13030022 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19753 WINTERGREEN DR CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 13030022
- CONDITIONING
OWNER'S NAME: YEUNG CHUN WUN AND CHEW TICK CHOO 1712 STONE AVE DATE ISSUED:03/05/2013
OWNER'S PHONE: 4084319907- ' SAN JOSE,CA 95125 PHONE NO:(408)2934717
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL LJ OMMERCIAL
License Class y 3 2Z0 Lie.# I REPLACE(E)FURNACE,SAME LOCATION
A
Contractor A A -{v f^J A-1 4 Date LZ Coo
I hereby affirm that I am licensed under the provisions of. hapter 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:$3500
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:36909026.00 Occupancy Type:
permit is issued.
.APPLICANT CERTIFICATION
I certify that I have read this application and state thatthe 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 O ' T ISSUANCE,OR
to building concoction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS M CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue againstsaid City in consequence of the '3
granting of this permit. Additionally,the applicant understands and will comply ed Date:
with all not- rce regulatiol s per the Cupertino Municipal Code,Section
�], RE-ROOFS:
Signature Date 3 �d 1 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
1,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. 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(a)should I 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 com I Me Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&S tyCode, ectio 15505,2 Z',
3 ,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner ora thorized agent: C Date: 20 I
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
Compensation laws of California. 14 atter making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
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.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 _ Date
�N
GENERAL PERMIT APPLICATION 00 ME
p
COMMUNITY DEVELOPMENT DEPARTMENT o$'UIL.DING DIVISION M
10300 TORRE AVENUE ,CUPERTINO, CA 95014-3255 I
CVRERTIN9 (408)777-3228 • FAX(408)777.3333 •building(cDcuoertinD.org
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PLUMLBING�'// NMCHANICAL ❑ELECTRICAL MISCELLANEOUS
P0.0JECI'ADDRESS 1glG`"1 W�ni�►' {^PQj1 P�V V AMM
399 - 0 9 - 02
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OWNER NAME �/1 luVn ! P}{DNE •431-� •� B� i .
STRESIADDRESI"jR i-Cr cM (4 fSDlLq FAX
CONTACT NAME MONS
E-MAJL
YTREET ADDRESS. a Ctrr,SrAM ZIP FAX
• ❑ OWNER ❑ OWN/E�R,•BSNLLDER ❑ OWNER AOENT �ONTRACrOR ❑CONTR MKAOE ❑ ARCF(= ❑ ENGMEER ❑ OEVEELOOPEA ❑ T WT
CONTRACTOR NAMrE, �i1 V1A j�f�. LICENSE'gT �I�/f I U �� BUS.UC1 `j�r'YSl
COWMYNAAQ IPyp.�y E.MAIL�II�(�� ( FAX _lJ�/�J�/
STREET ADDRESS 1�1'� cta,/10, aA0• �.1 C uk 0
AR0TE
6Cr/ENOINPSRNAaffi \Ya- 1 LICENSENOh03ER `/1 BUS.UCP
COMPANYNAME E�MAB. FAX
YrRFEr ADDRESS CRY,STATE,ZIP PHONE
USE OF D Or Duplex ❑ Muld-Family PROSECT IN WB.DLAND PROIECT N
Yrxucruxe: ❑ Commercial URBAN ovTFnPACE AREA ❑ Yes N0 FLOOD ZONE ❑ Yes IN9
DESCUMON OF WORK r-eme/ AndffVQCV ftistaq '�1V11acP/
TOTAL VALUATION: 10)U t Lo
By my signarure below,T certify h of the tm �j
ram the property owner or authorized agent to act on the property owner's behalf. I have read this
appl icationand the Informed have olid have reed[he Description of Work end verify it is accurate. 1 agree to comply with ell applicable local
ordinances and state laws rel Nng to buil I1?-;,
��co1 authorize representatives of Cupertino to enter the above property for imp coon taporea.
Signaturaof ApplicanNAgent: Date: Z Z ' 5-
SU#L—AUtA.L INFORMATION REQUIRED
Q�
MEPMuc.4pp_70l l.dac revved 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 19753 WINTERGREEN DR DATE: 0310512013 REVIEWED BY: MELISSA
APN: 369 09 026 1 BP#: 'VALUATION: 1$3,500
£PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION FURNIAC
USE: PERMIT TYPE:
WORK 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 y,,lo
, y
�f� R w ttx'��t' -�.2�` 7 �`,•y�+rv�lq p`'cr``?z s, n..>?,'�s,r e`er"
� E n •% y ,1 '''..l-'.;;:�,k: x";i.. Ya ° iti<r';.a:".a`ia.
