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12110044 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22791 MEDINA LN CONTRACTOR:A R II HEATING PERMIT NO: 12110044 OWNER'S NAME: YUJING WU 770 CIIF.SITUI'ST DATE, ISSUED: 11/082012 OWNER'S PRONE: 2019364817 SANJOSF-,CA 95110 PHONE NO:(408)279-0722 ❑ LIICpENSEII CON I'RACI'OR'S BECLAR-ATTION BUILDING PERMIT INFO: BLDG r ELECT IJ PLUNIB r License Class l =Z > Lie# - C4 Lf r ; r r IJ �i , _�` 01— 1Z NISCH RESIDENTIAL COMMERCIAL Contractor � Date 1 hereby affirm that lam licensed under the provisions or Chapter 9 JOB DESCRIPTION: UNITS A&B REMOVE AND REPLACE(2)FURNACES IN (commencing with Section 7000)of Division 3 of the Business d Professions Code and that my license is in fall force and effect. I hereby affirm under penalty of perjury one of the fallowing 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:$6000 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. APN Number:34230009.00 Occupancy Type. APPLICA\F CF.RTI FICATION I certify that 1 have read this application and state that the above information is correct.l agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK ISNOT 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 this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Issued by: �CA/1� /�7/�i6T Date://- 6 '/�- 9.18. Signature l e,�.�� /L--'ate �I RE ROOFS: ❑ OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material beiig installed.If a roof is installed without first obtaining an inspection,I agree to remove all new,materials for 1 hereby affirm that I am exempt from the Contractor's License Low for one of inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of property,am exclusively contracting with licensed contractors to ALJ.ROOF COVERINGS TO BE CLASS"A"OR BE-ITER construct the project(Sec.7044,Business S Professions Code). 1 hereby affirm under penalty of perjury one of the following three IIA'/-ARDOUS NIATF.RIALS DISCLOSIIRE 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 Ilealth A Safety Code.Sections 25505.25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Nlunicipal 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 work for which this contaminants as defined by the Ray Area Air Quality Management District I will permit is issued. maintain compliance with the Ilealth S Safety Code,Sections 2Cupertino 25533,and 25534.pertino Municipal Code,Chapter 9.12 and the I certify that in the performance of die 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 Ow ar authorized ager•) Compensation laws of California. If,after making this certificate ofexemption,l �--'ni become subject to the Worker's Compensation provisions of the Labor Code,I most forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUM ION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that 1 have read this application and state 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 conslmction,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, costs,and expenses which may accrue against said City in consequence of the ARCHITEM'S DECLARATION granting 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 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•buildino(dicuoertino.on7 PLUMBING ZMECHANICAL M /� ELECTRICAL Lj MISCELLANEOUS Z� /� 9 PROTECT ADDRESS 22 n I LT�7P'�Q '1 f ��Z- ✓D-`�`� 1 /yq� OWNER NAME Y_` 'I•I ` `/ NAY Lfq I ( l /" I7 1!-MAIL U `g14L QO� V,0,-+M STREET ADDRESS r/��^/j{{ `7 � /V I ` ,STA 'I.IP,7,�^11` VWO ! ,5 aA FAw% - CONTACT NAME % G^ '- �_ L�1 f • PHONE � ,E-MAIL STREET ADDRESS 776) r CT5I7_1,fQ7- 27- CITY,STAT 'IP �/ PAX ® ❑OWNER ❑ OWNER-BUILDER ❑ OWNF.RAGENT IB DN CTOR ❑CONIRACrORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CQ}ZM�tQR NAME 1 LICENSENUMBER LICENSETYP'/_]W BUS.LICH H7q '7q E'OMf1t<YNAMExwraomb ./I2 �� E IL �///8111� a Cis PA STREET'ADDRESS 77J ''&l f.G=/, (t .67- CITY,ST IP N f� 1� / 7/}'� PITONW ARCHTTEMENGINEER NAME /r� LICENSENUMBEERR�y`f (`7 /I (/ BUS.LIE COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF InSM.DUPLEX ❑ MULTI-FAMILY PROJECT IN WIIDLAND ❑ YES PROJECT IN ❑ YES ISTHEBIDGAN ❑YES BUILDING ❑COMMERCIAL URBANINTERFACEAREA ❑ NO ROOD ZONE ❑ NO EICIIIF.R HOME? 0N DESCRIPTION OF WORE I�`f J> 2LJ �`` ^(� A A) I r� , % 11 L< l rL(�ILQo LT- a 43 `t TOTAL VALUATION: 65. C)O RECEIVED BY: By my signature below.I certify 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 correct. 1 have rad the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to b 'Id'ng consu,clion. I au orize representatives of Cupertino to enter the above-identified propert for Inspection purposes. Signatureol'Applicam/Agent Date: L�— SUPPLEMENI-AL INFORMATION REQUIRED OFFICE USE ONLY _ OVER-TII E: 0U\TER 6 Y F' ❑ EXPRESS '1 Oa ❑ STANDARD V ❑ I.,1RCE a ❑ ,MAJOR MFPMiscApp_2011.doc revised 06121111 . . -.. . . .. ... -.. .. e nom.... .. ... __ .• ..�. .. .e. 3--�..- � r Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: 7-2 7 ( PERMIT# OWNER'S NAME: (-0 PI-IONS# / 7 GENERAL CONTRACTOR: BUSINESS LICENSE # YLO ADDRESS: Q — r &ff,(,— .5� CITY/ZIPCODE:�Pt-JW� l9 J= gSllO *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) NVILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable-subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # .Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum / Wood Glass /Glazing Heating . Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 22791 Medina Lane (Units A& B) I DATE: 1 110 812 01 2 REVIEWED BY: Sean 97APN: BP#: 'VALUATION: $6,000 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARYPENTAMATION USE: SFD or Duplex PERM1T Tl'PE: FURN/At; WORK Remove and replace 2 furnaces in units A & B. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTl' UNITS BP FEES Furnace, Forced-Air 1MFR=<100 2 # $266 TOTALS: F $266.00 Mech. Plan Check 0.0 hrs $0.00 Plunk. Plan Check Elea Plan Check Mech. Permit Fee: IMPE8MIT Plumb.Permit roe: Elea Permit Fee: Other Nlech. Insp. 1 0.0 hrs L$45.00 Other Plumb Insp. Other Elec.Insp. 'Uach.Insp.Fee: Plumb. losp. ree: Etee.Insp. Fee: A'OTE: This evdntate does not include fees Flue to other Departments(i.e. Planning, Public Works, Fire,Sanitary Server District,School District,etc.). These feev are hared on the prelitninart information available and are onh,an estimate. Contact the De t or addn 7 info. FEE ITEMS (Fee Revolution II-053 ED: 711/122 FEE QTY/FEE MISC ITEMS Plan Check Fee: Sappl. PC Fee PME Plan Check: $0.00 Permit Fee: Suppl. /nsp Fee PME Unit Fee: $266.00 PME Permit Fee: $45.00 Cmacnvction Tur: Administrative Fee: 1ADMIN $42.00 Work Without Permit? O Yes Q No $0.00 Advanced Planning Fees: Travel Documentation Fee: ITRA I DOC $45.00 Strong Motion Fee: IBSEISHICR $0.60 Select an Administrative Item Bldg Sids Commission Fee: IBCBSC $1.00 SUBTOTALS: $399.601 $0.001 TOTAL FEE: $399.60 Revised: 10/01/2012 I five Certificate of 2008 Residential HVAC Alterations CF IR ALT-VAC Climate Zones 1 and 3-7 II MEQ R d11 ModelNom bec II K k -r-DFFZ- 5B6D)49V3v4 SiteAddresx t FnfiixamentAgencp Date PenmtNo. naEDwA ,�ty A ��� Ct rye�2x.�rzTitoo /!-7- I Z FgnpmmtTypei I�List M inimuma Conditioned Doctlasulation Thermostat Effiden Floor Area requitement a Paged Unit OAFLJE oCOP O Saved by Over 40 ft of duds clt Crenae oSEER OHSPF • system Added Or replaced (if not already o Indoor Coil oEER ❑Resistance I.SOb sf in Unconditioned prewar,must ❑CondeosiugUnit spam beinstaU4 ❑Other ❑R 6(CZ 1,3-5) 1. EquipmmtType: Choose die egmpmenr betnginstalled if more than one system,use another CF 1R ALT- HVAC for each system II 2 Mmimim Equipment Rf i ieaci.v 13 SEEk 78%AFUFy 7.7 HSPF for typical residential systems. Contractor(Docantertmdon Audwes/Responsible Designees Declaration Statem=) • I Certify that this Cemficam of Compliance documentation is accurate and compete • I am ebgNe under Division 3 of the Cajifnmia Business and Profssions Code to accept responsthiltty For the design idmAed on this Ccrdfw&m of Compliance • I cadfy tbat the mew franncs and perforce specifitattons for the design identified on dhis Certificate ofCamptiaaoe conform to the reTliremmts of Tide 24,Parts land 6 of the f alifnmia ' Code of Reguhationsl ° The design features itdmtified on this fxrificate of Compliance are consistent with the infiu�atina documented on otic!applicable compliance forms,wodmbrets,abilatirmn plans and specifications submitted to theimf�roement agency for approval with the permit application Name DAL & P H43-CP 5 Co # tk K&- 0-- Date —'1 —I,Z Adder -1 D 5' u T S; license No t-f Z /Strata/ �L95� / Phone No_ Lfog 1-71—87 Z PlaantagAppouval: Setback from property: a l -Simp]iced Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-VAC Climate Zones 1 and 3-7 Mantifiactmer:T P, E- . odel Number: rr Site Address Enforoement Agency. Date Permit No. 2z7gl ZV INA AVE I1-7- lZ Equipment Type' list Nfi imum 2 Conditioned Duct Insulation Thermostat Efficiency Floor Area 1 requirement ❑Pa Unit aCOP O Served by Over 40 ft of ducts dSetback umace oSEER oHSPF_ system Added or replaced (hf not already o Indoor Coil oEER ollesistance /2-420 sf in Unconditioned present,must o Condensing Unit space be installed) •Otter - ❑R 6(CZ 1,3-5) 1. Equipment Type Choose the equipment being instaDed;if more than one system,use another CF-1R ALT- HVAC for each system. 2 M'mirmhm Equipment Efficienaes: 13 SEER,78°/a AFUE,7.7 HSPF for typical residential systems. Contractor(Documentation Author's/Responsible Designees Declaration Statement) • I certify that this Certificate of Compliance documentation is accurate and complete. • I am eligible under Division 3 of the Ca(ifomia Business and Professions Code to accept responsibility For the design identified on this Certificate of Compliance • I certify that the energy features and performance spmfications for the design identified on this Certificate of Compliance conform to the requirements of Tule 24,Parts land 6 of the Califomia Code of Regulations. e The design features i lmtifirA on this Certificate of Compliance are consistent with the information documeatz d on other applicable compliance forms,worksheets,calculations,plans and speaEtations submitted to the enforcement agency for approval with the pcamt application. Name DA L a Pt+Gj-P 5 S' Co $ tkR tVG. C_ Date Address: 1 j'7Wtt ' license No.: Z Ci /State/ -T-99F— t*10-Irt, Phone No. D -7 9-8'7 2- Pkmmng Approval- Setback fiom property.