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15110200AK CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS:.IT873 SHASTA SPRING CT CONTRACTOR: TFF HEATING AND AIR PERMIT NO: 15110200 CONDITIONING OWNER'SNAME KONG. SAMUEL KYANSAN AND SARAH AYE T 299 CORNING AVE DATE ISSUED: 11/30/2015 OWNER'S PHONE ':`1400506527- MILPITAS, CA 95035 PHONE NO: (408) 786-8120 ❑ : ', j'': ;. LICENSED CONTRACTORS DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] , REMOVE AND REPLACE FURNACE IN SAME LOCATION. p License .# - Class C' Z.C� ';_Lic.1 1 Contractor Date I hereby off "rm :tl at; I am licensed under the provisions of Chapter 9 (commencing `withSection'i7000) of Division 3 of the Business & Professions Code,and!that mylicerise: istin fall force and effect. I hereby affirm under penalty of perjury one of the following two declarations: ,..i I have andiwill maintain a certificate of consent to self -insure for Worker's i , �c ;, jai i .':�: ' Comp'ensation;[as prov�ded.for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $3500 performance of the :work.for which this permit is.issued. I have and will maintain Worker's Compensation Insurance, as provided for by APN Number 36655027.00 Occupancy Type: Section 3700 of the; abor Code,'for the performance of the work for which this permit is is . „ APPLICANT CERTIFICATION I certify that: I Have ieay , is,; 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 WITIHN 180 DAYS OF PERMIT ISSUANCE OR to building construction; and hereby authorize representatives of this city to enter upon the above'meritioned,pioperty 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 eI.xpenses which may'accrue against said City in consequence of the r Issued by: granting'of this permit. 'Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section RE -ROOFS: installed. If is 9.18. �,f;.;l�: ,,:..,:• ,: . ;;'i ;.:; : ,', , ;; : i . ,• ' (- 3O` Signature Date All roofs shall be inspected prior to any roofing material being a roof " installed without first obtaining an inspection, I agree to remove all new materials for inspection. r: ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two 'reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I, as owner of the property; of ;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 Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the ,(Sec.7044,, . , California Health & Safety Code, Sections 25505, 25533, and 25534. I will I herebyaffrrm iinderIpenalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarationsi: ,. Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and;will''marntau► 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 forwhich this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and;will mai tain Worker's Compensation Insurance, as provided for by the Health &Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this vL Owner or authorized agent: Date permit is issue&. :' _ 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 Com pensaiioir'iaws�of,Califomia. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker',§ Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith complywith•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 certifyth'at 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 constriction, 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 Cityof 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., t Signature Date CUPERTINO- GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 T ORRE AVENUE • CUPERTINO, CA °501 ^-3255 (15 �08) 777-3228 • FAX (408) 777-3333 • buildina(a OUDeriin0.orq 1�) l v0m I V ❑ PLU] eING - i CHA_NICAL ❑ ELECTRICAL ❑ 1,6ISCELLANIEOUS PROJ C7 ADDRESSV' C I AP = 'l lel OCv'K-R NAJ1 IE. S� PHONE - - I f . on Gs )- S TRE -FT L DDR SS CITY" ATB, ZIP, / 'LI I F. �� CONTACT NAME awyo rW PH J 12,0 E`iML STREET ADDRESS ❑ Oti =R ❑ OVR rP-3UtLD0\i tppA�GET ❑ CO IP.ACTDR LE £O?MRACTORAG-?NT El J,RC:Tt'ECT ❑ ENG L- ER ❑ DEVELOPE=R ❑<ic' AhT COINTR�:CTORK4J,B ISS NUI,BER 0 /, I LICENSE 7 P kf 15 I� C / COI✓,PATTY K; JME r - Y E -NAIL FAX STREET ADDRESS _ da yj n CITY, STATE, ZIP 1 PHON't (Y � P.RCMTECTrNGLT:ER NAM LICENSE TTU,BER BUS. LIC n COI✓,PATYWAIF E-MAIL I FAX STREET ADDRESS I CITY, S7ATE, Zip PHONE USE OF TFD or DUPLEX ❑ I✓,ULTI-F,4AOI.Y PROJECT LN )AM T)T LAI.TD ❑ Y?S PROTECT LN ❑: rS IS it = BLDG AN ❑r� '3 _'$ B u'ILDMIIG: ❑ CObO'=-? CIAL URBAY NTT- ACE AREA NO FLOOD ZONE NO EICFLER HOME? DF.SCPaIPTION OF l%'URIC n G `— tLj rv` TOTALVALUATION-: :i 5 . :•max x.a.....v ,. „...a.\> E ... .I* .�. ra..._R:55...':Lc nntlYrr..�.s .f..i .a}..-t.tki.<i.ur.'