15070079CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21453 SHANNON CT
CONTRACTOR: ABC COOLING &
PERMIT NO: 15070079
HEATING
OWNER'S NAME: LEE PING YU AND HUANG PI HUA
3266 INVESTMENT BLVD
DATE ISSUED: 07/13/2015
OWNER'S PHONE: 6699002438
HAYWARD, CA 94545
PHONE NO: (510)471-8181
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL
License Class 4/1'Lic. # 7 J
�7 �3
REPLACE (E) FURNACE, SAME LOCATION
`` S
A§, �wS �e_
Contractor �l NNa Date
1 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.
1 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
Sq. Ft Floor Area:
Valuation: $3246
performance of the work for which this permit is issued.
l have and will maintain Worker's Compensation Insurance, as provided for by
ction 3700 of the Labor Code, for the performance of the work for which this
APN Number: 36201006.00
Occ a pa nc� 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 LLED 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
--- —
granting of this permit. Additionally, the applicant understands and will comply
�siissued • Date: [/
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
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
1 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(x) 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
1 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, Sections 25505, 25533, and 25534.
Owner or authorized agent:
permit is issued.
1 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
Compensation laws of California. If, after making this certificate of exemption, I
CONSTRUCTION LENDING AGENCY
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
MEP
I�I 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 MISC CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • buildingCD_cupertino.org
PLUMBING RMECHANICAL ELECTRICAL MMSCELLANECUS
PROJECT ADDRESS 7-IL415S n CJ7.
r . r l -nIA,0 _ 0l
AM k ',,6 -c)
c� , O
OWNER NAME M.v�. 1,e-e-
, t me yc.J
o�-z
6b� - �,�t3
E-MAIL
STREET ADDRESSCITY,
-2-1453S C
STATE, ZIP
Cu n 5 l
FAX
CONTACT NAME
S CJ`✓ -
PHONE
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
Ar
CONTRACTOR NAME
LICENSE NUMBER 1 Z '
LICENSE TYPE ��O
BUS. LIC fl ?
J
COMPANY NAME
A c7 i n +i
E-MAIL,,,,,
�eo.G C o ' . Go"
FAX
510 -H 7I - 36
STREET ADDRESS t o �� t v
CITY, STATE, ZIP Cir C /A qC4 C1�
PHONE r O_ 1
ARCHITECTIENGINEER NAMED-
LICENSE NUMBER
BUS. LIC k
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY
BUILDING: ❑ COMMERCIAL
PROJECT IN WrLDLAND ❑ YES
URBAN INTERFACE AREA NO
PROJECT M ❑ YES
FLOOD ZONE NrNO
IS THE BLDG AN PYES
EICHLER HOME? NO
DESCRIPTION OF WORK o. -C +c A \ r 0. c -e -
TOTAL VALUATION:
Hy my signature below, I certify to each of the following: I am the property owner or authorized agent to act on a prope er's be ve read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. comply with all applicable local
ordinances and state laws relating to buil 'ng construction. authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date: %_w.- �S
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
w
❑ OVER -THF -COUNTER
❑ EXPRESS
U
❑ STANDARD
❑ LARGE
a.
❑ MAJOR
MEPMiscApp_2011.doc revised 06/21/11
��'�CITY OF CUPERTINO
{ �'� 0I FEE ESTIMATOR — BUILDING DIVISION
APPLIANCE / EQUIP TYPE
ADDRESS: 21453 SHANNON CT
DATE: 07/13/2015
REVIEWED BY: MELISSA
UNITS
APN: 362 01 006
BP#:
"VALUATION:
$3,246
*PERMIT TYPE: Mechanical Permit
PLAN CHECK TYP . Alteration / Addition / Repair
PRIMARY
USE: SFD or Duplex
$143
PENTAMATION
PERMIT TYPE: FURN/A
WORK
REPLACE E FURNACE SAME LOCATION _
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
Elec_
Furnace, Forced -Air
1MFR=<100
Other Elea. Insp.
El
1
#
$143
Pe rn it l" ee.
Suppl. lrtsp Fee
PME Unit Fee:
$143.00
PME Permit Fee:
$48.00
("Ons/ruction Tax:
Administrative Fee: 1ADMIN
$45.00
Work Without Permit? O Yes G) No
$0.00
TOTALS:
Travel Documentation Fee: ITRA VDOC
$143.00
Stronjg Motion Fee: IBSEISMICR
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 oreliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 711113)
Mech. Plan Check 0.0 hrs $0.00
QTY/FEE
Lw( i M
Mech. Permit Fee: IMPERMIT
P114111h. Permit Fee.
