B-2016-1756 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1756
19916 PRICE AVE CUPERTINO,CA 95014-3339(369 04 028) A&H HEATING&AIR
CONDITIONING
SERVICE INC
SAN JOSE,CA 95110
OWNER'S NAME: Mr&Mrs EDMOND YIUMAN AND ADA PUI-YEE LEUNG DATE ISSUED:04/13/2016
OWNER'S PHONE:408-373-0909 PHONE NO:(408)279-0722
I ICFNSED CONT TOR'S DECLARATION BUILDING PERMIT INFO:
License Class WARM-AIR HEATING VENTILATING AND AIR- ONDITIONING
Lic.#304472 X BLDG —ELECT _PLUMB
&
Contractor &H HEATING AIR CONDITIONING SERVICE INC Date X_MECH X RESIDENTIAL_COMMERCIAL
05/31/2017
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing JOB DESCRIPTION:
with Section 7000)of Division 3 of the Business&Professions Code and that my REMOVE AND REPLACE DOWNSTAIRS HVAC SYSTEM IN SAME
license is in full force and effect. LOCATION.
I hereby affirm under penalty of perjury one of the following two declarations:
I.. 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
erfbrmance of the work for which this permit is issued.
have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation $4975.00
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION APN Number: Occupancy Type:
I certify that I have read this application and state that the above 369 04 028
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 PERMIT EXPIRES IF WORK IS NOT STARTED
inspection purposes. (We)agree to save indemnify and keep harmless the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
City of Cupertino against liabilities,judgments,costs,and expenses which
may accrue against said City in consequence of the granting of this permit. 180 DAYS FROM LAST CALLED INSPECTION.
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18.
Issued by:SEAN HATCH
Date:04/13/2016 � C� Z
Signature ;,®e ,NeW d. Date 4-13-16
OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of the installed without first obtaining an inspection,I agree to remove all new materials for
following two reasons: inspection.
1. 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 Signature of Applicant:
sale(Sce.7044,Business&Professions Code) Date:4-13-16
z. I,as owner of the property;am exclusively contracting with licensed
contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three declarations:
i. 1 have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will
2. I have and will maintain Worker's Compensation Insurance,as provided for by maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Section 3700 of the Labor Code,for the performance of the work for which this Health&Safety Code,Section 25532(x)should I stare or handle hazardous
permit is issued. material. Additionally,should I use equipment or devices which emit hazardous
3. I certify that in the performance of the work for which this permit is issued,I 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
Owner or authorized agent:
Labor Code,I must forthwith comply with such provisions or this permit shall C Date:4-13-16
be deemed revoked. f CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION 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 Lender's Name
relating to building construction,and hereby authorize representatives of this city
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Address
to save indemnify and keep harmless the City of Cupertino against liabilities,
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 I understand my plans shall be used as public records.
and will comply with all non-point source regulations per the Cupertino Municipal
Code,Section 9.18. Licensed
Professional
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
10300 TORRE AVENUE.CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•buildinciOcuoertino.ora -�U1 MISC
176(0
PLUMBING 1JIMECHANICAL ELECTRICAL DMISCELLMSMOIUS
PROJECT ADDRESS a Q ��,Fl//� 4 /�
i it& atce- Ave. APN# 5(~ 0 • V2
OWNERNAME PHONE
STREET ADDRESS 1 f Q //`(v t t� CITY, TATE,ZIP -sn;i FAX
CONTACT NAME t PHONE EMAIL
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STREET ADDRESS l� CITY,S TE ZQ F
13 OWNER 11OWNERBUIMER 1:1 OWNER AGENT Voc'oNuACTOR OcoNRACTORAGENT 13 ARCHITECT ❑ENGINEER CI DEVELOPER ®TENANT
CONTRA ... LICENSE EA LICENSE D BUS.LIC#f 2y `
COMPANY NAME ... E-MAIL
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L.af cam[.-C� `.
STREET ADDRESS CITY,STATE,ZIP Pg-pNE
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF EKED or DUPLEX MULTI FAMILY PROJECT IN WUMAND 0 YES -=FLOODZ
❑n�YES ISTHEBLDGAN ®YES
BUILDING ❑COMMERCIAL URBAN INTERFACE AREA O W-V EICHLER HOME?
