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13070115 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21598 ROSARIO AVE CONTRACTOR:Tft&"I'O BE PERMIT NO:13070115 LUMIDWD OWNER'S NAME: CONNELLY THOMAS J AND DOROTHY tc', DATE ISSUED:07/18/2013 OWNER'S PHONE: 4083929999 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL❑ License Class �".�C Lic.# �? TS- REMOVE AND REPLACE FURNACE IN SAME LOCATION, t ADD Contractor L 1 h cf✓I t A/C TO SIDE OF SFDWL,DUCT CHANGE OUT 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:$7950 I have and will maintain Worker's Compensation Insurance,asprovided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:35619017.00 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 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 D2Z M LASTCALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, /� p costs,and expenses which may accrue against said City in consequence of the ZIssued by: Date: /•�0�l granting of this permit. Additionally,the applicant understands and will comply with all non-point source regul tions per the Cupertino Municipal Code,Section 9.18. l 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 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 cipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Section Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: l4 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 GENERAL PERMIT APPLICATION MEP . _ . .. COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228 FAX(408)777-3333•building(CD _cupertino.org tl misc CUPI�RTINQ r PLUMBING MECHAhIICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS APN OWNER NAME PHONE E-MAIL STREET ADDRESS t CITY, STATE,ZIP FAX I CONTACT NAME II' PHONE E-MAIL STREET11 ADDRESS i j CITY,STATE,ZIP FAX ❑ OWNER ❑ OWNERBUILDER:'., ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT . CONTRACT OR NAME 1 LICENSE NUMBER c� LIC SE E BUS.LIC# yt COMPANY NAME + ^J / E-MAIL FAX STREET ADDRESS t Com✓ 'v`L CITY,STATE,ZIP PHONE ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME�' E-MAIL, FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE'.OF ❑SFD of DUPLEX i; ❑ MULTI-FAMILY PROJECT INWB.DLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑.YES BUII.D]NQ''. ❑COMMERCIAL _ URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTIOI OFW0 I It t i '�t l ��il I '•+ � ' I t I I I 1 I I i I � - - TOTAL vA11 TIQIMMUNE By;my signature)below ertlfy;toteach of the following: I am the property owner or authorized agent to act property owner's behalf. I have read this appLcahotx and the uI£o tlon bhave provided is correct. I have read a Description of Work and verify it is a urate. I agree to complywith all applicable local' ordinances and state law$relating to buil' co on. au ze representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Appllcant/Agentl Date: IO •�� III' SUPPLEMENTAL INFORMATION REQUIREDFi S .o I I E. rar PJ I I l I x li. I I I 1 I MEPMiscApp_2011.doc revised 06/21/11 j� II I1 j1 III'I . ,I CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 21598 rosario ave DATE: 07/18/2013 REVIEWED BY: 7950 APN: BP#: *VALUATION: 1$7,950 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY PENTAMATION FURN/AC USE: SFD or Duplex PERMIT TYPE: i wORK remove and replace furnace in same location add a/c to side of sfdwl duct change out SCOPE APPLIANCE/EQUIP TYPE FEE ED QTY UNITS BP FEES A/C Units (<=10K cfm) 1BREMAIR 1 # $70 Furnace, Forced-Air IMFR=<100 1 # $139 TOTALS: $209.00 °dR 7!7717 .0 hrs $0.00 .P/zsrub.flan CheeElect.Plan G,heck rmit Fee: IMPERMIT Plumb.Permit Fee: F.Iec. Permit fee: .0 hrs $47.00 Other Plumb Insp. Other Elec.Insp. Li Plumb. htsp.Fee: 1 I'lec.Insp.I'ee: NOTE:This estimate does not include fees due to other Departments(La Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These fees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info, FEE ITEMS(Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl. T C 1,7ee PME Plan Check: $0.00 Perinit Fee: Supp 1. Insp Fee PME Unit Fee: $209.00 PME Permit Fee: $47.00 Consliwction?ax: Administrative Fee: IADMIN $44.00 Work Without Permit? 0 Yes (E) No $0.00 A(1vancecl PhMning Fees; Travel Documentation Fee: 1TRAVDOC $47.00 Strom Motion Fee: IBSEISMICR $0.80 Select an Administrative Item Bldi Stds Commission Fee: IBCBSC $1.00 ru $348.80 $0.00 $348.80 -1 Revised: 07/01/2013 Simplified Prewriptive'Certifiicate of Compliance:2008.Res1den"t d HVACA1ferations. CF-1R-ALT-HVAC, - Climate Zones I and 3-7 s�ceAa� Q r'o aiY v��thc �orcel,�er�rAg�9: �� pe>�#:. Conditioned Duct insulation ampme-ane, f�s't2ilmiiimcien floorAFea` Theiostt Packagtd Umt Over 408 of ducts 2M. 0�.:.. ER—r— ` rsetbacd Indoor Cott ® Served b3's3` tern added or replaced in ' (Ynor cdk'eady pr-!,g-,cu be Condensing Unit ®EER 13 Resistance sf unconditioned space, LMR 6 (CZ I,'3 S) Other • 1.Equipment Type:Choose the equipment being installed;if more than one system,use another CF-1R-ALT-HVAC for each system. 2.11fnimucn Equipment Efficiescies:13 SEER,7S%AFUE,7.7HSPF for typical residential systems. Contractor(Documentation Author's/Responsible Designees 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 to accept responsibility for the design identified on this Certificate of Compliance. • I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24,Pacts I and 6 of the 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,plans and specifications submitted to the enforcement agency for approval with the permit application, _ Name: ( ]Nf4f Sigaattsse: Company G C Date ... G Address License: City/state/Zig: G .Q Phone:�it 41- ,, . 2008 Residential Compliance Forms.doc revised 04/10/12 HVAC ALTERATIONS ENERGY COMPLIANCE FORM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ALBERT SALVADOR, P.E.,C.B.O., BUILDING OFFICIAL CUPERTIN10 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228•FAX(408)777-3333•buildina aacupertino.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 40ft 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 CUPERTINO Dov � Building Department COPS M!iNITY DmEfELOPMENT DEPARTMENT I,,,- CUPE BUILDI RTINO JUL 18 2013 AF�, E P-7nVD Av REVIEWED FOR CODE COMPLIANCE t of r' nsP.nr ,cfflcations MUST be kept at the It j.,3 ujjjawfuil to-, .eke any 0z se,or to devi"�e -------------------—--------------------— Reviewed By non am v�,j from the Building official. ;Ifi(,, nSSHALLN0Tq _oval of the viol-scion minanceO, Law.' UJ DATE VC CANNING DATE D(J)'G. 1)EPF— CLM, Fr—tq —T, Ef