Elec_
Other Mech. Insp.0.0 hrs $48.00
1
Other Phrmh hisp.
Other Elea. Insp.
El
t.1e c•h. Insp. Fee:
P/wnb. hcsp. Fee:
Eloo. Imp, 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 oreliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 711113)
FEE
QTY/FEE
MISC ITEMS
Plant Cheek Fee:
Suppl. PC Fee
PME Plan Check:
$0.00
Pe rn it l" ee.
Suppl. lrtsp Fee
PME Unit Fee:
$143.00
PME Permit Fee:
$48.00
("Ons/ruction Tax:
Administrative Fee: 1ADMIN
$45.00
Work Without Permit? O Yes G) No
$0.00
iClb'Cnt ced Planning, Fees:
Travel Documentation Fee: ITRA VDOC
$48.00
Stronjg Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS:
$285.50
$0.00 TOTAL FEE:
$285.50
Revised: 07/02/2015
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC)
Project Name:
21453 SHANNON CT I Date Prepared:
CF1R-ALT-02-E
(Page 1 of 3 )
2015-07-10
A. General Information
CF1R-ALT-02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be
documented, use one CF111-ALT-02 document for each dwelling unit.
01
Project Name
21453 SHANNON CT
02
Date Prepared
2015-07-10
03
Project Location
21453 SHANNON CT
04
Building Type
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
21453 SHANNON CT
07
Zip Code
95014
08
Dwelling Unit Conditioned
1787
Installing
Installing
Installing
Floor Area (ft2)
Location or Area
by this SC
ducted
containing
system
Number of space conditioning
entirely new
09
Climate Zone
4
30
(SC) systems in this dwelling
1
component?
components?
feet of ducts?
duct system?
unit.
Alteration Type
B. Space Conditioning (SC) System Information
01
02
03
04
05
06
07
08
09
10
Is the SC
Installing a
SC System
SC System
CFA served
system a
refrigerant
Installing new SC
Installing
Installing
Installing
Identification or
Location or Area
by this SC
ducted
containing
system
more than 40
entirely new
entirely new
Name
Served
System (ft2)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
Altered space
System 1
Location 1
1787
Yes
No
Yes
No
No
No
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b)1Diib)
This section does not apply to this project.
Registration Number: 215-A0189178A-000000000-0000
Registration Date/Time
2015-07-10 10:49:58
HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-07-10 10:50:01
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CFlR-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 2 of 3 )
D. Altered Space Conditioning System (Sections 150.2(b)1E and F)
01
02
03
04
05
06
07
08
09
10
11
12
Heating
Cooling
System
Heating
Altered
Heating
Minimum
Altered
Cooling
Minimum
Required
New or
Identification
System
Heating
Efficiency
Efficiency
Cooling
Cooling
Efficiency
Efficiency
Thermostat
Replaced
New Duct
or Name
Type
Components
Type
Value
System Type
Components
Type
Value
Type
Duct Length
R -Value
Central gas
All new
Central split
No cooling
This field or
This field or
Less than or
System 1
furnace
heating
AFUE
0.8
AC
component
section is not
section is not
Setback
equal to 40
R-6
components
altered
applicable
applicable
feet
Required Documentation:
CF2R-MCH-01-E - Space Conditioning Systems Ducts and Fans
-Duct insulation requirement for new plenums: R6.
MR -MCH -20-H & CF3R-MCH-20-H — Duct Leakage testing required when heating or cooling components are installed in ducted systems, or when more than 40 ft of dud length is replaced.
-Leakage rate compliance: 5 15%, or 510% leakage to outside, or seal all accessible leaks.
CF2R-MCH-25-H & CF3R-MCH-25-H Refrigerant Charge Verification required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15).
CF2RCF3R-MCH-23 & CF3R-MCH-23 Air Flow >_ 300 CFM/ton required when MCH -25 is required.
Exceptions:
-Dud systems registered with HERS provider as previously sealed are exempt from MCH -20 Dud Leakage Testing requirements.
-Heating-only systems and Air Handler/Furnace changes do not require verification of Air Flow MCH -23, or Refrigerant Charge MECH-25.
-Existing dud systems constructed, insulated or sealed with asbestos are exempt from MCH -20 Duct Leakage Testing requirements.
E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)1Diia and 150.2(b)lE, F)
This section does not apply to this project.
F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)1C)
This section does not apply to this project.
