15120103Mt
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7623 ORANGE BLOSSOM DR
CONTRACTOR: A-1 HEATING AND
PERMIT NO: 15120103
COOLING
OWNER'S NAME: LEE CHOK-KAU B AND VIOLA LENG
476 W TAYLOR ST
DATE ISSUED: 12/11/2015
OWNER'S PHONE: 4082538238
SAN JOSE, CA 95110
PHONE NO: (408) 283-9915
]° LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL
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9
REPLACE FURNACE AND SUPPLY DUCT AT SAME
LOCATION.
-2G'
License Class iLie. 4 l�O�pC'J
Contractor- , N -\e e,,N a A C,,r_V-h) DateA&kk-
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 frill 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
pe sation, as provided for by Section 3700 of the Labor Code, for the
Sq. Ft Floor Area:
Valuation: $10400
fo i ce of the work for which this permit is issued.
Kr
e and w11 maintain Worker's Compensation Insurance, as provided for by
tion 3 00 of the Labor Code, for the performance of the work for which this
APN Number: 36611079.00
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
IV�/l%l 12-J1111
Issued by: Date:
granting of this permit. Additio►iall�v ue pIicant understands and will comply
with all non -point source regulat s pert e Cupertino Municipal Code, Section
9.18.
Signah►r Date Z` t �- I e
RE -ROOFS:
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. 1 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(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 anagement District I
performance of the work for which this pen -nit is issued.
will maintain compliance with the Cupertino nicipal ode, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code�Section 5505, 5 and 2 534. 4Section
3700 of the Labor Code, for the performance of the work for which this
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 constriction 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 constriction, 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
4
RhA
CUPERTlt-IO'
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 T ORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • build! no a cupertino.org
PT-TiNMINCT L
ELECTRICAL
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LICENSE NU? OBER
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USE OF or DUPLEX ❑ muLTI-F.4h,jLY PROJECT IN PITT T)LA ND ❑ YES PROTECT LN EL YES
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By my sigoaatw-e below, I ee4i y to each of the following: I a� the prop= , OwDe or authorized agent to act on the property owner's be h I have read this
application and the information I have provided is c rrect. 1122)x rea '
e. Descr' tion of \�rak and verify it is accurate. I agree to comply with all applicable local
crdlnznces and sate laws relati -g to building cons . c Jon. to enter the above -identified property for inspection purposes.
ZOH2��upeftino
Signature of Applicant/Agent:
Date: (Z- (' (c-
SL-PPLEh6ENTAL L\TFORvATIOI\ R.F' U
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.AllEPAI-isc.4vp_2011. doc revised 06121/11
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 7623 Orange Blossom Dr
DATE: 12/11/2015
REVIEWED BY: Phuong
APN: 36611079
BP#:
*VALUATION: 1$10,400
*PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION FURN/AC
PERMIT TYPE: A
WORK
Replace furnace and supply duct at same location.
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
Furnace, Forced -Air
1 MFR=<l 00
1
#
$143
Mech. Plan Check 10.0 1 hrs $0.00 "'hec
Mech. Permit Fee: IMPERMIT P-Iv-fnii 1'ee:
Other Mech. Insp.L 06�,.v- Pho;6 Ll
Fo ohrs $48.00 l
E'Iec'. b1sp. fee:
10TE.- This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). 1hese-lees are based on the preliminary information available and are only an estimate Contact the Deptjor aaanl info.
FEE ITEMS (Fee Resolution 11-053.&JL7,11113)
FEE,
QTY/FEE
MISC ITEMS
1"kan ("'heek"
PME Plan Check:
$0.00
PME Unit Fee:
$143.00
PME Permit Fee:
$48.00
Administrative Fee: JADAIIIN
$45.00
Work Without Permit? 0 Yes (D No
$0.00
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: IBSEISMICR
$1.35
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
.
