11090206 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10490 AINSWORTH DR CONTRACTOR:CALIFORNIA DELTA PERMIT NO: 11090206
MECHANICAL INC
OWNER'S NAME: TSENG HUI-HUNG AND MING-CHU C 6056 E BASELINE RD STE 155 DATE ISSUED:09/29/2011
VER'S PHONE: 4085655673 MESA,AZ 85206 PHONE NO:(866)692-5273
lj/ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG� ELECT F PLUMB�
License Class C 2 O Lic.# ( l ( ( '1 r jf r
Q MECH RESIDENTIAL COMMERCIAL
Contractor I Date
I hereby affirm t ' cnsed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE FURNACE
(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:$2562
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
permit is issued. APN Number:32646003.00 Occupancy Type:
APPLICANT CERTIFICATION
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 PERMIT EXPIRES IF 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 DA S FROM 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 j l
with all non-point source re ons per the Cupertino Municipal Code,Section Issued by �! Date:
9.18. v
Signature Date
j
—" RE-ROOFS:
OWNER-BUILDER DECLARATION 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
I hereby affirm that I am exempt from the Contractor's License Law for one of inspection.
the following two reasons:
1,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 the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS 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 Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
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
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
[certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Se tions 25505,25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's Owner or autho ' a t:
Compensation laws of California. If,after making this certificate of exemption,I Date: - . Gi
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of cork's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I certify that I 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 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
-unify and keep harmless the City of Cupertino against liabilities,judgments,
and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
g.....iing 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
10 () v Lo QP
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 misc
CUPERTINO (408)777-3228• FAX(408)777-3333• buildinq(cicuoertino.orq
❑PLUMBING ®MECHANICAL ❑ELECTRICAL [:]MISCELLANEOUS
PROJECT ADDRESIQ <4c) R,n�vi o, v, APN#
OWNElg �y I PHO - �•r� E-MAIL
STREET ADDRES ry C Y1(�S1TATE,ZIP _ FAX
CONTACT NAME PHO E-MAIL
STREET AW)�'l CITY,S� ,T?TE �Z 2, I FA,� t7C7��1
❑ OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ��-❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
% �CENSE NUJvf ER ,(,1 I LICENSE� BUS.LIC#
COMPANY NAME E-MAIL �„_ FAX�b 9z S Z
OF AD SS C STATE,ZIP PHONE
ARCHITECT/ENGINEER NAME I LICENSE NUMBER BUS.LIC#
COMPANY NAME' E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP I PHONE
USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES I PROJECT IN ❑YES IS THE BLDG AN ❑ YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK
TOTAL VALUATION: RECEIVED BY:
By my signature below,I certify to each of the following: I am the pr erty over or authorized agent to act on the progeny owner's behalf. I have read this
application and the information I have provided is correct.=RAtATIO I have read the Desc�tion of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building constructtives of Cupertino to enter the above-identified property for inspection pu@oses.
Signature of Applicant/Agent: Date: "
SUPPLEMENTAL UIRED
OFFICE USE ONLY
W ❑ OVER-THE-COUNTER
c
❑ EXPRESS
Y
U
❑ STANDARD
U
❑ LARGE
❑ MAJOR
1EPMiscApp_2011.doc revised 06121111
t
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC CF-1R-ALT-HVAC
Alterations
Climate Zones 10- 15
Site Addre ss: Enforcement Agency: Date: Permit#:
uct nsulation Conditioned Floor
Equipment Typel List Minimum Efficiency2 requirement Area Thermostat
3 ackage Unit
R1 Furnace 0 AFUE 78% 0 COP U R 6 CZ 10-13 Setvgii_b s R Setback
[I Indoor Coil 0 SEER l]HSPF ( ) Y system if nor already present,
(,Condensing Unit .0 EER p Resistance R$(C�14-is) �---'f must be installed)
Ej Other
1.Equipment Type:Choose the equipment being installed,•ff more than one system,use another cF-IR-AL -HVAC for each system.
2.Minimum Equipment Efficiencies:13 SEER,78%AFUE,7.7HSPF for typleal msldenvaf systems,
HERS VERIFICATION SUMMARY Listed below are FOUR HVAC alteration Options.The Installer decides what work is
being done and picks one of the appropriate Options.Each Option lists the HERS measures that must be conducted.A
copy of the forms shall be left on site for final inspection and a copy given to the homeowner.At final,the inspector
verifies that the work listed on this form was in fact the work completed by the installer.The inspector also verifies that
each appropriate CF-6R and registered CF-411 forms(no hand filled CF-4Rs allowed)are filled out and signed.Beginning
October 1,2010,a registered copy of the CF-iR and CF-6R shall also be on site for final inspection.