DESCRIPTION OF WORK
TOTAL VALUATION: ItEC$IVEDY
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
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
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of ApplicantlAgent: Date:
SUPPLEMENTAL INFORMATTON REQUIRED u
xot 14'j AYDAII e
r
MEPMiscApp 2011.doc revised 06121111
CERTIFICATE OFCOMPLIANCE CF1R-ALT-02=E
Alterations to Space Conditioning Systems(formerly CF-IR-ALT-HVAC) (Page 1 of 3'
Project Name: 1991.6 Price/LEUNG Date Prepared: 2016-04-11
A.General Information
MR-ALT-02 Js applicable to multiple space Conditioning systems contained within a single dwelling unit.When multiple dwelling units must be,documented,
use one CFIR-ALT 02 document for each dwelling unit.
01 Project Name 19916 Price/LEUNG, 02 Date Prepared 2016-04-11
03 Project Location 19916 Price Ave 04 Building Type Single family
05 CA City Cupertino 06 Dwelling Unit Name 19916 Price/LEL1NG
Dwelling,Unit Conditioned
07 Zip Cade 95Q14 08 Floor Area(ftZ) 3112
Number of space conditioning
09 Climate zone 4 V 10 (SC)systems In this dwelling 2
unit.
m
B.Space Conditioning(SC)Systelnforrnation
a
01 02 J03 04 ' 05 p6 07" 08 09 10
k
is the SC�� Installing a
A
SC System SC System GFA served systema'. refrigera t Installmg`new SC Ir s>ralUng Insxaliing tnstalling
Identification or Location or Area b thin SC ducted'` containing system _ more y `g y e than 40 entirely new entirely new
Name Served System(ftZ) system? component? components? feet of ducts? duct system? SC system? Alteration Type
System 1 Downstairs 1550 Yes Yes Yes No No No Altered space
conditioning system
System 2 Upstairs 1562 Yes Yes Yes No No No Altered space
conditioning system
C.Extension of Existing Duct System,Greater Than 40 Feet(Section150.2(b)1Diib)
This section does not apply to this project..
Registration Number:216-A0134883A-000000000.0000 Registration Date/Time: 2016-04-1120:30:15 HERS Provider:CalCERTS
CA 3u lding Energy Eff iciency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-04-11 20:29:45
Schema Version:0.555SDD
CERTIFICATE QF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems(formerly CF-1R-ALT HVAC) (Page 2.of 3)
D.Altered Space(Conditioning System(Sections 150.2(b)1E and F)
01 02 03 04 05 +06 07 0$ 09 1.0 11 12
Heating Cooling
System Heating Altered Heating Minimum Altered Cooling Minimum Required New or
Identification System Pleating 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
No heating This field or This field or Central split All new This field or This field or
System 1 furnace component section is not section is not AC cooling SEER 14 Setback section is not section is not
alteredapplicable applicable components applicable applicable
No heating This field or This field or No cooling This field or This field or This field or This field or
System 2 Central gas component section is not section is not Central split component section is not section is not Setback section Is not section is not
furnace altered applicable applicable AC altered applicable applicable applicable applicable
R9uired Documentation:
CF211-MCH-01-E-Space Conditioning systems Ducts and Fans;
Duct insulation requirement for new ptenums R6."
CF2R-MCH-20-H&CF3R-MCH-20-H Duct Leakage testing required when heating or cdolmg°components are installed in ducted systems,or when more than 40 ft of duct length is replaced.
-Leakage rate compliance:5159%,or:5 10%leakage to outside,or seal ail accessible Jeaks.
CF2R-MCH-25=H&CF3R-MCH-25-H Refrigerant Charge Verification required whenrrefrigerant containing components'are nstalled,or altered,,(applicable in CZ 2�8-15).
.
CF2RCF3R-MCH-23&CF3R-MCH23 Air Flow z 300 CF,MJton requireowhen MCN-25 is required
EXceution5:.
-Duct systems registered with HERS provider as previously sea a are exempt fron; 20 Dgct Leakage�Testing requirements 1.'
