13120117CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10421 LANSDALE AVE.
CONTRACTOR: SANDIUM
PERMIT NO: 13120117
OWNER'S NAME: XU WEN AND FANG HAI
4223 VERDIGRIS CIR
DATE ISSUED: 12/16/2013
OWNER'S PHONE: 4082034727
SAN JOSE, CA 95134
PHONE NO: (408) 894-9072
2 LICENSED CONTRACTOR'S DECLARATION
�.
JOB DESCRIPTION: RESIDENTIAL COMMERCIALo4
License Class - 2 o Lic. # d0 G(
REMOVE AND REPLACE FURNACE IN SAME LOCATION
.
Contractor 0 l"1�_ Date Z
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: $9000
I have and will maintain Worker's. Compensation Insurance, as provided for by
APN Number: 36911006.00
Occupancy Type:
Section 3700 of the Labor Code, for the performance of the work for which this
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
WITHIIN 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 F ST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
�
costs, and expenses may acc a' ity in consequence of the
granting of th' ermit. Additionall a plicant un rstands and will comply
Issued by Date: /o`• ��'�
with all n -point source regulat s per th Cupertino unicipal Code, Section
RE -ROOFS:
9.18.
Si ature ate. 12 l3
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.
❑ OWNE BIUILDE LARATION
Signature of Applicant: Date:
I hereby affirm that.1 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:inteuded or offered for sale.(Sec.7044,
Business & Professions Code)
1, 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, Sectio Id I store or handle hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, uld I use equipmen r ces which it hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
Ba Area
air contaminants as fined by the Bay Area uality Managem nt District I
'cipal
performance of the work for which this permit is issued.
will maintain com iance with the ' o Mw Code, Cha ter 9.12 and
1 have and will maintain Worker's Compensation. Insurance, as provided for by
3700 the Labor Code, for the of the work for which this
the Health & Sa ty Code, Sections 255 , 25533, nd 25534.
1-7 13
Section of performance
Owner or auth ized agent• llalt,.
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 Cityy 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
CUPE>< TINO
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 n �\
(408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.org \ MISC
1—I ... , ,T �,. �TJ A ATT1 A T I—I> r Pr7P e rr a i _ F— MISCELLANEOUS
U ri.vrviouvv ���
- - - -
PROJECT ADDRESS
2 /�
APN # " ( 1 I 00&
OWNERNAME�
PHONE Z.v 3 L11:2-4-
E-MAIL C0 u /,A -1k p�•
C-'\
STREET ADDRESS/ v
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CITY, STATE, ZIP
U MC
FAX
CONTACT NAME
PHONE
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER �❑ OWNER -BUILDER ❑ OWNER AGENT
❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
L�
LICENSE NUMBER
LICENSE TYPE
-ZeD
BUS. LIC #
COMPANY NAME
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E-MAIL. P,0 o
STREET ADDRESSCITY,
`
STATE, ZIP
PHONE
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ti
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E -MALI,
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ sFD or DUPLEX
❑ MULTI-FAMQ.Y
PROJECT IN WILDLAND ❑ YES
PROJECT IN ❑ YES
IS THE BLDG AN ❑ YES
❑
BURRING: ❑ COMMERCIAL
URBAN BTTERFACE AREA ❑ NO
FLOOD ZONE ❑` NO
EICHLER HOME? NO -
DESCRIPTION OF WORK
-
r ,{ OL -)
RECEIVEDBYS
TOTAL VALUATION:
��
a�� T
By my signature below, I certi
to each of the followin roperty owner or au th ized agent to act on the property owner's behalf. I have read this
application and the inform
I have provided is.corr
t.d the Description of ork and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws rel
ing to building constru
f
4ofi. representatives Cupertino to enter the above -identified property for inspection purposes.
jau.
Signature ofApplicantJAgen :
Date:
SUPPLE N
TION UIRED�
Q ;�,���;M'FkTCEUSEONIY�'.�s��,�,.
EXPI2E$ Q
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MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
WN
>tJ VjW ri CTII•M A TnR _ RI TII.11INf DIVISION
Mech. Plan Check 10.0 1 hrs $0.00 Pliinrb. Plan Check
Mech. Permit Fee: IMPERMIT Phl-b. Permit flee:
Other Mech. Insp. 0.0 hrs $47.00 Offier Pirmb Insp.Li
Allech. ln.sp.. ee: Pluratb. Insp, Tee:
NOTF_: This estimate does not include fees due to other Departments (Le. Planning, Public
Dec. Plan (;heck
Elec. Permit Fee:
Other Elea. Insp. ET-1-
Elec.
Insp. Fee:
irks, Fire, Sanitary Sewer District, School
D' tr' t etc These ees are based on the relimina information available and are on1v an estimate. Contact the Ve t or aaan't info.
rs tc ,
FEE ITEMS Lee Resolution 11-053 E. 7if /1113)
ADDRESS: 10421 LANDSDALE AVE
DATE: 12/16/2013
REVIEWED BY: MENDEZ
APN:
BP#:
"VALUATION:
$9,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
p
hrs
PENTAMATION FURN/AC
USE:
PERMIT TYPE:
WORK
REMOVE AND REPLACE FURNACE IN SAME LOCATION
Suppl. Insp. Fee -0 Reg. Q OT
0,0
SCOPE
$0.00
Mech. Plan Check 10.0 1 hrs $0.00 Pliinrb. Plan Check
Mech. Permit Fee: IMPERMIT Phl-b. Permit flee:
Other Mech. Insp. 0.0 hrs $47.00 Offier Pirmb Insp.Li
Allech. ln.sp.. ee: Pluratb. Insp, Tee:
NOTF_: This estimate does not include fees due to other Departments (Le. Planning, Public
Dec. Plan (;heck
Elec. Permit Fee:
Other Elea. Insp. ET-1-
Elec.
