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13080222
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 948 ROSE BLOSSOM DR CONTRACTOR:QUAN'S ELECTRICAL PERMIT NO: 13080222 OWNER'S NAME: LIU YING-PING 10628 RANDY LN DATE ISSUED:08/29/2013 OWNER'S PHONE: 4085079522 CUPERTINO,CA 95014 PHONE NO:(408)366-1823 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL[] License Class 6_ J(t) —6-7-0 Lic.# 7 00 �/ `�- RELOCATE FURNACE TO ATTIC AND NEW AIR DUCTS Contractor ( 1/l./ 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. Sq.Ft Floor Area: Valuation:$4800 1 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:35906026.00 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 1 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 M LAST CALLED INSP TI N. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the T granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date B/ 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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 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,Section 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date P 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� COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (�1 sc CUPERTINO (408)777-3228•FAX(408)777-3333•building(abcupertino.org v M ' ❑PLUMBING []MECHANICAL ❑ELECTRICAL []MISCELLANEOUS PROJECT ADDRESS APN 5 OWNER NAME , PHONE v(S O V �r,c (n^ E-MAIL STREET ADDRE D C11 Y,STATE,ZIP o� FAX CONTACT NAME PHO�E E-MAIL STREET ADDRESS ,{.{// CITY,STATE,ZIP FAX 11 OWNER 11OWNER-BUILDER ❑ OWNERAGENT &CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME r n � LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME ( Ca E-MAIL FAX STREET ADDRESS ,© ?J CITY,STATE,ZIP � � PHONE !�_2 ARCHITECT/ENGINEER NAME TICENSENUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMH,Y PROJECT IN WH,DLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK � •_ , p_C R c, o fn,,d Ale,, �— TOTAL VALUATION: da- RECEIVED BY: By my signature below,I certi6jo each of the following: I am the property owner or authorized agent to act on the propefty 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 bjilding construction. I authorize representatives of Cupertino to enter the abode eenti�fied property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE NLY W OVER-THE-COUNTER ❑ EXPRESS V x ❑ STANDARD U ❑ LARGE a ❑ MAJOR MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 948 rose blossom dr DATE: 08/29/2013 REVIEWED BY: Mendez APN: BP#: "VALUATION: 1$4,800 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: FURN/A WORK relocate furnace to attic and new air ducts SCOPE Mech.Plan Check0,0 hrs $0.00 Plumb.Plan Check E ec...Plun Check Mech.Permit Fee: IMPERMIT Plumb. Permit Fee: Elec. Permit Tee, Other Mech.Insp. 0.0 hrs $47.00 Other Plumb Insp. Chher Elec,Insp. Li .1 Lech.Inch.lee: Plumb. Insp.Fee: Dec.Insp. Fee. NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District etc). Thesefees are based on the prelinmdina information available and are on an estimate Contact the Det&r addn'1 info, FEE ITEMS(Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Mechanical Suppl.PC Fee: (j) Reg. Q OT 0.0 1 hrs $0.00 $139.00 1MFR=<I00 I Furnace,Forced-Air PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee:(F) Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 Cons'br uclion 3a. Administrative Fee: IADAffN $44.00 Work Without Permit? ® Yes (j) No $0.00 G Advanced Planning Fee: $0.00 Select a Non-Residential 0 Travel Documentation Fee: ITRAVDOC $47.00 Building or Structure i Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 a3,. $139.50 $139.00 Cdr uEE $278.50 Revised: 07/01/2013 INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning Systems,Ducts and Fans (Page 1 of 2 Site Address: Enforcement Agency: Permit Number: Space Conditioning Systems Heating Equipment Duct Efficiency Location Equip (AFUE, (attic, Type ARI #of etc.)1,3 crawl- Heating Heating (package- CEC Certified Mfr.Name Reference Identical (>_CF-1R space, Duct Load Capacity heat um and Model Number Number 2 Systems value 4 etc.) R-value tu/hr (Btu/hr d 'Zo a 'S7 srko7a Cooling Equipment Efficiency Duct Equip (SEER Location Type and EER) (attic, (package #of 1'3 crawl- Cooling Cooling heat CEC Certified Mfr.Name ARI Reference Identical (>_CF-1R space, Duct Load Capacity um and Model Number Number 2 Systems value)4 etc. R-value (Btu/hr) (Btu/hr) 1.If project is nely construction, see Footnotes to Standards Table 1.51-B and Table 151-C for duct ceiling alternative compliance. 