14020095 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 18604 LOREE CONTRACTOR:COOPER BROTHERS, PERMIT NO: 14020095
INC.
OWNER'S NAME: TORREY LEON E AND MARGARET S 6017 SNELL AVE STE 331 DATE ISSUED:02/14/2014
OWNER'S PHONE: 4085541818 SAN JOSE,CA 95123 , PHONE NO:(408)437-2442
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPT DENTIAL E] COMMERCIAL ❑
REPLACE(E) ALL FURNACE WITH(N)FORCED AIR
License Class L' 9-C' Lic.# ?-2 J 1 6 CIS- SYSTEM INCLUDING ASSOCIATED DUCTWORK.
**EICHLER
Contractor 6- e e,^ 13y o f ems Date 2—/2-1 I y HOME,ALL DUCTWORK IN THE INTERIOR*
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:$4650
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:37525074 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 1 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 ROM LAST CALLED IN SPE 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
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
918.
RE-ROOFS:
Signature Date Z/ y 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. 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 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,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: mate: "2-1
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
rn/
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GENERAL PERMIT APPLICATION i� MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION /
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255MMM I S C
(408) 777-3228•FAX(408)777-3333•building 5cupertino.ong \
❑PLUMBING &ffi�ICAL ❑ELECTRICAL []MISCELLANEOUS
PROJECT ADDRESS D�O I APN# � ' Z 0 Ll
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❑ OWNER ❑ OATIER•BUII.DER ❑ ONMERAGIIdr ❑ CONTRACTOR ❑COhrTRACTORAGENT ❑ ARCHrMCT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
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COMPANYNAME EMAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WIALAND ❑ YES PROTECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING ❑CONNERCIAL URBAN INTERFACE AREA (SAO FLAOD ZONE [�O EICHLER HOME? &INO
DESCRIPTION OF WORK (�
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TOTAL I VALUATION: �J 6 ayED a^i T- s y�� cin
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By my signature below,I certify to each of the following: I am the property owner or authorized a o act on the property niers beha ave read this
application and the information I have provided is correct. I have read the Description of Work-92-verify it is accurate. I a y ivith all applicable local
ordinances and state laws relating to b g c truc' n. Maor'.ereesentatives of Cupertino to enter the above-i ntifiied ro�p/erty for inspection purposes.
Signature of Applicant/Agent: Date: �i ( ! /
S RE ULEMENTAL INFORMATI0IF
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QIRED � OFFSCE US1arOl>'7fY����
��O�VER THF COU3i3�ER� �'
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MEPMiscApp_201 1.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 18604 LOREE DATE: 02/14/2014 REVIEWED BY: MELISSA
APN: 375 25 074 BP#: '"VALUATION: 1$4,650
PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION FURN/AC
USE: PERMIT TYPE:
WORK REPLACE E WALL FURNACE WITH N FORCED AIR SYSTEM INCLUDING ASSOCIATED
SCOPE DUCTWORK. **EICHLER HOME, ALL DUCTWORK IN THE INTERIOR"
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced-Air 1MFR=<100 1 # $139
TOTALS:X $139.00
�€
W
Mech.Plan Check 0.0 1 hrs $0.00 Azvf,.b.P"'w" "'beck
Mech.Permit Fee: IMPERMITfiat,-b,f'c'€' ariPoe: <?e'£;. 'e'�,3aia?...,.
Other Mech.Insp. 0.0 hrs $47.00 Other Ph£jral7 fr,t:. Ome> s>ne,Ins"'.
1`7£c. Matt'. Fee:
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 relimina information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS(Fee Resolution 1.1-053 ff. 711/.13) FEE QTY/FEE MISC ITEMS
Alan Check
`r,.,.7s i. .P(...,1'3=; ee
PME Plan Check: $0.00
. '.Lir pL, in4.f'.3
PME Unit Fee: $139.00
PME Permit Fee: $47.00
i.f3fr:s`i r"P6C'2�fr�i z C%1
Administrative Fee: IADMIN $44.00
Work Without Permit? 0 Yes 0 No $0.00
iTr.F'e'es
Travel Documentation Fee: ITRAVDOC $47.00
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
131da Std.s Commission Fee: IBCBSC $1.00
y'cU3& +D 'AL
yam..... $278.50$278.50 $0.00
., .
Revised: 01/15/2014
HVAC ALTERATIONS ENERGY COMPLIANCE FORM
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
CUPERT[MC7 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333•building a cupertino.oro
WHEN IS A PERMIT REQUIRED
A construction permit shall be obtained from the enforcement agency prior to the erection,
construction, reconstruction, installation, relocation, or alteration of any mechanical system, except as
permitted in Chapter 1, Section 112.2 of the 2010 California Mechanical Code. Projects requiring
permits include, but are not limited to:
• New HVAC installation
• HVAC Changeout
• Replacement of furnace, coil,FAU or condenser ti
• Relocation of an existing HVAC unit
• Adding or replacing more than 40ft ducting in unconditioned space
BUSINESS AND PROFESSIONS CODE,SECTION 7110
Willful or deliberate disregard and violation of the building laws, including the California Building
Code, and local permit requirements constitutes a cause for disciplinary action from the Contractors
State License Board working in conjunction with the local building department. This action may
consist of fines up to $5,000 per violation or suspension/revocation of a contractor's license.
2008 BUILDING..+, ER, Y EFFICIENCY STANDARDS (Title 24,Part 6)REQUIREMENTS
INCLUDE:
1. Heating equipment must have a minimum 78%AFUE(Exception: Wall &floor furnaces; room
heaters).
2. Central air conditioners &heat pumps less than 65,000 Btu/hr must have a minimum 13 SEER.
3. Newly installed or replaced ducts must have a minimum insulation value of R-4.2.
4. A setback type thermostat(24 hr clock with four set points) is required for all alterations.
5. New or replacement ducts must meet the mandatory requirement of Section 150(m).
• All joints and openings in the HVAC system must be sealed.
• Only UL 181, UL 181A, or UL 181B approved tapes or mastic shall be used to seal duct
openings.
• Connections of metal ducts and the inner core of flex ducts shall.be mechanically fastened.
Flex ducts must be connected using a metal sleeve/coupling.
• Flex ducts that are suspended must be supported every 4 ft. max for horizontal runs with no
more than 2"of sag between supports and 6 ft. max for vertical runs.
6. The CF-6R-MECH-04 must be completed and signed by the installing contractor. The Inspector
will collect this form and verify that the model numbers are the same as the installed equipment.
2008 Residential Compliance Forms.doc revised 04/10/12
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