14030012N
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11718 RIDGE CREEK CT
CONTRACTOR: AAA FURNACE & AIR
PERMIT NO: 14030012
CONDITIONING
OWNER'S NAME: CHOU WEN L AND HSI HSIAO M
1712 STONE AVE
DATE ISSUED: 03/05/2014
OWNER'S PHONE: 4089730940
SAN JOSE, CA 95125
PHONE NO: (408)293-4717
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑
LI ENSED CONTRACTOR'S DECLARATION
License Class Lic. # CJ
REPLACE (E) FURNACE, SAME LOCATION
n2'
Contractor !rf l f �I �r tV4 GP Date 60�
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: $3827
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: 36604074 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 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 F 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
Date:
granting of this. permit. Additionally, the applicant understands and will comply
—3]S
ih all non- ont source regulations per the Cupertino Municipal Code, Section
�SigtznatureDate 2 J t \
RE -ROOFS:
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
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)
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, 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 s 2-55055 25 3, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date: ZlN
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 Q
\v
COMMUNITY DEVELOPMENT DEPARTMENT-- #U.ILDING DIVISION
10300 TORRE AVENUE r CUPERTINO, CA 95014-3255
(408) 777-3228 r FAX (408) 777-3333 r building5cupertino.org MIS C
r
r.rn r- MOUAMT(1AI IRT gr-nTrAT F7MISr ..1_I:A.NEOUS
PROJECT ADDRESS
OWNER'NAME
P sJ J
E-MAJL
STREET ADDRESS' iloo G ocw a -
V v�
CITY, STATE, zzP
FAX
ONTACT NAM
PHONE
7MAIL
S GREET ADDRESS c
Ci 1 Y, STATE, ZIP
FAX
• ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER ACENP CONTRACTOR ❑ coNiRAcroR AGENT ❑ ARCHTRCT ❑ eNowEER ❑ ouveLOPER ❑ TENANT
CONTRACTOR NAME t I M ^ �1 LICENSE NUNMEFI(Ar � I L! S TYPE BUS. LC
r -W
COMPANY NAME `J�CA�a(/C�D a MAu D
STREET ADDRESS I-1Iz`. C 1/fl -1 -��J `�
ARCHI ECTBN05MR,NAME LICENSE NUMBER BUS. LICI
COMPANY NAME E-MAIL FAX ~
STREET ADDRESS CITY, STATE, ZIP PHONE
USE of ,2'SFD or Duplex ❑ Multi -Family PROTECT IN WILDLAND PROJECT IN
STRUCTURE: ❑ Cort m=ial URBAN INTERFACE AREA ❑ Yes ez;No FLOOD ZONE ❑ Yes .B'No
DESCRIPTION OF WORK
Cc
TOTAL VALUATION: • $ 2 , -
13y my signature below, l cerfify to each of the following: i am the property owner or authorized agent to act on the property owner'o behalf. [have read this
application and the information i have provided ' correct. -1 have read the Description of Work and Yerify it is accurate. I agree to comply with all applicable local
ordinances and atate laws relating (%ding c truction. I authorize representatives of Cupertino to enter the abo a-iden ' ted property for inspection purposes.
Signature of ApplicanVAgent, Date:. Z -
SUP EN1EN7AL INFORMATION REQUIRED
&ffPNfucApp_Z011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
APPLIANCE / EQUIP TYPE
11718 RIDGE CREEK CT
DATE: 03/05/2014
REVIEWED BY: MELISSA
JimADDRESS:
APN: 366 04 074 1
BP#:
VALUATION: 1$3,827
YPERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: SFD or DuplexL—
PENTAMATION
I PERMIT TYPE: FURN/A
WORK
REPLACE E FURNACE SAME LOCATION
SCOPE
:9$p'M!. 11;sjo t_' V
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
Furnace, Forced -Air
1MFR=<100
1
#
$139
t'u , irrit Fe'c:
:9$p'M!. 11;sjo t_' V
PME Unit Fee:
$139.00
PME Permit Fee:
$47.00
L'tIJ2:S"7t'tit'rt(?I� 1cJ:t".`
Administrative Fee: IADMIN
$44.00
Work Without Permit? ® Yes 0 No
$0.00
TOTALS:
Travel Documentation Fee: ITRAVDOC
1 $139.00
Strong Motion Fee: IBSEISMICR
Mech. Plan Check 0.0 1 hrs $0.00 Pf unb. Plan L'hecG iE�. j stltl Cii :e!t
Mech. Permit Fee: 1MPERMIT
Other Mech. Insp.0.0 hrs $47.00 Other 1'is �n�tr Int��P. f}olwl' �i�c. Imp,
,..' Mlv;. 1,sv I'hintb, Fee: Ins) I -....
