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11050165CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1091 NOVEMBER DR CONTRACTOR: A & H HEATING PERMIT NO: 11050165 OWNER'S NAME: MICHAEL HUANG 770 CHESTNUT ST DATE ISSUED: 05/20/2011 OWNER'S PHONE: 4083985674 SAN JOSE, CA 95110 PHONE NO: (408)279-0722 L, LICENSED CONTRACTOR'S DECLARATION f- r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic. # tJb10ee7 4E= MECH T_ RESIDENTIAL COMMERCIAL � Contractor re" ` �'i rC_ Date ,5_�qG' < I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REMOVE & REPLACE FURNACE ADD A/C MINIMUM 5' (commencing with Section 7000) of Division 3 of the Business & Professions SET Code and that my license is in full force and effect. BACK I hereby affirm under penalty of perjury one of the following two declar ff"t 5: 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: $8000 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION APN Number: 36216025.00 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.� Signature Date �� 9 Issued big Date:,`-G'�"4 F 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 berg 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: I have and will maintain a Certificate of Consent to self -insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 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. permit is issued. Additionally, should I use equipment or devices which emit hazardous air 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 Owner pr2OWorized ent: J ?a^ !! Date: forthwith comply with such provisions or this permit shall be deemed revoked.�— 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 :.osis, and expenses which may accrue against said City in consequence of the �g of this permit. Additionally, the applicant understands and will comply A A non -point source regulations per the Cupertino Municipal Code, Section ARCHITECT'S DECLARATION ).18. I understand my plans shall be used as public records. Signature Date Licensed Professional 6 ITEMS OF 6 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36216025.00 DATE ISSUED.......: 05/20/2011 RECEIPT #......... BS000013513 REFERENCE ID # ...: 11050165 SITE ADDRESS 1091 NOVEMBER DR SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER MICHAEL HUANG ADDRESS 1091 NOVEMBER DR CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM ....: REINHARD PERLHEFTER CONTRACTOR PHELPS, DALE LIC # 12079 COMPANY A & H HEATING ADDRESS ..........: 770 CHESTNUT ST CITY/STATE/ZIP ...: SAN JOSE, CA 95110 TELEPHONE (408)279-0722 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ____ 1BCBSC VALUATION 8,000.00 ---------- 1.00 --------- 0.00 1.00 0.00 1BREMAIRHA NO.UNITS 1.00 63.00 0.00 63.00 0.00 0.00 1BSEISMICR VALUATION 8,000.00 0.80 0.00 0.80 0.00 1MFR=<100 UNITS 1.00 126.00 0.00 126.00 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 ---------- 274.80 0.00 274.80 0.00 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 274.80 --------------- 274.80 VOICE ID DESCRIPTION -------- ---------------------------- 505 FINAL ELECTRICAL 508 FINAL MECHANICAL REFERENCE NUMBER -------------------- VISA VOICE ID DESCRIPTION -------- ---------------------------- 507 FINAL PLUMBING CUPERTINO GENERAL PERMIT APPLICATION � IV=> OILS MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(Qcupertino.org 1-1 nr r rKmrNir, PkIlI[ECHANICAL /T1-Tr,LECTRICAL ❑ MISCELLANEOUS MISIC PROJECT ADDRESS Qtf. APN A (� 1 OWNER NAME . G d PHONE 4 C ! E-MAIL STREET ADD 76 t3 C CITY�sTE. zIP ^ l L/ FAX CONTACT NAN IIVJ jn o' J 7 P Q� TZ E MAa. STREET Sc �p�iT C A 3Az 0YJ I � 6 F T7 1 /6 ❑ OWNER ❑(OWNER -BUILDER ❑ OWNER AGENT 43 CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT El ENGINEER C1 DEVELOPER ❑ TENANT CONTRAMAV LICE / Z BU$� UC�� COMPANY 14 4VT_t Aki (4-1 L- E-MAIL Feld U 2 t / C �c ) R V d J Cm s �/ J t I Pe (J 6 C/ .STREET ARCHTTECT/ENGINEER NAME LICENSE NUMBER BUS. LIC 9 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE 'SE OF SFD or Duplex ❑ Multi -Family STRUCTURE: ❑ Commercial PROJECT IN WILDLAND URBAN INTERFACE AREA ❑ Yes ❑ No PROJECT IN FLOOD ZONE ❑ Yes ❑ No DESCRIP'T'ION OF WORK TOTAL VALUATION: &C0RECEI EIbl = f ;� , + f By my signature below, I certify to each of the following: I s �repetl weer or authorized agent to act on the property owner's behalf. I have read this application and the information I have prov' ect. I have read the scription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating t g construction. I autho ' epresentatives of Cupertino to enter the above-identifiedproperty for inspection purposes. Signature of Applicant/Agent: SUPPLEMENTAL INFORMATION REQUIRED _. , MEPMiscApp_201 1. doc revised 03/16/11 ��/ CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION I& ADDRESS: 1091 november dr. DATE: 05/20/2011 REVIEWED BY: bobs. UNITS APN: BP#: `EVALUATION: 1$8,000 'PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: # PENTAMATION FURN/AC PERMIT TYPE: WORK re lace existing furnace add new A/C unit. SCOPE APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES A/C Units (<=10K cfm) 1BREMAIR 1 # $63 Furnace, Forced -Air 1MFR=<100 1 # $126 PME Unit Fee: $189.00 PME Permit Fee: $42.00 Work Without Permit? 