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13110083 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21849 LINDY IN CONTRACTOR:-TUBE PERMIT NO: 13110083 �B. OWNER'S NAME: PANGRLE BARRY M AND SUZETTE K o G /-'-f�hn AA d DATE ISSUED: 11/13/2013 OWNER'S PHONE: 4084464624 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class G ZO Li,.# 1 t REMOVE AND REPLACE A/C UNIT Contractor ate 1 i l�'" 1 3 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 he e y affirm under penalty of perjury one of the following two declarations: I and will maintain a certificate of consent to self-insure for Worker's nation,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:$5200 I 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:35625022.00 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 WITHINDAYS 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' AY OM 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 Issued b granting of this permit. Additionally,the applicant understands and will comply y Date: •/�' with all non of s r r ions per the Cupertino Municipal Code,Section 9.18. (,3 RE-ROOFS: Signature j 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.exclusivelycontracting 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 withhe u rtino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sec u 3,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date —I � 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 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 MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 MISC CUPERTINO (408)777-3228•FAX(408)777-3333•building aacupertino.org ❑PLUMBING MECHANICAL ❑ELECTRICAL [:1 MISCELLANEOUS PROJECT ADDRESS Z`S` `'��p p� APN# ► ) o n a W ONER NAME���—M.^��S V�Ir )� �l / �13 G►F..G PHONE E-MAIL STREET ADDRESS t(� p i Dy { CITY, STATE,ZIP u D � r A t /FAX CONTACT NAME y L� � Il PHONE 40(•1 �j�`�y 7 Z E IMAII}� 1 �+ `.�,�,I./`/� STREET ADDRESS ,(+a] p. 1 7— Lz CITY,STATE,ZIP ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT V CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT` ❑ENGINEER ❑ DEVELOPER ❑TENANT CQNTRA OR AI F��� D ��n LICENSE NUMBERR/I O f3 "7©+-� LICENSE TYPE rq y � BUS.LIC# cW\eV Lo u 1A,kT e e4 (_ E-MAU t_ UI !X. NL_�CO u.C_6 A V FAX STET P�DDR�$SO ' crrS TM�F�SIP ARCHITECT/ENGINEER NAME LICENSE `NUMB] ER�,J BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF FD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA NO FLOOD ZONE NO EICHLER HOME? NO DESCRIPTION OF WORK TOTAL VALUATION: �j �y /�� �RECEiYEDB xyfi 5 LZJ F r 2a By my signature below,I certify to each of the fol owing: I am the property owner or authorized agent to act on the grope er's behalf. I have read this application and the information I have p 'We have read the Description of Work and verify it is accurate. I e to comply with all applicable local ordinances and state laws relating to bu inI authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: g 4-141 Date: SUP MENTAL INFORMATION REQUIRED „ S�RITHE CnIIISTER _ k ' fV�"rM rte#„, 0 HT ARD I , GE:fix��' MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 21849 lindy In DATE: 11/13/2013 REVIEWED BY: mendez APN: BP#: EVALUATION: 1$5,200 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: p PERMIT TYPE: WORK remove and replace a/c unit SCOPE Mech.Plan Check 0.0 hrs $0.00 Phonb.Plum C"heck Elec.Plan Check Meeh.Permit Fee: 11IPERMIT Plumb,Permit Pee: 1-Zee. Permit Fee: Other Mech.Insp. 0.0 hrs $47.00 Other Plumb Insp. Other Elec.Insp. Alk,,ch.Insp. Fee.- Plumb. Insp.Fee: Elee.Insp.Fee: EiLl NOTE.This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,eta). These fees are based on the prefinuna information available and are only an estimate. Contact the Dept for addn7 info, FEE ITEMS (Fee Resolution 11-053 E . 7ff 11113) FEE QTY/FEE I MISC ITEMS Plan Check Fee: $0.00 1 # Mechanical Suppl.PC Fee: E) Reg. 0 OT 0.0 hrs $0.00 $70.001 1BREMAIR A/C Units(<=10K cfm) PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee-.0 Reg.. 0 OT O,Q hrs $0.00 777=PME Unit Fee: $0.00 PME Permit Fee:' $47.00 Construction Tax: Administrative Fee: IADM1N $44.00 0 Work Without Permit? ® Yes .iq No $0.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential Travel Documentation Fee: ITRAVDOC $47.00 Building or Structure Strong Motion.Fee: IBSEISMICR $0.52 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC 1 $1.00 $139.521 $70.00jE $209.52 ti :. . Revised: 10/01/2013 HVAC ALTERATIONS ENERGY COMPLIANCE FORM COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228•FAX(408)777-3333-building ouoertino.org WHEN IS A PERIYHT 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 than40ft ducting in unconditioned space BUSINESS A.PU-PROFESSIONS CODE, SECTION 7110 Willful or deliberatedisregard and violation of the building laws, including the California Building Code, and local permit'requir`ements 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 EN!'ERGY 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 sea] 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 r Simplified Prescriptive Certificate of Compliance:2008 Residential HVACAIferadions CF-IR-ALT-HVAC Cfimste Zones 1 and 3-7 - - SheEAddr, Enforcanent Aje-7. Byte: -i Pernrit.1.1= 1tOWs LiUDy LA►�� yt- t° --t3 Conditioned Duct insulation ent Type' i §t2 .Ef id= fl6or`Area m Ilzgmostat Paelmged Umt g : Ovdr 40 8 of dads'' Furnace MAFUE COP Saved:by system added orreplaced in Q Setbaik Indoor Cog EaS t � ®HSPF flf notalready present a uat be Condensing Unit ®FmR �'Resistance ®R O sf unconditioned space ®R 6 (CZ I,3-3) Other • 1.Equipment Type:Choose the equipment being installed;if more than one-systems,use another CF-I R-ALT HVAC for each system. 2.Minimum Equipment Efficiencies:13 SEER,78%AFUE,7.7HSPF for typical residential systems. Contractor(Documentation Author's/Responsible Designer's Declaration Statement) • I certify that this Certificate of Compliance dowmentadon is accurate and cora iAme • I ant eligible under Division 3 of the California Business and Professions Code to awept 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 Compliant 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 ate consis=t information documented on other applicable compliance for=ms,worksheets,calculations,plans and specifications subm'. ent agency for approval with the permit application. Name: W %Y-S 1.d u 1A AY z s a-' Signatiue Company: l Date:1 Address i - p ZZ Luse $"l b 2 CitylState/Zip: A C A z L d S; c- r lb *70 Phone �E�a'� _p 7 2Z . 2008 Residential Compliance Forms.doc revised 04/10/12 ;'"`'Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 C U P E RT 1 N O Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR/SUBCONTRACTOR LIST JOB ADDRESS: 16S00 N, ptRnt� a/vol• PERMIT# AA6 201g6 OWNER'S NAME:(2 ;no Crosse"L1.C, PHONE# '�J�QS $�s�l • g �� GENERAL CONTRACTOR: tm% BUSINESS LICENSE# ADDRESS: i6go 17 j)o r., � pc. CITY/ZIPCODE: NAA& CA ICOT- *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL,BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing {/ Electrical Reakooerl C.; cr1lt��'►L Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass/Glazing Heating ACCO �-- Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock �— Tile er/Contra c ignature Aate ' ,