13120081 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10675 MARTIN WOOD WAY CONTRACTOR:A&H HEATING PERMIT NO: 13120081
OWNER'S NAME: DENGWEI FU 770 CHESTNUT ST DATE ISSUED:12/10/2013
OWNER'S.PHONE: 4084823532 SAN JOSE,CA 95110 PHONE NO:(408)279-0722
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIALE]
License Class
C-'Z-U- Lic.# q��Z REPLACE(E)FURNACE,SAME LOCATION
Contractor . JrI 1.1, �l� 0 S.. Date 1 Z-
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 o 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 3706 of the Labor Code;for the
performance of the work for which this permit'is issued. Sq.Ft Floor Area: Valuation:$2200
a� 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:36936028.00 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 constriction,and hereby authorize representatives of this city to enter
upon the above mentioned property;for inspection purposes. (We)agree to save 180 DAYS FROM LLED 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 ate: 2 l O l
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. w�
RE-ROOFS:
Signature�T 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 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 3706:6f 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,Sectio 5505,255A,and 25534. j
Section 3700 of the Labor Code,for the performance of the work for which this
er —1
p Owner or authorized agent: Date:
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
GENERAL PERMIT APPLICATION 0
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[us COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 \�
CUPERTINO (408)777-3228•FAX(408)777-3333•building@cuoertino.oro MISC
PLUMBING ETNECFJANICAL ELECTRICAL ONSCELLANEOUS
PROJECT ADDRESS//-J ��/f APN#LIE I
OwNERNAME 14, 9� Q �,rekol� �f�Z. -✓S3z ELdexiao Vl f�/C'
STREET ADDRESS Lj5- E ��� FAX _
CONTACT NAME \n PUF
PONE 7��
STREET ADDRESS ��
❑OwNER ❑ OIWNlER! -BUB,DER ❑ OwNER AGENT XcoNmcToR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
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CO CTOR�T LICENSE NUMBER LICEN�$F TYP BUS.LIC#
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C � N F�1- � 5�2.. ll�e• E � �}-GY_. C'o� F�FO�-2�t-�o17
STREET ADDRESS ( �� CTTY STATE,ZIP P ONE
`7 D 4 tf 57" u- 5 Iztz' t $ �F�Sr� SIO -Z -072 Z
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME EMAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD or DUPLEX ❑ MULTI-FAMB.Y -PROJECT IN wIIALAND ❑ YES PROJECT IN ❑YJFS IS THE BLDG AN ❑YES
BUILDING: 13COMMERCIAL URBAN INTERFACE AREA NO -7 FLOOD ZONE NO EICHLER HOME? 0-1-0
DESCRIPTION OF WORK
Iz PLL C Iz- �l19l�C /v
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TOTAL VALUATION: Z Z�✓•
By my signature below,'l 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 RFQUIRED OFFICE USE ONLY
W ❑ OVER-THE-COUNTER
a
EXPRESS
❑ STANDARD
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❑ LARGE
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0 MAJOR
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10675 MARTINWOOD:WAY DATE: 12/10/2013 REVIEWED BY: MELISSA
APN: 369 36 028 BP#: "VALUATION: $2,200
xPERMIT TYPE: Mechanical.Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or DuplexPENTAMATION FURN/AC
USE: I PERMIT TYPE:
WORK REPLACE E FURNACE SAME LOCATION
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced-Air 1MFR=<100 1 # $139
TOTALS: a a^ : r $139.00 b 3 �
MEMO
I
_
Mech.Plan Check0,0 hrs $0.00 Phwib.Plan Check Elec.Plan Check
Mech.Permit Fee: 1MPERMIT Plumb.Permit Fee'. lilec. Permit Fee.,
Other Mech.Insp: 0.0 ��s $47.!10 Other Plumb Insp. Other Elec.Insp.
D1ech.Insp. Fee: Plumb. hap.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). These fees.are based on:the prelimina information available and are only an estimate. Contact the Dept for addn'1 info,
FEE ITEMS(Fee Resolution 11-053 E . 7ff /1113) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
;Suppl. PC Fee
PME Plan Check: $0.00
Permit{gee:
Suppl. Insp Fee
PME Unit Fee: $139.00
PME Permit Fee: $47.00
Constrztction :Tax
Administrative Fee: IADMIN $44.00
Work Without Permit? ®Yes (E) No $0.00
Advanced Planning Fees,::
Travel Documentation Fee: 1TRAvDoC $47.00
Strong Motion Feer 1BSEISMICR $0.50 Select an Administrative Item.
Bldg Stds Commission Fee: 1BCBSC $1.00
$278.50 $0.00 $2
78.50
Revised: 10/01/2013
Simplified Prescriptive Certificate of Compliance:2008 Residential HYACAlterations CF-IR-ALT-HVAC
Climate Zones 1 and 3-7
Site Address: ID nrorcee gen Date: Permit(v7Y TINuPcz7-1Na 12-ioi3 #:
Conditioned Duct insulation
Equipment Type' List Minimum Efrtciency2 Floor Area requirement Thermostat
Packaged Unit
Over 40 ft of ducts
Furnace D
COP Served by system added or replaced in Setback
Indoor Coil 0 SEER Bi HSPF_ (I not already present,must be
Condensing Unit Q EER �Resistance 1 yDOsf unconditioned space metalled)
Other 0 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.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: C L�s Signature:
Company: Z / bl S e. Date'
Address:7�D / L s% �r 5,_ License:
3OVg72—
City/State/Zip: 5AL J S ll0 Phone: qOF7- / !O7ZZ
2008 Residential Compliance Forms March 2010