0 Yes No $0.00 TOTALS: Travel Documentation Fee: ITRA VDOC $189.00 Strong Motion Fee: IBSEISMICR Mech. Plan Check 10.0 1hrs $0.00 Mech. Permit Fee: IMPERMIT Other Mech.Insp. 1 0.0 1 hrs $42.00 NnTF• Thoco foot aro hacod nn tho nroliminary infnrmatinn availahlo and aro nnly nn ocfimafe_ Cnntart tho Dent for addn'l info. FEE ITEMS (Fee Resolution 09-051 fff.' ?7il(1) 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 No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 Strong Motion Fee: IBSEISMICR $0.80 Select an Administrative Item Bid,g Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $274.80 $0.00 TOTAL FEE: $274.80 Revised: 04/29/2011 Prescri five Certificate of Com fiance: iff CF -IR -ALT Residential Alterations Page 1 of 5 Project Name: Climate Zone # # of Stories ries General Information Site Address: `pg/Alp v XZ Enforcement Agency:4 Date: Building Type Single Family [3Multi Family Circle the Front Orientation: E, S, W, or degrees Conditioned Floor Area (CFA): 12.00 W r Project Type: AlterationsEnvelope Fenestration Roof HVAC Replacement or Change Out Duct Replacement Water Heater =U-* This form is not to be used for Newly Constructed Bullalfngs or Additions Insulation Values For Opaque Surfaces (for Furring use the Mass and Furring Strips Construction table below) Assembly Alteration ❑ Opening of framed cavity alone— Alterations that involve the opening of the framed cavity ofa wall, ceiling, or floor must install the mandatory minimum insulation value per §1 S0 for the altered assembly. Fill in Columns A —C and enter mandatory insulation value in Column H. ❑ Replacement of entire assembly — Replacement of an entire wall, ceiling, or floor assembly requires the installation of Component Package- D insulation values in Table 151-C. Fill in Columns A — J. Opaque Surface Details For the furred portioned of Mass Wails see Furring Strips Construction Table below. A B C D E F G I H I I J P NOW Standard Values From JA4 Table L M Framing Thickness, Framed Continuous JA4 Proposed Ta�/ ID Assembly Name or Type2 Material and Size' Spacing, U- JA4 Table or Other' factor4 Numbers Cavity R-value6 Insulation Assembly Assembly R -Valuer Row/Col' U -factor, $^� � >" � S —' < > Note: For furred assemblies, accounting for Continuous Insulation R -value, see Page JA4-3 and Equation 4-1. For calculating furred walls use the Mass and Furring Construction table below. 1. For Tag/ID indicate the identification name that matches the building plans. 2. Indicate the Assembly Name or type: Roof/Ceiling, Walls, Floors, Slabs, Crawl Space, Doors and etc ... Indicate in column G the Frame material and Size: For Wood, Metal, Metal Buildings, Mass, enter 2x4, 2x6, or etc... see JA4 for other possible frame type assemblies. 3. Enter the thickness for mass in inches or Spacing between framing members enter; 16 "or 24 "OC; or Other for all other assembly description such as Concrete Sandwich Panel, Spandrel Panel, Logs, Straw Bale Panel and etc.... 4. Based on the Climate Zone; enter the equivalent U factor found in JA4 Table based on the R -Value from Table 151-B, C, or D S. Enter the Table number that closely resembles the proposed assembly. 6. Enter the R -value that is being installed in the wall cavity or between the framing; otherwise, enter "0 ". 7. Enter the Continuous Insulation R -value for the proposed assembly; otherwise, enter "0 ". 8. Enter the row and column of the U factor value based on Column F Table Number and enter the Assembly U factor in Column J 9. The Proposed Assembly U factor, Column J, must be equal to or less than the Standard U factor in Column E to comply. Furring Stri Construction Table for Mass Walls Cml A B C D E F G I H I J I K L M Proposed Properties of Masonry and Concrete Walls From Reference Joint Appendix Table 4.3 4.3.6 4.3.7 Added Interior or Exterior Insulation in Furring Space from Reference Joint Appendix Table 4.3.13 Final Assembi U -factors' Comment Mass Thickness' Assembly Name or T 2 JA4 Table Number' a Q > k' � H O c 4 � a = $^� � >" � S —' < > 11 a to 2008 Residential Compliance Forms March 2010