14050140CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20100 PACIFICA DR
CONTRACTOR: AAA FURNACE & AIR
PERMIT NO: 14050140
CONDITIONING
OWNER'S NAME: REDMOND MICHAEL J AND RITA A T
1712 STONE AVE
DATE ISSUED: 05/23/2014
OWNER'S PHONE: 4082577111
SAN JOSE, CA 95125
PHONE NO: (408)293 -4717
LICENSED CONTRACTOR'S DECLARATION
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JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
REPLACE (E) FURNACE & A/C UNIT, SAME LOCATIONS
License Class Lic. # V
n a�
Contractor !1 m F(ICAI A c Q Date
I hereby affirm that I am licensed under the provision 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 ofponsent to self - insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
Sq. Ft Floor Area:
Valuation: $12031
rformance of the work for which this permit is issued.
have and will maintain Worker's Compensation Insurance, as provided for by
ection 3700 of the Labor Code, for the performance of the work for which this
APN Number: 36928024.00
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 IT 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 D ED 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
Is A-5-e- Date:
granting of this permit. Additionally, a applicant understands and will comply
with all poin urce regu 'o er the Cupertino Municipal ode, ection
9 18.
Pot' i/
't
RE- ROOFS:
Sig ature 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. 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.
hapter 9.12 and
will maintain compliant perti&,E-
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safe ode, Sections 2 505,
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or thorized agent: te: 2
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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
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GENERAL PERMIT AP"! XA,
COMMUNITY DEVELOPMENT DEPARTMENT `JLDING DIVISION
10300 TORRE AVENUE, CUPERTINO, CA S�01 4 -3255
C U E RT I O
(408) 777-3223 •FAX (406) 777-3333
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FEE ESTIMATOR - BUILDING DIVISION
20100 PACIFICA DR
FEE ID
DATE: 05/23/2014
REVIEWED BY: MELISSA
liaADDRESS:
APN: 369 28 024
BP #:
*VALUATION:
1$12,031
*PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: SFD or Duplex
$70
PENTAMATION
PERMIT TYPE: FURN /A �
WORK
REPLACE E FURNACE & A/C UNIT
SAME LOCATIONS
SCOPE
$139
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
A/C Units ( < =1 OK cfm)
1BREMAIR
1
#
$70
Furnace, Forced -Air
1MFR = <100
1
#
$139
PME Unit Fee:
$209.00
PME Permit Fee:
$47.00
( "On irl'Icli i"l t OX.
Administrative Fee: IADMIN
$44.00
Work Without Permit? 0 Yes 0 No
$0.00
TOTALS:
Travel Documentation Fee: 1TRAVDOC
$209.00
Strong Motion. Fee: 1BSEISMICR
Mech. Plan Check F0,01 hrs $0.00 Pleunh flirt Check
Mech. Permit Fee: 1MPERMIT 1'Irr nt>. 1'r:rnz2r N'C: l�,z:c. P emir
Other Mech. Insp. 0.0 hrs $47.00 C dwr Plumb fnv) Clrlrc�,� t,_le:�c. Ilsf� >,
ET—t-
�'!Cbz' fusee. J. "C 7'Iumb. hiss. 11'ee, rise L t. tr
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Tlictrirf otr ) Thoco foot nro hncod nn tho nroliminani infnrmafinn avnilahlo and nro nnly nn ocfimato_ f'nntart tho nont fnr addn'l info_
FEE ITEMS (Fee Resolution 11 -053 Ef . Z/ 3Z
FEE
QTY/FEE
MISC ITEMS
PC.' 111"'_
PME Plan Check:
$0.00
PME Unit Fee:
$209.00
PME Permit Fee:
$47.00
( "On irl'Icli i"l t OX.
Administrative Fee: IADMIN
$44.00
Work Without Permit? 0 Yes 0 No
$0.00
'{Glb'ckttf't'L/ I lCtYtfP1Y1£ /`e'.':i'.
Travel Documentation Fee: 1TRAVDOC
$47.00
Strong Motion. Fee: 1BSEISMICR
$1.20
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
STiTB
$349.20
$0.00 TOTAL FEE:
$349.20
Revised: 04/01/2014
Address
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SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • building(�cupertino.org
Permit No. 1405 0 LrJ Zo \ 0 fb (j�( d 0 2A e
# of Alarms Smoke: Carbon Monoxide:
PURPOSE
This affidavit is a self - certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
inspections are required.
GENERAL INFORMATION
Existing single- family and multi- family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds
$1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and /or Carbon
Monoxide Alarms be installed in the following locations:
AREA
SMOKE ALARM
CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the
bedroom(s)
X
X
On every level of a dwelling unit including basements
X
X
Within each sleeping room
X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel- burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl
space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for
alarms which must be connected to the building wiring.
As owner of the above - referenced property; I hereby certify that the alarm(s) referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms have been tested and are operational, as of the date signed
below.
I have read and agree to comply with the terms and conditions of this statement
Owner (or Owner Agent's) Name:
Signature.......... .................................................................... ............................... Date: ...................
