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14040054 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22322 CUPERTINO RD CONTRACTOR:ONE HOUR HEATING PERMIT NO: 14040054 AND AIR OWNER'S NAME: PON LEE LI 1400 PETALUMA HILL RD DATE ISSUED:04/09/2014 OWNER'S PHONE: 3105285832 SANTA ROSA,CA 95404 PHONE NO:(707)545-1800 Gr LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑ REPLACE(E)FURNACE,SAME LOCATION License Clas Zo-CZ---) Lie.# Contractor I herebyafcK that fam 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:$7767 cT ave 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:32650061.00 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 D T C D 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 Is a by: Date: 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. / RE-ROOFS: Signature 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. 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 25505,25533,and 25534. L/c Section 3700 of the Labor Code,for the performance of the work for which this 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 918. Signature Date xx GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE CUPERTINO,CA 95014-32552 (408)777-3228•FAX(408)777-3333•buildingacupertino.org MISC GU JEFtTIN0 E]PLUMBING ❑MECHANICAL ❑ELECTRICAL []MISCELLANEOUS PROJECT ADDRESS 22:322 Gupeo + k'o rte- APN# 2 C) , O OWNTERNAME PO1 (eip LI PHONE'v•452,Q E-[M�AII. STREET _D ICvG^/P/✓�IKO f 1 GCITU>STYTZ .U ,' C q50 7 I FAX CONTACT NAME Y C� PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR N � ���` LICENS ]ZUMB( E LIC ��SE TYPE BUS.LIC# us- 0 cGC.) COMPANY NAE-MAIL FAX ME STRE PHONE fiD SPetg/c�►rcr h�r�. ✓d S�hSf�Z� a �9 g3Ya 707- 1974S (8�a ARCHITECT/ENGINEERNAME LICENSE NUMBER. BUS.LIC# COMPANY NAME E-MAIL. FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MCTI.TI-FAMII Y PROJECT IN WI DLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN El YES BUILDING'. F1 COMMERCIAL. URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑ NO - DESCRIPTION OF WORK ( Tv v V%^ v TOTAL VALUATION: -776 6 n yB � E By my signature below,I certify to each of the following: I am the property owner or authorized agent to act n ope wner's ad this application and the information I have provided is correct. I have read the Description of Work and verify it' a ate. o comply v,�ith all plicle local ordinances and state laws relating to b�cction. uthorize representatives of Cupertino to enter the above-i GA ' pection purposes. Signature of Applicant/Agent: Date: -q. ,? . ' l . l UPPLEMENTAL INFORMATION RE � QUIRED �OFFRCE�JSE ©AVER TH><COL3�TER u 11-fti 00 � TAI�'DARD - LARGE _ MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 22322 CUPERTINO RD DATE: 04/09/2014 REVIEWED BY: MELISSA APN: 326 50 061 BP#: 'VALUATION: 1$7,767 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY PENTAMATION FURN/AC USE: SFD or Duplex 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: �' �' '„ $139.00 : x Mech.Plan Check 0.0 hrs $0.00 PfiwA Phm Mech.Permit Fee: IMPERMIT Ft'her Mech.Insp. 0.0 hrs $47.00 (.)ih>r Phdmh lns,�. P./zmlbt hasp. 7'c e: ec.Int 1 NOTE: This estimate does not include fees due to other Departments('tie.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These fees are based on the prelimina information available and are onL an estimate. Contact the De t for addn'1 info. FEE ITEMS(Fee Resolution 11-053 Eff. 711/13) FEE QTY/FEE MISC ITEMS Plan ('hec/f'F'ee: T__= S?fppl' PC h'ee FA PME Plan Check: $0.00 Perinit Fee: T4uppl, 111sp 1-'(!e PME Unit Fee: $139.00 PME Permit Fee: $47.00 ('ouvriictior Tdv.' I— 1E Administrative Fee: IADMIN $44.00 Work Without Permit? 0 Yes Q No $0.00 Travel Documentation Fee: 1 TRAVDOC $47.00 Strong Motion Fee: IBSEISMICR $0.78 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $278.781 $0.00 TOTAL FEE: $278.78 Revised: 04/01/2014 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-HVAC Climate Zones 1, 3-7 Site Address: 7Enforcement Agency: Date: Permit#: 22322 CUPERTINO RD CUPERTINO, CA 95014 City of Cupertino Mar 31, 2014 1 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 ❑EER [3 Resistance [3 R 4.2 (CZ 6, 7) 1500 sf 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: Kevin Schaff Signature: Kevin Schaff Company: BIGHAM SERVICES INC dba ONE HOUR HEATING&A/C Date: Mar 31, 2014 Address: 1400 PETALUMA HILL RD License: 740999 City/State/Zip: SANTA ROSA/CA/95404 Phone: (707) 545-1800 - s ar � Reg: 214-A0021899A-000000000-0000 Registration Date/Time: 2014/03/31 12:05:20 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms July 2010