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12090228 CITY OF CUPERTINO BUILDING PERMIT RIIILDING ADDRESS: 21165 LAURET`fA DR CONTRACTOR:VALLEY HEATING& PERMIT NO: 12090228 COOLING OW'NER'S NAME: HSUEH CHUN I AND LI Y 1171 N 4'1'11 SI' DATE, ISSUED:09262012 OWNER'S PHONE: 4084069167 SAN.JOSE.CA 95112 PHONE NO:(408)294-6290 Y LICENSED CONTRACTOR'S DECLARATION G BUILDING PERMIT INFO: BLDG r ELECT F7PLUNIR r License Class C'A20 Lic.H 2 5 grJ'Y� / AIECII r RESIDENTIAL F COMMERCIALr Contractor VI�Py Hra tike Date y/L4• �— JO B DESCR I PT ION:ADD A/C ONLY 1 hereby affirm that I am licensed under the provisions of Chapter 9 (commencing wish 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 falloa ing 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 pemmit is issued Sq.Ft Floor Area: Valuation:$3744 1 have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the labor Code,for the performance of die work for which this permit is issued. ANN Number:32655017.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and stale that the above information is correct.l agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES 1F WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities.judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of permit. Additionally,the applicant understands and will comply 9 with all non-point source regulations per the Cupertino Municipal Code,Section Issued by: Zf=Vs� •� v Date: 9.18. n Signature',L��K(i�ya�i//Dile RE-ROOFS: ❑ OWNER-BUILDER DECLARATION All roofs shall be inspected prior to may roofing material being installed If a roof is installed without first obtaining an inspection,I agree to remove all new materials for I hereby affirm that I nm exempt from the Contractor's License Law for one of inspection. the fallowing two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicmt: Date: will do the work,mid the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO RF.CLASS"A"OR BETTER construct the project(See.7044;Business&Professions Code). I hereby affirm under penalty of perjury one of the fnlloxing three ILVLARDOUS NIATF.RLUS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California I Icalth S Safety Code.Sections 25505,25533,and 25534. 1 will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the com plin nce with the Cupertino Municipal Code,Chapter 9.12 and the Ilealth S performance of the work for which this permit is issued Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued Health&Safety Code,Sections 2.5505,25533.and 25534. 1 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 Owner or t uthar)''sedpgent: Compensation laws of California. If,after making this certificate ofcxemption,lrRii.-c-s oeS.tS=.7iDate: become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this pemtit shall be deemed revoked. CONS'IRIJ17FION LENDING AGENCY I hereby amrm that there is a construction lending agency for the performance of swrk's AI'PLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application mid shoe that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCIII'I'IiC"I"S DECLARATION costs,=it expenses which may accme against said City in consequence of the grinning of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date — a1 ! — 1 ' I ��- ' -- -- — `a CL d m - c N • I T' - _ d � _ I -- —Vill IZv � vz� GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 mi �1 CUPERTINO (408)777-3228• FAX(408)777-3333•huiIcina(dcupertino.oro `\/ PLUMBING MECHANICAL ELECTRICAL ❑MISCELLANEOUS P0.01ECT ADDRESS 2116-5 44cc�ek4 Dr_ APNd �� ,/ ! 01 -1 OWNER NAME ..J/tCn�rRX /1 PIIONEg0g g0b_1167 E-NIAILJ ✓� SIREEr ADDRESS� I Z7 S`DA/ jar- CITY'.STATE,ZIP ,/_J4 e'r, /qu q I FAX CONTACT NAME C �rQ c�17/ I/ PI10NE �' y / >10-1 E-\FAIL SrREET ADDRESS -/ CITY,STATE.ZIP `T G ( FAX ❑ OWNER ❑ OWNER.BUILDER ❑ OWNERAGEYT ❑ CONTRACTOR YCONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑OTENAANT CONTRACTOR NAME /� _ t r ` L� LICF.NSF.NIISIBE2 S G5 U LICESSE�PF.�e) BUS.LIC d/ COMPANY NAME I r f 7 171' E-MAIL o FAX SIACLTAUURESS117/ .