. By my signatu-e below, I certify to each of the following: I an the property owner or au`uo ,zed aaent to act on the property 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 ordi'ances and state laws relati-2g to b ildina construction. I authorize representatives of Cupertino to enter the above-identined property for inspection purposes. Signatnreof?.pplican/Agent: Date: �.� — 50— 1 S PLEh ENTAL LRTF'ORvIATION REQULRED w; k r F flSCr�LSE0TL1 r� x.aia ea v' w ' CO,��Z'r,R;;M� 3. ', -5--PE �LEREJSs{ _ X a W Al .�; ..R iE Rnm -X` S xx: -ArEP.Al17SC 4vp_2011.doc revised 06121/11 CITY OF CUPERTINO nTn r vrvlrl%Ar A rrnn i2TTTT T1TNC- "-FV-FQFnN APPLIANCE / EQUIP TYPE - 1'JLJ1:J JLJ"1i'I--i v QTY ADDRESS: 11873 Shasta Spring Ct DATE: 11/30/2015 REVIEWED BY: Sean Furnace, Forced -Air 1MFR=<100 BP#: 'EVALUATION: $3,500 1 APN: $143 $0.00 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY . or Duplex �AMTATPION FURN/AC PEYE: USE:SFD IBCBSC WORK Remove and replace furnace in same location. SUBTOTALS:' $285.50 SCOPE APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced -Air 1MFR=<100 1ADMIN 1 # $143 $0.00 I. f. :_1 ITRAVDOC $48.00 1 BSEISMICR $0.50 IBCBSC M n'rv. 7%— .,oti—t l dnve not inrh/do toe3 dlle to Otner VeDartments ti.e. rturintrim, X-140114, r► ulna, r.r c, ..s•.....•,r — -. ---�-- ___, District, eta . These ees are based on the relimina information available and are onlyan estimates Contact the Dept or aadn'[ to o. FEE ITEMS , Fee Resolution 11-053 F, . 7%1/13) FEE QTY/FEE MISC ITEMS Su ,()/7l. X'y 1' PME Plan Check: Permil If ec': Srr/ipl, PME Unit' Fee: PW' Permit Fee: Rxw- Administrative Feer.: Work ,Without Permit? t'clva nr;ed .Plaitrd ' f t?eS: Travel.Documeritation Fee: strong'Motion Fee:' Bid% Stds Cominission Fee: $0.00 Select an Administrative Item TOTAL, FEE: $285.50 Kevisea: iu/w/zL $143.00 $48.00 1ADMIN $45.00 0 Yes (E) No $0.00 ITRAVDOC $48.00 1 BSEISMICR $0.50 IBCBSC $1.00 SUBTOTALS:' $285.50 $0.00 Select an Administrative Item TOTAL, FEE: $285.50 Kevisea: iu/w/zL CERTIFICATE OF COMPLIANCE Alterations to Space Conditioning Systems (formerly CF -IR -ALT HVAC) Project Name: Sam Kong I Date Prepared: CF1R-ALT 02-E (Page 1 of 3 ) 2015-11-30 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 Sam Kong 02 Date Prepared 2015-11-30 03 Project Location 11873 Shasta Spring Ct 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name Sam Kong 07 Zip Code 95014 08 Dwelling Unit Conditioned 2445 Installing new;=SC Installing; Installing ;Installing Floor Area (ft2) Identification or Location or Area by this SC ducted containing Number of space conditioning more than 40 09 Climate Zone 4 10 (SC) systems in this dwelling 1 system? component? components? feet of ducts? unit. SC system? B. Space Conditioning (SC) System -Information ;Yli 1,+ 01 02 '03 .; t;. 041- 05 06 _ ' 07" ` i 08 09 10 'Y :Is the SC'` Installing a SC System SC System `CFA served system aG,- 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 System 1 Location 1 2445 Yes No Yes No No No Altered space 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-A6409408A-000000000-0000 Registration Date/Time: 2015-11-30 11:56:57 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-11-30 11:56:55 Schema Version: 0.555SDD CERTIFICATE OF COMPLIANCE CF111-ALT 02-E Alterations to Space Conditioning Systems (formerly CF -1R -AU -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 Gas furnace No cooling This field or This field or This field orrse s field or System 1 furnace AHU AFUE 0.78 No cooling component section is not section is not Setback section is notion is not altered applicable applicable applicableplicable Required Documentation: CF2R-MCH-01-E - Space Conditioning Systems Ducts and Fan`s -Duct insulation requirement for new plenums: R6. CF2R-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 duct length is replaced. -Leakage rate compliance: 515%, 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 Airflow? 30.0 CF,M%t'on required:when-MCH-25 is required. Exceptions: -Duct systems registered with HERS provider as•p�reviously sealed are exempt from MCH -20 Duct Leakage Testing requirements.,, -Heating-only systems and Air Handler/Furnace changes do not require venf+cat+on'"ofA+r Flow MCH=23, or`Refr+gerant"Charge M,ECH 25 -Existing duct systems constructed, insulated or sealed with asbesfos;are exempt from MCH-2dbucti Leakage Test+ng,requ+rdments I , E. Entirely New or Complete Replacement Duct System, with or withouUquipment Changeout (Sections 150.2(b)1DIia and 150 2(b)1E, 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-A6409408A-000000000-0000 Registration Date/Time: 2015-11-30 11:56:57 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-11-30 11:56:55 Schema Version: 0.555SDD CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E Alterations to Space Conditioning Systems (formerly CF -IR -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: Ferreira, Tony Company: Signature Date: T F F HEATING AND AIR CONDITIONING 2015-11-30 11:56:57 Address: CEA/ HERS Certification Identification (if applicable): 299 CORNING AVENUE City/State/Zip: Phone: MILPITAS CA 95035 408-786-8120 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 land 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'cornpliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for,,approval witk this building permit application. >. 