14090135CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10148 ADRIANA AVE
CONTRACTOR: ALLIED AIRE SERVICE
PERMIT NO: 14090135
INC
OWNER'S NAME: KHO KOFERIANTO AND YONG ING -HU
887 AMES AVE
DATE ISSUED: 09/22/2014
OWNER'S PHONE: 4084460678
MILPITAS, CA 95035
PHONE NO: (408)934 -8844
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑
REPLACE (E) FURNACE, SAME LOCATION
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License Class�A/P Li�c.'# 0�
Contractor �' '10 (=E-�c
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
erformance of the work for which this permit is issued.
Sq. Ft Floor Area:
Valuation: $2000
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 32620012.00
Occupancy Type:
Section 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 EXPIRES IF IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 D OF F' IT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
180 DAY T CALLED INSPECTION.
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
which may accrue against said City in consequence of the
n
7 A �
costs, and expenses
Issu Date:
granting of this p .t. Additionally the applicant understands and will comply
with all non -po' t s e Cupertino Municipal Code, Section
9 18.
Date t!
RE- ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
Signature
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 Athe 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 t up al Code, Chapter 9.12 and
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
the Health & Safety Code, Se on 5 , 255 ,and 2 4.
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
9 18.
Signature Date
CUPSAFT 0
GENERAL PERMIT APPLICATION
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COMMUNITY DEVELOPl%liEN7 DEPARTMENT - BUILDING DIVISION G
D300 TORRE AVENUE • CUPERT INO, CA 95014-3255
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ordinances and state laws relating to i nstru on. I vAho epresentmtves of to enter tine abo--l' , "---Itd --�y for inspection purposes.
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CITY OF CUPERTINO
rV__W FF.F, FNTIMATOR - RITILDING DIVISION
ADDRESS: 10148 ADRIANA AVE
DATE: 09122/2014
REVIEWED BY: MELISSA
APN: 326 20 012
1 BP#:
*VALUATION: F$2,000
APERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Du p lex
E
PENTAMATION FURN/AC
I
USE:
$0.00
PERMIT TYPE:
WORK
REPLACE (E) FURNACE, SAME LOCATION
SCOPE
APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced-Air 1MFR=<100 1 # $143
$1 TOTALS: 143.00
Mech. Plan Check 0.0 1 hr's $0.00 Phwib. Pfan Cl'wck I I P /ec, /'f an ("fle(l, 14 1 1
Mech. Permit Fee: IMPERMIT P("'rtnif 1' et": I Tle(
Other Mech. Insp. 0.0 1 h;s $48.00 Oihicr Tlunab lnsfi E3
Z' h syv_ F 1117mA Inv. Fee:
7Vt)TF- This intimate does not include fees due to other Departments (i.e. Planniniz, Public Works, Fire, Sanitary Sewer District, School
District etc These f-es are based on - the Drelimina information available and are on1v an estimate. Contact the Deptfor addn 7 info.
FEE ITEMS (Fee Resolution 11-053 Eff 711143)
FEE
QTY/FEE
MISC ITEMS
Plan Check
E
PME Plan Check:
$0.00
Permit Fee:
PME Unit Fee:
$143.00
PME Permit Fee:
$48.00
Coyi.srrj,.chon 711X:
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? 0 Yes (j) No
$0.00
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
In
$285.50
$0.00 TOTAL FEE:
$2
Revised: 08/20/2014
STATE OF CALIFORNIA
ALTERATIONS - HVAC
CEC -CFIR- ALT -03 -E Revised 06/14 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R- ALT -03 -E
Alterations - HVAC CZ 1, 3 to 7 and 16 (formerly CF -1R- ALT -HVAC) (Page 1 of 1)
Site Address:
Enforcement Agency:
Date Prepared:
Permit #:
poigg iZl ,� J
GAT-1 ^--1� v
Equipment Type
Equipment Efficiency
New: Ducting, Plenums, Lineset
Conditioned
Thermostat
Required R -value
Floor Area (sq ft)
• Packaged System
❑ Evaporator Coil
AFUE
COP
❑ R -6 (CZ 1,3 -7) Ducts
Served by system
CSetback
• Split System
❑Condensing Unit
SEER
❑ R -8' (CZ 16) Ducts
s ft
q
(if not already
HSPF
❑ R -6 (all CZ's) Plenums
P resent must
Furnace
❑ Lineset
EER
❑ R -5 or R7.5 Lineset3
be installed)
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this
form is allowed to be filled out'by`hand. For final inspection all forms are to be registered (no hand filled forms allowed) and a copy left on site.
