15080038CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1104 MILKY WAY
CONTRACTOR: DG HEATING & AIR
PERMIT NO: 15080038
CONDITIONING
OWNER'S NAME: LIM JASON Y AND LI JANICE J
1040 COMMERCIAL ST STE 104
DATE ISSUED: 08/05/2015
OWNER'S PHONE: 5108465727
SAN JOSE, CA 95112
PHONE NO: (408) 978-1411
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
L '
License ClassLic. #
INSTALL A/C WITH 3 TON CONDENSER UNIT IN
BACKYARD.
��rr
-' ^JContractor`
Date % S
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
Sq. Ft Floor Area:
Valuation: $3995
formance of the work for which this permit is issued.
p"tion
ve and will maintain Worker's Compensation Insurance, as provided for by
3700 of the Labor Code, for the performance of the work for which this
APN Number: 36220005.00
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 FROM LAST CALLED 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
�� G L
d�i '7
granting of this pe Additionally, the applicant understands and will comply
Issued by: i� l Date: 61 r
with all non -point ou ce regulations per the Cupertino Municipal Code, Section
9.18.
^
RE -ROOFS:
Sign �,eJ)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 upertino Municipal 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 of the work for which this
the Health & S Code, Sectio 25505, 25533, and 2 553
"moi
performance
Owner or s oriz GL� Date:b
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
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
collect. 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 MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 M
'
CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • build ing(a)cupertino.org /�lD 2b S C
F-1 Pi I TmHiNr I9MFCHANICAL I5IELECTRICAL 6 nMISCELLLANEEO(U,S
PROJECT ADDRESS 1104 MILKY WAY
APN # �� a ' d�
OWNER NAME
JASON LIM
PHONE
510-846-5727
E-MAIL
STREET ADDRESS
1104 MILKY WAY
CITY, STATE, ZIP
CUPERTINO, CA 95014
FAX
CONTACT NAME JASON LIM
PHONE510-846-5727E-MAIL
STREET ADDRESS
1104 M11 KY WAY
CITY, STATE, ZIP
CUPERTINO CA 95014
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT
❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANI
CONTRACTOR NAME
LICENSE NUMBE 2831 5
LICENSE TYPE
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
1040 ADDRESS
ST. STE.104
§AK'96§E CA 95112
PHON408-201-9411
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF 1xFD or DUPLEX ❑ MULTI -FAMILY
BUILDING: ❑ COMMERCIAL
PROJECT IN WILDLAND ❑ YES
URBAN INTERFACE AREA NO
PROJECT IN ❑ YES
FLOOD ZONE NO
IS THE BLDG AN ❑ YES
EICHLER HOME? EkO
DESCRIPTION OF WORK INSTALLATION OF A 3 TON CONDENSER IN THE BACKYARD.
TOTAL VALUATION: $`3995.00
RECEIVED BY:
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have proviod is correct. 1 have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relatin to buildi construction. I authorize repres tat of Cupertino to enter the above-identified
�^property for inaction purposes.
Signature of Applicant/Agent: Date: O J""/ 5/
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
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OVEN -THE -COUNTER
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❑ EXPRESS
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❑ STANDARD
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❑ LARGE
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❑ MAJOR
MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
W—W FEE ESTIMATOR — BUILDING DIVISION
im,ADDRESS:
1104 Milky Way
DATE: 08/05/2015
REVIEWED BY: Sean
UNITS
APN:
BP#:
*VALUATION: 1$3,995
°PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
#
PENTAMATION FURN/AC
PERMIT TYPE:
WORK
Install A/C with 3 ton condenser unit in backyard.
SCOPE
,`.,;,, ppl. lrrsp Fcfc
APPLIANCE / EQUIP TYPE
FEE ID
11,mb
QTY
UNITS
BP FEES
Elec. Permit Fee:
A/C Units (<=10K cfm)
1 BREMAIR
1
#
$72
F,r ulit 1" c e:
,`.,;,, ppl. lrrsp Fcfc
PME Unit Fee:
$72.00
PME Permit Fee:
$48.00
(' 'ons1ruclion 1 rrx:
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? 0 Yes 0 No
$0.00
TOTALS:
Travel Documentation Fee: ITRA VDOC
$72.00
Strom>, Motion Fee: IBSEISMICR
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the preliminary information available and are onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711113)
Mech. Plan Check 0.0 1 hrs $0.00
11,mb
h3ee. Plat Check
Mech. Permit Fee: I MPERMIT
Elec. Permit Fee:
Other Mech. Insp. 0.0 hrs
Other ]'t,,r,,,h hr ,.>.Li
PME Plan Check:
$0.00
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the preliminary information available and are onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711113)
FEE
QTY/FEE
MISC ITEMS
Plan C tec .1iee:
�trfrpl. PC Fee
PME Plan Check:
$0.00
F,r ulit 1" c e:
,`.,;,, ppl. lrrsp Fcfc
PME Unit Fee:
$72.00
PME Permit Fee:
$48.00
(' 'ons1ruclion 1 rrx:
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? 0 Yes 0 No
$0.00
I,Ivanced Planning Feces:
Travel Documentation Fee: ITRA VDOC
$48.00
Strom>, Motion Fee: IBSEISMICR
$0.52
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$2--F-14.52
$0.00 TOTAL FEE:
$214.52
Revised: 07/02/2015
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC)
Project Name:
JASON LIM I Date Prepared:
CF1R-ALT-02-E
(Page 1 of 3 )
2015-08-05
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 CF1R-ALT-02 document for each dwelling unit.
