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13120079CITY OF CUPERTINO BUILDING PERMIT BUILDING. ADDRESS: 22565 SALEM AVE. CONTRACTOR: FLANDERS HEAT & AIR PERMIT NO: 13120079 SYSTEMS, INC OWNER'S NAME:. TONY GAO . 555 PETERS AVE STE 255 DATE ISSUED: 12/10/2013 OWNER'S PHONE: 4089691363 PLEASANTON, CA 94566 PHONE NO: (925)161-3333 LICENS D CONTRACTOR%DECLARI�ATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL fjc. .� QREPLACE (E) FURNACES (2), SAME LOCATIONS License Clas # 7 ! � Contractor f CZ,d Gcs Pal/4i T 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: $3865 I ave and will maintain Worker's Compensation Insurance, as provided for by APN Number: 34212100.00 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 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 DAYS + A LED 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 a � ( Q granting of this permit: Additio , the. applicant understands and will comp with all non -point so regal tion er the Cupertino Municipal Code, Section RE -ROOFS: 9.18. 44 Signatu D at 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. D 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 oroffered 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 (See.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 Cu ertino Municipal Code, Chapter 9.12 and 'ons I have and will maintain Worker's Compensation Insurance, as provided for by the Health &Safety Code, Se 50 , 2 ,and 25534. Section 3700 of the Labor Code; for the performance of the work for which this Owner or authorized agent- Date permit is issued.. 1 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 CO RUCTION 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 cityand 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 Cupertmo:agamst 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 APPLICATIONO�M E P COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION �� 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 M ME S Aft (408) 777-3228 •FAX (408) 777-3333 • building aacupertino.org j ❑ PLUMBING IN(MECHANICAL ❑ ELECTRICAL [:]MISCELLANEOUS PROJECT ADDRESS Q r � APN # OWNER NAME 1 d /_ �.(] V PHONE �� b� n ` n _ r ` i E-MAIL[ ` c� &L `t (p`j 1 (P Tp n 0.f STREET ADDRESS Z 2 r' S em AvenucCTTY, STATE, ZIP FAX C er-}-Ino LA 50f CONTACT NAME r*, ;-�\r,� PHONE 2r f _ y E�-jM/A,I,L/ L�_ ` C\I n n,I�Q��(1 (.`, ^�P STREET ADDRESS��i -F-` JL ..H- ZG 1na�_+CM'C_A STATE, ZIP 1J q ✓ ll� lOV VFAX112-7-5)y �V1 - [ 1 ❑ OWNER ❑ OW.NFER-BUILDER ❑ OWNERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME1 �� LICENSE NUMBER �� LLIICENSE TYPO ^ BUS. LIC # _7 1 ,5 C) BrIet COMPANY NAMEk ` , E-MAIL I FAX cr -7419 co F + _ 0 fc Sct_e� 5 - STREET ADDRESS Pe�V� j+ 25.5 CI STATE ZIP i (�(� PCEzf -:553 ARCHITECT/ENGINEER NAME ' f LICENSE NUMBER `� BUS. LIC # J J COMPANY NAME Y E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD., DUPLEX ❑ MULTI -FAMILY PROJECT IN WLDLAND ❑ YES PROJECT IN ❑ YES IS THE BLDG AN ❑ YES BUILDING: ❑ COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO EICHLER HOME? ❑ NO DESCRIPTION OF WORK Ch a,n 0C oc-,)+ r L0-ce fiLA--Yo 3(C7 .,. TOTAL VALUATION: By my signature below, I certify to each of the following: I am the property owner or authorized agent to act nth s ehalf 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 comp y with all app icable local ordinances and state laws relating to building construct'`�authorrize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agen Date: SUPPLEMENTAL INFORMATION REQUIRED .-... . , :4 kFICEa sE ONLY ��RxER SHE COUNTER ter, Off.,41 41 1 F l MEPMiscApp_2011.doc revised 66121/11 V_* LaADDRESS: 22.565 SALEM AVE. DATE: 12/10/2013 REVIEWED BY: MELISSA UNITS i APN: 34212.100 BP#: "'VALUATION: $3,865 —� *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Dulex P $278 PENTAMATION FURN/AC USE: PERMIT TYPE: WORK E FURNACES 2 SAME LOCATIONS 1 -REPLACE SCOPE $278.00 APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES Furnace, Forced -Air 1MFR=<100 2 # $278 Permit. "ee: Suppl. Insp Fee PME Unit Fee: $278.00 PME Permit Fee: $47.00 Construction Tax: Administrative Fee: IADMIN $44.00 Work Without Permit? 0 Yes, (E) No $0.00 TOTALS:,., Travel Documentation Fee:. ITRA VDoc $278.0( Mech. Plan Check"00 $0;00 Plumb. Plum Check F_tec. Plan Check . Mech. Permit Fee: IMPERMIT Plumb -Permit Fee: Elec. Permit Pee: Other Mech: Insp. 0.0 hr$47.00 Clther Plumb Insp. Other Elec. Insp. Mech. Insp. Ice Plurnb. h7sp. Fee: Glee. Insp. lee: NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District etc.These hees arebased onahe prelimina 'information avauanie ana are om an estimate. i,onaucr cne "e i ur uaun t in u. FEE ITEMS (Fee Resolution 11-053 Eff.' 711113) FEE QTY/FEE MISC ITEMS Plan Check I ee: ;Suplrl. PC.Iee PME P1an.Check: $0.00 Permit. "ee: Suppl. Insp Fee PME Unit Fee: $278.00 PME Permit Fee: $47.00 Construction Tax: Administrative Fee: IADMIN $44.00 Work Without Permit? 0 Yes, (E) No $0.00 Advanced Plcannin17ees: Travel Documentation Fee:. ITRA VDoc $47.00 Strong Motion .Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $417.50 $0.00T_1;rFEE $417.50 Revised: 10/01/2013 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVA CAlterations CF -1R -ALT -HVAC Climate Zones 10 to 15 Site Address: E rcement A ency: Date: Permit #: Conditioned Floor Equipment T el List Minimum Efficienc 2 Duct insulation requirement Area Thermostat Packaged Unit Furnace X X jj AFUE 10 ® COP Over 40 ft of ducts added or replaced in unconditioned space Served by system Setback .. �(1 not already Indoor Coil Condensing Unit ®SEER EER ® HSPF _ Resistance R 6 (CZ 10-13) sf present, must be installed R 8 (CZ 14-15) Other 1. Equipment Type: Choose the equipment being installed, • if more than one system, use another CF -1 R ALT -HVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEER, 78%AFUE, 7.7HSPFfor typical residential systems. HERS VERIFICATION SUMMARY Listed below are four HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate. Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this form was in fact the work completed by the installer. The inspector also verifies. that each appropriate CF -6R and registered CF -411 forms (no hand filled CF-4Rs allowed) are filled out and si ed. Beginning October 1, 2010, a registered copy of theCF-IR and CF -6R shall also be on site for final inspection. 1. HVAC Changeout Required Forms: CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS • All HVAC Equipment replaced CF -4R forms: MECH-21 and fors lit stems MECH-25 • Condenser Coil and /or CF -6R forms: MECH-2I-HERS and (for split systems) MECH-25-HERS • Indoor Coil and/or CF -4R forms: MECH-21 and (for split systems) MECH-25 • Furnace For Split Systems: Duct leakage < 15 percent; RC, CCA >_ 300 CFM/ton(Minimum Air Flow Requirement), TMAH For Packaged Units: Duct leakage < 15 percent Exempted from duct leakage testing if: 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or 2. Duct systems with less than 40 linear feet in unconditioned space, or 3. Existing ducts stems are constructed, insulated or sealed with asbestos 2. New HVAC System Required Forms: • Cut in or Changeout with new CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS ducts: (all new ducting and all CF -4R forms: MECH-20, and (for split systems) MECH-22, and MECH-25 new equipment) For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 350 CFM/ton, FWD, TMAH, SIMS, and either HSPP or PSPP. For Packaged Units: Duct leakage < 6 percent ®3. New Ducts with Replacement Required Forms: • Includes replacing or installing all new ducting CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS and/or outdoor condensing unit and/or indoor CF -4R forms: MECH-20 and (for split systems) MECH-25 coil and/or furnace. Not all equipment changed. For Split Systems: Duct leakage < 6 percent, RC, CCA >_ 300 CFWton, TMAH For Packaged Units: Duct leakage < 6 percent 4. New Ducting over 40 feet Required Forms: • Includes adding or replacing more than 40 CF -6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH 21 linear feet of duct in unconditioned mace. For splits stem or packaged units: Duct leakage < 15 percent EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos. 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. • 1 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, calculationsplans andspecifications submitted to the enforcement agency fora al wLegoEit M -tion. Name: Bret Flanders signature: Company:Flanders Heat & Air Systems, Inc. Date: r3 Address: 555 Peters Ave., #255 License: 677502 city/state/zip•Pleasanton ' CA 94566 Phone: 925/4613333 2008 Residential Compliance Forms July 2010 t► INSTALLATION CVRTICATE CF-4R-MECH-04 Space Conditionin V` S stems; Ducts and Fans (Page l of 2 Site Address: Enforcement'Agency: Permit Number: Space Conditioning Systems Equip e " (package heat um CEC Certified Mfr. Name and.-ModeINumber ARI Reference Number # of Identical Systems Efficiency (SEER and EER) I' 3 (zCF-1R value)4 Duct Duct R-value(Btu/hr) Cooling Load Cooling Capacity hVhr Efficiency - Location Equip ARI # of (AFUE, etc P3 (attic, crawl- Heating Heating Type (package- CEC Cert►fied Mfr. Name ' Reference 2 " Identical (zCF-1R a space, Duct R -value Load Capacity heat um and` Mo'del'Nuinber Number S stems value etc. QQ or 7ti'1 oa r ,;1_ �' (�,b7h-1qJl ao©o � 0 p ('1d4Q� 4— r� a�Ie�Iq Joao 7ti $� ��0 -m< Equip e " (package heat um CEC Certified Mfr. Name and.-ModeINumber ARI Reference Number # of Identical Systems Efficiency (SEER and EER) I' 3 (zCF-1R value)4 Duct Location (attic, crawl- space, etc.) Duct R-value(Btu/hr) Cooling Load Cooling Capacity hVhr 1.Ifproject°isnewconstrucnon;_seerov:nviessuotuc,uur"OA"U.�—A-...M.—».-,.-_ ------------ Compliance. 2. ARI Reference NumberVcan. be found by entering the equipment,model number at http: //www. aridirectory. org/ari/ac php# 3. Lisfed efficiency, o. thi page.m"ust be greater than or equal(>_)"to the value shown on;the CF --IR form. 4. When CF -IR is reference it is also applicable to the CF -IA CF -IR AA or CF -IR -ALT ALL BOXES MUST BE C.HECKMD 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 ACCA. §i50(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'l50-B and includes a vapor retardant or is enclosedentirely in conditioned space. 2008 Residential Compliance Forms August 2009