14050067 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10377 SOMERSET CT CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 14050067
CONDITIONING
OWNER'S NAME: GOTTWALS DAVID F AND CATHERINE 1712 STONE AVE DATE ISSUED:05/09/2014
OWNER'S PHONE: 4082520586 SAN JOSE,CA 95125 PHONE NO:(408)293-4717
ALICENS CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
Q /� REMOVE&REPLACE(E)FURNACE&A/C,SAME
License Class (2Z2 3 Lic.# lD V� / ( LOCATIONS
Contractor Al JrAJA<X- Date `LOl
I hereby affirm that I am licensed under the provisi,as o 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
erformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$7500
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:36929028.00 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-PAYS 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 O T LED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence o
granting of this permit. Additionally,the applicant understands ply Issue I b Date:
witl onhT' poin sdti cc regulati s the Cupertino Munici ode,Section
918.
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
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 b e Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain com a with the Cu ArAir
Mcipal Code,Chapter 9.1�and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health ety Code,Sections 255 5, and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owne or authorized agent: Date:
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
918.
Signature Date
GFEN'ERAL PERMIT APPLICATION D
COMMUNITY DEVELOPMENT DEPARTMENT- i-81J.ILDING DIVISION (�
I, 10300 TORRE AVENUE , CUPERTINO, CA 950143255
(408)777-3228 - FAX(408)777-3333 'buildino cupertino.org v 1 s c
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WNTACP NAME LJ Jv1�tl/1 v1 PHONE lJfi E
STREET ADDRESS CITY,STATE, ZIP FAX
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' ❑OWNER ❑ OWNER•EUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENONEER. ❑ owtLoPEt ❑TENANr
CONTRACTOR NAME r;'�A ��^ , LICENSE NUMEER U921 1 Tu
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COMPANY NAME 3-MAA FAX -2!0 � -34 c6s- -
STREET ADDRESS (!/ c(�\, _p• ,.1 ( MA , t/f 14
ARCHITECr/ENOWEERNgME LICENSE NUMEER HUS.UC I
COMPANY NAME E-MA11. FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF 1.4�SFD or Duplex ❑ Multi-Family PROJECT iN WILDLAND PROJECT IN
mucrURB: ❑ Commercial URBAN tMWACE AREA ❑ Yes 1-9-No FLOOD ZONE ❑ YeS a2'VO
DESC}t8r1'TON OF WORK Vr` Ip CfiAnfp MJ
TOTAL YALUATION:
ay my signaNn below,T certify to ear of the fo owi 1 am the property owner or authorized agent to act on the property owner`s betialf. I have read this
application and the information I have ided is o t. ave read the Description of Work and verify it is accurate. I agree to compiv with all applicable local
or,
and state lawn relad to b It- M ' 1 0 'z tativ s of Cupertino to enter the e d pr petty for inspection purposca.
Signature ofApplicanVAgent Date,.
u ..
SUPPLEMENTAL MORMA'MON REQUMD
MEPdfucApp 1011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 10377 SOMERSET CT DATE: 05/09/2014 REVIEWED BY: MELISSA
APN: 369 29 028 BP#: *VALUATION: 1$7,500
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: FURN/A
WORK REMOVE & REPLACE E FURNACE &A/C SAME LOCATIONS
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
A/C Units (<=10K cfm) 16REMAIR 1 # $70
Furnace, Forced-Air 1MFR=<100 1 # $139
TOTALS: F $209.00
Mech.Plan Check 0.0 hrs $0.00 Phw;h.Plan Check /:';rr:. I';��n t:he(";;
Mech.Permit Fee: IMPERMIT ph"Mb. Il emit F"e'
Other Mech.Insp. 0.0 hrs $47.00 Other Plumb ln."p. Odlt ?r 117"'c'
A-!(",r hi"J)' j"C"': phvitb. lnsp3 Fee: tier_1ny, Y�,:c:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Thesefees are based on the prelhiniina information available and are only an estimate. Contact the De t or addn 7 info,
FEE ITEMS (Fee Resolution 11-053 Eff 711/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
S'trfgd' PC Fee
PME Plan Check: $0.00
Suppl. hvq) 1='ec
PME Unit Fee: $209.00
PME Permit Fee: $47.00
Administrative Fee: 1ADMIN $44.00
Work Without Permit? ® Yes (F) No $0.00
r Gtil';.7)-7£'t'Ct f�"/£Cfi'dtld?tom I't'E'S.
