13020026 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11366 BUBB RD CONTRACTOR:VALLEY HEATING& PERMIT NO: 13020026
COOLING
OWNER'S NAME: CHOU CHEN-YUNG AND SHAO-HUA Y 1171 N 4TH ST DATE ISSUED:02/07/2013
OWNER'S PHONE: 4089730172 SAN JOSE,CA 95112 PHONE NO:(408)294-6290
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 OMMERCIAL
License Class C-2"' Lic.# f 555°f d REPLACE(E)FURNACE,SAME LOCATION
Contractor (/a 111 f. Nceg4 c;' Date 2
�-
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.
hereby affirm under penalty of perjury one of the following two declarations:
1 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:$2830
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:36211062.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above information is PERMIT EXPIRES RI{IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 F 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 DAY AST CALLED 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: Z f
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 _-+�< ,.L �-V- Date All roots shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,1 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 m 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). 1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I 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(x)should 1 store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 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
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 25505,2555533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: %�-�� S .i"�L Date:—�r7
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 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 1 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 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 Dale
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• buildina(a cupelti F0.Org ^ O v
[]PLUMBING MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECTADDRESS �3u�6 ( APNk 36
/ �f - I I i 06
OWNERNAME� K `j /(O PHONE (� r� E-MAIL 1.1
_101-q73-6172
STREET ADDRESS / CITY, STATE,ZIP / !y FAX
CONTACT NAME a PHONE E-MAIL
STREET ADDRESS CITY,STATE, ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR CONTRACTORAGENI' 13 ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
C'ONTRAC'TOR NAME QI LICENSE NUMBER LICENSE TYPE BUS,LICA
COMPANY NAME Ir /r E-MAIL FAX C,
STREET ADDRESS 1171 14� f ] /C 1
CIL Y,STATE,ZIP �.� PHONE
. 7
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC b
COMPAN AME E-MAIL FAX
EEI'ADDRESS CITY,STATE,ZIP PHONE
USE OF yy SFD or DUPLEX ❑ MULTI-FAMILYPRO/ECT IN WILDLAND ❑ YES PROJECT IN ❑ YES ISTHEBLDG AN ❑ YES
BUILDING- COMMERCIAL URBANINTERFACE AREA NO / FLOOD ZONE Cl NO EICHLERHOMEY ❑ NO
DESCRIPTION OF WORK � I/ f P Grt f IOC-'li/r C<
TOTAL VALUATION: b3Q R ED BY:
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act ona property owner's behalf. 1 have read this
application and the information I 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: 5 Date: 2/f-i/13
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
1�24VER-THE-COUNTER
4
❑ EXPRESS
Y
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❑ STANDARD
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❑ LARGE
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❑ MAJOR
MEPMiseApp_201 Ldoc revised 06/21/11
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAtterations CF-IR-ALT-HVAC
Climate Zones 1 and 3-7
Site Address: Enforcement Agency: Date: Permit N:
d3 u 7
Conditioned Duct insulation
Equipment T e' List Minimum Efficiency2 Floor Area requirement Thermostat
Packaged Unit Over 40 ft of ducts
Furnace AFUE� ®COP Served by system added or replaced in Setback
Indoor Coil SEER_ HSPF Wnor already present,must be
Condensing Unit [3 EER ®Resistance sf unconditioned space ;,walled)
®Other ®R 6 (CZ 1, 3-5)
1.Equipment Type:Choose the equipment being installed;ifmore thanone system,use another CF-IR-ALT-HVAC for each system.
2.Minimum Equipment Efficiencies: 13 SEER,78%AFUE,7.7HSPF for typical residential systems.
Contractor(Documentation Author's/Responsible Designer's Declaration Statement)
• I certify that this Certificate of Compliance documentation is accurate and complete.
• I am eligible under 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 Certificate of Compliance conform to the
requirements of Tide 24,Parts 1 and 6 of the California Code of Regulations.
• The design features identified on this Certificate of Compliance 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
application.
Name: ��.` S.fG.c Signature: j
Company: /' t Date:
Ya Oe f7 " /..r. It'll3
- License:
Lfffs
l N. W4, 1 .7SS5q
City/Stale/Zip: ' ^ o e 541,7 Phone: <{Og 29</Z 2y�
2008 Residential Compliance Forms A4arch 2010
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ECI ADDRESS: 11366 BUBB RD DATE: 02/07/2013 REVIEWED BY: MELISSA
APN: 362 11 062 BP#: 'VALUATION: $2,830
PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY PENTAMATION FURN/AC
USE: SFD or Duplex PERMIT TYPE:
wows REPLACE E FURNACE SAME LOCATION
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced-Air 1MFR=<100 1 # $133
TOTALS: $133.00
7Mech. heck 0.0 Ins $0.00 N:wd' N("o G'c'Mech.PennitFee: IMPERMIT Insp. 0.0 hs IMT
Olbcl P/umh/n"p Udtr'l lcr. leq.
1kd�-Ingz P"r.. Pii' h Dup_ Ge,.
NOTE: This estimate does not include fees due to other Departments(le.Planning,Public Works,Fire,Sanitary Sewer District,School
District etc). These fees are based on the Prelimina in ormation available and are only an estimate. Contact the Dept for addn'l in o.
FEE ITEEFee:
ution I/-053 E 7 1 12I FEE QTY/FEE MISC ITEMS
Plan Chec
S'rrpp(.PME Pla $0.00Penna f4Suppl. MtcPME Un $133.00PME Per $45.00Cwtvnvc
Administrative Fee: ]ADMIN $42.00
Work Without Permit? 0 Yes Q No $0.00
Advanced Planning I et' .
Travel Documentation Fee: ITRA VDOC $45.00
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldv Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $266.50 $0.00 TOTAL FEE: $266.50
�\ Revised: 01/01/2013