Co ra for ame: [/�J�
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Si nature ............... Lic. #
Date:l�...�
Smoke and COform.doc revised 03118114
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2008 Residential Compliance Forms.doc revised 04110112
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Prescriptive Certificate of Compliance: Residential CF -IR -ALT
Residential Alterations (Page 4 of 5)
Project Name: Climate Zone # # of Stories
HVAC SYSTEMS - HEATING
Nlinimum Duct or Piping Configuration
Heating Equipment Efficiency Distribution Insulation Thermostat (Central, Split,
Tvne and Caoacitvn''3 (kFUE or HSPF) Type and Location R -Value T e Space, Package or .Hy
1. Indicate Heating Type (Cent: -al Furnace, .Wall Furnace. Heat pump, Boiler, Electric Resistance, etc.)
?. Electric resistance heating is allowed only in Component Package C, or except where electric heating is supplemental (i.e., if total capacity
< 2 KW or 7,000 Btu /hr electric heating is controlled by a time - limiting device not exceeding 30 minutes). See ¢151(6)3 exception.
3. Refer to the HERS' Verification section on Page 4 of the CF -IR -ALT Form for additional requirements and check applicable boxes.
4. Indicate Type or Location (Duets. Hydronic in Floor, Radiators, etc.)
HVAC SYSTEMS - COOLING
Minimum
Efficiency Duct or Piping Configuration
Cooling Equipment (SEER/EER or Distribution Insulation Thermostat (Central, Split,
Type and Ca acit SOP) Type and Location; R -Value Type Space, Packa a or H dr
11r.1d1+ h_,':� ily�- tho sff-o- Cevtir�l
1. Indicate Cooling Tvpe (A /C. Heat pump, Evap. Cooling, etc)
2. Refer to the HERS Verification section on Page 4 of the CF- IR -ALT Form for additional requirements and check applicable boxes.
3. Indicate Type or Location (Ducts, H dronic in Floor, Radiators, etc.)
WATER HEATING
List water heaters and boilers for both domestic hot water (DFlW) heaters and hydronic space heating. Individual dwelling DHW heaters must be
Igas or propane fired, and may not exceed 50 gallons. Hot water pipe insulation from the DHW heater to the kitchen(s) and on all underground
hot water pipes is required in all com onent packages in all climate zones. E t al Tank
xern
Water Heater Type /Fuel Distribution Type Number In Tank Energy Factor or Insulation
'r —.1 (Standard. Recirculating) I System Capacity (gal) Thermal Efficienc R- Value3
1. Indicate Tvpe (Storage Gas, Heat Pump, Instantaneous, etc.)
3. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of §1 50(n). The Prescriptive requirements do
not allow the installation of a recirculating water heating system for single dwelling units.
3. The external water heating tank and pipes shall be insulated to meet the requirements of §1506).
SPECIAL FEATURES The enforcement agency should pay special attention to the Special Features specified in this checklist oetow_
These items may require written justification and documentation and special verification.
NEW- ROOF ASSEMBLY - Radiant Barrier
The radiant barrier requirement of § 151( 2 does22L2p2l to roof alterations.
Slab Edge (Perimeter) Insulation 0 YES l7 NO
YES: In Climate Zone 16 in Component Packages D, R -7 insulation is required.
Heated Slab Insulation ❑ YES O NO
YES: Slab edge insulation required for all heated slabs in all Climate Zones. See details
Raised Slab Insulation ❑ YES ❑ NO
YES: In Climate Zones 1, 2, 11, 13, 14 & 16, R -8 insulation is
Thermal Mass
To obtain Compliance Credit
r the installation of there
1 18 -A of the standards.
in Climate Zones 12 & 15, R -4 is required under
the Performance
Registration Number: Registration Date/Time:
2008 Residential Compliance Forms
HERS Provider:
August 200
11;;
INSTALLATION CERTIFICATE CF -6R- MECH -04
Space Conditioning. Systems, Ducts and Fans (Page 10 2
Site Address: Enforcement Agency: Permit Number:
.Space Conditioning Systems
Heating Equipment
Equip
Type
(package-
heat um
CEC Certified Mfr. Name
and Model Number
ARI
Reference
Number 2
# of
Identical
Systems
Efficiency
(AFUE,
etc.)1'3
(zCF -1R
value )4
Duct
Location
(attic,
crawl-
space,
etc.
Duct
R -value
Heating
Load
Btu/hr
Heating
Capacity
Btu/hr
fit
b
Cooling Equipment
Equip
Type
(package
heat
um
CEC Certified Mfr. Name
and Model Number
ARI Reference
Numbers
# of
Identical
systems
Efficiency
(SEER
and EER)
I' 3
(zCF -1R
value )4
Duct
Location
(attic,
crawl-
space,
etc.
Duct
R -value
Cooling
Load
(Btu/hr )
Cooling
Capacity
(Bftvlu
1. If project is new construction, see Footnotes to Standards Table 151 -B and Table 1 J 1- c,',1or duct ceutng alternative
compliance.
2. ARI Reference Number can be found by entering the equipment model number at http:l Avww .aridirectory.org/ari/ac.php#
3. Listed efflciency on this page must be greater than or equal ( >_) to the value shown on the CF -I R form.
4. When CF -IR is reference it is also applicable to the CF -1R, CF -IR -AA or CF -IR -ALT
ALL BOXES MUST BE CHECKED TO BE A VALID FORM
❑ §110 - §113: 14VAC equipment is certified by the California Energy Commission.
❑ § 150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA, or ACCA.
❑
§150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of §112(c).
❑ § 1500)2: Pipe insulation for cooling system refrigerant suction, chilled water and brine lines meets minimum
requirements of Table 150 -B and includes a vapor retardant or is enclosed entirely in conditioned space.
2008 Residential Compliance Forms
August 2009