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11060131 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 853 LONNA LN CONTRACTOR:VALLEY HEATING& PERMIT NO: 11060131 COOLING OWNER'S NAME: SUSAN DAVIS 1171 N 4 TH ST DATE ISSUED:06/15/2011 ER'S PHONE: 4089308967 SAN JOSE,CA 95112 PHONE NO:(408)294-6290 LICEN,,S�E��D CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB� License Class ��CJ Lie.# .0 �// /� MECH RESIDENTIAL COMMERCIAL Contractor Vail, �7e4�1 . `�4Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE&REPLACE FURNACE(SAME LOCATION- (commencing with Section 7000)of Division 3 of the Business&Professions CLOSET); ADD AIR CONDITIONING Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declar t' 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. 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 Sq.Ft Floor Area: Valuation:$6903 permit is issued. APPLICANT CERTIFICATION APN Number:35919027.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. / "> ` Issued b ' _ Date: Signature � QcC �e/G • Y, ��te- / �� -i' L OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. 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 O r oEauthpr* ed forthwith comply with such provisions or this permit shall be deemed revoked. 41 -S Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save i-' -nify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address and expenses which may accrue against said City in consequence of the &-. ting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional Sim ii ied Prescriptive Certificate of Compliance: 2008 Residential HVAC CF-M-ALT-HVAC Climate Zones 16 Site Address: „ / l Enforcement Agency: Date: Permit#: Conditioned Equipment T e' List Minimum Efficient z Floor Area Duct insulation requirement Thermostat Packaged Unit3 Over 40 ft of ducts added or urnace AFUE� ❑COP replaced in unconditioned Setback Served by systems ace (If not already present, Indoor CoilSEER� HSPF sf ondensing Unit EER RResistance R 8 (CZ 16) must be installed) Other 1,Equipment Type:Choose the equipment being installed;if more than one system,use another CF-I R-ALT-HVAC for each system. 2.Minimum Equipment Efficiencies: 13 SEER,78%AFUE,7.7HSPF for typical residential systems. HERS VERIFICATION SUMMARY Listed below are four HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted.A copy of the forms shall be left on site for final inspection and a copy given to the homeowner. At final,the inspector verifies that the work listed on this form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF-6R and registered CF-4R forms(no hand filled CF-4Rs allowed)are filled out and signed. Beginning October 1,2010,a registered copy of the CF-111 and CF-611 shall also be on site for final inspection. 1.HVAC Changeout Required Forms: • All HVAC Equipment replaced CF-6R forms: MECH-04 and MECH-2I-HERS CF-4R forms: MECH-21 • Condenser Coil and/or CF-6R forms: MECH-2I-HERS • Indoor Coil and/or CF-4R forms: MECH-21 • Furnace For Split Systems:Duct leakage<15 percent For Packaged Units: Duct leakage<15 percent Exempted from duct leakage testing if- 0 1.Duct system was documented to have been previously sealed and confirmed through HERS verification,or 2.Duct systems with less than 40 linear feet in unconditioned space,or 3.Existing ducts stems are constructed,insulated or sealed with asbestos 2.New HVAC System Required Forms: • Cut in or Changeout with new ducts:(all CF-6R forms: MECH-04 and MECH-2I-HERS new ducting and all new equipment) CF-4R forms: MECH-21 For Split Systems:Duct leakage<6 percent, For Packaged Units:Duct leakage<6 percent 3.New Ducts with Replacement Required Forms: • Includes replacing or installing all new ducting and/or outdoor condensing unit CF-6R forms: MECH-04 and MECH-20-HERS and/or indoor coil and/or furnace. Not all CF-4R forms:MECH-20 equipment char ed. For Split Systems:Duct leakage<6 percent For Packaged Units: Duct leakage<6 percent 4.New Ducting over 40 feet Required Forms: • Includes adding or replacing more than 40 CF-6R forms: MECH-04 and MECH-2I-HERS linear feet of duct in unconditioned space. CF-4R forms: MECH-21 For splits stem or packaged units: Duct leakage< 15 percent split Existing duct systems constructed,insulated or sealed with asbestos. Contractor(Documentation Author's/Responsible Designer's Declaration Statement) • I certify that this Certificate of Compliance documentation is accurate and complete. • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. • 1 certify 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. • The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms,worksheets,calculations,plans andspecifications submitted to the enforcement agency for approval with the permit application. Name: "? Signature: C Lr•,G t ( Company: Date:U c+ /' L�(F ���Gf l Address: S License: i l City/State/Zip: �� �`S t, ��� Phone: /�� —2 14 L 2008 Residential Compliance Forms March 2010 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RTI N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: i<53 Z-allic, In PERMIT# D` OWNER'S NAME: PHONE# 3,0— � GENERAL CONTRACTOR: BUSINESS LICENSE# 1 ADDRESS: N, Ij CITY/ZIPCODE: stn T & 9-Si/Z *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: ''G" ��� /� Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum /Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date I ► () (_Po ( 5 1 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 MISC (408)777-3228• FAX(408)777-3333•building(cDcupertino.org GUPERTINQ ❑PLUMBING KMECRANICAL ❑ELECTRICAL ❑ MIS�C,E {j LLANEOUS ��PROJECT ADDRESS APN xJ �K� lope OWNER NAME e- PHONE E-MAIL -Gd 5Qrt b�l V.'S ot;