the buddin��gg„snd,apade available to,the enforepment,agency1for all applicable inspections. I understand that a signed copy ofthis Installation Certificateis required to be included with the documentation the builder provides to the building owner at occupancy. t. _ Company Name: (Installing Subcontlactor dr General Contractor or tuild,/Owor Ro-nduzS {kciz” Pct S r1C , Responsible Person's Name-'- Respdhsible Person's ature: b . . CSLB License: Dare. .ioned. position With Co any(T1 0: 9L 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning Systems,Ducts and Fans (Page l of 2 Site Address: Enforcement Agency: Permit Number. Q r'J�'1 net Space Conditioning Systems Heating Equipment Duct Efficiency location . Equip (AFUE, (attic, Type ARI 4 of etc.)1.3 crawl- Heating Heating (package- CEC Certified Mfr.Name Reference Identical (ZCF-1R space, DuctCapacity heat um and Model Number Number 2 systems value° etc. R-value ad' t Vhr &00)0 Cooling Equipment Efficiency Duct Equip (SEER Location Type and EER) (attic, (package #of �'3 crawl- Cooling Cooling heat CEC Certified Mfr.Name ARI Reference Identical (ZCF-1R space, Duct Load Capacity um and Model Number Number 2 Systems value)' etc. R-value w/hr) (Bw/hr 1.Ifproject is new construction, see otnotes to Standards Table 151-B and Table 151-Cfor duct ceiling alternative compliance. 2 ARI Reference Number can be found by entering the equipment model number at http://www.aridirectory.orglarilac.php4 3.Listed efficiency on this page must be greater than or equal(>_)to the value shown on the CF-IR form. 4. When CF-IR is reference it is also applicable to the CF-IR CF-IR-AA or CF-1R-ALT ALL BOXES MUST BE CFIECKED TO BE A VALID FORM 0 §110-§113:HVAC equipment is certified by the California Energy Commission. tr�,t§150(h):Heating and/or cooling loads calculated in accordance with ASHRAE,SMACNA,or ACOA. tkt §150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of§112(c). 041500)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 Simplified Prescriptive Certifieate ofCompliance:2008Residen11a1HVACAIteralionS CF-M-ALT-HVAC C6mateZones 1 and 3-7 - Mk Address.- a L+nforcementAgency: Dat'Lg j 3 Permit#: Conditioned Duct insulation EquipmeatTyrie, List3dinimum,Effid FloorArea requirement Thermostat 13 Packaged unit AFUEB COP_ Over 40 fl of ducts Setback t�q+=-�� Servedb u Indoor Coil ©SEER_ ®,HSP/ Y system added or replaced in already pmew,mma be ©Condeasing.Unit 0 EER_ �Reastaoco sf unconditioned space hwmle4 Offer ®R6 (CZ1,.�L5) e 1.Equipment Type:Choose thoequipmnent being installed;ifmow than one system,use.anotherCF-1R ALT-HVAC for each system. 2.M aurum Equipment Ef deteies:l3"SEER;78%AFUE,7.7E8PF for typical residential systems. Contractor(Documentation Author's/Responsible Designer's Declaration Statement) • I certify that this Certificate of Compliance documentation is accurate and complete. • I am eligible under Division 3 ofthe California Business and Professions Code toaccept responsibility for the design identified on this Certificate of Compliance. - • I certify that the energy features and performance specificationsfor the design identified on this Certificate of Compliance conform to the requirements of Title 24,Potts l and 6 of die California:Code.of Regulations. • The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms,worksheets;calculations,plan•and specifications submitted to the enforcement agency for approval with the permit avolicadon. �-^ Name: 13M+ FI�YIuG s Signature: Company:HaMerS Rest- £ �r S e$EQ m S l rte . Date: f 29( i 3 Aaareaa:555 (a aS v ire, v�fe 255 License: (o-7750Q 'CitytstatelZip: Ua - Phone: Q26)40-3333 2008 Residential Compliance Forms.doc revised 04110112 GENERAL PERMIT APPLICATION M E p COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ■ 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 MIS C CUPERTINO (408)7773228• FAX(408)777-3333•buildinaQcuoertno.ora � ❑PLUMBING MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROSECIADDRESS -7 7lp 2- obi nc - I ( O•. AM# r OWNER NAME R tit PHONE 3 1 I-D2 0 J ESS sTREt7ADDRE55 Z9�0_CNvi SoSe. 6 CA g512� Fax CONTACT NAME c ina Ka+y /� PHONE 1 _� JE-MAIL sTR+-FTADDREssa_I o"c �'1 I U/) /T v e.. 6 11 2 ❑ OwNat ❑ OWNER BW DER OWNEAAGENT 13 COMPACTOR El CONTRACTORAOT ❑ ARcJmrEcT 1:1 EcnSEzs. 13 DEVELOR 13 TENANT sEIEfPECONTRACTORNAME �m+ FIW dESS Q8533 COMPANY NAME Flonder5 l4ta{- £- A-tf E' �'lar�cFcr'�S i$ / / lof7Rl-n F Ccta5�41p1-7�( SIREETADDRESS 555 QGlirS \X. *}2 ,STATE,ZIP 55 on A: R46to(a PEGE ARCHITECTIENGINE ENAME LICENSE NUMEER -cv BUS.I]C* COMPANY NAMEE-MAM FAX STRW ADDRESS CITY,STATE,W PHONE USE OF SFD.DtIPIFX ❑ MULTI-PAIMY I PROJECT IN WD.DLAND ❑ YS PROTEC7IN El YES YFS THE BLDG AN ❑ YES BUILDING. ❑COWaRCIAL _ URBANATERFACEAREA NO I FLOODZONE -fi3NO MCHIER NOME? NO DESCRIPTION OF WORK 0.02 L Lr TOTAL VALUATION: W 5'75 RECEIVED BY: C By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I bave read this application and the information I have provided is correct I have Tend the Description of Work and verity it is accurate. I ag v;r comply with all applicable Iota] ordinances and state laws misting to building con etion. Iauthoriu representatives of Cupertino to enter the above-identifiedproperty for inspection putposes. Signature ofApplicanttAgent Date: SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY OVER-THE-COUNTER ❑ EXPRESS U ❑ STANDARD U 5 ❑ I.ARCE ❑ AWOR MEPMarcApp_2011.doc re+iced 06/27/11 -