Travel Documentation Fee: ITRAVDOC $47.00
Strong Motion Fee: IBSEISMICR $0.75 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
$348.75 $0.00 t TOTA%FEE: $348.75
Revised: 04/01/2014
Simplified Prescriptive Certificate of Coin Uance:3A08.Residenttal YAC Alterations. CF 1R-ALT-AV, C
Comste Zones:i and 3-7
t�lA E forcPmenrAgerrcp: 1er
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Co{ncfiiuoned Duct insulation
ECPIi==tTyPeI
L"tSL.lrtutuuLw' T GICn :..TC S .
z
:.
COP Serve0y added ar cxd ui
® - , � Setback
Indoor Coil ' [ HSPI'^ y s} M. areudy presort must be
sf unconditioned span .. � .
ondensing Unit ®EER Rssistance ®R 6 (CZ 1,3 S) ,
t39=
1.E.q.dipmentType-,Choose the equipment beingbstalled,ifmore than onepystem,use another CF-IR-ALT-HVAC for eacb system.
2.Minimum Equipment Efficiencies:13 SEER,78%AFUE,7.7HSPF for typical residential:systesns•
Contractor(b?ocumentation Aatbor's/Responsible Desigasr's Declaration Statement)
• I certify that this CMtif gate of Compliance docUment;atian is accinate aud'ct5iitplete
• I am eligible tinder Division 3 of the Califb,,ma Business and Professions Code to accept responsibility for;the design.identified.on this
Certificate of Compliance.
• I testify that the euerfy features and performance•spccifxcations for the design identified on ibis Cer#ificate of Compliance conform to the
requirements of Tit.e 24,Parts I and 6 of the California Code of Regulations.
• The designfeatures identified on this Certificate of Compliance are consistent vat the information documented on other applicable
compliance forms,worIsabeets,calculations,plans and specfficaiiomssub,.p mi4ed t agency for approval wjth the permit
, 1117
.lection.
Name: MOMU
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''"""" 2008 Residential Compliance Forms.doc revised 04110112
INSTALLATION CERTIFICATE CF-6R-MECH-04
Space Conditioning Systems,Ducts and Fans a"e 1 of 2
Site Address: Enforcement Agency: Permit Number:
Space Conditioning Systems
Heating Equipment
Duct
Efficiency Location
Equip (AFUE, (attic,
Type ARI #of etc.)1,3 crawl- Heating Heating
(package- CEC Certified Mfr.Name Reference Identical (ztUwIR space, Duct Load Capacity
heat pump)
and
Model Number Number 2 Systems value)'_ etc. R-value Btu/hr Btu/hr
v ►� �y�1
Cooling Equipment
Efficiency Duct
Equip (SEER Location
Type and EER) (attic,
(package #of 1,3 crawl- Cooling, Cooling
heat CEC Certified Mfr.Name ARI Reference Identical (2tCF-1R space, Duct Load Capacity
pp um and Model Number Number 2 Systems value)4 etc. R-value (Btu/hr) (Btu/hr
1.If project is new construction, see Footnotes to Standards Table 151-B and Table 151-C for duct ceiling alternative
compliance.
Z ARI Reference Number can be found by entering the equipment model number at http://www.aridirectory.org/ari/ac.php#
3.Listed efficiency on this page must be greater than or equal(>_)to the value shown on the CF--I R form.
4. When CF-IR is reference it is also applicable to the CF-1R, CF-IR-AA or CF-IR-ALT
ALL BOXES MUST BE CHECKED TO BE A VALID FORM
❑ §110-§113: HVAC equipment is certified by the California Energy Commission.
❑ §150(h):Heating and/or cooling loads calculated in accordance with ASHRAE,SMACNA,or ACOA.
❑ §150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of§112(c).
❑ §1500)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