11040169 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10337 COLD HARBOR AVE CONTRACTOR:VALLEY HEATING& PERMIT NO: 11040169
COOLING
OWNER'S NAME: LU,YING&GENG 1171 N 4 TH ST DATE ISSUED:04/25/2011
O`'-'FR'S PHONE: 4082034634 SAN JOSE,CA 95112 PHONE NO:(408)294-6290
LICENSED CONTRACTOR'S DECLARATION
/ BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class— Lic.# c2- 59 5LAD I r r
MECH RESIDENTIAL COMMERCIAL
Contractor Date
I hereby affirm that m censed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE&REPLACE FURNACE AT EXISTING UTILITY
(commencing with Se—e—on 7000)of Division 3 of the Business&Professions ROOM.
Code and that my license is in full force and effect. ADD ON 4 TON A/C UNIT ON LEFT SIDEYARD
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.
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 Sq.Ft Floor Area: Valuation:$5850
permit is issued.
APPLICANT CERTIFICATION APN Number:36910007.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
_
� f Issued Date: L/
Signature L� "t Date _O i5_' '
L OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
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 I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
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 Ownered agent:
or
forthwith comply with such provisions or this permit shall be deemed revoked. Date:
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
C ind expenses which may accrue against said City in consequence of the
g. ig of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
6 ITEMS OF 11 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36910007.00
DATE ISSUED. . . . . . . : 04/25/2011
RECEIPT #. . . . . . . . . : BS000013283
REFERENCE ID # . . . : 11040169
SITE ADDRESS . . . . . : 10337 COLD HARBOR AVE
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : LU, YING & GENG
ADDRESS . . . . . . . . . . : 10337 COLD HARBOR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-3329
RECEIVED FROM . . . . : VALLEY HEATING & CO
CONTRACTOR . . . . . . . : ATKINSON, THOMAS LIC # 141
COMPANY . . . . . . . . . . : VALLEY HEATING & COOLING
ADDRESS . . . . . . . . . . : 1171 N 4 TH ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (408) 294-6290
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 5, 850 . 00 1. 00 0. 00 1.00 0.00
1BREMAIRHA NO.UNITS 1.00 63 . 00 0 . 00 63 .00 0. 00
1BSEISMICR VALUATION 5, 850 .00 0.59 0 .00 0.59 0. 00
1MFR=<100 UNITS 1.00 126. 00 0.00 126.00 0. 00
1MPERMITFE FLAT RATE 1.00 42 . 00 0.00 42 .00 0. 00
1TRAVDOC FLAT RATE 1.00 42. 00 0.00 42 .00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 274.59 0. 00 274 .59 0.00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
CITY OF CUPERTINO
JtAPNFEE ESTIMATOR-BUILDING DIVISION
:
DDRESS: 10337 cold harbor ave. DATE: 04/25/2011 REVIEWED BY: bobs.BP#: "VALUATION: $5,850 __771
Y°PERMIT TYPE:
:echani�calPe�rmit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY PENTAMATION FURN/AC
USE: SFD or Duplex PERMIT TYPE:
WORK remove and replace furnace at garage local.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced-Air 1MFR=<100 1 # $126
A/C Units (<=10K cfm) 1BREMAIR 1 # $63
TOTALS: $189.00
Mech.Plan Check 0.0 hrs $0.00
Mech.Permit Fee: 1MPERMIT
Other Mech.Insp. 0.0 hrs $42.00 -
NOTE. These fees are based on the preliminatrTy in ormation available and are only an estimate. Contact the Dept for addh 7 info.
FEE ITEMS (f'ee Resolution 09-OSI 1'ff. ' L-%O) FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.00
PME Unit Fee: $189.00
PME Permit Fee: $42.00
Work Without Permit? 0 Yes E) No $0.00
Travel Documentation Fee: ITRA VDOC $42.00
Strong Motion Fee: IBSEISMICR $0.59 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $274.591 $0.00 TOTAL FEE: $274.59
Revised: 04/01/2011
Simplified Prescriptive Certificate of Compliance:2008 Residential HVACAlterations CF-IR-ALT-HVAC
Climate Zones 8
Site Address: Enforcement Agency: Date. Permit#:
p 3 3-7 4Sr-�7 S—/I
Equipment T e List Minimum Effici7ncy 2 Conditioned Floor Area Thermostat
Packaged Unit
Furnace AFUE7. COP Served by system (Setback
Indoor Coil SEER B HSPF �Ri°►�i sf T(Ifnot already present,must be installed)
Condensing Unit EER El Resistance '�3i'�
Other
1.Equipment Type:Choose the equipment being installed if more than one system use another CF-IR-ALT-HVAC for each system.
