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11050144CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 19936 BAYWOOD DR I CONTRA MECHANICAL OR: RELIABLE AIR I PERMIT NO: 11050144 I OWNER'S NAME: LI LAO 13670 D CHARTER PARK DR I DATE ISSUED: 05/18/2011 1 :R'S PHONE: 3103842707 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. # 9 5&1 Ll&� O Contractor f rr�Date � 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. 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 permit is issued. �,^ APPLICANT CERTIFICATION 6f 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this pe ionally, the applicant understands and will comply with all n mt source r ulation per the Cupertino Municipal Code, Section 9.18 Signature Date L OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 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. If, after making this certificate of exemption, I 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. 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 upon the above mentioned property for inspection purposes. (We) agree to save ins'- -inify and keep harmless the City of Cupertino against liabilities, judgments, C nd expenses which may accrue against said City in consequence of the gr....,ng of this permit. Additionally, the applicant understands and will comply with all non-Egjuts�►rce regulations per the Cupertino Municipal Code, Section 9.18. r-�' y Date SAN JOSE, CA 95136 PHONE NO: (408) 266-7267 BUILDING PERMIT INFO: BLDG r— ELECT r- PLUMB f— MECH RESIDENTIAL COMMERCIAL JOB DESCRIPTION: REPLACE FURNACE AT HALL LOCATION Sq. Ft Floor Area: I Valuation: $2000 APN Number: 31630007.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: RE -ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air 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 Healthy& Safety Code, Sections 25505, 25533, and 25534. Date: `// CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional 6001=welatif CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 31630007.00 DATE ISSUED.......: 05/18/2011 RECEIPT #.........: BS000013481 REFERENCE ID # ...: 11050144 SITE ADDRESS .....: 19936 BAYWOOD DR SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ...... OWNER ............. LI LAO ADDRESS ..........: 19936 BAYWOOD DR CITY/STATE/ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM ....: PHILLIP A DORE CONTRACTOR .......: PHIL DORE LIC # 32027 COMPANY ..........: RELIABLE AIR MECHANICAL ADDRESS ..........: 3670 D CHARTER PARK DR CITY/STATE/ZIP ...: SAN JOSE, CA 95136 TELEPHONE ........: (408) 266-7267 OPERATOR: patg COPY # : 1 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ---------- 1BCBSC ------------- VALUATION ---------- 2,000.00 ---------- 1.00 ---------- 0.00 ---------- 1.00 ---------- 0.00 1BSEISMICR VALUATION 2,000.00 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 ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 360.00 --------------- 360.00 VOICE ID DESCRIPTION -------- ---------------------------- 505 FINAL ELECTRICAL 508 FINAL MECHANICAL REFERENCE NUMBER -------------------- #5058 VOICE ID DESCRIPTION -------- ---------------------------- 507 FINAL PLUMBING CUPERTINO 0�5 01 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building( cupertino.org fqUMBING MECHANICAL ELECTRICAL ❑ MISCELLANEOUS PROJECT ADDRESS - ,/j 1APN# 0 0 1) 7 OWNER NAMEL -- /� r PHO.110 - J� `l` d� 61 E -MAIL (-� v STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME PHONE - < � �- � d� E-MAIL STREET ADDRESS /� r� Com. STAT&f �' S (� d F 3 El OWNER ❑ OWNER -BUILDER 1:3OWNER AGENT CONTRACTOR ❑ CONNTRACTOR AGENT ❑ ARCHITECT ❑ ENGMEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME f)n(e LICENSE NUMBED S ( qO b LICENSE TYPE _ ) V BUS. LIC H COMPANY NAMELA`/ �1 A C(_ E MAII, f '+ 1 N'� S k) J L �V L. 1p STREET ADDRESS r ` C- r 7 V F" CITY, STATE, G j r 2 j L JO PHONE s; ` 6 - � � I C� ARCHITECTIENGINEER NAME LICENSE NUMBER BUS. LIC 9 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or Duplex ❑ Multi -Family STRUCTURE. ❑ Commercial PROJECT IN WILDLAND URBAN INTERFACE AREA ❑ Yes ❑ No PROJECT IN FLOOD ZONE ❑ Yes ❑ No DESCRIPTION OF WORK , l tn•+ a- �t TOTAL VALUATION: r�CF......AWKs��"f By my signature below, I certify to following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the informatio avepro d is co ct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relatingo ui m constru pn. I onze representatives of Cupertino to enter the above -id ' led property for inspection purposes. Signature of Applicant/ C Date: SUPPLEMENTAL INFORMATION REQUIRED -°i 1� 4 -rX�=�i�'� MEPILfucApp 1011. doc revised 03/16/11 4 (!j 040-2 W-MA CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 19936 baywood dr. DATE: 05/18/2011 REVIEWED BY: bob s. UNITS APN: BP#: "'VALUATION: 1$2,000 'PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: # PENTAMATION FURN/AC PERMIT TYPE: WORK replace furnace at hall location SCOPE APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES Furnace, Forced -Air J 1MFR=<100 1 # $126 PME Unit Fee: $126.00 PME Permit Fee: $42.00 Work Without Permit? 