13070171 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22543 WOODRIDGE CT CONTRACTOR:ONE HOUR HEATING PERMIT NO:13070171
AND AIR
OWNER'S NAME: MAU CHENG-I AND TZU-TING 1400 PETALUMA HILL RD DATE ISSUED:07/29/2013
OWNER'S PHONE: 4088575510 SANTA ROSA,CA 95404 PHONE NO:(707)545-1800
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL[]
License Class G Z`Lic.# 7%0? 1 REPLACE(E)A/C UNIT IN SIDE YARD
Contractor Date -7-2-q—(3
I hereby a m that am licensed under the provisions of Chapter 9
(c acing 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. Sq.Ft Floor Area: Valuation:$5910
JI 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:34215062.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
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 DAY_S FR CALLED 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 Z9
Date:
granting of this permit. Additionally,the applicant understands and will comply Is
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
--7�2 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
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)
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 6.95 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 this Owner or authorized agent: Date? Z9—/
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 CONSTRUCTION LENDING AGENCY
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
GENERAL PERMIT APPLICATION �\
MEP
10 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ^,� )
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 'x\"
CUPERTINO (408)777'-3228•FAX(408)777-3333•building(g)cupertino.org MISC
❑PLUMBING ❑MECHANICAL ❑ELECTRICAL []MISCELLANEOUS
PROJECT ADDRESS ^ 3 '�� . APN# S q 1 15O 6
OWNER NAME M:yi l r I O ��. �� '` E-MAIL
STREETADD��3 / ,�It.J�!'� 1 C CT G6�STAT I64O FAX
CONTACT NAME �1(� PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACT AM LICENSE ER LICENSE TYPE BUS.LIC#
I� OU Qz i NCS /41 I� C eo G 2 O
COMPANY NAME �C- E-MAIL FAX
STREET l� CITY STATE,ZI PHONE
Mq ) L Kb TKA A CA 15; tHa7-.5 5
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
i
USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND El YES PROJECT IN ❑YES IS THE BLDG AN El YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO Q FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK P-C-F L 66 A/c CQ IV t"
TOTAL VALUATION: 5cll b D BY:.
By my signature below,I certify to each of the following: I am the property owner or authorized itis age n o pr owner's behalf. I have read s
application and the information I have provided is correct. I have read the Description of Work and verify acc e. I agree to comply with all applicable local
ordinances and state laws relating to building w cf n. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: -7- 2 t — 3
MENTAL INFORMATION REQUIRED OFFICE USE ONLY
w OVER-THE-COUNTER
EI EXPRESS
u'
STANDARD
U:
I ❑ LARGE
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❑ MAJOR
MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 22543 WOODRIDGE CT DATE: 07/29/2013 REVIEWED BY: MELISSA
APN: 342 15 062 BP#: *VALUATION: 1$5,910
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: FURN/A
WORK REPLACE E A/C UNIT IN SIDE YARD
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
A/C Units (<=10K cfm) 1BREMAIR 1 # $70
TOTALS: '' $70.00
Mech.Plan Check 0.0 hrs $0.00 Plrsnib.Plan Check Elec.Plan Check
Mech.Permit Fee: 1MPERMIT Plumb. PermitI�:e: Elec. Permit Fee:
Ler Mech.Insp. 0.0 hrs $47.00 Other Plumb Insp. Other Elec.Insp.