Insp. Fee:
irks, Fire, Sanitary Sewer District, School
D' tr' t etc These ees are based on the relimina information available and are on1v an estimate. Contact the Ve t or aaan't info.
rs tc ,
FEE ITEMS Lee Resolution 11-053 E. 7if /1113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
= # Mechanical
$139.00 1Afl7R=<100 Furnace, Forced -Air
Suppl. PC Fee: (D Reg. 0 OT
0:0 1
hrs
$0.00
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
Co nstp-tic tion .Tax:
Administrative Fee: IADMIN
$44.00
MIR
Mech. Plan Check 10.0 1 hrs $0.00 Pliinrb. Plan Check
Mech. Permit Fee: IMPERMIT Phl-b. Permit flee:
Other Mech. Insp. 0.0 hrs $47.00 Offier Pirmb Insp.Li
Allech. ln.sp.. ee: Pluratb. Insp, Tee:
NOTF_: This estimate does not include fees due to other Departments (Le. Planning, Public
Dec. Plan (;heck
Elec. Permit Fee:
Other Elea. Insp. ET-1-
Elec.
Insp. Fee:
irks, Fire, Sanitary Sewer District, School
D' tr' t etc These ees are based on the relimina information available and are on1v an estimate. Contact the Ve t or aaan't info.
rs tc ,
FEE ITEMS Lee Resolution 11-053 E. 7if /1113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
= # Mechanical
$139.00 1Afl7R=<100 Furnace, Forced -Air
Suppl. PC Fee: (D Reg. 0 OT
0:0 1
hrs
$0.00
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
Co nstp-tic tion .Tax:
Administrative Fee: IADMIN
$44.00
E)
Work Without Permit? 0 Yes (E) No
$0.00
Advanced Planning Fee.
$0.00
Select a Non -Residential
Building or Structure
Travel Documentation Fee: 1TRAVDOC
$47.00
Strong Motion Fee:' : IBSEISMICR
$0.90
Select an Administrative Item
Blda Stds Commission Fee:.::. IBCBSC
$1.00
wlm
$139.90
$139.00
$278.90
Revised: 10/01/2013
CUPERTINO
HVAC ALTERATIONS ENERGY COMPLIANCE FORM
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408)777-3333 building aacupertino.org
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 i7
• 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 disciplinary action from the Contractors
State License Board working in conjunction with the local building department. This action may
consist of fines up to $5,000 per violation or suspension/revocation of a contractor's license.
2008 BUILDING ENERGY EFFICIENCY STANDARDS (Title 24, Part 6) REQUIREMENTS
INCLUDE:
1. Heating equipment must have a minimum 78% AFUE (Exception: Wall & floor furnaces; room
heaters).
2. Central air conditioners & heat pumps less than 65,000 Btu/hr must have a minimum 13 SEER.
3. Newly installed or replaced ducts must have a minimum insulation value of R-4.2.
4. A setback type thermostat (24 hr clock with four set points) is required for all alterations.
5. New or replacement ducts must meet the mandatory requirement of Section 150(m).
• All joints and openings in the HVAC system must be sealed.
• Only UL 181, UL 181A, or UL 181B approved tapes or mastic shall be used to seal duct
openings.
• Connections of metal ducts and the inner core of flex ducts shall. be mechanically fastened.
Flex ducts must be connected using a metal sleeve/coupling.
• Flex ducts that are suspended must be supported every 4 ft. max for horizontal runs with no
more than 2" of sag between supports and 6 ft. max for vertical runs.
6. The CF-6R-MECH-04 must be completed and signed by the installing contractor. The Inspector
will collect this form and verify that the model numbers are the same as the installed equipment.
2008 Residential Compliance Forms.doc revised 04/10/12
S teAddress
EnforcemetttAgettcy:
Date*',-� PiMit.# ,
Conditioned
Duct insulation
ent T
I;isiIviinimum'E#1"icaen
-OOZ rr:$
i'e
'thermostat
Packaged Uiut
q�q
�AFUEa
COP
ifT1 t%
f
;
Ove! of darts
L3 Furnace
BIndoor Coil
Condensing Unit.
USEEP,
0 EER
®HSPF
® Resistance
Served by system `
j % 00 sf
—f---
added or icgiaced is
honed m .
etbark
ff nor already present, must be
itistalleii�
M76 I, 3-Sj
0 Other
1. Equipment Type: goose the equipment being installed, if more than one system, use another CF -1 R ALT -HVAC. for each system.
2. llf;nimum Equipment Efficiencies: 13 SEED 78% AFDE, 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:
dept on dbility for, a design identified, on this
• I am eligible under Division 3 of the California Business and Professi?itted
Certificate of Compliance.
• I certify that the energy features and performance specifications for ttified on this Certificate o C ce conform to the
requirements of Tide 24, Parts 1 and 6 of the California Code of Reg
• The design features identified on this Certificate of Compliance are rthe information d
ted on other plicabie
compliance forms, wor3Csheets, calculations, plans and specifications he enforgement ag
_ for approval 'th the permit
application. _
Name t.1 1 Si311V
/"77
Company ate
Address: License:
Cry, asP, I c
�Z �� �� .
City/StatelZip: o Phone:
o 2 1 �t
2008 Residential Compliance Forms. doc revised 04/10/12