15010017 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22281 BELLEVUE AVE CONTRACTOR:RESIDENTIAL HEATING PERMIT NO:15010017
AND A/C INC
OWNER'S NAME:
CAMPBELL,CA 95008 PHONE NO:4083774073
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
License Classn FURNACE REPLACEMENT&DUCT WORK SAME LOC
�J, i LiNc.# ���C
Contractor ►`QS�llll{� M Il�01l)1l DateAS I
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:$12675
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:35701011 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 DPERMIT 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 OM L C LED INSP C ION.
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 by: Date:
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
918.
RE-ROOFS:
Signature /�`---- 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-hove 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 Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,
��, // S
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
CUPERTIINCa (408)777-3228•FAX(408)777-3333•building@cupertino.org M 's
❑PLUMBING MECHANICAL ELECTRICAL [:]MISCELLANEOUS
PROJECT ADDRESS 2 2 2 B I B^i evu , en q , APN# 31�(j 0 10 I
OWNER
CONTACT NAME L C1 PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME C/1+� LICENSE NUMBER -io a5q LICENSE TYPE 6 BUS.LIC#
COMPANY NAME keS1 dv_n� a I �A( C E-MAIL k� @res the ,C0M FAX
STREET ADDRESS/„C C�/r�I`s'�i CITY,STATE,ZIP l•V PHONE
lj/J h e cam ( c.A a� q -3,7-4��
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 IN W ILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK I Q C ing f4fnacc u,J ctwO_�,
Yv` sctrnc Iocafiio
�a � ,�,
TOTAL VALUATION: �s
p 1
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-Fe-half. I have read this
application and the information
of Cupertino to enter the above-identified property for inspection purposes.
�Signature of Applicant/Agent: � � Date: �7
SI JPPLENfRNTAT,INFORMATION REQUIRED
�;;jji� ;j; /,iiiia
MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
WDDRESS: 22281 bellevue ave DATE: 01/05/2015 REVIEWED BY: Mendez
PN: BP#: *VALUATION: 1$12,675
xPERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
PRIMARY PENTAMATION FURN/AC
USE: SFD or Duplex PERMIT TYPE: i
WORK furnace replacement&duct work same loc
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Gravity-Type 1MFR=<100 1 # $143
TOTALS: $143.00
y
Mech.Plan Check 0.0 hrs $0.00 111-unib.Plata Check 1=iec.Pi-ars Cha ck
Mech.Permit
Fee: IMPERMIT phimb.
Other Mech.Insp. 0.0 �rs $48.00 07i'+er Plumb Insp. ED
�lerr;. Ir?s1t, (<<c: P;urarla. Iitsla. 7-e<,; Ifc Ini� l��e:
NOTE:This estimate does not include fees due to other Departments(i.e.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 Dept for addn7 info.
FEE ITEMS (Fee Resolution 11-053 Ef. 7/f 1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fce:
Suppl. P(" Fee
PME Plan Check: $0.00
Perinit 1*int;':
.Supp/. Insp 'Ce
PME Unit Fee: $143.00
PME Permit Fee: -T-T $48.00
f.`c RM7101on 7e'1a:
Administrative Fee: IADMIN $45.00
Work Without Permit? ® Yes (E) No $0.00
r1Llb'C111C'(1L1 i'(tIrollrig,Fef-''s'
Travel Documentation Fee: 1TRAVDOC $48.00
strong Motion Fee: IBSEISAfICR $1.65 0 # Revisions
Bldp-Stds Commission Fee: IBCBSC $1.00 $0.00 IREVSFDWL SFDWL
TOFf AL FEE: $286.65
$286.65 $0.00 ; E
Revised: 10/01/2014
STATE OF CALIFORNIA
ALTERATIONS - HVAC
CEC-CF I R-ALT-03-E Revised 06/14 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ALT-03-E
Alterations-HVAC CZ 1,3 to 7 and 16(formerly CF-IR-ALT-HVAC) (Page 1 of 1)
Site Address: Enforcement Agency: Date Prepared: Permit#:
Z2.Z81 gtII�VU�' f�V�hUQ
Equipment Type Equipment Efficiency New:Ducting,Plenums,Lineset Conditioned Thermostat
Required R-value Floor Area(sq ft)
❑ Packaged System ❑Evaporator Coil AFUE COP CZ R-6 (CZ 1,3-7)Ducts Served by system ❑Setback
❑Split System ❑Condensing Unit SEER ❑R-8' (CZ 16)Ducts �q Q sq ft (If not already
HSPF ❑R-6(all CZ's)Plenums present,must
Furnace ❑Lineset EER ❑R-5 or R7.5 Lineset3 be installed)
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this
form is allowed to be filled out by hand. For final inspection all forms are to be registered(no hand filled forms allowed)and a copy left on site.