Registration Number: 215-A0189178A-000000000-0000
Registration Date/Time
2015-07-10 10:49:58
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-07-10 10:50:01
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CF111-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 3 of 3 )
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature: / / /'
t e ecchin
Cecchin, Mike
Company:
Signature Date:
ABC COOLING & HEATING SERVICES INC
2015-07-10 10:49:58
Address:
CEA/ HERS Certification Identification (if applicable):
3266 INVESTMENT BLVD
City/State/Zip:
Phone:
HAYWARD CA 94545
(510) 471-8181
Responsible Person'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 Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible designer).
3. 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 California Code of Regulations.
4. 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 permit application.
S. I will ensure that a registered copy of this Certificate of Compliance shall be made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable
inspections. I understand that a registered copy of this Certificate of Compliance is required to be included with the documentation the builder provides to the building owner at occupancy.
Responsible Designer Name:
Responsible Designer Signature:
Cecchin, Mike
t e ecc in
Company:
Date Signed:
ABC COOLING & HEATING SERVICES INC
2015-07-10 10:49:58
Address:
License:
3266 INVESTMENT BLVD
382383
City/State/Zip:
Phone:
HAYWARD CA 94545
(510) 471-8181
Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document, and in noway implies Registration Provider responsibility for the accuracy of the information.
Registration Number: 215-A0189178A-000000000-0000 Registration Date/Time: 2015-07-10 10:49:58 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-07-10 10:50:01
Schema Version: 0.555SDD
HOME COMFORT
PROPOSAL & AGREEMENT
customer 1-"-i
Grdwjw is AF* Y ar... .32661rtvegment Blvd
=5,".'.56,
{gy�yerr Gd 4{4545
' Fax: 5104? t 8368 AveFra�sno�� A A3
D-'. "
r'S>L 559-
www.ab1c1,C4MvB cc>rrn
=3001 • tiatt Free: tt > cc�cx
SreNiCes,11K.
ps e3t
= ood51Frersrw s9:�2%3t4
2e
CCL#382$3 1
..__,_ .. ..._..,.._.��.� �£Y°rt J+� t •..,...._ w iilt'l�ll i�1�P_ ,�
City_..A
mate 7.#p
We hereby proPose to furnish, install and service eq-.jipmpnt for your home as specified b;310w;
ixRemrsvol of exisfing equipment
v,ti �r a r! r�Ke to ,P'i t.,turtrtt�'ttF
- "'t4:�"
D flew
r:" Hciiz
I _
54eeyarci
L�
P�sr l ya+ci
w3 Citi r
C'
Upflowr
U
Driflow
1.
.'
Sid-eyord
0
Baclrynrd
['J Ci fIOr
`iideyurd
tJ
BaCTtyo ct
rt fie�Li
#:arinw
i
te4e ,r
3"'
E A C,
ixRemrsvol of exisfing equipment
v,ti �r a r! r�Ke to ,P'i t.,turtrtt�'ttF
- "'t4:�"
] Pecover refrigerant 4'w EPA requlrilm s
New Refs. rete# s i.:r:s
i ge "
�s 7 ai
0 h1ter'Drior
y^� Rewn Plenum
J{fPPfY �nuia•i v�
: t rau
- -
coviple?e h..},th i 6 4fraaf'Y`:i
POr"
, �.. 1p ttfq
1
tai
l] Now Cond@rase'r
� :: f L f r,.`P i :� 11• .j` ,.,.. 1'i , 1 L Y` �. .`9...1,`i' �'
El Condensate Pump
.._,
D ReC4?l7nect 10 iaCistiag.; Gas
Ru, Now Gcm.....,..,-..,-•°^"`"^""'.,,w-.,_
from ,rte.
#:arinw
ikensettr "tnti�red:;oaadeCl '
7i3
Yearf arts) 4 a 1 ; exi3c Parts"/ toboY •� _ F Y$4z�sf `
Y�csrf sl ComP�sscr
Yearlbl cola _ ..
ye
crls) Neter
fc +°,5urn LST;_ s la inner xtFrxan C rr+P�rrh�r � _
.. � ��rsllc�wb; f� pelt! _,,_.-_••-- __ � y ,
be made ..�+ ""°"r" Cts -t lPr t .r
fa+a,;aeltfd
t°a+'. 9ryrp.AdW d ,s y wL7YG�
pea 00
",A
Y � 147�
m " Aar+ y�rt u rr..nz„ r_ r;aro ' f31 f�
J*#PE1i @; fMr t vf.CF Pr r^
s e�lfc t r
�F✓r � srkrix>
Yt(m_ e,prior
.a rw 4r "ht
dd#nr4
.tre5ct sr�.t�_�m e'r•*Ps n.,Y�� _,,,;
t
_