0 Yes E) No $0.00 TOTALS: Travel Documentation Fee: ITRA VDOC $126.00 Strong Motion Fee: IBSEWECR Mech. Plan Check 10.0 1hrs $0.00 Mech. Permit Fee: IMPERMIT Other Mech. Insp. 1 0.0 1 hrs 1 $42.00 NnTF• Thoco franc aro hacvd an thv nrvliminary infnrmatinn availahle and are anly an ocfimaty_ Cnntact the Dent fnr addn'i info. FEE ITEMS (Pe Resolution 09-051 1ff. 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 E) No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 Strong Motion Fee: IBSEWECR $0.50 Select an Administrative Item __71 Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $211.50 $0.00 TOTAL FEE: $211.50 Revised: 04/29/2011 Prescri tive Certificate of Compliance: Residential CF -IR -ALT Residential Alterations (Pa e 4 of 5) Project Name: Climate Zone # # of Stories I lis HVAC SYSTEMS - HEATING List water heaters and boilers for both domestic hot water (DHW) heaters and hydropic space heating. Individual dwelling DHW heaters must be gas or propane fired, and may not exceed 50 gallons. Hot water pipe insulation from the DHW heater to the kitchen(s) and on all underground Nbnimum Duct or Piping Configuration Heating Equipment Type and Capacity" 2,3 Efficiency (AFUE or HSSP✓F�) Distribution Type and Location Insulation R -Value Thermostat (Central, Split, Type Space, Package or H dronic G e A, Insulation R-Value3 -`ti\S L• 05c"A_- 1.Indicate Heating Type (Central Furnace, Wall Furnace, Heat pun1p, 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 total capacity < 2 KW or 7,000 Btu/hr electric heating is controlled 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 for additional requirements and check applicable boxes. 4. Indicate Type or Location (Ducts, Hydronic in Floor, Radiators, etc) HVAC SYSTEMS - COOLING Minimum Efficiency Duct or Piping Configuration Cooling Equipment (SEER/EER or Type and Capacity" COP) Distribution Type apd Location3 Insulation R -Value Thermostat Type (Central, Split, Space, Package or H dronic) 1. Indicate Cooling Type (A/C, Heat pump, Evap. Cooling, etc 2. Refer to the HERS Verification section on Page 4 of the CF- IR -AL T Form for additional requirements and check applicable boxes. 3. Indicate Tye or Location (Ducts, H dronic in Floor, Radiators, etc.) WATER HEATING List water heaters and boilers for both domestic hot water (DHW) heaters and hydropic space heating. Individual dwelling DHW heaters must be gas or propane fired, and may not exceed 50 gallons. Hot water pipe insulation from the DHW heater to the kitchen(s) and on all underground hot water pipes is required in all com onent packages in all climate zones. External Tank Water Heater Type/Fuel Type' Distribution Type Number In (Standard, Recirculating)2 System Tank Capacity (gal) Energy Factor or Thermal Efficiency Insulation R-Value3 1. Indicate Tvpe (Storage Gas, Heat Pump, Instantaneous, etc. 2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of §150(n). The Prescriptive requirements do not allow the installation of a recirculating water heating system for single dwelling units. 3. The external water heating tank and i es shall be insulated to meet the requirements o 150 ' . SPECIAL FEATURES The enforcement agency should pay special attention to the Special Fees specified in'this checklist below. These items may require written 'usti rcation and documentation and special verification. NEW ROOF ASSEMBLY - Radiant Barrier The radiant barrier requirement of § 151( 2 does not apply to roof alterations. Slab Edge (Perimeter) Insulation ❑ YES ❑ NO YES: In Climate Zone 16 in Component Packages D, R-7 insulation is required. ! `t Heated Slab Insulation ❑ YES ❑ NO YES: Slab edge insulation required for all heated slabs in all Climate Zones. See details in Table 118-A of the standards. Raised Slab Insulation ❑ YES ❑ NO YES: In Climate Zones 1, 2, 11, 13, 14 & 16, R-8 insulation is required; in Climate Zones 12 & 15, R-4 is required under component Package D. Thermal Mass To obtain Compliance Credit for the installation of thermal mass, use the Performance Approach. Registration Number: Registration Date/Time: 2008 Residential Compliance Forms HERS Provider: August 2009 Prescriptive Certificate of Compliance: Residential CF -IR -ALT Residential Alterations (Page 5 of 5) Project Name:; ��, �t Climate Zone # # of Stories __ s/1 .D L 1 CfASo I. Ll l HERS VERIFICATION SUMMARY The enforcement agency should pay special attention to the HERS Measures specified in this checklist below. A completed and signed CF -4R Form for all the measures specified shall be submitted to the building inspector before final inspection. Duct Sealing & Testing HERS verification is required for this measure. ❑ YES ❑ NO YES: In Climate Zones 2 and 9-16, if more than 40 linear feet of new or replacement ducts are installed in unconditioned space, the ducts are to be sealed per § 152(b) ] Dii and the newly installed ducts are to be insulated per § 151(f)10. ❑ EXCEPTION: Existing duct systems that are extended, which are constructed, insulated or sealed with asbestos. ❑ YES ❑ NO YES: In Climate Zones 2 and 9-16, if the existing space -conditioning system (HVAC equipment and ducting) is replaced, the ducts are to be sealed per § 152(b)1 Di. ❑ YES ❑ NO YES: In Climate Zones 2 and 9-16, if the existing HVAC equipment is replaced (including the replacement of the air handler, outdoor condensing unit of a split system, cooling or heating coil, or the furnace heat exchanger) the ducts are to be sealed per § 152(b)1 E. ❑ EXCEPTION: Duct systems that are documented to have been previously sealed confirmed through HERS verification in accordance with procedures in the Reference Residential Appendix RA3. ❑ EXCEPTION: Duct systems with less than 40 linear feet in unconditioned space. ❑ EXCEPTION: Existing ducts stems constructed, insulated or sealed with asbestos. Refrigerant Charge - Split System HERS verification is required for this measure. ❑ YES ❑ NO YES: In Climate Zones 2 and 8-15, when the existing HVAC equipment is replaced (including the replacement of the air handler, outdoor condensing unit of a split system A/C or heat pump, cooling or heating coil, or the furnace heat exchanger) a refrigerant charge measurement shall be verified per § I52(b)1F. Central Fan Integrated (CFI) Ventilation System and Fan Watt Draw The ventilation requirements of § 150(o) do not apply to existing residential homes. Ducted Split Systems - Air Conditioners and Heat Pumps: Airflow HERS verification is required for this measure. ❑ YES ❑ NO YES: In Climate Zones 10 through 15, when the existing space -conditioning system (HVAC equipment and ducting) is replaced, the airflow and fan watt draw shall be verified per 152(b)1Ci to meet the requirements of § 151(f)7B. Documentation Author's Declaration Statement • I certify that this Certificate of Compliance documentation is accurat Name: Signa e: ) f j Company: yve Date: 1�--c � r u(c Address:7If 1 C �' -- ` Applicable 11 CEA or ❑ CEPE (Certification #): City/State/Zip: Phone: ,__/ ,,,_ CJ Responsible Building Designer's Declaration Statement • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design identified on this Certificate of Compliance. • I certify that the energy features and performance specifications for the building 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 building design features identified on this Certificate of Compliance are consistent with the information provided to document this building design on the other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building emit application. Name: Signature: Company: Date: Address: License: City/State/Zip: Phone: For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300. Registration Number: Registration Date/Time: 2008 Residential Compliance Forms HERS Provider: August 2009 :UPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: L PERMIT # OWNER'S NAME: PHONE # .% GENERAL CONTRACTOR: r ,i7_� BUSINESS LICENSE # ADDRESS:CITY/ZIPCODE: `J *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 AL TRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. � r �'- I am not using any subcontractors: l Signature Date Please check applicable subcontractors and complete the following information: Owner / Contractor Signature Date 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