2.ARI Reference Number can be found by entering the equipment model number at http:11wiviv.aridirectory.org/ari/ac.php# 3.Listed efficiency on this page must be greater than or equal(>_)to the value shoiam on the CF-1 R form. 4. When CF-IR is reference it is also applicable to the CF-IR, CF-JR-A,4 or CF-IR-ALT ALL BOXES MUST BE CHECKED TO BE A VALID FORM ❑ §110-§113:HVAC equipment is certified by the California Energy Commission. ❑ §150(h):Heating and/or cooling loads calculated.in accordance with ASHRAE,SMACNA,or RCCA. ❑ §150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of§112(c). ❑ §1500)2:Pipe insulation for cooling system refrigerant suction,chilled water and brine lines meets minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entirely in conditioned space. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-,MECH-04 S ace;Couditionin Systems,Ducts and Fans (Fa e 2 of Z Site Address:' Enforcement Agency: Permit Number: �- Ducts and Fans §150(m):Duct and Fans ❑" 1.All air-distribution system ducts and plenums installed,sealed and insulated to meet the requirements of CMC Sections 601,602,603,604;605 and Standard 6-5;supply-air and return-air ducts and plenums are insulated to a minimum installed level of 11=4.1 or enclosed-entirely in conditioned space. Openings shall be sealed with mastic,tape or other duct-closure system that meets the applicable requirements of UL 181,UL 181A,or UL 181B or aerosol sealant that meets the requirements of UL 723. If mastic or tape is used to seal openings greater than 1/4 inch,the combination of mastic and either mesh or tape shall be used;and ❑ 1.Building cavities,support platforms for air handlers,and plenums defined or constructed with materials other than sealed sheet metal,duct board or flexible duct shall not be used for conveying conditioned air. Building cavities and support platforms may contain ducts. Ducts installed in cavities and support platforms shall not be compressed to cause reductions in the cross-sectional area of the ducts. El. 2D.Joints and seams of duct systems and their components shall not be sealed with cloth back rubber adhesive duct tapes unless such tape is used in combination with mastic and draw bands. ❑ 7.Exhaust fan systems have back draft or automatic dampers. ❑ 8.Gravity ventilating systems serving conditioned space have either automatic or readily accessible,manually operated dampers. ❑ 9.Protection of Insulation.Insulation shall be protected from damage,including that due to sunlight,moisture, equipment maintenance,and wind.Cellular foam insulation shall be protected as above or painted with a coating that is waxer retardant and provides shielding from solar radiation that can cause degradation of the material. ❑ 10.Flexible ducts cannot have porous inner cores. DECLARATION STATEMENT • I certify under penalty of perjury,under the laws of the State of California,the information provided on this form is true and correct. • Iam eligible under Division 3 of the Business and Professions Code to accept responsibility for construction,or an authorized representative of the person responsible for construction(responsible person). • I certify that the installed features,materials,components,or manufactured devices identified on this certificate(the installation) conforms to all applicable codes and regulations,and the installation is consistent with the plans and specifications approved by the enforcement agency. • I reviewed a copy of the Certificate of Compliance(CF-1R)form approved by the enforcement agency that identifies the specific .requirements for the installation, I certify that the requirementsdetailed on the CF-1R that apply to theinstallationhave been met. • I will ensure.that a completed,signed copy,of this Installation Certificate shall,be posted;or made available with the building permit(s)issued for the building,and made available to the enforcement,agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. Comp ame: (Installing Subcontractor or General Contractor or Builder/Owner) ResponsiblPro= ame:J %' Responsible Person's Si afore: CSLB License: Date Signed Position With Company Title): 70 2008 Residential Compliance Forms August 2009 K OFFICIIE COPY , J V Al a� W .NIS ? zrt"""L a Of Lp a �w�r�^^ Z C U � �"^ U •= N LU ac rn o� I - _--- tv O LU ! a!� .. *..:-tions FAUST be kept at the It is un!awfui to make any ai os,same,or to deviate r"ri, +r thout an roval from the Building Official. .f this pla 7 and specifications SHALL NOT b:= ;,i to p i rinit or to be an approval of the violation of any provi ions of any City Ordinance or State Law. BY DATE PERMIT NO. 068'0= 0--.4 4f F-atrACiYQ '4