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16010024CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 10171 PARLETT PL OWNER'S NAME: LI HONGYU AND LIU CHUNMEI CONTRACTOR: O �s A-/2 I PERMIT NO: 16010024 DATE ISSUED: 01/05/2016 OWNER'S PHONE: 4082306929 1 . I PHONE NO: bdffl LICENSED CONTRA,CQTOR'S DECLARATION License Clas Lic.#/ _3 � 6 0 Contractor piy (y- (�E`� D to 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: re and will maintain a certificate of consent to self -insure for Worker's ompensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 permit is issued. APPLICANT CERTIFICATION 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 o save indemnify and keep harmless the City of Cupertino against liabilities, �u to , costs, and expenses which may accrue against said City in consequence of the G granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature/ Date 6 ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 performance of the work for which this permit is issued. 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 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] REPLACE (E) FURNACE, SAME LOCATION Sq. Ft Floor Area: I Valuation: $1450 APN Number: 31626048.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN180 DAYS IT. ISSUANCE OR 180 DAY LAS LLED INSPECTION. ssue RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed withoutfrst obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 12 and the Health & Safety Code, Secti ,rts 25505, 255 , and 25534. Owner or authorized agent Dat CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional GENERAL PERMIT APPLICATIONMEP COMPJUNI TY DEVELOPh/SEN T DEPARTMENT •BUILDING DIVISION 10300 T ORRE: AVENUE. CUPERTINO, CA 9501A 3255 (408) 777-3228 •FAX (LOS) 777-3333 • buildino0cuoetno.org®/o0� SUP: RT[t`i©- - M 1 ❑ PLU)1 ,3 C, MECILAYICAL ❑ ELECTRiCA-L ❑ IA/aSC.ELLA?��OUS PRorrcT ADDP�ss /!?z—f�Y �`C� � I `�'•` - � ` � ' � r � �� r � � yjL P'r'.0?�� � � � 1✓ t.�Z r I�� L,2111 ST?tEETlJDRE .. q2 CITY, STAT=,ZIP I +, t F::X CO'N'TACT MME 'Z—/ I PHO � � E•I✓_tom Q/v V / STr2' i A DDP SS da / Q� e c CITYIT. r _, ZIP .. . © ❑ OFA,=Z OVr,`?-3U T1� ❑ ORr nG= I ❑ COh7 _ACTOR ❑ COI,-? 1,CTOR AGM�T ❑ ?.RC -TjECi ❑ G1 =tZ ❑ D=1 tL0?=Z ❑ is Sn� CONTRA.CTOR''A],=E ze— LIC = I LICA PH I BUS.LiC- C� COl✓�PA1Y 7 kI� VC ,v1 9--Q— E•MAiZ (0 o C e-�./ (/(llIIO ((f r A STREET F&DitE +;� I � v, ST.k , Zip � P� <?2C'r77 CT �t Gi? SER TA1J I LICENSE '�%T_7I+43ER BUS. LIC COMMNY : AIS• E-'\ kM FAX STRE:1 ADDRESS I CITY, STATE, Z?P I PHONE USE OF ❑ SEEDor DT PL El?✓L'LTI-FAumx . PROTECT P, W LAND ❑ Y?S ?RO _CT L' ❑ ti�5 S 1 BLDG ANT E3 ti S B u-T?)Ll\'G: ❑ C0]'0' -7- cLA_T. I L?3 A?,' L Ti=RrACE A.RE4 ❑ NO FLOOD ZONE ❑ I:'0 HOME -1 ❑ ?.'0 D-ESCP.IPTIOhT OF GrORKr � � S i rA e -- TOTAL VALUATI00 By my signature below, Ice if,/ to each of the foilowing: lam the arope_-iy owner or authorzed a t o act o e - _ mer's behalf. I ha` e read this application and Le Lnfo=ation I have provided is co_,ect. I have read the Description of )Work and ve.. '� _ accu ate. 1 zg-ee to compl_y;; ith zll aaalicable local ordinances and state'?ws relating to bu ldi g nstruc i `i. I au hone representatives of Cope, no to enter he above -id iced propel+ for nspec ion pu noses. Sig-atcre )� of Applicgnt/Agent: STj ? _?\ i�I� 1,� LN FORvIATIO?t REQL! �r D s' OV£I ZPTF COTi�T�Maim _ S Z 1 1JE?2ol'isc•%vp_?011. doc revised 06/21/11 CITY OF CUPERTINO VM -1 FEE ESTIMATOR - BUILDING DIVISION IAADDRESS: 10171 PARLETT PL DATE: 01/05/2016 REVIEWED BY: MELISSA N I APN: 6 26 048 1 BP#: *VALUATION: 1$1,450 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: --FP—ENTAMATION I PERMIT TYPE: FURN/AC WORK REPLACE (E) FURNACE, SAME LOCATION SCOPE Mech. Plan Check 0.0 1 hrs $0.00 Phuwb� Ilion (Jivok Elle, ;,P!an {.`/81111;* IMech. Permit Fee: JAIPERMIT A,'ionh, Other Mech. Insp. 0.0 1 hrs $48.00 Othl-v- I'la.wb fr-sY4 hl -;. T- ,.,: Phwnb. 1jisi;k `c'c: x;£t. F£,T-: VOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). Thesefees are based on the preliminary information available and are only an estimate. Contact theDept,for aaan't info. FEE ITEMS (Fee Resolution] 1-053 L -d.' 7/ 1/131 FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 I -Tee PME Unit Fee: $143.00 PME Permit Fee: $48.00 W, on f's XV: Administrative Fee: (ADMIN $45.00 Work Without Permit? 0 Yes 0 No $0.00 ry Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select all Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: -TOTAL FE $0.00 T T, $285.50 Revised: 10/01/2015 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 -IR -ALT -HVAC) (Page 1 of 1) Site Address: Enforcement Agency: Date Prepared; Permit#: () Erle �� o Grr rzr �o 11-t-11C)IL Equipment Type Equipment Efficiency New: Ducting, Plenums, Lineset Conditioned Thermostat Required R -value Floor Area (sq ft) ❑ Packaged System ❑ Evaporator Coil O&FUE COP FTR-6 (CZ 1,3-7) Ducts Served by system ❑ Setback ❑ Split System ❑ Condensing Unit SEER ❑ R-8' (CZ 16) Ducts W sq ft (If not already ❑ R-6 (all CZ's) Plenums \ present, must -mrHSPF Furnace El Lineset EER ❑ R-5 or R7.5 Lineset' be installed) HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. Atp'emitsapplicatlomthisr o� rmBls�allowed�to�bE=fPfleh# 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: Can 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, o4 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-.... I ❑ 2. New HVAC System Required Compliance Documents to be left on site for Final: All new equipment and All New Ducts' CF111-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 >_ 350 CFM/ton (or Standards Table 150.0-C / D alternative) ❑ 3. 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 >_ 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. ' R-5 (i" 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 -2y.", 5T-4%" 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 permit application. Responsible Designer Name: Responsible Designer ignature: Date Signed: License: c- C� 1 1 g 60(Ifo Company : IL0r �s , lz CAP -C- Address:'City/State/Zip: �?o E� (1v s �N n� yv��) Phone: For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300 653?