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14060016I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10420 IMPERIAL AVE CONTRACTOR: A & H HEATING PERMIT NO: 14060016 OWNER'S NAME: KLAN PHILIP AND CHEN SHIRLEY 770 CHESTNUT ST DATE ISSUED: 06/04/2014 OWNER'S PHONE: 6268405043 SAN JOSE, CA 95110 PHONE NO: (408)279 -0722 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ REMOVE AND REPLACE FURNACE ADD A/C UNIT License Class_ Lic. # 3 DW '7/�� -� / Contractor. M44 Ar-�'&K Date to 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: $8900 I ave and will maintain Worker's Compensation Insurance, as provided for by APN Number: 35719092.00 Occupancy Type: n 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 E IRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 8 YS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter 180 DAY M LAST CALLED INSPVVON. upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino agaihst liabilities, judgments, said City in consequence of the / I� costs, and expenses which may accrue against Issued 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, 25 533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date:Ao 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 CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • buildinaCcDcupertino.ora I_IPLUMBING VUMPL'_HAmr'AT iZPT Rr- MTI-AT �o O 1 ?..fTQf'MT T AIJenT TO MEP misc PROJECT ADDRESS M OWNERNAME Ir LR PHONE &z& E-MAIL STREET ADDRESS ,g IyZ0 (,A, (>r ( I r'-- I��1 •! S7 ZIP FAX CONTACT NAME � /i7 � `�� PHONE STREET ADDRESS [ ©L�y 1 �.�,6'��ieyG•-� (uumat CI?Y,ST ., ,f"/ fO FVG79 L 71/017 ❑ Owm ❑ Owm -B 13 awmAAGGmfr CON7R =R ❑CONTRACTORA` fr ❑ ARCHrwT ❑ ENGmmR ❑ DEVELOPER ❑ TENANT CONTRAcroR NAME %% .� T LICENSE a Z r LICENSE T „�j y� BUS. UC # J 2 ) "7 / COMPANY NAME ) �j► �r l.� C►� EMA1L� /lM /,i/T04&''P Lam/ FAX 2740 STREET ADDRESS f� V � c" ST54 p) /� PH .y * Z d BUS.LIC# ARCHITEMENOINEERNAME LICENSENUMBER COMPANY NAME E MAII FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF SFD or DUPLEX ❑ MULTI - FAMILY BUILDING. ❑COMMERCIAL PROJECTIN WI.DLAND ❑ YES URBAN INTERFACE AREA NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES EICHLER HOMES ❑ NO DESCRIPTION OF WORK ItZ- Jr-Act TOTAL VALUATION: -73 AD ^mot` By my signature below, I certify to each of the fallowing: I am the property owner or authorized agent to act n the #r6perty 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 buildin construction I authorize Ares tatives of Cupertino to enter the above - identified property for inspection purposes. Signature of Applicant/Agent: ate: C47 SUPPLEMENTAL INFORMATION REQUIRED or1a cE use oNLX:� P '7QiXNTER r `. Ii1A jOR MEPMiscApp 2011.doc revised 06 121111 r M CITY OF CUPERTINO �UU UQrPYl%4 A rr"ID _ RTTTT .n1NC_ T)TVTCTnN Mech. Plan Check 0.0 1 hrs $0.00 P /rlwbt Plan C hec!" Mech. Permit Fee: IMPERMIT Fiu nh. 1,crmi1 ?,'ce: Other Mech. Insp. 1 0.0 1 hrs 1 $47.001 other Plumb fngyp P /atrrrl?, hvr ). V! e: NOTE: This estimate does not include fees due to other vepartments y.e. rtammng, ruanc rr urna, 1 wa, vuroosu.y �••� - __ Ulsirict, etc.. inese ees are auseu orr ruc ressnurswi FEE ITEMS (Fee Resolution 11 -053 E . 7ff /1/13) 10420 imperial ave DATE: 06/04/2014 REVIEWED BY: Mendez 1wdADDRESS: APN: BP #: *VALUATION: 1$8,900 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex Suppl. PC Fee: (j) Reg. ® OT PENTAMATION FURN /AC PERMIT TYPE: USE: $0.00 PME Plan Check: $0.00 WORK remove and replace furnace add a/c unit Permit Fee: SCOPE Suppl. Insp. Fee-.(F) Reg. ® OT Mech. Plan Check 0.0 1 hrs $0.00 P /rlwbt Plan C hec!" Mech. Permit Fee: IMPERMIT Fiu nh. 1,crmi1 ?,'ce: Other Mech. Insp. 1 0.0 1 hrs 1 $47.001 other Plumb fngyp P /atrrrl?, hvr ). V! e: NOTE: This estimate does not include fees due to other vepartments y.e. rtammng, ruanc rr urna, 1 wa, vuroosu.y �••� - __ Ulsirict, etc.. inese ees are auseu orr ruc ressnurswi FEE ITEMS (Fee Resolution 11 -053 E . 7ff /1/13) .. �••»•�•• �• »•-•- FEE --- -- -__ _. _ QTY /FEE ____ ____ MISC ITEMS Plan Check Fee: $0.00 # $139.00 Mechanical IMFR = <100 Furnace, Forced -Air Suppl. PC Fee: (j) Reg. ® OT 0.0 hrs $0.00 PME Plan Check: $0.00 1 # $70.00 Mechanical 1 IBREMAIR A/C Units ( < =10K cfm). Permit Fee: $0.00 Suppl. Insp. Fee-.(F) Reg. ® OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 T_7= C.ollstrvcZion 7'0x. Administrative Fee: IADMIN $44.00 0 E) Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential Building or Structure .,7 A Travel Documentation Fee: 1TRAVDOC $47.00 Strom Motion Fee: IBSEISMICR $0.89 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $139.89 $209.00: '. TOTAL FEE: $348.89 rcevisea: u4ru ircu ��+ CUPERTINO HVAC ALTERATIONS ENERGY COMPLIANCE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • buildinaa- cupertino.oro WHEN IS A PERMIT REQUIRED A construction permit shall be obtained from the enforcement agency prior to the erection, construction, reconstruction, installation, relocation, or alteration of any mechanical system, except as permitted in Chapter 1, Section 112.2 of the 2010 California Mechanical Code. Projects requiring permits include, but are not limited to: • New HVAC installation •. HVAC Changeout • Replacement of furnace, coil, FAU or condenser • Relocation of an existing HVAC unit • Adding or replacing more than 40ft ducting in uncon6tioned space BUSINESS AND PROFESSIONS CODE, SECTION 7110 Willful or deliberate disregard and violation of the building laws, including the California Building Code, and local permit requirements constitutes a cause for disciplinary action from the Contractors State License Board working in conjunction with the local building department. This action may consist of fines up to $5,000 Per violation or suspension/revocation of a contractor's license. 