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14020069 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22081 CAROLINE DR CONTRACTOR:A&H HEATING PERMIT NO: 14020069 OWNER'S NAME: YING BING H AND YUK F 770 CHESTNUT ST DATE ISSUED:02/12/2014 OWNER'S PHONE: 4087460578 SAN JOSE,CA 95110 PHONE NO:(408)279-0722 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑ J RELOCATE FURNACE TO ATTIC,(7)NEW SUPPLY AIR L License Class &-7,12 Lic.# 3 t9 C47 Z ( DUCTS ' Contractor Date z`�`'f 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:$7300 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:32603017 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 O RMIT 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=STCALLED 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 granting of this permit. Additionally,the applicant understands and will complyIssued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9 18. RE-ROOFS: Signatur 71_1?_/ 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 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 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,Sections 25505,255 ,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this 2`�Z_� permit is issued. Owner or authorized agent: ate ,2- 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 0o ISC (408) 777-322 M 8•FAX(408)777-3333•building(51cugertino.org 1 cups-ft- N0 E]pLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS I APN# J 4 OWI�ERNAME� 1 t4� IV O E-MAIL W64 [ 1� ��� W 41 . :d IdASTItEETADDRESS22,C>Q LIME- �s CITY STATF 6 Zf �I I FAX CONTACT NAME �J oNa —l( MAJL L • m STREET ADDRESS t��O /� /� .r-rr5 r CITY, AT ZIP.�� 9.1Z,7/C) FCAMS,AX _`� /•!7 ❑ O� '❑ OV!'NER.BUIIAER ❑ OWNER AGENT ✓�I.CONTRACTOR ❑CONPRACTORAGENT ❑ ARCHrPECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CO CTOFNAME e LICENSE NUMBER LICENIE BUS.LIC# �j^7 Q f� CO AN ' /�/ FAX[tAj� G ! /10 7 CITY,ST TE, GW`^ PHON�}EC�� STRW A7 s i GG 5� ARCF=C<T/ENGINEER NAME LICENSE NUMBER BUS.LIC# CONIPANY NANM E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD.,DUPLEX ❑ MULTI-FAMQ.Y PROJECT IN WII.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 Nr �. �f TOTALVALUATION: ? 3bb ROOM 3Fags= s - F 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 wilding construction. I authorize repre entatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: gR" 12--— 1[ ` SUPPLEIAENTAL INFORMATION REQUIRED900 9 � PON ca cou�,T>> me . ON IM MEPMisa4pp_2011.doc evised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION LEI ADDRESS: 22081 caroline dr DATE: 02/12/2014 REVIEWED BY: Mendez APN: BP#: *VALUATION: 1$7,300 xPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION FURN/A USE: PERMIT TYPE: WORK relocate furnace to attic 7 new supply air ducts SCOPE r Mech.Plan Check0.0 hrs $0.00 Phiwh. Plan C he:Cn 17e;:.Ct'<an("7a.'ck Mech.Permit Fee: 1MPERMIT Plitmh. Other Mech.Insp. 0.0 L!:jooio 1111,1,112b Ir>rn. Uthe>t` iec zns�. 31 ch, jnvs). /.re: Plurrrh. Insp. Fee: filec.Insp, Vcv' NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). Theseees are based on the prefiWina information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 # Mechanical Suppl. PC Fee: (D Reg. ® OT0,0 hrs $0.00 $139.00 IMFR=<100 I Furnace,Forced-Air PME Plan Check: $0.00 [__L_j # Mechanical Permit Fee: $0.00 $70.00 IBAPPLOT Other Appliance/Equip Suppl. Insp. Fee: Reg. ® OT 0,0 hrs $0.00 PME Unit Fee: $0.00 ffPME Permit Fee: $47.00 1. 13i"W'11f.'Non Tax: Administrative Fee: 1ADMIN $44.00 0 Work Without Permit? ® Yes (F) No $0.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential Travel Documentation Fee: 1TRAVDOC $47.00 Building or Structure 0 i Strong-Motion Fee: 1BSEISMICR $0.73 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $139.731 $209.00 TOTAL FEE: $348.73 Revised: 01/15/2014 Simplified Prescriptive Certificate of Compliance:2008 Residential HVACAlteradons CF-IR-ALT-HVAC Climate Zones 1 and 3-7 Site Address:.Z^ D � r �I Enforcement et�cy. Date. Permit#: 4 �1 Con itioned Duct insulation Equipment T e' List Minimum EfficiencY2 Floor Area requirement Thermostat Packaged Unit Furnace QQ,�,, Over 40 ft of ducts �AFUEtS�/ ®COP Setback Indoor Coil Served by system added or replaced in ®SEER HSPF /,,�.-� (I not already present,must be Condensing Unit [3 EER ®Resistance Iels sf unconditioned space installed) OtherR 6 (C21,3-5) 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:WLC� Signature: Company % .7 i � �� � Date: r --( Address-,7 70 944 'T � License:3o Lf r[L- - City/State/Zip: -7-6;s 5z r 0 Phone: qV 6 1-2 —07 211- 2008 Z2008 Residential Compliance Forms March 2010 OFFICE COr4 � X T 30Y 3F 1> LA Y ojl cl Ll an Le u &�)Y Pic of Ml ZC)bl CUPID TINO ',�[Jlrilnp D nartment f--A- -ro A--tT L,o -r-t+ F V? A-L ter.r--( -AC FEB I g EV.� r46p- REVIEWED FOR CODE COMPLIANCE 0 Reviewed By: 4 ;