13010120 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:.7941 OCTOBER WAY CONTRACTOR:RESCUE AIR SERVICE PERMIT NO: 13010120
OWNER'S NAME: MING CHENG - 6007 MAJORCA CT - DATE ISSUED:01/232013
OWNER'S PHONE: 4088915426 SAN JOSE,CA 95120 PHONE NO:(408)655-9916
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL -
License Class C. I—O Lie. REPLACE(E)FURNACE,SAME LOCATION
Contractor I7.PCr reD Nr-r-
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:$2350 . _
I 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:36212028.00 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 FRO LED 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 Issu Date:
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. _. .
RE-ROOFS:
Signature /?• Date `�23C (3 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 1 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 with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534. 1 3.
Section 3700 of the Labor Code,for the performance of the work for which this Z-
Owner or authorized agent: �. ��-.- Dale: (
pernitis 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 CONSTRUCTION LENDING AGENCY
Compensation laws of California. If,after making this certificate of exemption,I
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.Iagree 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 a M E P
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 M ' A
CUPERTINO (408)777-3228•FAX(408)777-3333•buildinG(cocuoertino.ong \/
[]PLUMBING N MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECTADDRESS —
, 1 0�-r� Y APNk 3 0? _ 1 2 _ Q Z_ (�
OWNER NAME Yr `\in ^ yarka^ PHONE — n �-�L E-MAIL 6
STREET ADDRESS \L\1 (3C,-MTj!6r2.\-. ITY, $CTATE,ZIP O - FAX
L� v V `N f n t C.1A
CONTACT NAME PHONE \ E-MAIL
STREET ADDRESS (000 t CITY,STATE, ZIP O S_k� FAX
OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR 13 CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTORNAME Cu �C^ LICENSE NUMBERI �(( - 1 LICENSE TYPE^ .2 /t� BUS.LIC#
COMPANY NAME ` \ E-MAIL VV V LV FAX
STREET ADDRESS � CITY,STATE ZIP I PHONE',t�
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC H�Jo�D �1l
COMPANY NAME. E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFDor DUPLEX ❑ MULTI-FAMILY PROJECT Id WI,DLAND ❑ YES PROJECTIN �jT�7 YES IS THE BLD 'AN CI YES
BUILDING: COMMERCIAL URBAN INTERFACE AREA N a FLOOD ZONE El NO EICHLER HOME? NO
DESCRIPTION OF WORK � ,/�
S\Ze,
Q�
TOTAL VALUATION:
1 T
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 ehalf I have read this
application and the information 1 have provided is correct. 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 construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: "tea b Date:
SUPPLEMENTAL INFORMATION REQUIRED l ,a G�.�c�-S�s 'v'N LY
� w ,D�k'�I`{>ie.DPutrcEx
f
t xkQ."STA(JDARD
❑ LARGE, ,
t
MEPMiscApp201 Ldoc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 7941 OCTOBER WAY DATE: 01/23/2013 REVIEWED BY: MELISSA
APN: 362 12 028 BP#: VALUATION: $2,350
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PENTAMATION FURN/AC
PRIMARY SFD or DupleX PERMIT TYPE:
USE:
WORK REPLACE E FURNACE SAME LOCATION
SCOPE
y I�£ ` s>
Mech.Plan Check 0.0 hrs - $0.00 Plumb.Plan Check Elec.Plan Check -
Mech.Permit Fee: IA PERMIT Plumb.Permit Fee: Flee.Permir.Fee:
Other Meeh.Insp. 0.0 lVs $45.00 Oilier Plumb Insp. Ocher Elec.In.
B4ech.Insp. Fee:
Plumb. Insp.Pee: Elec.Insp.Fee:
f i -
NOTE:This estimate does not include fees due to other Departments 61 C,Planning,Public Works,Fire,Sanitary Sewer District,School
District etc.). These fees are based on the relimina in armation available and are onl an estimate. Contact the De t or addn'1 info.
FEE ITEMS(Fee Resolution 11-053 E 7l�11112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 1 # Mechanical
Suppl.PC Fee: Q Reg. OOT 0.0 hrs $0.00 $133.00 IMFR=, 00 Furnace,Forced-Air
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl.Insp.Fee Q Reg. OOT T0,70 h� $0.00
PME Unit Fee: $0.00
PME Permit Fee: $45.00
Consnzcction Tax:
Administrative Fee: tADMIN $42.00
Work Without Permit? O Yes Q No $0.00
Advanced Planning Fee: $0.00 Select allon-Residential 0
Building or Structure O
Travel Documentation Fee: ITRAVDOC $45.00
Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
�g
-` $133.50 $133.00 1 �T $266.50
Revised: 10/01/2012
INSTALLATION CERTIFICATE CF-6R-MECH-04
Space Conditioning Systems,Ducts and Fans (Page 1 of 2
Site Address: Enforcement Agency: Permit Number.
�oy� octb w t3o1
012�
Space Conditioning Systems
Heating Equipment
Duct
Efficiency Location
Equip (AFUE, (attic, .
Type ARI #of et..)1,3 crawl- Heating Heating
(package- CEC Certified Mfr.Name Reference Identical (2CF-1R space, Duct Load Capacity
heat um and Model Number Number a System value° etc.) R-value ti/hr (Bm/br
Cooling Equipment
Efficiency Duct
Equip (SEER Location
Type and EER) (attic,
(package #of 1.3 crawl- Cooling Cooling
heat CEC Certified Mfr.Name ARI Reference Identical (ZCF-IR space, Duct Load Capacity
um and Model Number Number 2 Systems value)' etc. R-value (Btu/hr (13M/hr)
1.Ifproject is new construction, see Footnotes to Standards Table 151-B and Table 151-Cfor duct ceiling alternative
compliance.