h. Insp.Fee: Plumb. hap.Tee: Elec.Insp.l'ee:
NOTE:This estimate does nottinchide fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). Theseees are based on the relimina information available and are only an estimate. Contact the Det or addn7 info,
FEE ITEMS ff ee Resolution 11-053 E . 711/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
PME Plan Check: $0.00
Permit Fee:
.Suppl. Insp tree
PME Unit Fee: $70.00
PME Permit Fee: $47.00
Construction 7 crx: -F-T
Administrative Fee: 1ADMIN $44.00
Work Without Permit? 0 Yes iq No $0.00
Advanced Planning Fees:
Travel Documentation Fee: 1TRAVDOC $47.00
Strong Motion Fee: 1BSEISMICR $0.59 Select an Administrative Item
Bldg Stds Commission.Fee: IBCBSC $1.00
ia <
$209.59 $0.00 .. `= $209.59
lown a
\� N Revised: 07/01/2013
lv
HVAC ALTERATIONS ENERGY COMPLIANCE FORM
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E.,C.B.O., BUILDING OFFICIAL
CV PERTfIQ 10300TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildinoecupertino.ong
WHEN IS A PERMIT REQUIRED
A construction permit shall be obtained from the enforcement agency prior to the erection,
construction, reconstruction, installation, relocation, or alteration of any mechanical system, except as
permitted in Chapter 1, Section.112.2 of the 2010 California Mechanical Code. Projects requiring
permits include, but are not limited to:
• New HVAC installation
• HVAC Changeout
• Replacement of furnace, coil,FAU or condenser
• Relocation of an existing HVAC unit
• Adding or replacing more than 40ft ducting in unconditioned space
BUSINESS AND PROFESSIONS CODE, SECTION 7110
Willful or deliberate disregard and violation of the building laws, including the California Building
Code, and local permit requirements constitutes a cause for discip'linary action from-the Contractors
State License Board'wotking ire conjunction with the local building,department. This action may
consist of fines up to,$S;p00 per violation or suspension/revocation of a contractor's license.
2008 BUILDING ENERGY EFFICIENCY STANDARDS (Title 24,Part 6)REQUIREMENTS
INCLUDE:
1. Heating equipment must have a minimum 78%AFUE(Exception: Wall &floor furnaces; room
heaters).
2. Central air conditioners&heat pumps less than 65,000 Btu/hr must have a minimum 13 SEER.
3. Newly installed or replaced ducts must have a minimum insulation value of R-4.2.
4. A setback type thermostat(24 hr clock with four set points) is required for all alterations.
5. New or replacement ducts must meet the mandatory requirement of Section 150(m).
• All joints and openings in the HVAC system must be sealed.
• Only UL 181, UL 181A, or UL 181B approved tapes or mastic shall be used to seal duct
openings.
• Connections of metal ducts and the inner core of flex ducts shall.be mechanically fastened.
Flex ducts must be connected using a metal sleeve/coupling.
• Flex ducts that are suspended must be supported every 4 ft. max for horizontal runs with no
more than 2"of sag between supports and 6 ft. max for vertical runs.
6. The CF-6R-MECH-04 must be completed and signed by the installing contractor. The Inspector
will collect this form and verify that the model numbers are the same as the installed equipment.
2008 Residential Compliance Forms.doc revised 04/10/12
Simplified Prescriptive Certificate of Compliance:2008 Residential HVACAlterations CF-IR-ALT-HVAC
Climate Zones l sad 3-7
S7te Enforeerrrerd Agency: -.(�
� 3 Wo z. !�1
Conditioned Duct insulation
Equil-entTypel List Mmirni m Efficiency- 1*166r Area re Thermostat
Padcaged Unit Over 40 8 of ducts'
[�Furnace ® COP Served by system added or replaced in ` Setback
Indoor Corr Q ®HSPF (Taoiidreadypresem,mustbe
fjCondensing Unit EER gesistance O0 sf unconditioned space l �
Other R 6 (CZ 1,3-5)
1.Equipment Type:Choose the equipment being installed;if more than one_system,use another CF-IR-ALT-HVAC for each system.
2.Afinimum 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 I and 6 of the California Code of Regulations.
• The design features identified on this Certificate of Compliance areconsistent 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 t c- (-EV Signature:
CompanyDam
RUU 'R KU*TikA A(IQ
. &
Address:I PCM 11L)M 14 : ly It
city/state/zig: -r/a RQS/CF c G ,� Phone: o7-SES-I r o c>
2008 Residential Compliance Forms.doc revised 04/10112