01
Project Name
JASON LIM
02
Date Prepared
2015-08-05
03
Project Location
1104 MILKY WAY
04
Building Type
Single family
05
CA City
06
Dwelling Unit Name
JASON LIM
07
Zip Code
95014
08
Dwelling Unit Conditioned
1673
SC System
SC Sys
FA serve
Floor Area (ft2)
refrigerant
Installing new SC
Installing
Installing
Number of space conditioning
09
Climate Zone
4
10
(SC) systems in this dwelling
1
system
more than 40
entirely new
entirely new
unit.
Name
B. Space Conditioning (SC) System Information
01
02
03
04
05
06
07
08
09
10
Is the SC
Installing a
SC System
SC Sys
FA serve
systema
refrigerant
Installing new SC
Installing
Installing
Installing
Identification or
Location o`= ea
'ducted
containing
system
more than 40
entirely new
entirely new
Name
Sery ;, � ;
Sy
System?
component?
components? -
feet of ducts?
duct system?
SC system?
Alteration Type
System 1
Tk'
No
Yes
Yes
No
No
No
Altered space
conditioning system
�t �oqHUZ-Taters
C. Extension of Existing Duct System, Greater Than 40 Feet (Section 15O.2(b)1Diib)
This section does not apply to this project.
Registration Number: 315-A1O10001A-000000000-0000
Registration Date/Time: 2015-08-05 11:43:34
HERS Provider: USERA
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-08-05 11:44:12
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF-lR-ALT HVAC) (Page 2 of 3 )
D. Altered Space Conditioning System (Sections 150.2(b)lE 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
System 1
Central gas
No heating
component
AFUE
78
Central split
All new
cooling
SEER
13
Setback
Less than or
equal to 40
R-6
furnace
altered
AC
components
feet
Reauired Documentation:
CF2R-MCH-01-E - Space Conditioning Systems Ducts and Fans
-Duct insulation requirement for new plenums: R6.
CF2R-MCH-20-H & CF311-MCH-20-1-1 — Dud Leakage testing required when heating or cooling components are installed in ducted systems, or when more than 40 ft of duct length is replaced.
-Leakage rate compliance: < 15%, or <_ 10% leakage to outside, or seal all accessible leaks.
MR -MCH -25-1-1 & 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:
-Duct systems registered with HERS provider as previously sealed are exempt from MCH -20 Duct 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 duct systems constructed, insulated or sealed with asbestos are exempt from MCH -20 Duct Leakage Testing requirements.
Registration Number: 315-AIO10001A-000000000-0000 Registration Date/Time: 2015-08-05 11:43:34 HERS Provider: USERA
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-08-05 11:44:12
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 3 of 3 )
Documentation Author's Declaration Statement
11. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
Tina Mercado
Company:
DG Heating and Air Conditioning, Inc.
Address:
1040 Commercial Street Ste. 104
City/State/Zip:
San Jose CA 95112
Responsible Person's Declaration statement
Documentation Author Signature:
Signature Date:
2015-08-05
CEA/ HERS Certification Identification (if applicable):
928315
Phone:
408-599-4212
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.
5. 1 will enserW t a registey of tlys sof Compl4halt-ba'e avadah yaotbebuilding permit(s) t ved for the building, and made available to the enforcement agency for all applicable
insoectiors.c'nderstand t '" regi s required to lie included -with the doetatrientation the builder provides to the building owner at occupancy.
us
Registration Number: 315-A1010001A-000000000-0000
'This digital signature is provided in order to secure
the content of this registered document. and in no
way implies Registration Provider responsibility for
the accuracy of the information."
Registration Date/Time: 2015-08-05 11:43:34
HERS Provider: USERA
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-08-05 11:44:12
Schema Version: 0.555SDD
_: IaS0 ti Ll h�
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F �
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COMMUNITY ARTMENT
DING DIVi310N - CiJPERTItvO
APFROVED
VE
is set of plans and specifications MUST be kept at tF
job site during construction. It unlawful to make any
changos or alterations on same, or to deviate
therefrom, without approval from the Building Official.
Tho stamping of this plan and specifications SHALL NC
ba W to permit or to!re an ap!,roval of the violation
o4i any provisions of any CiL, -uinance or State Law.
PEti vi1 NO.
.5 /
KT��EIVED
AUG 0 5 2015
BY
OFFVCE COPY