B-2016-1203CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1203
10846 S BLANEY AVE CUPERTINO, CA 95014-4544 (369 23 048)
( RESCUE AIR SERVICE
INC)
SAN JOSE, CA 95120
OWNER'S NAME: WONGZHEN
DATE ISSUED: 01/19/2016
OWNER'S PHONE:
PHONE NO:
LICENSE]) CONTRACTOR'S DECLARATION
BUILDING .PERMIT INFO:
Lic. # ' ;? ,'ZO
License Class
Contractor ( RESCUE AIR SERVICE INC) Date t! V(A/'
X BLDG —ELECT —PLUMB
X MECH X RESIDENTIAL _ COMMERCIAL
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.
JOB DESCRIPTION:
Revise furnace and ducts. Add new AC unit at rear.
I hereby affirm under penalty of perjury one of the following two declarations:
n. 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.
(ir2. 1 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
Sq. Ft Floor Area:
Valuation: $10050.00
this permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
Number:
Occupancy Type:
information is correct. I agree to comply with all city and county
369 23 048
3 69
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
PERMIT EXPIRES IF WORK IS NOT STARTED
expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally, the applicant understands and will
comply with all non -point source regulations per the Cupertino Municipal
180 DAYS FROM LAST CALLED INSPECTION.
Code, Section 9.18.
Issued by: ,tq�0 w�—
I / �-
Signature ��t�— Datooyl 04(' t (F
Date:
OWNER-BUTLDER DECLARATION
RE -ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of the
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
following two reasons:
t. I, as owner of the property, or my employees with wages as their sole
inspection.
compensation, will do the work, and the structure is not intended or offered
for sale (Sec.7044, Business & Professions Code)
Signature of Applicant:
2. I, as owner of the property, am exclusively contracting with licensed
Date:
contractors to construct the project (Sec.7044, Business & Professions Code).
ALI, ROOF COVERINGS TO BE CLASS "A" OR BETTER
I hereby affirm under penalty of perjury one of the following three declarations:
r. 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
HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued.
I have read the hazardous materials requirements under Chapter 6.95 of the
z. I have and will maintain Worker's Compensation Insurance, as provided for
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
by Section 3700 of the Labor Code, for the performance of the work for which
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(x) should I store or handle hazardous
this permit is issued.
3. I certify that in the performance of the work for which this permit is issued, I
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
shall not employ any person in any manner so as to become subject to the
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
Worker's Compensation laws of California. If, after making this certificate of
the Health & Safety Code, Sections 25505, 25533, and 25534.
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
Owner or authorized agent,*
be deemed revoked.
Date: l l(
APPLICANT CERTIFICATION
` CONSTRUCTION LENDING AGF,NCY
I hereby affirm that there is a construction lending agency for the performance
I certify that I have read this application and state that the above information is
of work's for which this permit is issued (Sec. 3097, Civ C.)
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
Lender's Name
to enter upon the above mentioned property for inspection purposes. (We) agree
to save indemnify and keep harmless the City of Cupertino against liabilities,
Lender's Address
judgments, costs, and expenses which may accrue against said City in
ARCHITECT'S DECLARATION
consequence of the granting of this permit. Additionally, the applicant
understands and will comply with all non -point source regulations per the
I understand my plans shall be used as public records.
Cupertino Municipal Code, Section 9.18.
Licensed
Professional
Signature Date
CUPERTINO
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • build ingr7a.cupertino.org
LPLUMBING LMECHANICAL LELECTRICAL LMISCELLANEOUS
PROJECT ADDRESS �+ , / APN # �, j
OWNER NAME PHONE' pin E-MAIL
STREET ADDRESS CITY, STATE, ZIP C LLAX
CONTACT NAME C PHONF, dd E-MAIL
-�1�ceCf'�'�'(,
STREET AD12USS _ _ r CITY, STATE, ZIP ^ s �� T `� FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT .N CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER LICEN�-ETYPE BUS.LIC#� ($� kS0
COMPANY NAME C E-MAI��SC C �C Ili'� ` L% FAX
STREET ADDRESS j9i ��) ®�.• �p CITY, STATE, ZIP /ems Isk-2-t PHONE
ARCHITECT/ENGINEER NAME J� LICENSE NUMBER } HUS. LIC #
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY, STATE, ZIP PHONE
USE OF ❑ SFU or DUPLEX ❑ MULTI -FAMILY PROJECTIN WILDLAND ❑ YES PROJECT IN ❑ YIS IS THE BLDG AN ❑ YES
BUILDING: ❑ COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO EICHLER HOME? ❑ NO
DESCRIPTION OF WORK �e 9 �A ` � f� '� � tNS
TOTAL VALUATION: � 4 0 �� I RECEIVELSI
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
ription of Work and verify it is accurate. I agree to comply with all applicable local
application and the information I have provided is correct. I have read the Desc
ordinances and state laws relating to building cons • ction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date: 6j
SUPPLEMENTAL INFORMATION REQUIRED oFr�Ic> us>ovY'
U
❑ owR TILE -COUNTER
a
❑ EaPRBSS' F
❑ STANDARD
❑ LARGE
❑ MAJOR'
MEPMiscApp_201l.doc revised 06/21/11
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC)
Project Name:
Zhen WongI Date Prepared:
CF1R-ALT-02-E
(Page 1 of 3 )
2016-01-18
A. General Information
CHR -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.