$28635
$0.00 TOT t.'FEE:
$286.35
Revised: 10/01/2015
ALTERATIONS - HVAC I ` Print __� Clear Form
CEC-CFIR-ALT-04-E (Revised 06/14) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF111-ALT-04-E
Alterations - HVAC CZ 2, and 8-15 (formerly CF -IR -ALT -HVAC) (Page 1 of 1)
C t,JVq yr V :\A0
Site Address: 7623 ORANGE BLOSSOM
Enforcement Agency:
Date Prepared:
(2-1 45
Permit#:
City of oto?
t
Equipment Type
Equipment Efficiency
New Ducting, Plenums, Lineset.
Conditioned
Thermostat
Required R -value
Floor Area (sq ft)
❑ Packaged System
❑ Evaporator Coil
.96 AFUE
COP
❑ R-6 (CZ 2, 8-13) Ducting
Served by system
0 Setback
❑ Split System
❑ Condensing Unit
10 R-8' (CZ 11, 14,15) Ducting
sgft
(if not already
❑ Mini Split
❑ Compressor
SEER
HSPFpresent,
❑ R-6 (all CZ s) Plenums
must
®Furnace
®Lineset
11R-5 or R7.5) Lineset"
be installed)
10 TXV
EER
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.
01. HVAC Changeout/Repair
Required Compliance Documents to be left on site for Final:
All Equipment,
CF1R-ALT-02-E
Condenser Unit, Evaporator Coil,
CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24)2 -HERS, MECH-25-HERS2
Compressor, TXV, Lineset,
CF3R: MECH-20-HERS, MECH-(23 or 24) -HERS', MECH-25-HERS1
Air Handler/Furnace' (Can include new ducting)
Installer Requirement: Duct leakage (:<_15%, , or < 10% to outside, or seal all accessible leaks), Air Flow 2--300 CFM/ton, Refrigerant Charge.
Exempted from duct leakage testing if:
101. Duct system registered with HERS provider as previously sealed, or 1Z2. 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'
CFI11-ALT-02-E
including Mini Split
CF2R: MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS', MECH-25-HERS'
CF3R: MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS', MECH-25-HERS'
Mini Splits require CF111-ALT-02-E, CF2R-MECH-01, and (CF2R-CF3R) MECH-25-HERS
Installer Requirement: Duct leakage < 6%, Fan Efficacy (.58W/CFM), Air Flow >_ 350 CFM/ton (or alternative), Refrigerant Charge
❑ 3. All New Ducts with Replacement Required Compliance Documents to be left on site for Final:
All New Ducts3 and one or more of the following CFIR-ALT-02-E
replaced: Condenser Unit, Evaporator Coil, CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS
Compressor, TXV, Lineset, Furnace' CF3R: MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS
Installer Requirement: Duct leakage < 696, Air Flow >_ 350 CFM/ton (or alternative), Refrigerant Charge
Exempted from duct leakage testing if: ❑ 1. Existing duct systems are constructed, insulated or sealed with asbestos
❑ 4. New Ducting over 40 feet I Required Compliance Documents to be left on site for Final:
New ducting but less than All New Ducts3 I CFIR-ALT-02-E, CF2R: MECH-20-HERS, CF3R: MECH-20-HERS
Installer Required to: Duct leakage (:S_15% or, < 10% to outside or, or seal all accessible leaks)
❑ EXCEPTION: Existing duct systems 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.
2 Heating only systems and Air Handler/Furnace changes do not require Air Flow MECH-(23 or 24), or Refrigerant Charge verification MECH-25
3 All New Ducts is when at least 75 percent of the duct system is 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 handier, coil, plenums, duct material)
4 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%", 3.5 to 4T-2%", 5T -4W
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 this ertificate of Compliance are consistent with the information
provided on other applicable compliance documents, workshee , calcul ions, plans and specifications submitted to the enforcement
agency for approval with this building permit applica on.
Responsible Designer Name:
Responsible Desi er signal
Date Signed:
«—l(
License:
1966809
BRAD GENTILE
—1
Company:
Address:
/State/Zip:Phone:
A-1 HEATING & COOLING
475 W. TAYLOR ST.
SAN JOSE, CA 95710
408-283-9915
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300