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13120151 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21049 MANITA CT CONTRACTOR:ABC COOLING& PERMIT NO:13120151 HEATING OWNER'S NAME: DAVID CHEN 3266 INVESTMENT BLVD DATE ISSUED: 12/19/2013 OWNER'S PHONE: 4088283898 HAYWARD,CA 94545 PHONE NO:(510)471-8181 *J LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL E] 2 Q REPLACE(E)FURNACES,SAME LOCATIONS License Class 9� Lie. ContractorTl � �yt"rts Date 1 a� �-3 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 Valuation:$8000 performance of the work for which this permit is issued. Sq.Ft Floor Area: 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:36223055 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 construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FRO T CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, c costs,and expenses which may accrue against said City in consequence of the Date: Z- ` 1 L3 granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Secti n 918. RE-ROOFS: Signaturq �//` ��l Date f Z a' 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER the following two reasons: 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) HAZARDOUS MATERIALS DISCLOSURE I,as owner of the property,am exclusively contracting with licensed contractors to 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,Section 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this � — Date:la_19 Owner or authorized age 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 I hereby affirm become subject to the Worker's Compensation provisions of the Labor Code,I must firm that there is a construction lending agency for the performance of work's for which this permit is issued(Sec.3097,Civ C.) forthwith comply with such provisions or this permit shall be deemed revoked. 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 918. Signature Date GENERAL PERMIT APPLICATION © COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION MEP 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•building@cuper ino.org misc ❑PLUMBING X MECHANICAL ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS 21049 � 9`'UV M�A.�N`� ITA 1C,T APN k 3 Z - Z- 3 —09S 3 OWNER NAME CHEN, YSdDJ/y 1 v Ip. PHONE408 828 3898 E-MAIL STREET ADDRESS 21049 MAN I TA CITY,STATE,ZIP CUPERTINO _T_FAX CONTACT NAME MAGGIE MENDOZA I PHONE510471 8181 E-MAILMAGGIEM@ABCCOOLING.COM STREETADDRESS3266 INVESTMENT BLVD '"Y'STATE, ZIP HAYWARD CA 94545 FAx510 471 8368 ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT III] CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHrmcr ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME S C OTT LUN DAY I LICENSE NUMBER 382383 1 LICENSE TYPE C20 BUS.LIC# COMPANY NAME ABC COOLING & HEATING I E-MAILMAGGIEM@ABCCOOLING.COM F'`510 471 8368 STREETADDRESS3266 INVESTMENT BLVD CrTY,STATE,ZIP HAYWARD CA 94545 PHONE 510 471 8181 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC N COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK REPLACE 2FURNACE WITH 70KBTU C5 TOTAL VALUATION:8000.00 ,_WWRx- �` By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on property owner's be alf. 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 ng construction. I authorize.represeptatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: �'�� s �� Date: SUPPLEMENTAL INFORMATION REQUIRED MEPMiscApp 2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 21049 manita ct DATE: 12/1912013 REVIEWED BY: melissa { *VALUATION: $8,000 APN: 362 23 055 BP#: *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY PENTAMATION FURN/AC USE: SFD or Duplex PERMIT TYPE: WORK replace a furnaces same locations SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 2 # $278 TOTALS: 3 $278.00 t f �ry � °ip:... .. .--. x .. i € �P` k�Mn.I mss""—, :v Mech.Plan Check 0.0 hrs $0.00 1'httatb. 1'Zurt Check Elec—Plan(..heck Mech.Permit Fee: 1MPERMIT Phtmh. Permit Tee: Elec. Permit Tee: Other Mech.Insp. 0.0 hrs $47.00 Other Plumb Insp. Other Elec.Insp. Alf ech. Insp.T.e: Plumb. Insp. Tec. 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 preffinWdna information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1113) FEE QTY/FEE MISC ITEMS Plan Check Fee: Sup1)l. PC F'ee PME Plan Check: $0.00 Perrnit.Fee: Suppl. hasp F'ee PME Unit Fee: $278.00 PME Permit Fee: $47.00 Construction Tax: Administrative Fee: IADMIN $44.00 Work Without Permit? ®Yes (j) No $0.00 .,Idvanced Plarming Fees: Travel Documentation Fee: 1TRA VDOC $47.00 A Strong Motion.Fee: IBSEISMICR $0.80 Select an Administrative Item Bldg Stds Commission.Fee: IBCBSC $1.00 01 $417.80 $417.80 � $0.00 EES r vim' Revised: 10/01/2013 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-lR-ALT-HVAC Climate Zones 1,3-7 Site Address: Enforcement Agency: Date: Permit#: 21049 MANITA Cupertino, CA 95014 City of Cupertino Dec 13, 2013 Duct insulation Conditioned Floor Equipment Type1 List Minimum Efficiency2 requirement Area Thermostat ❑Package Unit ®Furnace ®AFUE 80% ❑COP ❑R 6(CZ 1,3-5) Served by system ®Setback [3 Indoor Coil [3 SEER [3HSPF If not already present, must be [3 Condensing Unit [3EER [3 Resistance R 42 CZ g 7 sf Resistance ( ) -'31 installed) ❑Other 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: Scott Lundy Signature: Scott Lundy Company: ABC COOLING&HEATING SERVICES INC Date: Dec 13, 2013 Address: 3266 INVESTMENT BLVD License: 382383 City/State/Zip: HAYWARD/CA,&84545 Phone: (510) 471-8181 g . :: s z� gA Ji 77 Y 4Yt 's. zfz ✓ h 's - f Reg: 213-A0093211A-000000000-0000 Registration Date/Time: 2013/12/13 11:45:22 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms July 2010