O3
Project Name
Zhen Wong
02
Date Prepared
2016-01-18
03
Project Location
10846 S. Blaney Ave
04
Building Type
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
1
SC System a
.i SC System j
CFA served
08
Dwelling Unit Conditioned
1176
07
Zip Code
95014
Floor Area (ft2)
location or',Area
bythis�Gb
ducted
containing
system
Number of space conditioning
entirely new
09
Climate Zone
4
30
(SC) systems in this dwelling
1
component?
components? ".
feet of.ducts?
duct system?
unit.
Alteration Type
B. Space Conditioning (SC) System Information
O1
02
03
04
05
06
07
08
09
30
r Is the 5C
installirj`g a
SC System a
.i SC System j
CFA served
system a
refrigerant
Installing new SC
Installing
Installing
Installing
Identification or
location or',Area
bythis�Gb
ducted
containing
system
more than 40
entirely new
entirely new
Name
Served
System (ft2)
I system?
component?
components? ".
feet of.ducts?
duct system?
SC system?
Alteration Type
r
"E
Entirely new or
System 1
m
GARAGE
1176
Ye
Enemy
Yes
Y
Assoc
Yes
iad
Yes
Yes
complete
replacement space
. .
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section15O.2(b)1Diib)
This section does not apply to this project.
Registration Number: 316-A1019028A-000000000-0000 Registration Date/Time: 2016-01-18 22:11:09 HERS Provider: USERA
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2016-01-18 22:13:08
Schema Version: 0.555SDD
i
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 2 of 3 )
D. Altered Space Conditioning System (Sections 150.2(b)IE and F)
This section does not apply to this project.
E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)lDiia and 150.2(b)lE, F)
This section does not apply to this project.
F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)lC)
01 02 03 04 05 06 07 08 09 10 11
Heating Cooling
System
Heating
Minimum
Cooling
Minimum
Required
Identification or
Heating System
Altered Heating
Efficiency
Efficiency
Cooling
Altered Cooling
Efficiency
Efficiency
Thermostat
New Duct
Name
Type
Component
Type
Value
System Type
Component
Type
Value
Type
R -Value
Central gas
All new heating
FAFUE
Central split
All new cooling
SEER
14
SetbackTher
R-6
System 1
furnace
components
96.00
AC
components
mostat
Required Documentation.
,
CF2R-MCH-01-E - Space Conditioning Systems Ducts and Fens
-Duct insulation requirement for new plenums R6
CF2R & CF311-MCH 20 H Ouct Leakage 4eriflcation tequired
-Leakage rate complialce :k 6% i
CF2R & CF3R-MCH 22�6'n�Efficacy Venf tatibn
'
CF2R & MR -MCH -23,446 Air Flow,R2t9 Verdlcotl,on
-Compliance: Fan Efficaqy SQ 58 ViY/cfm end Sysfern;Airflgw X350 cfm/ton ' '"'-. .
MCH
-Alternative Compliance: CF2R kkF3R=MCH-28 Returnv0uctci, on Veriflcatlon'is an alternative to MCH -22 and -23 verification. - - `-
CF2R & CF3R-MCH-25-H Refrigerant Charge Verification required when
rEUe amt co ta' i p ne t ,a i Iled q(�a red,(�gglFtab rye 8-15J.
Exceotians:
7>. , #1 r°a"t'
Heating -only systems are exempt from the 0.58 W/cfm and 350 cfm/ton
requirements.
Note:
An "entirely new or replacement duct system" means 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 handler, coil, plenums, duct material) if the reused parts are accessible and can be sealed to prevent leakage
Registration Number: 316-A1019028A-000000000-0000 Registration Date/Time: 2016-01-18 22:11:09 HERS Provider: USERA
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2016-01-18 22:13:08
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:
James Kim
Signature Date:
Company:
Rescue Air Service Inc.
2016-01-18
Address:
CEA/ HERS Certification Identification (if applicable):
6007 Majorca Ct
826201
City/State/Zip:
Phone:
San Jose CA 95120
408-655-9916
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 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 ensure that a registered copy of this Certfficateof Compliagce shall, be made available with the;bpilding permits) issued for the building, and made available to the enforcement agency for all applicable
'ertif[cate;of 'Uffed'tobeln'tivcled,with
inspecUorts`i.rinderstand tF�ata registered copyhf ti fS Compliance is re the docymelttation the builder provides to the building owner at occupancy.
Responsible Designer Name:
Respohsible Designer Signature. r{.y ....,. ��
lJ�1l�
James Kim s
_.__.._.. ..._.-.-._______....
Comparry + .,
P Y
Rescue Air Service ltle k�
Date Signed:. - -
2016 01-1$
Address:
U.S. Ener°
License:
license:,
i
ssodation
6007
6007 Majorca Ct
City/State/Zip:
Phone:
San Jose CA 95120
408-655-9916
T f _E
FJ � J=r.��r�g Potu A�:c3a:cf�aa-a
Registration Number: 316-A1019028A-000000000-0000
-This digital sign ature.is provided in, order to secure
the content of this ragistered doc"umerit; and iii no
wayinipiles Registration Providsrrospbnsibiglyfor
the accuracy of the information.°
Registration Date/Time: 2016-01-18 22:11:09
HERS Provider: USERA
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2016-01-18 22:13:08
Schema Version: 0.555SDD
Google Maps
Google Maps 10846 S. Blaney Ave Cupertino CA 95014
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Page I of I
***A/C ADD ON
CUPERTINO
Building Department
JAN 19 2016
REVIEWED FOR CODE COMPLIANCE
Reviewed BY:
httDs://www.izooiale.com/mai)s/0,37.-'1106617,-122.0228921,21Z 1/18/2016