2.Minimum Equipment Efficiencies: 13 SEER,78%AFUE,7.71ISPF for typical residential systems.
HERS VERIFICATION SUMMARY Listed below are three 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-4R forms(no
hand filled CF-4Rs allowed)are filled out and signed. Beginning October 1,2010,a registered copy of the CF-1R and CF-6R shall
also be on site for final inspection.
1.HVAC Changeout Required Forms:
• All HVAC Equipment CF-6R forms: MECH-04,MECH-25-HERS
replaced CF-4R forms: MECH-25
• Condenser Coil and/or CF-6R forms: MECH-25-HERS
• Indoor Coil and/or CF-4R forms: MECH-25
• Furnace
For Split Systems: RC,CCA>300 CFM/ton,TMAH
For Packaged Units: No testing required
2.New HVAC System Required Forms:
• Cut in or Changeout with CF-6R forms: MECH-04,MECH-25-HERS
new ducts:(all new ducting CF-4R forms: MECH-25
and all new equipment)
For Split Systems:RC,CCA>300 CFM/ton,TMAH.
For Packaged Units:No testing required
3.New Ducts with Replacement Required Forms:
• Includes replacing or installing all new CF-6R forms: MECH-25-HERS
ducting and/or outdoor condensing unit CF-4R forms: MECH-25
and/or indoor coil and/or furnace. Not all
equipment chaned.
For Split Systems: RC,CCA>300 CFM/ton,TMAH
For Packaged Units:No testing required
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 Title 24,Parts I 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: ALI Signature:
Company: Date:
Address: i License:
/ /v. qA S �585y v
City/State/Zip: �n �� �� ey�—f� Phone: t���_ �Jqz/_��Q
2008 Residential Compliance Forms March 2010
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-HVAC
Climate Zones 8
Site Address: Enforcement Agency: D : Permit#:
033 daR&'� ;7-js-/C
E ui ment T pel List ency,4 Conditioned Floor Area Thermostat
Packaged Unit
Furnace AFUE COP Served by system Setback
Indoor Coil SEER]:% HSPF sf (If not already present,must be installed)
Condensing Unit BEERA� E]Resistance
Other
1.Equipment Type:Choose the equipment being installed if more than one system use another CF-IR-ALT-HVAC for each system.
2.Minimum Equipment Efficiencies: 13 SEER,78%AFUE,7.7HSPF for typical residential systems.
HERS VERIFICATION SUMMARY Listed below are three 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-4R forms(no
hand filled CF-4Rs allowed)are filled out and signed. Beginning October 1,2010,a registered copy of the CF-1R and CF-6R shall
also be on site for final inspection.
1.HVAC Changeout Required Forms:
• All HVAC Equipment CF-6R forms: MECH-04,MECH-25-HERS
replaced CF-4R forms: MECH-25
• Condenser Coil and/or CF-6R forms: MECH-25-HERS
• Indoor Coil and/or CF-4R forms: MECH-25
• Furnace
For Split Systems: RC,CCA>300 CFM/ton,TMAH
For Packaged Units: No testing required
2.New HVAC System Required Forms:
• Cut in or Changeout with CF-6R forms: MECH-04,MECH-25-1-JERS
new ducts:(all new ducting CF-4R forms: MECH-25
and all new equipment)
For Split Systems:RC,CCA>_300 CFM/ton,TMAH.
For Packaged Units:No testing required
Q 3.New Ducts with Replacement Required Forms:
• Includes replacing or installing all new CF-6R forms: MECH-25-HERS
ducting and/or outdoor condensing unit CF-4R forms: MECH-25
and/or indoor coil and/or furnace. Not all
equipment char ed.
