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15070119s CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10913 NORTHFIELD SQ CONTRACTOR: VALLEY HEATING & PERMIT NO: 15070119 COOLING OWNER'S NAME: KAMBLI RAJIV AND PESHNE PRAJAKTA 1171 N 4TH ST DATE ISSUED: 07/23/2015 OWNER'S PHONE: 4084294994 SAN JOSE, CA 95112 PHONE NO: (408)294-6290 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL L] COMMERCIAL �/ �j �� U �10 f U INSTALL (N) A/C UNIT (2.5 TONS, 14 SEER) NEAR FURNACE License Class Lic. # (� PATIO AND INSTALL (1� FORCED AIR (80 ��,% �r %` U� 1 �Q `�� t C ""Oath 2 T` (r AFUE, Contractor y 70K BTU) IN (E) LOCATION IN GARAGE 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 Sq. Ft Floor Area: Valuation: 58413 S performance of the work for which this permit is issued. 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: 31637022.00 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 WS FROM LAST CALLED INSPE TION. 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: 3 granting of this permit. Additionally, the applicant understands and will comply with all non -point sourc regulations per the Cupertino Municipal Code, Section RE -ROOFS: 9.18. 7 //f 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 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 1, 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(x) 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 Cu erti Municipal Code, Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 05, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Dater 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 [50 -01Iq COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildina(a)cupertino.oro CUPERTINO ❑ PLUMBING ❑ MECHANICAL ❑ ELECTRICAL ❑ MISCELLANEOUS PROJECT ADDRESS (� Nbr+� �• E-MAIL OWNER NAME J lr. n C� ^ n PTD V` STREET.ADDRESS O -3 n' � f L' _ /�l�J �( e 1 "lj� CITY, S"TE,� $q� �� / L/ FAX — C ( CONTACT NAME ��ruCr < PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑COhTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NADA i l LICENSE 1 [JI IDERq ( I ) \ (�J� LICENSE TYTE BUS. LIC # COMPANY NAME E-MAILU V7 FAX STREET ADDRESS I I CITY, STATE ZIP % s o f 1/ PHONE9 6 `, (� 2 � O I t ARCMTECT/ENGINEER NAME LICENSE NUMBER BUS. LIC R COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY PROJECT IN WILDIAND ❑ YES BUADING: ❑ COMMERCIAL URBAN'' INTERFACE AREA ❑ NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO DESCRIPTION OF WORK ASIA So 4FvE -7ok- 07u1 TOTAL VALUATION: 3 J2ECE'., _ ':.: / V k By my signature below, I cJ fy to Jach of the following: I am the property owner or authorized agent to act on the p ope, y owner's behalf. i have read this application and the information I have provid s correct I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to build in n tion. I a/representatives of Cupertino to enter the above-' e ti ed�� f inspection purposes. Signature of Applicant/Agent: � 1 � `' Date: _ 7- SUPPLEMENTAL INFORMATION REQUIRED OFFICE: USS ONL. l 0VEI.-TI E-COUNTI-1, - EAPF:I;SS Z -- U 1J(7R MEPATiSCAPP_2011.doc remised 06121/11 §F_M7 CITY OF CUPERTINO (5 vl (q FEE ESTIMATOR - BUILDING DIVISION 9a, ADDRESS: 10913 Northfield Sq. DATE: 07/23/2015 REVIEWED BY: Paul EMN APN: 316 37 022 BP#: *VALUATION: 1$8,435 .'PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: # PENTAMATION FURN/AC PERMIT TYPE: WORK Install N A/C Unit 2.5 Tons 14 SEER near Patio and Install N Forced Air Furnace 80 AFUE 70K SCOPE BTU) in (E) location in garage APPLIANCE / EQUIP TYPE FEE ID "ht :1,. flan G:ec�/. QTY UNITS BP FEES L'lec. PermitF'ee: A/C Units (<=10K cfm) 1 BREMAIR Other Elec. Insp Li 1 # $72 Furnace, Forced -Air 1MFR=<100 irppl. Insp Fee 1 # $143 PME Unit Fee: $215.00 PME Permit Fee: $48.00 onstruct l (.m 14n. Administrative Fee: ]ADMIN $45.00 Work Without Permit? O Yes (F) No $0.00 TOTALS: Travel Documentation Fee: ITRA VDOC $215.00 Strom/ Motion Fee: IBSEISMICR 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 preliminary information