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
n:..f..;..r .,i.. Cnntart the Dent fnr addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711/13)
FEE
QTY/FEE
MISC ITEMS
Marl Ckl"c'ck
PME Plan Check:
$0.00
t'u , irrit Fe'c:
:9$p'M!. 11;sjo t_' V
PME Unit Fee:
$139.00
PME Permit Fee:
$47.00
L'tIJ2:S"7t'tit'rt(?I� 1cJ:t".`
Administrative Fee: IADMIN
$44.00
Work Without Permit? ® Yes 0 No
$0.00
Travel Documentation Fee: ITRAVDOC
$47.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg* Stds Commission Fee: 1BCBSC
$1.00
7-7
_ z&
$278.50
$0.00 TOTAL FEE:
$278.50
Revised: 01/15/2014
;ii:•;
lied Prescriptive Certificate of Compliance: 20091esfdenfurl VACAlierations CF 1R -ALT -HVAC
Zones: i sud 3 - 7
SftAddrers ' 1��9
EnforcemertrAgerscy:
Die.;
eritrit #:r: > ::
Equj=entType'1irtti
`Efr€CiEri'
Cond_itgnne�d
T1`'
Dnct insulation
Padsagw uAlt} ; , Ovcr 44 8 of duels` Setback '
Olumace COP Serv�'by system added err enlaced nt
. �HSPF_ �trorc�readypresrnr crust be
Indoor COB (0�' sf unconditionedVacc,
Condensing Unit ® HER Itisistaitce ®R 6 (CZ 1,'Z)
Other
1. Equipment Type, Choose the equipment being installed; if morn than one -system, use another CF- I R -ALT{ HVAC for each system.
2. A I uimum Equipment E#5cieacies: 13 SEER, 78%a AFM 7.7HSPF for typical residential systems.
Contmetor{I3ocu mentation Author's /Responsible Des beer's Declaratidn Statement)
• I certify that this Certificate of Compliance documentation is acoinuw and aois�lete
• 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 performanoe 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 desigt.faatww identified on this Certificate of Compliance are `consistent with the infomtationocumented on other applicable
compliance forms, worksheets, calculations, plans and specdicaiions. submitted to the forcemeat envy for approval,with the permit .
application. _:
Name VI V1 V1 i% �/ Signat�ue:
Company: p
LL
Date:a 2C 14
Address:
f� �1At �/1 fl hZ
Iace??se .Ir 1`i1
CitylState/Zip: 2 -Alk Ow nqvzt
PYioiie 3'� i'1
2008 Residential Compliance Forms. doc revised 04110112
.w -
INSTALLATION CERTIFICATE CF-6R-MECH-04
Space Conditioning Systems, Ducts and Fans (Pate 1 of 2
Site AI �.r
1 J _ G ! C� Enforcement Agency: Permit Number:
w
Space Conditioning Systems
Heating Equipment
Equip
Type
(package-
heat um
CEC Certified Mfr. Name
and Model Number
ARI
Reference
Numbers
#of
Identical
Systems
Efficiency
(AFUE,
etc. l'3
(�:CF4R
value °
Duct
Location
(attic,
crawl-
space,
etc.)
Duct
R -value
Heating
Load
Btu/hr
Heating
Capacity
Btu/hr
A4"Qce
Uft "WP2UWAV,9
j
i
T-
i
Cooling Equipment
Equip
Type
(package
heat
Pump)
CEC Certified Mfr. Name
and Model Number
ARI Reference
Number 2
# of
Identical
Systems
Efficiency
(SEER
and EER)
�'3
(zCF-IR
value)4
Duct
Location
(attic,
crawl-
space,
etc.
Duct
R-value(BW/hr)
Cooling,
Load
Cooling
Capacity
(Btu/hr
1. If project is new construction, see Footnotes to Standards !'able 101-n ana 1 aoce 1 J1 -c, Jor aucl ceuuiK aueinuu NG
compliance.
2. ARI Reference Number can be found by entering the equipment model number at http://wwiv.aridirectory.org/ari/ac.php#
3. Listed efficiency on this page must be greater than or equal (>_) to the value shown on the CF -1 R form.
4. When CF -IR is reference it is also applicable to the CF -IR, CF -IR -AA or CF -IR -ALT
ALL BOXES MUST BE CHECKED 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.
❑ § 150(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 150-B and includes a vapor retardant or is enclosed entirely in conditioned space.
2008 Residential Compliance Forms
August 2009