iJ 1.HVAC Changeout Required Forms:
•All HVAC Equipment CF-6R forms: MECH-04,MECH-2I-HERS and(for split systems)MECH-25-HERS
replaced CF-4R forms:MECH-21 and(for split systems)MECH-25
•Condenser Coil and/or CF-6R forms: MECH-04,MECH-2I-HERS and(for split systems)MECH-25-HERS
•Indoor Coil and/or CF-4R forms: MECH-21 and (for split systems)MECH-25
•Furnace
'For Split Systems:Duct eakage< 15 percent; RC,CCA<_300 CFM/ton(Minimum Air Flow Requirement),TMAH
For Packaged Units:Duct leakage< 15 percent
Exempted from duct leakage testing if:
d 1.Duct system was documented to have been previously sealed and confirmed through HERS verification,or
C]2. Duct systems with less than 40 linear feet In unconditioned space,or
Q 3.Exitan9'ifusystems are CA stru_tgd'insulated +see[eti withsbtos :;
O Z NelAisIYAC Requiroq: ptfs.: vti x� u
= y:
System _.._
•Cut W.Wi Lhangeout w
bR ti::[ttis�►'CECH-04,MEQ =HERS, r split systetirt i�MJCN-12
with nkducts:�alh _ -
_
new dir u r-;
e
�
IN _
�� -i:ITI5. -
�O L-�. 1
:[ .. :3t1ti fIl ... M M 5.::
new equ��l'ft�t} -.--.._ -:. . ..._. -... . .._.. . .. .-.
For Split Systems: Duct eakage<`:6 percent;RC,CCA z 350 CFM/ton,FWD,TMAH, STMS,and either HSPP or PSPP.
For Packaged.Units:Duct leakage.<6 percent }
C;3.New Ducts with/or without Required Forms:
Replacement
Includes replacing or installing all
new ducting and/or outdoor CF-611 forms: MECH-04,MECH-20-HERS,and(for split systems)MECH-25-HERS
condensing unit and/or indoor coil CF-4R farms:MECH-20 and(for split systems)MECi-I-25
and/or furnace.No or some
equipment changed.
For Split Systems: Duct leakage<6 percent; RC,CCA k 300 CFM/ton,TMAH
For Packaged Units:Duct leakage<6 percent
I]4.New Ducting over 40 feet Required Forms:
.Includes adding or replacing more CF-6R forms: MECH-04,MECH-2I-HERS
unconditioned spacee..
than linear feet duct in CF-4R forms: MECH-21
For split system or packaged units:Duct leakage<15 percent
p EXCEPTION:Existing ducts stems constructed,insulated or sealed with asbestos.
Contractor(Documentation Aui or'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 responsibilitr for the design rdentKed on this
Certificate of Compliance.
•I certify that the energy features and performance speciflcatlons for the design identified on this Certificate of Compliance conform to
the requirements of Title 24,Parts 1 and S of the California Code of Regulatlons.
•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: Brian Cannon )Signature:Orion Cannon
Company: CALIFORNIA DELTA MECHANICAL INC Date: i�,1����►�Ul '
Address: 1235 GRAND AVE License: 811114
City/State/Zip: SPRING VALLEY/CA/91977 Phone: (480)898-0007
i
Reg: 211-A0019108A-011000000-0000 Registration Date/Time: 2011/44/19 01:14:49 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms July 2010
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10490 ainsworth I DATE: REVIEWED BY:
APN: I BP#: "VALUATION: 1$2,562
*PERMIT TYPE: Mechanical Permit I PLAN CHECK TYPE: Alteration /Addition/ Reps
PRIMARY SFD or Duplex I PENTAMATION
USE: PERMIT TYPE:
WORK replace furnace like for like
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Select a Mech Item
Furnace, Forced-Air 1MFR=<100 1 # $130
TOTALS: I I $130.00
Mech.Plan Check 0.0 hrs $0.00 I I I I
Mech.Permit Fee: IMPERMIT
Other Mech.Insp. 0.0 hrs I $44.00
NOTE. This estimate does not include fees due to other Depts(i.e.Public Works,Sanitary Sewer District,School District,etc.).
These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1,11) FEE QTY/FEE I MISC ITEMS
PME Plan Check: $0.00
I I
n
PME Unit Fee: $130.00
PME Permit Fee: $44.00
n
Administrative Fee: 1ADMIN $41.00
Work Without Permit? ® Yes G No I $0.00
Travel Documentation Fee: ITRAVDOC I $44.00 I I i
Strone Motion Fee: IBSEISMICR I $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC I $1.00
SUBTOTALS: $260.50 $0.00 TOTAL FEE: I $260.50
Revised: 09/02/2011