5. 1 will ensure that a registered copy ofthis. Certificate of. Compliance shalibe 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: T Ferreira, Tony /rG Company: Date Signed: T F F HEATING AND AIR CONDITIONING 2015-11-30 11:56:57 Address: License: 299 CORNING AVENUE 917350 City/State/Zip: Phone: MILPITAS CA 95035 408-786-8120 Digitally signed by Ca10ERTS. 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-A6409408A-000000000-0000 Registration Date/Time: 2015-11-30 11:56:57 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-11-30 11:56:55 Schema Version: 0.555SDD 'WATER -CONSERVING PLUMBING FIXTURES FILE 0 OWNER CERTIFICATE OF COMPLIANCE. COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 f' - (408) 777-3228 . FAX (408) 777=3333 • building cDcupertino.orq Owner Name 'KOVy(, Sf�(Uti� j y 4� M1) �Aaft_i_4 AV. -•i Permit No. 014 l1 OaOn Address _ I i � X1-1 Ar�TA PR l r11O CT, NQS' . q S O I" 1. Is your real property a registered historical site? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of fonn. P( No Go to Question 2. 2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the property or its plumbing, installation of water -conserving plumbing fixtures is not technically feasible? ❑ Yes Civil Code Sections 110 1. 1 through 1101.8 do not apply. ❑ The licensed plumber's certification has been provided to the Building Division. Skip the rest of the fonn and sign -bottom of form. No Go to Question 3. 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. 1( No Go to Question 4. 4. Is your real property built and available for use or occupancy on or before January 1, 1994? ❑ No My real property is built and available for use or occupancy after January 1, 1994. Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. 011 1A Yes My real property is built and available for use or occupancy on or before January 1, 1994. Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign bottom of form.. 5. Please check ONE of the following: My property is a single-family residential real property. See Civil Code Section 1101.4. On and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1, 2017, all non- compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless of whether property undergoes alterations or improvements). ❑ My property is a multifamily residential real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water - conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). ❑ Myproperty is a commercial real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). I, as the owner or owner's agent of this property, certify under penalty of perjury that non-compliant plumbing fixtures will be replaced prior to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 through 11.01.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's installation requirements, and that the water -conserving plumbing fixtures comply with the requirements as indicated in the table on the following nage. Owner or Owner Agent's SignatG�, ` �_rb_u DaUponcompleting and signing this Certificate, please return it to e Building Division in order to final y�Kg,_rmit. SB407 2015.doc revised 08/26/15 CVtlaERT11140 SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE > CUPERTINO, CA 95014-3255 (408) 777-3228 o FAX (408) 777-3333-;buildingna.cupertino.org a-ar -� a 1511 nt�;-®0 t r i L�[a C,11 L + t : A i Ite: ©- ul cit _ tia,a ide: P RIVUT CANNOT BE 1FINALED AND COMPLETE D UNTD, THIS CERTIFICATE bA51V _J____M AND ;�. ET -1 .. f.o THE BiT.IC1C-bfNG DIVISION 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. 1 have read and agree to comply with the terms and rnnditinn.c of this CtAtPmPnt °, or ner-Agents)Namee: � � �- h_ afire. .����. ................................................................................. D q � 1 Is- CofiLF�efo��Name: Si cull --- Si__ re...................................................................Lie:�#��.................................... Da:te:....... ............ Smoke and: CO form.doc remised 03118/14