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11040170 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22583 WOODRIDGE CT CONTRACTOR:VALLEY HEATING& PERMIT NO: 11040170 COOLING OWNER'S NAME: YANG JEFF N AND YIH-NAN 1171 N 4 TH ST DATE ISSUED:04/25/2011 V' IER'S PHONE: 4085057874 SAN JOSE,CA 95112 PHONE NO:(408)294-6290 0 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class�1 0- Lic.# IQ CJ�U MECH RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I li used under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE&REPLACE l IOK BTU FURNACE IN EXISTING (commencing with Section 7000)of Division 3 of the Business&Professions LOCATION(GARAGE) 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. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$2950 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:34215066.00 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 to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. 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. -a ll Issued by: a, Date: Signature Date S t 1 C OWWR-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Date: Business&Professions Code) 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 HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this 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 maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,I Owner or erix d agent. become subject to the Worker's Compensation provisions of the Labor Code,I must Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments, cc nd expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION gi g of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 5 ITEMS OF 11 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 34215066 .00 DATE ISSUED. . . . . . . : 04/25/2011 RECEIPT #. . . . . . . . . BS000013283 REFERENCE ID # . . . : 11040170 SITE ADDRESS . . . . . : 22583 WOODRIDGE CT SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : YANG JEFF N AND YIH-NAN ADDRESS 22583 WOODRIDGE CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2674 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 2, 950 .00 1. 00 0. 00 1.00 0.00 1BSEISMICR VALUATION 2, 950 .00 0.50 0. 00 0.50 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 211.50 0. 00 211.50 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 486 .09 #21971 --------------- TOTAL RECEIPT 486. 09 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 22583 woodbridge ct. DATE: 04/25/2011 REVIEWED BY: bobs. tAPN: BP#: "VALUATION: $2,950 0 ;PERMIT TYPE: Mechanical Permit 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 t- TOTALS: $126.00 Mech.Plan Check 0.0 hrs $0.00 Mech.Permit Fee: IMPERMIT Other Mech.Insp. Fo.0 hrs $42.00Li El NOTE. These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info, FEE ITEMS (Fee Resolution 09-051 Ef'. 7,1"10) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $126.00 PME Permit Fee: $42.00 Work Without Permit? 0 Yes G No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 Strom Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $211.50 $0.00 TOTAL FEE: $211.50 Revised: 04/01/2011 ' Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAlterations CF-IR-ALT-HVAC Climate Zones 8 Site Address: ,Enforcement Agency: Dat Permit#: aa58'3 �,� o � . Equip ment Type List Minim ' Efficiency' Conditioned Floor Area Thermostat Packaged Unit I rDE—F urnace AFUI COP Served by system Setback Indoor Coil SEER HSPF sf 5( n.t already present,must be installed) Condensing Unit EER 0 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 CFNVton,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 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 a lication. Name: Signature: Company:, ate: �! Address: 1171 , / A) ��+ License: S`'f0 City/State/Zip: -e— ey 6//a Phone: _ -Mq- 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: woGf�(-� E C T - PERMIT# & OWNER'S NAME: A e" Zv1 PHONE# 40k — 'E�b S — -1F -) GENERAL CONTRACTOR: b ,\ `t BUSINESS LICENSE# '��S4() ADDRESS: CITY/ZIPCODE: S� csI l 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. I am not using any subcontractors: �ignure 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 //vy 017 0 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333•buildinGacupertino.org MISC CUPERTINO Ef PLUMBING MECHANICAL r EC=CAL ❑MISCELLANEOUS PROJECT ADDRESS (� ' 0 APN#� A /N� 0 1 ^ OWNER NAME l J/4 (� Y 1 9� 6-r\�i PHONE j'V�_GJ `�G,`s-1 a-7 i E-MAIL STREET ADDRESS CITY,STATE,ZIP �lca-) � j FAX CONTACT NAME �•� PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT XSONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME 'I�.^n LICENSE NUMBER LICENSE TYPE BUS.LIC(#��[ COMPANY NAME +,�\� IL 1►�'� �1 EMAII FAX holo CJ Vv��1 Y\CS•��✓ .c LICXI - 0�7 STREET ADDRESS 'I,(� CITY,STATE,ZIP LjeaXn /�S`t PHONE �W, yy _&)Ct V r� ARCHITECTIENGINEERN1AME LICENSE NUMBER 1 BUS.LIC# p�� COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑ SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ No DESCRIPTION OF WORK �k\��\Ul V t,U�'�i KJ✓1 V`- � E l.t � 6'tl�i r _ TOTAL VALUATION: _ _ BYES - 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 construc uthorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: L dS—( SUPPLEMENTAL JOWATION REQUIRED Q1 "``� � L a Ems, _cam MEPMiscApp 2011.doc revised 03/16/11