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14030109 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10192 FIRWOOD DR CONTRACTOR:ATLAS-TRILLO HVAC PERMIT NO: 14030109 OWNER'S NAME: SHILPA MERCHANT 1965 KYLE PARK CT DATE ISSUED:03/18/2014 OWNER'S PHONE: 6509066869 SAN JOSE,CA 95125 PHONE NO:(408)286-8931 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL ❑ � �� REPLACE(E)FURNACE AND(E)WATER HEATER,SAME ` License Class Lic.# C� Q, LOCATIONS Contractor A-flQ ` Date 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:$2800 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:34235021 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 DAYS FROM LAST CALLED INSPECTI N. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the 3 ,8 granting of this permit Additionally,the applicant understands and will comply pe with all non-point sou tions per the Cupertino Municipal Code,Secti 9 18. E-ROOFS: 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 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 w' he Cu ertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code, c' s 25 5,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this �1 Datg permit is issued. Owner or authorized age 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 EP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 MISCJJJ 408 777-3228•FAX(408)777-3333-buildina(c�cupertino.org �Upl`Et`INQ ( ) ❑PLUMBING ❑MECHANICAL ❑ELECTRICAL []MISCELLANEOUS PROJECT ADDRESS o Dy © Z 1 OVWNHRNAME I P /� c / E-MAIL — wwl STREET ADDRESS G 0 L I6 (/V SATE. Sr r � ) I FAX i CONTACT NAME f PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑ OW"I ER ❑ OWNER-BUILDER ❑ OWNER AGNT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT• ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME 1 /'\ �� /I_ LI E LIC 'S BUS.LIC# COMPANY NAME `[ if (^�,/ E-MAIL FAX STREET ADDRESS CTTY,STATE, /� Sy� OzT) qS U- ARCHI TECT/ENGINEER NAME LICENSE NUMBER S.LIC# COMPANYNAME E-MAIL FAX STREET ADDRESS CrTY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WIIALAND ❑ YES PROJECT IN ❑ YES IS THE BLDG AN El YES BUIIDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHT.IIt 1401,? ❑NO DESCRIPTION OF WORK /'n O ►6� ��_ CC J"l� a (�r -- 1Z TOTAL VALUATION: _ By my signature below,I certify to each of the follo I am the property owner or authorized agent to act on e e alf I have read this application and the information I have provided is ave read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building stru ion authorize re resentatives of Cupertino to enter the above id tifigd pr7rty fo nspection purposes. Signature of Applicant/Agent: Date: /��J SUPPLEMENTTAL INFORMATION REQUIRED � oFFacElJsrsbi` , MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10192 FIRWOOD DR DATE: 03/18/2014 REVIEWED BY: MELISSA APN: 342 35 021 BP#: VALUATION: 1$2,800 xPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: FURN/A WORK REPLACE E FURNACE AND E WATER HEATER SAME LOCATIONS SCOPE 1110 ,2 y� ' T Mech.Plan Check 0.0 hrs $0.00 Plumb.Plan Check 0.0 hrs $0.00 f'/an J?,vAl Mech.Permit Fee: 11PERMIT Plumb.Permit Fee: IPPERMIT Other Mech.Insp. 0.0 hrs $47.00 Other Plumb Insp. 0.0 hrs $47.00 o/cj,lFiec_Insp, llc tr I? t}. F'Cc: 1'ixntb. 1>lC c. NOTE.This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These ees are based on the prelimina information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Mechanical Suppl. PC Fee: Reg. ® OT 0.0 hrs $0.00 $139.00 IMFR=<100 Furnace,Forced-Air PME Plan Check: $0.00 1 # Plumbing Permit Fee: $0.00 $28.00 1PRWHEATR Water Heater Suppl. Insp. Fee:Q Reg. Q OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $94.00 tl.�,C1 i55?7°7tF.'tif}}7 .�ct.l: Administrative Fee: IADMIN $44.00 0 Work Without Permit? 0 Yes iq No $0.00 Advanced Planning EeI $0.00 Select a Non-Residential G Travel Documentation Fee: ITRAVDOC $47.00 1 Building or Structure 0 i Strong Motion Fee: 1BSEIS1vffCR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $186.50 $167.00 $353.50 W;w T..O -AL FEE• Revised: 01/15/2014 HVAC ALTERATIONS ENERGY COMPLIANCE FORM COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O.,BUILDING OFFICIAL CUPERTIN0 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228•FAX(408)777-3333•building cDcupertino.or4 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 ? • 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 ENERGY 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 1 Shnplified Prescriptive Certificate of Compliance:2008 Residential HVA CAR erations. CF-IR-ALT-HVAC Cfis ixte Tones 1 and 3-7 S7te Addro Enforcer J Agency rLb 3J Condition Q^/ Dud insulation ent Type' -1i!ANEhiirqumEfftciencY2Floor Aiea Therrostai ; I ckaged Unit, ; Over 4U 8 of duel mace AFUE COP Seaved by system added or replaced m Setback door Coil SESTt ®HSPF_ (lf mat already pres09 must be ondensing Unit ®EER E3 Resistance sf unconditioned space i ther _ El R 6 (CZ 1,3-5) 1.Equipment Type:Choose the equipment being installed;if more than one_systeiu,use another CF-IR-ALT-HVAC for each system 2.Afinimum Equipment Efficiencies:13 SEER,78%AFUE,7.7HSPF for typical residential systems. 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 ofthe California Business and Professions Code to accept responsibility for the design identified_on this Certif cate of Compliance. • I certify that the energy feafures and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24,Parts I 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 and specifications submitted to the en ent agency for approval with the permit application, Name: Tyt Signature: CompanyM� r- `.� 'RVA � Dom,.. �. �. DO Address ��rr License: V City/State/Zip: v 6 5 Phone: G� 2008 Residential Compliance Forms.doc revised 04110112