2008 BUILDING ENERGY EFFICIENCY STANDARDS (Title 24, Part 6) REQUIREMENTS INCLUDE: I . Heating equipment must have a minimum 78% AFUE (Exception: Wall & floor furnaces; room heaters). 2. Central air conditioners & heat pumps less than 65,000 Btu/hr must have a minimum 13 SEER. 3. Newly installed or replaced ducts must have a minimum insulation value of R -4.2. 4. A setback type thermostat (24 hr clock with four set points) is required for all alterations. 5. New or replacement ducts must meet the mandatory requirement of Section 150(m). • All joints and openings in the HVAC system must be sealed. • Only UL 181, UL 181A, or UL 181B approved tapes or mastic shall be used to seal duct openings. • Connections of metal ducts and the inner core of flex ducts shall. be mechanically fastened. Flex ducts must be connected using a metal sleeve /coupling. • Flex ducts that are suspended must be supported every 4 ft. max for horizontal runs with no more than 2" of sag between supports and 6 ft. max for vertical runs. 6. The CF- 6R- MECH -04 must be completed and signed by the installing contractor. The Inspector will collect this form and verify that the model numbers are the same as the installed equipment. 2008 Residential Compliance Forms.doc revised 04110112 SheAddrew A"t, EnjorcemerrtAj=Cy: Date: ;x Ferrrrk ;. , l Z 0 Conditioned Dnct insulation Equipm ent'h ..'�I:rst G3enr 'Floor e�FC8 - 7 .. .. ThertnosTat ! -J: Package_d,Umi Furnace COP- ®HSPF ' Serve d by system OVer 40 fl of duds added driioaiced m Setback J'_, already Indoor Con Condensing Unit ® EER E3 ResistMce sf unconditioned space , - ir-w preanu, must be - � R 6 (CZ I, 3 -S) • Other ., 1. Equipment Type: Choose the equipment being installed; if more than one_system, use another CF -I R- ALT -HVAC. for each system_ 2. Alinimum Equipment ?sfciencies 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 responsibillty 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 I and 6 of the California Code of Regulations. • The design features identified on this Certificate of Compliance are consistent with the infomration documented on other applicable compliance forms, worksbeets, calculations, plans and specifications submitted to the enforcement agency for apprrn:al,with the permit application. _ _ lame! Net nqwyk- s-e 1P Company, [� '.' Date:...<p L I f . �7 Address S/ License: 90 y/ G City/State,Zip: '' Phone: yOy 2008 Residential Compliance Forms.doc revised 04110112 ' N .Lww3d �0 31vat`7,QU� a�� up�p I �Ue } 0 SUO 01 p184 aq ip oa ad Aug 10 onv o oidde ue aq 01 J0 }►w}a st=olle ± }Dads pue ueld slgl }o •let ^1.;.': ±piing w011 lewidde 0041, a�et�,�p a} �o `awes uo suoltejalle 10 6 eV Aug GV.� 0; Ind Jun Sl al 'uol}on1 }suoa 6� u p atls got aye }e tdat aq 1S A suolMl}Joads pu `u is 5141 c U�I- ono 114i rnNoo \P 4� t �0 Pic., CUPERTINO sariinq Department JUN 0 4 20% R VIEWS j FOR C,CDE COMPLIANCE V Reviewed By. j4' "Y 6' Add lq/(f Con,&,e - to F--,z 361r�- Am WA A46, PLOT PLA1N5 CHECKED BY DATE I,ANNI DEFT. DATE Address ,\� • SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • buildingPcugertino.org nFILE Permit Nn_ 14-04 06 1 t� PURPOSE This affidavit is a self- certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections are required. GENERAL INFORMATION . Existing single - family and multi- family dwellings shall be provided with Smoke Alarms and Carbon Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds $1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and /or Carbon Monoxide Alarms be installed in the following locations: AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the bedroom(s) X X On every level of a dwelling unit including basements X X Within each sleeping room X Carbon Monoxide alarms are not required in dwellings which do not contain fuel- burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated. In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for alarms which must be connected to the building wiring. As owner of the above - referenced property, I hereby certify that the alarm(s) referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes. The alarms have been tested and are operational, as of the date signed below. / have read and agree to comply with the terms and conditions of this statement Owner (or Owner Agent's) Name: Philip4A.alb /!4 Signature.. ........................................................ ............................... Date:.!��2� Contractor Name: SSi ' S.Q....^........ �.i... g nature ............... :-:...:... ....... .... .......... .# Date:Vt. W Smoke and CO form.doc revised 03118114