1. HVAC Changeout /Repair
Required Compliance Documents to be left on site for Final:
an include new ducting
All Equipment,
CFIR- ALT -02 -E
Condenser Unit, Evaporator Coil,
CF2R: MECH -01, MECH -20 -HERS
Air Handler /Furnace
CF3R: MECH -20 -HERS
Installer Requirement: Duct leakage (<,15% or, < 10% to outside, or seal all accessible leaks)
Exempted from duct leakage testing if:
❑ 1. Duct system registered with HERS provider as previously sealed, or ❑ 2. There is less than 40 linear feet of duct in unconditioned
space, or 3. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building .......
❑ 2. New HVAC System
Required Compliance Documents to be left on site for Final:
All new equipment and All New Ducts'
CFIR- ALT -02 -E
CF2R- MECH -01, MECH -20 -HERS, MECH -22 -HERS, MECH -(23 or 24) -HERS
CF3R- MECH -20 -HERS, MECH -22 -HERS, MECH -(23 or 24) -HERS'
Installer Requirement: Duct leakage < 6 %, Fan Efficacy (.58W /CFM), Air Flow 2 350 CFM /ton (or Standards Table 150.0 -C / D alternative)
113. All New Ducts with Replacement
Required Compliance Documents to be left on site for Final:
Includes replacing or installing All New
CFIR- ALT -02 -E
Ducts' and one or more of the following:
CF2R- MECH -01, MECH -20 -HERS, MECH -(23 or 24) -HERS
Condenser Unit, Evaporator Coil, Furnace
CF3R- MECH -20 -HERS, MECH -(23 or 24) -HERS
Installer Requirement: Duct leakage < 6 %, Air Flow 2 350 CFM /ton (or Standards Table 150.0 -C / D alternative)
Exempted from duct leakage testing I existing duct systems are constructed, insulated or sealed with asbestos.
❑ 4. New Ducting over 40 feet
Required Compliance Documents to be left on site for Final:
Adding or replacing ducts in unconditioned
CF1R- ALT -02 -E
space but less than All New Ducts'
CF2R: MECH -20 -HERS
CF3R: MECH -20 -HERS
Installer Required to: Duct leakage L15% or, < 10% to outside, or seal all accessible leaks)
Exempted from duct leakage testing I existing duct systems are constructed, insulated or sealed with asbestos.
All new ducting R -8 required when more than 40 ft installed and R -6 when less than 40 ft installed. This includes in walls, between floors etc.
' A New Duct system is when the duct system is constructed of at least 75 percent new duct material, and up to 25 percent may consist of reused
parts from the dwelling unit's existing duct system (e.g., registers, grilles, boots, air handler, plenums, duct material.
3 R -5 (1" thick insulation) for linesets 1" and less. R -7.5 (1.5" thick insulation) for linesets over 1 inch. Most mfg will require Suction line Diameter
with insulation as the following 1.5- 2T -2 % ", 2.5- 3T- 2' /a ", 3.5 to 4T- 2'/. ", 5T -4Y."
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
I certify the following under penalty of perjury, under the laws of the State of California:
1. The information provided on this Certificate of Compliance is true and correct.
2. 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the information on this document.
3. 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 (CCR).
4. That the energy features and performance specifications, materials, components, and manufactured devices for the building design or
system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the CCR.
5. The building design features or system design features identified on this Certificate of Compliance are consistent with the information
provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement
agency for approval with this building perm' a plica '
Responsible Designer Name:
Re ons' le e ner Sig ture:
Date Si ned:
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License:
9 Y,
06�35
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ddress:
7
City /State /Zip:
Phone: Q Q /�/
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For assistance or questions regarding the Energy Standards, contact the Energy Hotline it: 1-800-772-3300