14110023 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10955 MIRAMONTE RD CONTRACTOR:CALIFORNIA DELTA PERMIT NO: 14110023
MECHANICAL INC
OWNER'S NAME:
MESA,AZ 85206 PHONE NO:(866)692-5273
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL
C/ REMOVE AND REPLACE FURNACE.
License Class C Z O Lie.#�f��� 7
Contractor v0 Date
I hereby affir 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
ormance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$4550
ave 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:35601014 00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
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 DAYS FROM 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 ��— � /� f//fir i /
granting of this permit. Additionally,the applicant understands and will comply Y Dater
with all non-point source reguI ' per the Cupertino Municipal Code,Section
9 18.
RE-ROOFS:
A-
Signature Date r 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,Sections 25 533,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.
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
GENE'PAL Pl_,Rf f t KPi CAI fQCM E P
COMMUNITY DEVELOPMENT DEPARTIi✓EN T- BUILDING DMSION
10300 TORRE AVENUE- CUEER 1 INTO,CA 95014-3255
(408) 777-3228 FAX(408)7777-3333-+ouildino0).cuoe tino.oro m I s _
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CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 10955 Miramonte Rd DATE: 11/04/2014 REVIEWED BY: Sean
APN: BP#: *VALUATION: 1$4,550
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION FURN/A
USE: PERMIT TYPE:
WORK Remove and replace furnace.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced-Air 1MFR=<100 1 # $143
TOTALS: $143.00
Inswe
Mech.Plan Check 0.0 1 hrs $0.00 P!uttr . 1'lurr Cheei,
Mech.Permit Fee: 1MPERMIT
Other Mech.Insp. 0.0 hrs $48.00 Other t'lumh True
tleci fop' Phviib. Insp. Fee: L,-re:c'. I aft. F_'c.
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . Theseees are based on the prelimina information available and are only an estimate. Contact the Dept-for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check P'ee:
r.rjr 1. P('1.'ee
PME Plan Check: $0.00
P j
t'
PME Unit Fee: $143.00
PME Permit Fee: $48.00
i'(JJ7:�t7'1,1C'IICJrt :tL7:Y':
Administrative Fee: IADMIN $45.00
Work Without Permit? ® Yes 0 No $0.00
Travel Documentation Fee: ITRAVDOC $48.00 A
Strony,Motion Fee: IBSEISMICR $0.59 Select an Administrative Item
Bld,p Stds Commission Fee: 1BCBSC $1.00
€® $285.59 $0.00 TOTAL FEE: $285.59
r �r
Revised: 10/01/2014
CERTIFICATE OF COMPLIANCE CFIR-ALT-02-E
Alterations to Space Conditioning Systems(formerly CF-IR-ALT-HVAC) (Page 1 of 4}
Project Name: 10955 Miramonte Rd Date Prepared: 2014-10-29
A.General Information
CFIR-ALT-02 Is applicable to multiple space conditioning systems contained within a single dwelling unit.When multiple dwelling units must be
documented,use one CFiR-ALT 02 document for each dwelling unit.
01 Project Name 10955 Miramonte Rd 02 Date Prepared 2014-10-29
03 Project Location 10955 Miramonte Rd 04 Building Type Single family
05 CA City Cupertino 06 Dwelling Unit Name 10955 Miramonte Rd
07 Zip Code 95014 Q8 Dwelling Unit Conditioned 1670
Floor Area(ft2)
Number of space conditioning
09 Climate Zone 4 10 (SC)systems In this dwelling 1
unit.
B.Space ConditioningSCS yst
em= .;,•�:.,.
( ) jyg
,information
jW.
<:'` ,.
02 03.
01 rr.
R37 %K t?mo--
09 10
ts`th
SC System SC System CFA served system a refrigerant Installing new SC Installing Installing Installing
Identification or Location or Area by this SC ducted containing system more than 40 entirely new entirely new
Name Served System(ft2). system? component? components? feet of duets? 1 duct system? SC system? Alteration Type
Furnace Whole Home 1610 Yes No Yes No-- INo No Altered space
conditioning system
C.Extension of Existing Duct System,Greater Than 40 Feet(Section150.2(b)1Di1b)
This section does not apply to this project.
Registration Number:214-A0128906A-000000000-0000 Registration Date/Time: 2014-10-2916:08:16 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2014-10-29 16:08:53
Schema Version:0.5515DD
CERTIFICATE OF COMPLIANCE
CF111-ALT=02-E
Alterations to Space Conditioning Systems(formerly CF-IR-ALT-HVAC) (Page 2 of 4)
D.Altered Space Conditioning System(Sections 150.2(b)1E and F)
01 02 03 04 05 06 07 08 09 10 11 12
Heating Cooling
System Heating Altered Heating Minimum Altered Cooling Minimum Required New or
identification System Heating Efficiency Efficiency Cooling Cooling Efficiency Efficiency Thermostat Replaced New Duct
or Name Type Components Type Value System Type Components Type Value Type Duct Length R-Value
Central gas All new No cooling This field or This field or This field or This field or
Furnace furnace heating AFUE 0.78 No cooling component section is not section Is not Setback section is not section is not
components altered applicable applicable applicable applicable
Required lamentation:
CF2R-MCH-01-E-Space Conditioning Systems Ducts and Fans
-Duct insulation requirement for new plenums:R6.
