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12050162 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19970 PRICE AVE CONTRACTOR:A & H HEATING PERMIT NO: 12050162 OWNER'S NAME: HSU FAN AND MILLIE 770 CHESTNUT ST DA IT ISSU6:0:05/22/2012 OWNER'S PnoNE: 4087812145 SAN JOSE, CA 95110 PHONE:NO:(408)279-0722 ❑ LICENSED CONTRACTOR'S DECLARATION r r r nun.nlNc Peaan r INFO: 01.nc Et.ecr PLUMBLicense Class C' ZU Lic.4 5-0 yq?L r r r )IF.CII RESIDENTIAL CO?Ia1ERC1AL Contractor lky l•'1'f' - Date 2 T - .1014 ut;SCRII'1'ION: REPLACE FURNACE AND A1C UNI IS 1 hereby nlTirm that lam 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. 1 hereby affirm under penalty of perjury one of the following two declarations: I have and will maimain a certificate of consent to sell'-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this peril is issued. Sit.F1 Floor Area: Valuation:S8000 1 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:36904014.00 Occupancy'I'ype: permit is issued. COLD- APPLICANT CERTIFICATION TQ r - l I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct, l ounce 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 R l LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupenino against liabilities,judgments. / costs,and expenses which may accrue against said City in consequence of the granting of this permil. Additionally,the applicant understands and will comply, Issued by: Date• wide all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signalurc Dale Jl�—-i� All tools shall he inspected print to any roofing material being installed. 11'a runt is installed w'ithMn first obtaining an inspection. I agree to reunite all newmaterials lin inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: 1 herchy 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 BE 1-1 ER 1,as miner 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(Sea 7044, Business&Professions Code) I.as owner of the property,am exclusively contracting with licensed contractors to IIA%ARDOUS MA"ITRIA LS DISCLOSURL construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Ilealth&Safety Code,Sections 25505,25533,and 25534. 1 will 1 hereby nffinn under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Ilealth&Safety Code,Section 25532(x)should I store or handle hazardous I have and will maintain a Certificate of Consent to sell'-insure for Worker's material. Additionally,should 1 use equipment or devices it hich emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Qualify Management District 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 Ilealth&Safety Codc,Sections 15505,25533 lid 111-534. Section 3700 of the labor Code,for the performance of the work I'ot which Itis pcnnil is issued Owner or authorized agent' Dale: I certify that in the perOmnanee of the work for which this permil is issued.I shall not employ any person in any manner so as to become subject to the Worker's Compensation lases ot'California. If.after making this cenificale of exemption.I CONS'hRUC"ZION 1.&LADING AGENCI' become subject to the Worker s Compensation provisions of the Labor Code I must I hereby'allirm that there is a construction lending agencc I'or the perfunnatcc of forthwith comply with such provisions or this permit slmll be deemed revoked. work's for hich this permit is issued(Sec,31197.Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 1 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 :\NCIII'I'ISC'I"S DISCL:\Ii:\'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 I understand my plans shall be used as public records. grunting 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 Dote Simplified Prescriptive Certificate of Compliance:2008 Residential HVACAllerations CF-IR-ALT-FIVAC Climate Zoom I sad 3-7 sre .0 �tQ Elf,itA �� �?h2 re>mta: Conditioned Duct insulation ent Typel -UstWu:timu6Ef5ciency2 Floor Area requirement Thermostat El Padcwd Unit Ova 40 ft of ducts ®Furnace ©AFUE ®COP_ Served by system added or replaced 'vi �r ®indoor Col OSEEIL I S IiSPF_ (f(nmalready pmeN,mmrbe Condensing Unit 13EER ©Resisba sf Unconditioned spas iMdted/ Omer ©R 6 (CZ 1,3-5) /.Equipmeat Type:Choose the equipment being installed;if more than one system.use mother CF-IR-ALT-HVAC frr each system. 