1601001801
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21541 COLUMBUS AVE
CONTRACTOR: SERVICE CHAMPIONS
PERMIT NO: 16010018
OWNER'S NAME: ZHONG YI AND ZHANG LEI
7020 COMMERCE DR
DATE ISSUED: 01/05/2016
OWNER'S PHONE: 4088599139
PLEASANTON, CA 94588
PHONE NO: (925) 4444444
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
REPLACE 4 (E) SUPPLY DUCTS
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License Clas v�0 Li,. # l7 O �-f!�
411 ContractoC*?��Oate
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: $2976
performance of the work for which this permit is issued.
ONa 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
APN Number: 35618025.00
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
W T 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
1 C LED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judg s,
costs, and expenses which may accrue against said City in consequence o
l6
granting of this permit. Additionally, the applicant understands and will comp y
Iss y: te:
with all non -point source regula ' s per the Cupertino Municip 1 Code, Section
9.18.
RE -ROOFS:
Signatur •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. 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(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 Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25505, 25533 4.
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Owner or authorized ager ate%t
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
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
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
GENERAL PERMIT APPLICATION! M E
COMMUNITY DEVELOPIdENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 9501A 3255
(L08) 777-3228 • FAX (4-08) 777-3333 ^ buildinola cuceTtino.org
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USE OF ❑SFDorDL-PL= ❑ I,tiLTI-r'AJ,GLY PROY.CTLN WTILT LJ -ND ❑ yzS PROP=CTN ❑ Y=s
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By any signa o e below, I certify to each of the following: I a -m the prope.Ly owner or autborized agent to act on eny Owner -s behalf. I have read this
application and the inform lon I have provided is c I have - a the Description of'Work and verify it is accurate. I agree to compl-y with all applicable local
crd»ances and state laws rela`' u a co _ C tlZ.= =`fares of Cuue:lino to enter the above-identifed propel y for inspection purposes.
Si�—att:re ofApplican /Anent:
Date: f�S�
Lr triENTALT _ MATIONT tZFQU!RtD
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7,�YP.hlisc_/�pp_2011.doc revised 06121/11
CITY OF CUPERTINO
W'- WMA FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 21541 COLUMBUS AVE
DATE: 01/05/2016
REVIEWED BY: MELISSA
APN: 356 18 025
1 BP#:
*VALUATION: 1$2,976
*PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
I
PENTAMATION
I PERMIT TYPE: IRMAID1
WORK
REPLACE 4 (E) SUPPLY DUCTS
SCOPE
Sfuj.�J-L Insf).Fee
Mech. Plan Check 0.0 1 hrs $0.00 llluwb. i'llin Ce. Ph
IMech. Permit Fee: IMPERMIT
10C, Per"ni"
Other Mech. Insp. hrs 1 $48.00 li,,sp- odier h7e,
.Ue,ch. ly.'Sv.
DOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, Schooi
District, etc.). These_ fees are based on the preliminary information available and are only an estimate. Contact the Dept for aaan't info.
FEE ITEMS (Fee Resolution 11-053 gff.71�1113
FEE
QTY/FEE
MISC ITEMS
Plan (..`heck1f`ee,'
'A
F
PME Plan Check:
$0.00
perwil't.",ee:
Sfuj.�J-L Insf).Fee
PME Unit Fee:
$72.00
PME Permit Fee:
$48.00
Administrative Fee: 1ADMIAT
$45.00
Work Without Permit? 0 Yes (j) No
$0.00
Travel Documentation Fee: ITR,4VDOC
$48.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
S
'tlitto 'S
$214.50
00 TOTAL
1 $0.'
$214.501
Revised: 10/01/2015
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 1 of 3 )
Project Name: LEI ZHANG Date Prepared: 2016-01-04
A. General Information
MR -ALT -02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented,
use one MR -ALT -02 document for each dwelling unit.
01
Project Name
LEI ZHANG
02
Date Prepared
2016-01-04
03
Project Location
21541 COLUMBUS AVE
04
Building Type
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
LEI ZHANG
07
Zip Code
95014
08
Dwelling Unit Conditioned
0
SC System
SC System
CFA served
Floor Area (ft2)
refrigerant
Installing new -.SC
11stalling
;Installing
Inst41 alling
Number of space conditioning
Identification or
09
Climate Zone
4
10
(SC) systems in this dwelling
1
entirely new
entirely new
Name
unit.
System (ft2)
B. Space Conditioning (SC) System Information
01
02
System Identification or
Name
New Duct R -Value
System 1
R-6
01
02
03
04 :
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 2 of 3 )
CF211-MCH-01-E - Space Conditioning Systems Ducts and Fans
-Duct insulation requirement for new plenums: R6.
CF213 & CF311-MCH-20-1-1 — Duct Leakage Verification
- Leakage rate compliance: <_ 15%, or 510% leakage to outside, or seal all accessible leaks
Exceptions:
Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH -20 duct leakage testing requirements
D. Altered Space Conditioning System (Sections 150.2(b)1E and F)
This section does not apply to this project.
Registration Number: 216-A0002880A-000000000-0000
CA Building Energy Efficiency Standards - 2013 Residential Compliance
Registration Date/Time: 2016-01-04 14:22:35
Report Version: 2013-1.006
Schema Version: 0.555SDD
HERS Provider: CaICERTS
Report Generated: 2016-01-04 14:22:57
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: j'
Salazar, Barbara
arbara acazar
Company:
Signature Date:
i PERMIT E RATERS
2016-01-04 14:22:35
Address:
CEA/ HERS Certification Identification (if applicable):
31225 La Baya Drive #213
City/State/Zip:
Phone:
West Lake Village CA 91362
818-735-7876
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 orsystem design identified on this Certificate of Compliance conform to the
requirements of Title 24, Part 1 and Part 6 of the California Code of Regutat'r'ons. V ii
4. The building design features or system design features identified on this Certific ate of Compliance are consistent.with the iriformat ,provided on other,applicab 2 compliance documents, worksheets,
.
calculations, plans and specifications submitted to the enforcement;agency for,approvaiwith this building permit a'pplicatiatt.
5. 1 will ensure that a registered co of this Certificate of,Compliance shall be,made avail ble witn-the tiUildiia
g PY g permit(s) issuer) forithtq; uildii g, and Y 6 avatiabie 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 pdilder provides to the building owner at occupancy.
Responsible Designer Name:w•
Responsible Designer signature:
Salazar, Barbara
'Barbara Jalazar
Company:
Date Signed:
ON-TIME AIR CONDITIONING & HEATING INC dba SERVICE CHAMPIONS
2016-01-04 14:22:35
Address:
License:
7020 COMMERCE DR
817040
City/State/Zip:
Phone:
PLEASANTON CA 94588
925-598-1911
Digitally signed by Ca10ERTS. 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 Number: 216-A000288OA-000000000-0000 Registration Date/Time: 2016-01-04 14:22:35 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2016-01-04 14:22:57
Schema Version: 0.555SDD