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13090031 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10711 RAE IN CONTRACTOR:VALLEY HEATING& PERMIT NO:13090031 COOLING OWNER'S NAME: GACHINA DOROTHY R TRUSTEE&ET 1171 N 4TH ST DATE ISSUED:09/06/2013 OWNER'S PHONE: 4084464701 SAN JOSE,CA 95112 PHONE NO:(408)294-6290 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL License Class C_Z U` Lic.# 25 25q b REMOVE AND REPLACE FURNACE,11 NEW DUCTS ADD y/b/ DEDICATED GAS LINE TO FURNACE Contractor VQ���v f7'ea +„.a 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:$10351 I have and will maintain Worker's Compensation.Insurance,as provided for by ection 3700 of the Labor Code,for the performance of the work for which this APN Number:35607056.00 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 DAY M 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 9 granting of this permit. Additionally,the applicant understands and will comply Issued by: 6 Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. gn C Date�� ROOFS: Si ature � .w�✓i All roofs shall be inspected prior to anyy 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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. 1 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 Owner or authorized agent: Date: permit is issued. 9 3 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 �` M E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION O' 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTlNQ (408)777-3228•FAX(408)777-3333•buildingAcupertino.ong b misc \� ❑PLUMBING MECHANICAL []ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS 16711 e em e I APN# 3 0,6-u OWNERNAME _ yw� ��� HONE +uD E-MAIL Q r2 /yl O l ) I STREET ADDRESS 1671( lz CITY,STATE,ZIP FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME, /� /�e �� LICENSE NUMBER LICENSE TYPEC��D BUS.LIC# ta 1125 815#0 COMPANY NAME 7 r !f E-MAIL FAX q6g ;fq_rZ4 T STREET ADDRESS (( 71 /.I` CITY,STATE,ZIP PHONE -( 'r � Cf f� S�. S gsrr z �lag_z9�f- 24D 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 PROJECT M WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO E[CHLER HOME? ❑NO DESCRIPTION OF WORK _ f A r L r e, Il !� Aace7 ft lQC�rLod ( d TOTAL VALUATION: (� 35 RECEIVED BY. By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the pro erty owner'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 accura . 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: / K Date: SUPPLEMENTAL INFORMATION REQUIRED Itgnr�cotIN:fI R © Sl'ANDARD y 'U s+3, �A�RGE y ©�nia�ox MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10711 rae In DATE: 09/05/2013 REVIEWED BY: Mendez its APN: BP#: "VALUATION: 1$10,351 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Du lex PENTAMATION FURN/AC USE: p PERMIT TYPE: WORK remove and replace furnace 11 new ducts add dedicated gas line to furnace SCOPE =- 3-M Mai mWwl! OW Mech.Plan Check 0.0 hrs $0.00 Plumb.Plan Check 0.0 hrs $0.00 Elec..Plan Check Mech.Permit Fee: IMPERMIT Plumb.Permit Fee: IPPERMIT lilec.Permit Fee: Other Mech.Insp. 0.0 hrs 1 $47.00 Other Plumb Insp. 0.0 hrs 1 $47.00 Olher Elec.Insp. I.AZech.Insp.Fite: Plumb. hap.Fee: Elec.Insp.Fee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). Theseees are based on the prelindna information available and are only an estimate. Contact the Dept-for addh7 info. FEE ITEMS(Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F1 # Mechanical Suppl.PC Fee: (F) Reg. 0 OT 0:0 hrs $0.00 $139.00 IMFR=<100 Furnace,Forced-Air PME Plan Check: $0.00 1 # Plumbing Permit Fee: $0.00 $70.00 IPGASRES Piping,Gas<=4 Outlets Suppl. Insp.Feer Reg. Q OT 0.0 1 hrs $0.00 0 # Mechanical PME Unit Fee: $0.00 $70.00 IBAPPLOT Other Appliance/Equip PME Permit Fee: $94.00 Construction Tax: Administrative Fee: IADMIN $44.00 Work Without Permit? ®Yes 19 No $0.00 Advanced Plannin&Fee: $0.00 Select a Non-Residential 0 Travel Documentation Fee: 1TR4YDOC $47.00 Building or Structure i Strong Motion Fee: IBSEISMICR $1.04 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 $187.04 $279.00 $466.04 , m Revised: 07/01/2013 HVAC ALTERATIONS ENERGY COMPLIANCE FORM COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL CUFERTth(© 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228•FAX(408)777-3333•building ancupertino.org 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. I�Tewly 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 04110/12 .fA t Simplified Prescriptive Certificate of Compliance:2o98 ResidenW HYACAlterations CF-1R-ALT-1 VAC -: Climate Zones 1 and 3-7 ,Site Address: Enforcm—rAgerscp: Dates;;; Permit#..- 711 e. Late Q Conditioned Duct insulation ent T 1 isi'IvFmiaiai' en floor Arca r e " 'Th:Prnostat Furnace Unit P F[TE�/°� COP j Over 40 8 of wc`s` Served'by system added oriiglaced rn Rsetback Indoor Cott SSR HSPF aat afire Pres 4 be sf unconditioned space. Condensing Unit ®EER ®Resistance 6 (CZ 1,3-5) Other 1.Equipment Type:Choose the equipment being installed;if more than one_syste�,use another CF-1R f.L l- AC.for each system 2.Afinimurn Equipment Efficiencies:13 SEER,78%AFUF,7.7HSPF for typical resideatial systems. ContractorfDocumentat on Author's/Responsible Designer's Declarsfion Statement) • 1 certify that this Certificate of Compliance docamientation is acctaate and complete. • 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. • 1 certify that the energy features 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. • The design features identified on this Certificate of Compliance are consistent with the iafommil on documented on other applicable compliance forms,worksheets,calculations,plans and specifications,submitted to the enforcement agency for appr(wal with the pernit application. Name Stu . Signature: P y- COnl an !�e� r` Date: Addre r N qfA S >tie 5.?54/6 City/StateCLip: Sa e /J Phone:t fes;2' q i�626 2008 Residential Compliance Forms.doc revised 04110112 COMMUNi Ty ' NT BULDNO,D; ai ""0 This set Of PIP9, 6 and job ime, therefrom,without appIr,vaircm the; C-le ,ion's The stem, this p' ark sQeClfic;`� ,mr-ing of beheld tOpermit ortchear ppravalofl!,,,v - _;, of any provisions of any City Ordinance or State Law. BY DATE PERMIT NO. 7 JGaS ,e 21q Jr/,- i e) 3C f CUPERTINO Building Department y li G ! a 2013 V` F'���ICE OP REVIEWED FOR CODE COMPLIANCE Reviewed By.