2.ARI Reference Number can be found by entering the equipment model number at http:111vwu+.aridirecto7y.org/ari/ac.php#
3.Listed efficiency on this page must be greater than or equal(>_)to the value shown on the CF-IR form.
4. When CF-IR is reference it is also applicable to the CF-IR CF-IR-AA or CF-IR-ALT
ALL BOXES MUST BE CHECKED TO BE A VALID FORM
Qr§110-§113:HVAC equipment is certified by the California Energy Commission.
§I50(h):Heating and/or cooling loads calculated in accordance with ASHRAE,SMACNA,or ACOA.
l!J §150(i): Setback Thermostat on alLapplicable 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
1.W1
INS PALS ATION CERTIFICATE CF`6 ;MECH-04
S -acd Cd`nditi6uin .System ,Duets and Fans I:v,-:' a e-2 of 2
Site Address " Enforcement Agency: Pe 1 Numtier.
Ducts and Fans
§150(m):Duct and Fans
❑ I.Ail air distribution system duds and plenums installed,sealed and insulated to meet the requirements of CMC
Sections 601,602,603,6040605 and Standard 6-5;supply-air and retum-air ducts and plenums are insulated to a
minimum installed level.of 114c1oi enclosedaentirely in conditioned space. Openings shall be sealed with mastic,tape
or other duct-closure systemthat meets the-applicable requirements of UL 181,UL 181A,or UL 181B or aerosol
sealant-that meets the requirements of UL 723.. If mastic or tape is used to seal openings greater than 1/4 inch,the
combination of mastic and either mesh or tape shall be used;and
❑
I.Building cavities;support platforms for:air handlers,and plenums defined or constructed with materials-
aterials other
tl an sealed sheet metal,dugt,boatil onccr t{le duct shall not be used for cone j±mg conditioned air.' Building cavities'
and support platforms may contain ducts. Ducts installed in cavities and support platform's shall not be compressed to
cause reductions in the cross-sectional area of the ducts.
❑ 2D.Joints and seams of duct systems and their components shall not be sealed with cloth back rubber adhesive
duct tapes unless-such tapers used in combination with mastic and draw bands.
❑ 7.Exhaust fan systems have back draft or automatic dampers.
❑ 8.Gravity ventilating systems serving conditioned space have either automatic or readily accessible,manually
operated dampers.
❑ 9.Protection of Insulation.Insulation shall be protected from damage,including that due to sunlight,moisture,
equipment maintenance,and wind.Cellular foam insulation shall be protected as above or painted with a coating that is
water retardant and provides shielding from solar radiation that can cause degradation of the material.
❑ 10.Flexible ducts cannot have porous inner cores.
DECLARATION STATEMENT -
• I certify under penalty of perjury,under the laws of the State of Califomia,the information provided on this form is true and correct
• I ameligibleunder Division 3 of the Business and Professions Code to accept responsibility'for construction,or an authorized
representative of the person responsible for construction(responsible person).
. re
• I certify the installed featumres,materials,components,or manufactured devices identified on this certificate(the installation)
conforms to all applicable codes and regulations,and the installation is consistent with the plans and specifications approved by the
enforcement agency.
• I reviewed a copy ofthe Certificate of Compliance(CF-1R)form approved by the enforcement agency that identifies the specific
requirements for.theinstall ,I,certify.that?hetequirements.detailed•on the:CF-1R that apply to the.installation have been met.
• I will ensure that a complgted,signed copy,ofthis Installation•.Cprtificate shall-be.posted;or made.available withthe building
permit(s)issued for the building,pnd made available to,the enforcement agency,for.all applicable inspections. I understand
that a signed copy of this Installation Certificate is required to be inclndedwith`the documentation the builder provides to
the building owner at occupancy.
Company Name: (Installing Subcontractor oz General Contractor orBuilder/Owner)
Responsible PersonsName:•'- .- - - ResponsiblePer'son'sSign
CSLB License. �. Date Signed - Position.With.Company(Title):
2008 Residential Compliance Forms - - August 2009
Building Department
.F City Of Cupertino
a _
10300 Tone Avenue
u l•11N�MiN(.1 'J\�\I1111_3J��
CUPERTINO Fax 408-777-3333
CONTRACTORI SUBCONTRACTOR LIST
JOB ADDRESS: 9 L � ,w PERMIT# 1 &0 I o 1 20
OWNER'S NAME: PHONE# 40 —
GENERAL CONTRACTOR, BUSINESS LICENSE# 7
ADDRESS: f. 1 r- CITY/ZIPCODE:.
*Our municipal code requires-all s fiesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL'OR FINAL-OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE
I am not using any subcontractors: - 9ee ga ec-�b Z
Signature Date
Please check applicable Apbcontractors,and='-complete the following information:
t/ SUBCONTRACTOR: BUSINESS NAME BUSINESS LICENSE#
Cabinets &Millwor)C
Cement Finishing--
Electrical
inishing Electrical
Excavation
Fencing '
Flooring/Carpeting_
Linoleum/Wood
Glass/Glazing
Heating `
Insulation
Landscaping
Lathing ,
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing n
Roofing
Septic Tank
Sheet Metal
Sheet Rock -
Tile
Owner-/'ContractorSignature Date