2.11fmimum Equipment Efficiencies: 13 SEER,78%AFUE,7JHSPF for typical residential systems. Contractor(Documentation Autbor's/Responsible Designer's Declaration Statement) • 1 certify that this Certificate of Compliance documentation is accurate and complete. • 1 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 catify that the coergy features 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 Califnmia Cade of Regulations. • The design features identified on this Certificate of Complimce are consistent with the information documented on other applicable compliance forms,worksheets,calculations,plans and specifications submitted to the enforcement agency for approval with the permit anDlication. Name: e^ Signanue: Company: Y- 44 to/ 14(—*' Y/1 C Datyt. 2 I Address: 7'70 V.a Ir J LioelmKa;, y��L City/State2ip: ;-Cr- : S`I 10 Phoue:274 G?Z'Z 2008 Residential Compliance Forms.doc revised 04/10111 CITY OF CUPERTINO 191. FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 19970 Price Ave DATE: 05/22/2012 REVIEWED BY: Sean APN: BP#: `VALUATION: $8,000 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY SFD or Duplex PENTAMATION FURNIAC USE: PERMIT TYPE: WORK Remove and replace existing furnace and A/C units in same locations. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES A/C Units (<=10K cfm) 1BREMAIR 1 # $65 Furnace, Forced-Air 1MFR=<100 1 # $130 TOTALS: $195.00 Mech.Plan Check 0.0 hrs $0.00 Plumb. Plan Check Elec.Plan Chock Mech. Permit Fee: IMPERMIT Phunh. Pca'mit Fec•: Elec. Permit Fre: Other Meeh. Insp. 1 0.0 hrs L $44.00 Ocher Plumb Imp. Li Ocher F.ler.hrsp. Li I ,Ilcclr. Imp. /Src: Plumb. hi.rp.Fee: Eler. laq,. Fec. NOTE: This estimate does riot include fees due to other Departments(Le Planning,Public Warks,Fire,Sanitary Sewer District,School District,etc). Thesefees arebased on the prelinddha information available and are only an estimate Contact the De t or addn7 info. FEE ITEMS(Fee Resohnion 11-053 Elf 7/1/Il) FEE QTY/FEE MISC ITEMS Plan Check Fete .Supp/. l'C.'Fee PME Plan Check: $0.00 Penni/ Fee: snppl. Insp /-'cc PME Unit Fee: $195.00 PME Permit Fee: $44.00 Construction Tax: Administrative Fee: IADMIN $41.00 Work Without Permit? D Yes Q No $0.00 Advanced Plunnin,¢ Fees: Travel Documentation Fee: ITRAVDOC $44.00 Strone Motion Fee: IBSEISMICR $0.80 Select an Administrative Item 131de,Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $325.80 $0.00 TOTAL FEE: 1 $325.80 Revised: 04/01/2012 GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 M I sc CUPERTINO (408)777-3228• FAX(408)777-3333• building(CDCUDertino.org 2 1osp I L.o� PrL�UMBING MECHANICAL ®ELECTRICAL [-]MISCELLANEOUS PROTECTADDRESS 199?O tC n `� �p AP40 OWNER NAME yn; Jj I` ,e `1� ` P� )-2 !('�� W E-MAH. 1 V STREET ADDRESS Q QL�L-I�bC /yrJ�l ee CITY. STATJ� IZIP L 5 � Q�Ul`/ FAY CONTACT NAME /('1() I � /I _ �� PHZt s, yte C7 rz?-P E-MAM 7 ql(� �7(� STREET ADDRE59�� CI Q eyy CITY.S YT�O G ft �l ! t 16 F VOO Z/ 1 Ca I ❑OwNER ❑ OWNER-BUR-DER ❑JO1W�NERAGENT gf CONl C1'OR ❑CCOO`INTRAACIORAGENT ❑ ARCHITECr ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTORN ^ nl ^ LI{>BJ�EJiSJ� � LICFS=ryyEn' BUS-LICA COMPANY NAME J 1 A '4- 1 I� {y�/•�I �c !/E`-7MA`rL C^V FAX -rte]4 /01-7 01"Z STREET AD �^�•``� Y'I/'�A _ i K pTC �1' C" ' `Zf�,/f- Q 'rn a '90RS 12 5 G?2 ARCHITECTIENGINEER NAME ►W LICENSE NUMBER BUS,LIC N COMPANY NAME E-MAIL FAX STREET ADDRESS CIN,STATE,LP PHONE USE OF ❑SM.,DUPLE% MULTI-FAMILY PRO=IN WB.DLAND ❑ YES PROIER LN ❑YES IS THE BLDG AN ❑ YES BUIIDDIG: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME' ❑NO DESCRIPTION OF WORK vricx.—P— Ltaah �x,� 220 Am ►9!c (!odlego'Tc ef"p . TOTAL VALUATION: Q C 6 c CI^, RECEIVED BY: By my signature below,I certify to each of the following: 1 am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I ito provi d is correct. I h of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relatingu g con. 1 au natives of Cupertino to enter theS-71—,e2, gkoovve-identified property for.inspection pufposes. Signature of ApplicanVAgent: Date: ✓ 7/—(2r SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY v OYER-THE-COUNTER i F' ❑ EXPRESS U U W ❑ STANDARD u ❑ LARGE ❑ NIA.IOR MEPMucApp_2011.doc revised 06/21/11