Mech.Plan Check 0.0 hrs $0.00 Plumb. Plan Check Elec. Plan Check
Mech.Permit Fee: IMPERWT I Plumb. Permit Fee: Elco, Permit Fee:
Other Mech.Insp. 0.0 hrs $45.00 01her Plumb Insp. Li Ocher Elce.Insp.
Adech. Insp. Fee: Plumb. Insp.Fee: Elee.Insp. Fee:
NOTE:This estimate does not include fees due to other Departments Cr.a Planning,Public Works,Fire,Sanitary SewerDistrict,School
District,eta). These fees are based on the prellmina Information available and are only an estimate. Contact the Dept for addh info.
FEE ITEMS (Fee Resolution 11-053 E . 7/!/121 FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
PME Plan Check: $0.00
Permit Fee.:
Suppl. Insp Feer
PME Unit Fee: $133.00
PME Permit Fee: $45.00
Construction Tax:
Administrative Fee: IADMIN $42.00
Work Without Permit? O Yes Q No $0.00
Advanced Planning Fees;
Travel Documentation Fee: ITRAVDOC $45.00
Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item
Bide Stds Commission Feet IBCBSC $1.00
WE=r $266.50 $0.001— 'f I TPTAT SEE p $266.50
��' Revised: 01/01/2013
c,U Pp
CF-IR-ALT
Prescri five Certificate of Compliance: Residential �Paize 4 of ti)
Residential Alterations Climate zone H #of Stories
Project Name:
HVAC SYSTEMS-HEATING Duct or Piping Configuration
Minimum - Central,Split,
Heating Equipment Efficiency Distribution Insulation ThermoTypstat Space,Package or rH dronic)
Type and Ca aci �'_'� ( >,FUE or HSPF T e and Location' R-Value
1.indicate Heating Type(Central Furnace..Wolf Furnace. Hear pump, Boiler. Electric Resistance. etc.)
2.Electric resistance heating is allowed only in Component Package C, or except where electric heating is supplemental(i.e., if rota(capacity
r < 2 KWO,%.000 Btu/hr electric hearing is conn-olfed by a time-limiting device not exceeding 30 minutes). See§151(b)3 exception.
3.Refer to the HERS Verification section on Page 4 of the CF-IR-ALT Form Jor additional requirements and check applicable boxes.
4. Indicate Type or Location(Ducts. Hvdronic in Floor. Radiators.etc.)
HVAC SYSTEMS-COOLING
Minimum Configuration
Efficiency Duct or Piping g
Insulation Thermostat (Central,Split,
Cooling Equimnt (SEER/EER or Distribution
Type
eandCa Type and LocationR-Value Type Space,Package or H
dronic
1. Indicate Cooling Tvpe(A/C. Heat pump, Evop. Cooling, etc)
2. Refer to the HERS Verification section on Page 4 of the CF-IR-ALT Form Jor additional requirements and check applicable boxes.
3. Indicate Type or Location(Ducts, H dronic in Floor, Radiators, etc.)
WATER HEATING
List water hearers and boilers for both domestic hot waver(DHW)heaters and hydropic space hearing. Individual dwelling DHW heaters must 6.
gas or propane fired,and may not exceed 50 gallons. Hot water pipe insulation from the DHW heater to the kitchens)and on all underground
hot water pipes is required in all com onent acka es in all climate zones. External Tank
Energy Factor or Insulation
Water Heater Type/Fuel Distribution Type
Number In Tank
Type' (Standard,Recirculating)' S stem Capacity( al) Thermal Efficient R-Values
1. Indicate Type(Storage as, Heat Pump,Instantaneous, etc.)
2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of§/50(n). The Prescriptive requirements do
not allow the installation of a recirculating water heating system for single dwelling units.
3. The external water heatin I tank and pipes shall be insulated to meet the re ruirements of§150 .
SPECIAL FEATURES The enforcement agency should pqv special attention to the Special Features specified in this checklist below.
These items may require written justification and documentation ands ec(al verification.
NEW.ROOF ASSEMBLY-Radiant Barrier
` The radiant barrier re uimnent of§151( 2 does notapply to roof alterations.
Slab Edge(Perimet(er)Insulation 0 YES ❑NO
YES: In Climate Zone 16 in Component Packages D,R-7 insulation is required.
Heated-Slob 0 YES ❑ NO
YES:Slab edge insulation re uired for all heated slabs in all Climate Zones. See details in Table I I8-A of the standards.
Raised Slab Insulation O YES ❑ NO
YES: In Climate Zones 1,2, 11, 13, 14& 16,R-8 insulation is required;uired; in Climate Zones 12 & 15,R-4 is required under component Pac
' Thermal Mass
To obtain Compliance Credit for the installation of thermal mass,use the Performance Approach.
Registration Date/Time: HERS Provider:
Registration Number: August 20
2008 Residential Compliance Forms