CFZR-MCH-20-H&CF3R-MCH-2D-H—Duct Leakage testing required when heating or cooling components are Installed in ducted systems,or when more than 40 ft of duct length Is replaced.
-Leakage rate compliance:S IS%,or:5 10%leakage to outside,or seal all accessible leaks.
MR-MCH-25-11&CF3R-MCH-25-H Refrigerant Charge Verification required when refrigerant containing components are installed or altered(applicable in CZ 2,8-15).
CFZRCF3R-MCH-23&MR-MCH-23 Air Flow 2 300 CFM/ton;required when MCH-25 is,required -
U otion
Duct systems registered with HERS provider as p vllgmausIV sealed are exemp;frorlr iVICH-20 Duct L fta ,Testin ; 'uireYil�tif.
-Heating-only systems and Air Handler Furnace ""'F """i' ,ter
/ Changes do not require verf�catCon.of Air Flow Mtflc23,or Refri nt,.Cha a MECH=25.
-Existing duct systems constructed,Insulated or�sealed with a;bfeestgsFare ""`frim MCH-20 Duc�lleaka e T B '' "i s,
dntt�:R g re rement5;:;^
E.Entirely New or Complete Replacement Duct Systeim with or without Equipment Changeout(Sections 150.2(b)1Diia and 150.2(b)1E,F)
,t
This section does not apply to this project.
Registration Number:214-A0128906A-000000DOD-0000 Registration Date/Time: 2014-10-2916:08:16 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2014-10-29 16:08:53
Schema Version:0.551SDD
CERTIFICATE OF COMPLIANCE
CFIR-ALT-02-E
Alterations to Space Conditioning Systems(formerly CF-IR-ALT-HVAC) (Page 3 of 4)
F.Entirely New or Complete Replacement Space Conditioning System(Section 150.2(b)1C)
This section does not apply to this project.
x
0,;
N, ;F,
9F,
xg:
Registration Number:214-A0128906A-000000000-0000 Registration Date/Time: 2014-10-2916-.08:16 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2014-10-29 16:08:53
Schema Version:0.551SOD
................... ....... ..........
CERTIFICATE OF COMPLIANCE
CF1R-ALT 02-E
Alterations to Space Conditioning Systems(formerly CF-1R-ALT-HVAC) (Page 4 of 4)
Documentation Author's Declaration Statement
1.1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name: Documentation Author Signature: r,l7D MW C1'�
Frederick,Aianna CX1tCCz
Company: Signature Date:
CALIFORNIA DELTA MECHANICAL INC 201410-29 16:08:16
Address: CEA/HERS Certification identification(if applicable):
1235 GRAND AVE
City/State/Zip: Phone:
SPRING VALLEY CA 91977 (480)898-0007
Responsible Person'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. I am eligible under Division 3 of the Business.and Professions Code to accapt.responslbility fot�the building, esign or,system,desfgn Identified an this Certificate of Compliance(responsible designer).
s. r
3. That the energy features and performance speciflcaUons,materia)s,,components;grid manufactured devices fprtCie buEldtig desigpr system design Identified on this Certificate of Compliance n
zri• s p e co form to the
requirements of Title 24,Part 1 and Paft:6 of the Californl&Cod'.of.Regulations.
4. The buildingdesign features or ;�.. _
8 sys , esign features 1denUfletl an alis Certiffwte of pifance aii,bMistent with:thei;informatli,$rovided on other applicable compliance documents worksheets
;:,::
ez�..
calculations,plans and speciflcatiori's. bmitted:to:the erorcement a en fora roJaiwith this bulldtn s
s.. x,,,� 6,P,mt pp,,faUon.
z .
S. 1 will ensure that a r H.•:= " �• � V�•, '"
egistered copy of:this,Certtflcate of:CoiN'lance h I, e..* "' '
p!„ s a,ibe,iri3de;available;;wlh}he;titUldi'"'L`'`"rmits!+l5suedfo`
{�,,, e,building;!anis°mdc;�avaiteble to the enforcement agency for all applicable
Inspections.l understand that a registered copy of ttii5 Certiflcatie of Compliance'ts PegUireif td'tie Irtcii'Wed with"the documentatioe the builder provides to the building owner at occupancy.
Responsible Designer Name: Responsible Designer Signature: p
Frederick,Alanna c9V& l/za c 2+P,G�Pi1 f
Company: Date Signed:
CALIFORNIA DELTA MECHANICAL INC 201410-2916:08:16
Address: Ucense:
1235 GRAND AVE 811114
City/State/Zip: Phone:
SPRING VALLEY CA 91977 1(480)898-0007
Digitally signed by CaICER TS. This digital signature is provided in order to secure the content of this registered document and in noway implies Registration Provider responsibility for the accuracy of the information.
Registration Number:214-A0128906A-000000000-0000 Registration Date/Time: 2014-10-2916:08:16 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:201403-31 Report Generated:2014-10-29 16:08:53
Schema Version:0.551SDD