13070032 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21995 MCCLELLAN RD CONTRACTOR:ONE HOUR HEATING PERMIT NO:13070032
AND AIR
OWNER'S NAME: KENG FAI LEE 1400 PETALUMA HILL RD DATE ISSUED:07/05/2013
OWNER'S PHONE: 4085505453 SANTA ROSA,CA 95404 PHONE NO:(707)545-1800
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALE]
License Class ClD C Lic.# `7 �Q� REPLACE(E)HVAC UNITS,SAME LOCATION
Contractor - Date -- f
I hereby alffii m4iciused under the provisions of Chapter 9
(comnKnci with Section 7000)of Division 3 of the Business&Professions
Code AW 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:$14545
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 APN Number:35713009.00 Occupancy Type:
permit is issued.
APPLICANYCERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I j'
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.
Z RE-ROOFS:
Signature Date / 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.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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,
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 695 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code;for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 05,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this1
Owner or authorized agent:( Dater ^�3
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 CONSTRUCTION LENDING AGENCY
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 I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
—
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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
V
M
GENERAL PERMIT APPLICATION
EP . '
.', COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION - -
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 0
(408)777-3228•FAX(408)777-3333•building(a)-cupertino.org m1SC
CUPIER.IN0 ,
I ❑PLUMBING'/, ^ ❑NECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS I' { •C GL GLEN. �.�' APN#
OWNER E-MAIL V
- So- 5ys3
STREET ADDRES§ / •i C 1 41, ':4 i4 (�! �� &gT T /pndC g.�C� FAX
CONTACT NAMB PHONE E MAII FAX ADDRESS CITY,STATE,ZIP
FAX
❑OWNER !J QWNER-BUILDER. ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER El TENANT
CO RACTOR NAIv�E T�N LICEI�$E ER LICENSE TYPE BUS.LIC#
COMPANY NAME E-MAIL FAX
ST E DS I' -' ••. K[ � /LLJ C IV{ E,ZIP rI C4 19 L P i J ::9 VQV
05
ARCHITECT/ENGINEERNAME LICENSE NUMBER BUS.LIC#
i I
COMPANY NAME i l I' E-MAIL FAX
STREET ADDRESS i CITY,STATE,ZIP PHONE
i
USE OF I ,❑SFD&DUPLEX :❑ MULTI-FAMILY PROJECT IN WILDLAND - ❑ YES PROJECT IN ❑YES IS THE BLDG AN [].YES
BUILDING. ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
i
DESCRIPTION;OF�,V�ORiC :i.I I { �
l h i li
I I
I
li I �
OT?
' INI I 1SIILVAI�pAT?Q ' 1111
By!Imy signature below,I certify toleach of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
apphcatloix ande Informationil have prodided is correct. I have read the Description of Work and verify it is accurate. I agree to comply'with all applicable locat!
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 21995 MCCLENNAN RD DATE: 07/05/2013 REVIEWED BY: MELISSA
APN: 357 13 009 BP#: EVALUATION: 1$14,545
,PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: FURN/A
WORK REPLACE E HVAC UNITS SAME LOCATION
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
A/C Units (<=10K cfm) 1BREMAIR 1 # $70
Furnace, Forced-Air 1MFR=<100 1 # $139
TOTALS: a $209.00
xx m
ELM=w-
as
Mech.Plan Check 0.0 hrs $0.00 Phimb.Plan Check Elec.Plan(:;heck
Mech.Permit Fee: 1MPERMIT Plumb.Permit I%ee: Elec_Permit Pee:
Other Mech.Insp. 0.0 hrs $47.00 Other Plumb Insp. Li Other Glee.Insp.
tllJech, Insp.Fee: Plumb. hish.Fee: Elec.Insp,Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). Theseees are based on the prelimina information available and are only an estimate. Contact the De t or addn7 info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711112) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Feer
PME Plan Check: $0.00
Perin it Fee:
suppl. Insp Fee
PME Unit Fee: $209.00
PME Permit Fee: T-T $47.00
C'clnsiructivn Tax.-
Administrative
cax:Administrative Fee: IADMIN $44.00
Work Without Permit? ®Yes 0 No $0.00
Adwincec/PhinninL,Fees:
Travel Documentation Fee: ITRAVDOC $47.00
Strom Motion Fee: IBSEISMICR $1.45 Select an Administrative Item
Bldy Stds Commission Fee: 1BCBSC $1.00
s
, ��r. $349.45 $0.00 i $349.45
Revised: 07/01/2013
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-HVAC
Climate Zones 1, 3-7
Site Address: Enforcement Agency: Date: Permit#:
21995 MCCLELLAN RD CUPERTINO, CA 95014 7City of Cupertino Jul 1, 2013
Duct insulation Conditioned Floor
Equipment Typei List Minimum Efficiency2 requirement Area Thermostat
❑Package Unit
®Furnace H AFUE 98% ❑COP ®Setback
❑Indoor Coil ®SEER16. ❑R 6 (CZ 1, 3-5) Served by system
0 ❑HSPF If not already present, must be
®Condensing Unit [I EER E] [3 R 42 CZ 6, 7 Resistance ( ) 1500 sf installed)
[3 Other
1.Equipment Type:Choose the equipment being installed;if more than one system,use another CF-1R-ALT-HVAC for each system.
2.Minimum Equipment Efficiencies: 13 SEER,,78%AFUE,7.7HSPF for typical residential systems.
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: Kevin Schaff Signature: Kevin Schaff
Company: BIGHAM SERVICES INC dba ONE HOUR HEATING&A/C Date: Jul 1, 2013
Address: 1400 PETALUMA HILL RD License: 740999
City/State/Zip: SANTA ROSA/CA/95404 Phone: (707) 545-1800
5
Reg: 213-A0048532A-000000000-0000 Registration Date/Time: 2013/07/01 15:12:25 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms July 2010