❑1.HVAC Changeout/Repair Required Compliance Documents to be left on site for Final:
Can include new ducting
All Equipment, CF1R-ALT-02-E
Condenser Unit,Evaporator Coil, CF2R:MECH-01,MECH-20-HERS
Air Handler/Furnace CF3R:MECH-20-HERS
Installer Requirement:Duct leakage(<15%or,<10%to outside,or seal all accessible leaks)
Exempted from duct leakage testing if:
❑1.Duct system registered with HERS provider as previously sealed,or❑2.There is less than 40 linear feet of duct in unconditioned
space,or ❑3.Existing duct systems are constructed,insulated or sealed with asbestos(list manufacture date of building
❑2.New HVAC System Required Compliance Documents to be left on site for Final:
All new equipment and All New Ducts2 CF111-ALT-02-E
CF2R-MECH-01,MECH-20-HERS,MECH-22-HERS,MECH-(23 or 24)-HERS
CF3R-MECH-20-HERS,MECH-22-HERS,MECH-(23 or 24)-HERS2
Installer Requirement:Duct leakage<6%,Fan Efficacy(.58W/CFM),Air Flow>_350 CFM/ton(or Standards Table 150.0-C/D alternative)
JJ 3.All New Ducts with Replacement Required Compliance Documents to be left on site for Final:
Includes replacing or installing All New CF1R-ALT-02-E
Ducts2 and one or more of the following: CF2R-MECH-01,MECH-20-HERS,MECH-(23 or 24)-HERS
Condenser Unit,Evaporator Coil,Furnace CF311-MECH-20-HERS,MECH-(23 or 24)-HERS
Installer Requirement:Duct leakage<691.,Air Flow>_350 CFM/ton(or Standards Table 150.0-C/D alternative)
❑Exempted from duct leakage testing I existing duct systems are constructed,insulated or sealed with asbestos.
q4.New Ducting over 40 feet Required Compliance Documents to be left on site for Final:
Adding or replacing ducts in unconditioned CFIR-ALT-02-E
space but less than All New Ducts2 CF2R:MECH-20-HERS
CF3R:MECH-20-HERS
Installer Required to:Duct leakage(<15%or,<10%to outside,or seal all accessible leaks)
❑ Exempted from duct leakage testing I existing duct systems are constructed,insulated or sealed with asbestos.
'
All new ducting R-8 required when more than 40 ft installed and R-6 when less than 40 ft installed. This includes in walls,between floors etc.
2 A New Duct system is when the duct system is constructed.of at least 75 percent new duct material,and up to 25 percent may consist of reused
parts from the dwelling unit's existing duct system(e.g.,registers,grilles,boots,air handler,plenums,duct material.
3 R-5(1"thick insulation)for linesets 1"and less. R-7.5(1.5"thick insulation)for linesets over 1 inch. Most mfg will require Suction line Diameter
with insulation as the following 1.5-2T-2%",2.5-3T-2%",3.5 to 4T-2Ys",5T-4%"
Contractor(Documentation Author's/Responsible Designer's Declaration Statement)
I certify the following under penalty of perjury,under the laws of the State of California:
1. The information provided on this Certificate of Compliance is true and correct.
2. 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the information on this document.
3. That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24,Parts 1 and 6 of the California Code of Regulations(CCR).
4. That the energy features and performance specifications,materials,components,and manufactured devices for the building design or
system design identified on this Certificate of Compliance conform to the requirements of Title 24,Part 1 and Part 6 of the CCR.
5. The building design features or system design features identified on this Certificate of Compliance are consistent with the information
provided on other applicable compliance documents,worksheets,calculations,plans and specifications submitted to the enforcement
agency for approval with this building permit application.
1 / / 5//-/ -705591/
Company:' Address: City/State/Zip:
For assistance o questions regarding the Energy Standards,contact the Ener6 Hotline at:1-800-772-3300