(r of/L S[ CITV,STATE,ZIP S. / `75��2 PIfONEI'O91— 1µ ARCHITECTIE:NGINEER NAME ,v 1 LICIT SE NUMBER I BUS.LICCrd (OG COMPANY NAME E-MAIL FAX STREET ADDRESS CRY,STATE,ZIP PHONE USE OE SEDor DUPLEX ❑ MULTIFAMILYPROI[CT P'N'ILDLAND ❑ Y'Es PROJECT IN ❑YES ISTIIERLDGAN ❑YES BUILDING'. ❑COMMERCIAL URDAB IpTERFACEAREA ❑ NO FLOODZONF. ❑No EICHLER HOMM ❑NO DESCRIPTION OF WORK ( 1 A( TOTAL VALUATION: 3 7Y41 RECEIVED BY: By my signature below,I ceni(y to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is coma. I have 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 constmc`�lan> l aauthorize r resentatives of Cupertino to enter the above dentifted pro n}�/(or�inspection purposes. Signature of Applicant/Agent: /r�-�� Date: �' F/jL(J SUPPLEMENTAL INhORMATION REQUIRED OFFICE IISE ONLY ❑ OYER-TIIF.COUNIER ❑ EXPRFSS -1 ❑ STANDARD U i ❑ Id RCE r ❑ MAJOR ,IIEAViscApp 101 Ldoc revised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 21165 lauretta dr DATE: 09/26/2012 REVIEWED Bl': larrys APN: BP#: `VALUATION: $3,744 *PERMIT TYPE: Mechanical Permit PLAN CIIECK TYPE: Alteration /Addition/ Repair PRIMARY SFD Or Duplex PENTAMATION FURN/AC USE: PERMIT TYPE: WORK add a/c only SCOPE APPLIANCE/EQUIP TYPE FEE ID QTl' UNITS BP FEES A/C Units (>10K cfm) 1MRAI A w 1 # $67 I TOTALS: $67.00 Mech. Plan Check0.0 hrs $0.00 PI...b.Plan Cheek Flee.Plan Check Mech. Perini[ Fee: /A4PERMIT Plumb.Permit Fee: F.lec.Permit Fee: Other Mech. Insp. 0.0 Ins $45.00 Other Plumb lnsp. El Other Flee.Insp. ,tle.ch. hasp. Fee: Plumb. hcyn.Fee: Flee.Insp.Fee: NOTE: This evtinnae does not include jeer rine to atber Departments(i.e. Planning, Public Harks, Fire,Sanitary Sewer District,School District, etc. . These eev are based on the prelindnan•information available and are onle an estimate. Contact the De ( or adt/n'I info. FEE ITEMS (Fee Resohuion 11-053 Fff 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl. PC Fee PME Plan Check: $0.00 Permit Fee: Suppl. Insp Fee PME Unit Fee: $67.00 PME Permit Fee: $45.00 Construction Tar: Administrative Fee: IA0,11W $42.00 Work Without Permit? O Yes 0 No $0.00 Ativanced Planning Feu': Travel Documentation Fee: ITRA VDOC $45.00 A, Strong Motion Fee: IBSFISMICR $0.50 Select an Administrative Item Mile,Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $200.50 $0.001 TOTAL FEE: $200.50 Revised: 07/01/2012 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAlterations CF-IR-ALT-HVAC Climate ZaaeS 1 and 3-7 - Site Address: Enforcemem'Agency: Dwe-V26 'Permit D: !l 5 La,��ettu Conditioned Ductinsulation E i meta T r List Minimum EfficicricyiFloor Area requirement Thermostat Packaged Unit Over 40 ft of ducts ❑Furnace ❑AFUL• COP_ Setback Served by system added it replaced in Coil SEER�� HSPF_ sf unconditioned space ff".1 mart be 29 Condensing Unit ❑EER ❑Resistance ❑R 6 (CZ 1.3-3) imalfrd Other 7. Equipmeot Type:Choose the equipment being installed;if more than one system,use another CF.[R-ALT•FIVAC for each system. 2.Minimum Equipment Efficiencies: 13 SEEK 78%AFUE,7.7HSPF for typical residential systems. Contractor(Documentation Author's/Responsible Designer's Declaration Statement) • I eenifythat this Certificate of Compliance documentation is accurate and complete. • I am eligible unda Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance • I certify that the energy features and performance specifications for the design identified on this Certifimte of Compliance conform to the requirements of Tide 24,Parts I and 6 of the California Code of Regulations. • The design features identified on this Certificate of Compliance arc consistent with the information documented on other applicable compliance fortes,worksheets,plculauons,plans and specifications submitted to the enforcement agency for approval with the permit _ a liration. ' Names: rrR.2 ✓'�a Gar Sngnature. Company: • Date: 7l Y /r eQtirP 7 Ad4 dress: ' 7C1 AVI /` ,r License: 55 s�{O City/State2ip: J�! r'51 2 Phone: Z-0 3^.Z N Ie 2008 Residential Compliance Fornrs.doc reviser/04110112