For Split Systems: RC,CCA>300 CFM/ton,TMAH
For Packaged Units:No testing required
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 Title 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: Signature:
Company:��'' Date:
Address: 10( License:
City/State/Zip: S� GSI/ Phone: If0S—p19e/ - f� �0
2008 Residential Compliance Forms March 2010
i
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVA C Alterations CF-IR-ALT-HVAC
Climate Zones 8
Site Address: Enforcement Agency: Dat : Permit#:
0 7 atZ AWW tool, �
Equipment T e List Minimum Efficienc Conditioned Floor Area Thermostat
Packaged Unit
Furnace AFUE COP Served by system Setback
Indoor Coil SEERJ-j7--..S HSPF_ .gyp�s f (If not already present,must be installed)
Condensing Unit EER Resistance
Other
1.Equipment Type:Choose the equipment being installed if more than one system use another CF-IR-ALT-HVAC for each system.
2.Minimum Equipment Efficiencies:13 SEER,78%AFUE,7.7HSPF for typical residential systems.
HERS VERIFICATION SUMMARY Listed below are three 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-4R forms(no
hand filled CF-4Rs allowed)are filled out and signed. Beginning October 1,2010,a registered copy of the CF-1R and CF-611 shall
also be on site for final inspection.
1.HVAC Changeout Required Forms:
• All HVAC Equipment CF-6R forms: MECH-04,MECH-25-HERS
replaced CF-4R forms: MECH-25
• Condenser Coil and/or
CF-6R forms: MECH-25-HERS
• Indoor Coil and/or CF-4R forms: MECH-25
• Furnace
For Split Systems: RC,CCA>300 CFM/ton,TMAH
For Packaged Units: No testing required
0 2.New HVAC System Required Forms:
• Cut in or Changeout with CF-6R forms: MECH-04,MECH-25-HERS
new ducts:(all new ducting C4 forms: MECH-25
and all new equipment)
For Split Systems:RC,CCA>_300 CFM/ton,TMAH.
For Packaged Units:No testing required
3.New Ducts with Replacement Required Forms:
• Includes replacing or installing all new CF-6R forms: MECH-25-HERS
ducting and/or outdoor condensing unit CF-4R forms: MECH-25
and/or indoor coil and/or furnace. Not all
equipment chaned.
For Split Systems: RC,CCA>300 CFM/ton,TMAH
For Packaged Units:No testing required
Contractor(Documentation Author's/Responsible Designer's Declaration Statement)
• 1 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 Title 24,Parts I 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: ACk, 7
,y�S Signature:
Company: f1 `D l W ate: q—j G,( f
Address. License:
1 l
I-P
City/State/Zip: 3� �� Phone:
2008 Residential Compliance Forms March 2010
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: 408-777-3228
U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: Lb el PERMIT#
OWNER'S NAME: `i'�r� PHONE# Lt0 �a0�3 - Ll LO
GENERAL CONTRACTOR: rA ��,n � I BUSINESS LICENSE# -S?S'4b
ADDRESS: tV . CITY/ZIPCODE: -A 30 Coq q�<<a
*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) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. , J
1 am not using any subcontractors:
gn ure 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
11OLI 0 (-'e>
GENERAL PERMIT APPLICATION
MEP
`r
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
,CUFE.RTlNO (408)777-3228• FAX(408)777-3333•building(cDcupertino.or4 MISC
PLUMBING kMECHANICAL ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS 'r •� (I g _ ,�&„p \k\Q APN
OWNER NAME I� - PPI J 1 lip 7 q E-MAIL
STREET ADDRESS
C STATE
`1 O 14 , nve FAXn , �7jqe) L7.50 I
CONTACT NAME PHONE
E-MAIL
STREET ADDRESS J C CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME ^ •I � LICENSE NUMBER LICENSE TYPE BUS.LIC
-07 6
COMPANY NAME , ,44 1� Y�IO�_L/� /' 1`/ E-MAIL (Cl vL FAX
Y ( L T `oG 1✓v;=o �) c!(t hr��.fi►� c�� �/��"�l%-�'a�7
STREET ADDRESS n 1 / ' CITY,STATE,ZIP }£ S//� PHONE
/ I yoa� - y-lei
ARCHTTECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF XSFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN
,TRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ No
DESCRIPTION OF WORK A
.bt / &pry A&D GIr7 g G On l /vC
(� k - 41-
;' _ -
TOTAL VALUATION: SS�� t CELEIZSY ' n
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. 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: Date: Li—a S�
SUPPLEMEORMATION REQUIRED
g
- .
MEPMiscApp 1011.doc revised 03/16/11