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13120058 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1131 SCOTLAND DR , CONTRACTOR:A&H HEATING PERMIT NO: 13120058 OWNER'S NAME: DENG LIPING AND JINGPING 770 CHESTNUT ST DATE ISSUED:12/05/2013 OWNER'S PHONE: 4089738940 SAN JOSE,CA 95110 PHONE NO:(408)279-0722 LICENSED CONTRACTOR'S AECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class G2-0Lic.# ,:5REMOVE AND REPLACE FURNACE IN SAME LOCATION Contractor � � Arv�ElY1L"batGe �` S I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 1000)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 c.9 isent,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:$2800 I have and will maintain Worker's Compensation Insurance,as provided for by ction 3700 of the Labor Code,for the performance of the work for which this APN Number:36226055.00 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 authorizerepresentatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST 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 Issued by:. Date 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. RE-ROOFS: Signataug;�” ae 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 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 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 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent n^te: / 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 6f-exemption,I become subject to the Worker's Compensation provisions of thei 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 (408)777-3228•FAX(408)777-3333•buildingacupertino.ora \(j MISC CUPERTINO ❑PLUMBING MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS I APN# �(O 3/`7,�2C, —DCS_5 OWNERNAME PHONE E-MAIL A� /p \h Tih V 7V) STREET ADDRESS 3 _4c,464 �r CITY,STATE,Z1.IP: ��w FAX GJ L CONTACT NAME - PH NE E-MAIL 6r-0 ®g z� -o�27 A A Np �Ai fi' L r STREET ADDRESS �7 o0 CI_ _ -14 w+, CTTY, ATE, R se- CA '�rl I h FAX —101 ❑OWNER ❑ OWNER-BUILDER `/�❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑I ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME 1 \ n LICENSE NUMBERT27 LICENSE TYPE CZ® BUS.LIC# 120-7(3 COMPANY NAME �� kr I ni E � /I_ FAX Cl h1 V _ j ' 6 Z — VT j 7 STREET ADDRESS�� - CTTY TATE,ZIP rT 0 CI&J6 94477 / PHONE og _6 72 ARCHITECT/ENGMER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF FD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WRDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO - DESCRIPTION OF WORK I -20,000 &� �.�rwe- ►o TOTAL VALUATION: �' - �' xj�i. By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property 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 building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED IrN `9Y a +`OVER THIiCOUNTER *:, yE RESS 6 R �T .A s r jik MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO it . .FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 1131 scottland dr DATE: 12/05/2013 REVIEWED BY: Mendez s APN: BP#• ''VALUATION: 1$2,800 %PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Du lex PENTAMATION FURN/AC USE: p PERMIT TYPE: woRK remove and replace furnace in same location SCOPE Mech.Plan Check 0.0 hrs $0.00 Plzsrrib.Plcm Check Elec.Plan Check Mech.Permit Fee: IMPERMIT Plumb.Permit Fee: Elec. Permit Fee: Other Mech.Insp. 0.0 hrs .$47.00 Other-Plumb Insp. Other Elec.Insp. Li ,tlech.Insp.Fee: Plumb. hrsh. Fee: Elec.Insp,Fec: NOTE:This estimate does not inchide fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These&q are based on.the relimina information available and are only an estimate. Contact the Det fiv addn'l info. FEE ITEMS(Fee Resolution 11-053 E . 7ff 11113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F 1 # Mechanical Suppl.PC Fee: 0 Reg. 0 OT; 0.0 hrs $0.00 $139.00 IMFR=<100Furnace,Forced-Air PME Plan Check: $0.00 Permit Fee: $0.00 Suppl.:Insp.Fee.0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 Construction Tcax: Administrative Fee: 1ADAffAt $44.00 Work Without Permit? ®'Yes 0 No $0.00 Advanced Planning Feer : $0.00 Select a Non-Residential 0 Travel Documentation Fee: ITRAVDOC $47.00 Building or Structure ®� Strong Motion.Fee: IBSEISMICR $0.50 0 # Revisions Bldg Stds Commission Fee: IBCBSC $1.00 $0.00 IREVCOMTI Tenant Improvement $139.50 $139.00 $278.50 Revised: 10/01/2013 Simplified Prescriptive Certificate of Compliance:2008 Residential HVACAlteradons CF-IR-ALT-HVAC Climate Zones 1 and 3-7 Site Addrel s. 6G i�n r Enforcementtgency:�� G AO Date.S '3 Permit#: l Conditioned Duct insulation Equipment T e` List Minimum EfficienCy2Floor Area requirement Thermostat PackagFurnced Unit AFUE q COP Over 40 8 of ducts ck Indoor Coil SEER HSPF Served by system added or replaced in nottaallready present,must be Condensing Unit 13 EER Resistance / 4 dO sf unconditioned space Other ,nstalled) R 6 (CZ 1,3-S) 1.Equipment Type:Choose the equipment being installed,if more than one system,use another CF-IR-ALT-HVAC for each system. 2.Minimum Equipment Efficiencies: 13 SEER,78%AFUE,7.7HSPF for typical residential systems. Contractor(Documentation Author's/Responsible Designer's Declaration Statement) • I certify that this Certificate of Compliance documentation is accurate and complete. • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. • I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24,Parts I and 6 of the California Code of Regulations. • The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms,worksheets,calculations,plans and specifications submitted to the enforcement agency for approval with the permit application. Name: (-,5 LUy,e Signature: Company: 11 � �` / -� "�I h l ti'`l l irtOf►► Y v G2 �vi Date: Z /3 Address: -7 -70 ( � J � License:3 O�y.7 City/State/Zip: Q h SC�c f-- //Q Phone: L(d$ Z 7 1 — 0 7ZZ 2008 Residential Compliance Forms March 2010