available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution I1-053 ET. 7/1/13) Mech. Plan Check 0.0 1 hrs $0.00 "ht :1,. flan G:ec�/. I-3ec, Platt Check Mech. Permit Fee: IMPERMIT !'lamb. ; L'lec. PermitF'ee: Other Mech. Insp. 0.0 hrs $48.00 )Ater Plumb ]/Isle. Other Elec. Insp Li 11.. h /u'p_ h ; i'ltrmb. Insp. /` : klec. Insp. Nee 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 preliminary information available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution I1-053 ET. 7/1/13) FEE QTY/FEE MISC ITEMS Plast Check I%ee: '� uppl. PC Fee PME Plan Check: $0.00 '<rmit Fee: irppl. Insp Fee PME Unit Fee: $215.00 PME Permit Fee: $48.00 onstruct l (.m 14n. Administrative Fee: ]ADMIN $45.00 Work Without Permit? O Yes (F) No $0.00 I rlvoneed Planning Fees: Travel Documentation Fee: ITRA VDOC $48.00 Strom/ Motion Fee: IBSEISMICR $1.10 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $358.10 $0.00 TOTAL FEE: 1 $358.10 Revised: 07/02/2015 STATE OF CALIFORNIA ALTERATIONS - HVAC CEC-CFIR-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:I n /,7�/J, Enforcement Agency, 2, Daterp �% � Permit#: 2/3 Equipment Type Equipment Efficiency New: Ducting, Plenums, Lineset Required R -value Conditioned Floor Area (sq ft) Thermostat ❑Packaged System Evaporator Coil • JAFUE COP ❑ R-6 XZ 1,3-7) Ducts ❑ R-8' (CZ 16) Ducts Served by system ��_sq ft Setback (If not already ❑ Split System Condensing Unit SEER HSPF ❑ R-6 (all CZ's) Plenums present, must Furnace ❑ Lineset EER ❑ R-5 or R7.5 Lineset' 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 (:L15% 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 112. 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 Ducts' CF1R-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) -HERS' Installer Requirement: Duct leakage < 6%, Fan Efficacy (.58W/CFM), Air Flow >_ 350 CFM/ton (or Standards Table 150.G -C/ D alternative) 113. 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 Ducts' and one or more of the following: CF2R-MECH-01, MECH-20-HERS, MECH-(23 or 24) -HERS Condenser Unit, Evaporator Coil, Furnace CF3R-MECH-20-HERS, MECH-(23 or 24) -HERS Installer Requirement: Duct leakage < 6%, 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. ❑ 4. New Ducting over 40 feet Required Compliance Documents to be left on site for Final: Adding or replacing ducts in unconditioned CF1R-ALT-02-E CF2R: MECH-20-HERS space but less than All New Ducts' CF3R: MECH-20-HERS Installer Required to: Duct leakage I<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 dud 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-2%", 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. S. 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. Responsible Designer Na e: Respons' igner Signa/ Date Signed: ZL License: Company: Address: Gty tate/Zip: Phone: For assistance or questions regarding the Energy btanaaras, contact the tnergy nomne at.-ouu-f.&-aavu OFFICE COPY PLANNE APPROVAL REOUIRFn PRIOR TO F NAL' OCCUPANC SIGNA RE, �E COMMUNITY DEVELOPMENT DEPARTMENT -BUILDING DIVISION - CUPERTINO APPROVED This. set pf plans and specifications MUST be kept at e job site during r alterrUCt1' onn. tsamel, orfto deviate l to make any__ charges Ofificial.- the'refrom, without approval from the Building The stamping of this plan and specifications SHALL NO b h '^ �rinit"nr'tn ho an approval.of tha_viu ltrun or Stale Law. Of s, 119 CUPERTINO Building Department JUL 2 3 2015 REVIEWED FOR CODE COMPLIANCE Reviewed By: �� W PLANNE APPROVAL REOUIRFn PRIOR TO F NAL' OCCUPANC SIGNA RE, �E COMMUNITY DEVELOPMENT DEPARTMENT -BUILDING DIVISION - CUPERTINO APPROVED This. set pf plans and specifications MUST be kept at e job site during r alterrUCt1' onn. tsamel, orfto deviate l to make any__ charges Ofificial.- the'refrom, without approval from the Building The stamping of this plan and specifications SHALL NO b h '^ �rinit"nr'tn ho an approval.of tha_viu ltrun or Stale Law. Of s, 119 CUPERTINO Building Department JUL 2 3 2015 REVIEWED FOR CODE COMPLIANCE Reviewed By: ��