-Heating-only systems and Air Handler/Furnace changes do not require'verification of Air Flow MCH,23,or Refrigerant Charge MECH 25
'
irements:xeequ-Existin duct systems constructed,insulated or sealed with asbestos are`empreTi
E.Entirely New or Complete replacement Duct System,with or without Equipment Changeout(Sections 150.2(b)1,Diia 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,216-A0134883A-000000000+0000 Registration Date/Time: 2016-04-11 20:30:15 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-04-11 20,29:45
Schema Version;0,555SDD
CERTIFICATE OF COMPLIANCE CFIWAI.T*q411;
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:
Phelps,Dale
Company: Signature Date:
A&H BEATING&AIR CONDITIONING SERVICE INC 2016-04-1120:30:15
Address: CEA/HERS Certification Identification(if applicable):
770CHESTNUT STREET
City/Stale/Zip: Phone:
SAN JOSE CA 95110' 408-279-0722
Responsible Person's Declaration statement',k
I certify#he following'under penalty of perjury,under the laws ofthe State of California:
1. The information provided on this Certificate of Compliance is:true and correct.
2. l am eligible under Division 3`of the Business and Professions Code to accept,ratoonsibiilty 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 h of the California Code of Reg"ulations.
4. The building design features or system,design features identified on this Certificate of Compliance are consistent withthe information provided on other applicable compliance documents;worksheets,
calculations,plans and specifications submitted to the enforcement agency for"approval with this building permit application',
S. l wilf ensure that a registered copy ofthisGertificate of Compliance shall,be m dQ available with file building permit(sl issued for fhe,buildhi ,and,made available;tothe„i?nforcement agency for all applicable
g Compliance-is requirgd to be included with the documentatlor.th2Wider provides to the building owner at occupancy,
mspectaons.l understand that a re istered copy of this•Certificate of Cq y � ,
Responebie Designer Name: , 77Responsible Designer Sii)nature:
Phelps,Dale
Comparpv,: Date Signed:
A&H'HEATING&AIR CONDITIONING SERVICE INC 2016-04-1120:30:15
Address License:
770 CHESTNUT STREET 304472
City/State/Zi
P. Phone: .
SAN JOSE CA 95110 408-279-0722
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-A0134883A-000000000-0000 Registration pate/Time: 2016-04-1120:30:15 HERS Provider:CaICERTS
CA sulding Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-04-11 20:29:45
Schema Version:0.555SDD
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCFIL E
COMMUNITY DEVELOPMENT DEPARTMENT.BUILDING DIVISION
� � RL er�
10300 TORRE AVENUE•CUPERTINO,GA 95014-3255
(408)777-3228• FAX(408)777-3333 building(a.cupertino.om
� Q •Zbtt�-17
r1.d ess #o ►s � 'R : 77
b •_
CURT MAQ
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 larms 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 SMDke Alarms and/or Carbon
Monoxide Alarms be installed in the following locations:
AREA SMOKE LLARM CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the X X
bedroom(s)
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 shallcomply 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 ceih-ng finishes or there is no,access by mean 3 of attic,basement or crawl
space.Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2.An ele trical 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)refe enced above has/have been
installed in accordance with the manufacturer's instructions and in compliance w Ith the California Building
and Califonua Residential Codes.The alarms have been tested and are operational, as of'the date signed
below.
1 have read and a .,ee to con 1:with the terms and conditions of f:is,statement
........... 63a1
_ i na(u e wLrc .............. ....4...� ....................
WATER-CONSERVING PLUMBING FIXTU IES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISIC N
GUPERTtIdO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
D&L4*777.--33228• AX 08)777-3333•buildin4na cupertino.org Q r-/
Owner Name W�fJ�1 Il��i�'` Permit N �J 17 y t�
Address l Le VVV Cc
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.fo and sign bottom of form.
No Go to Question 2.
2. Does your real property have a licensed plumber certifying that,due to the age or configurai ion of the property or its
plumbing,installation of water-conserving plumbing fixtures is not technically feasible? ;
Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
❑ The licensed plumber's certification has been provided to the Building Divisi n.
Skip the rest of the form and sign bottom of form.
No Go to Question 3.
3. Is water service permanently disconnected for your building?
El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the fo and sign bottom of fonn.
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.
Yes My real property is built and available for use or occupancy on or before January 1, 1994.
5.WCivil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign
bottom of form..
VPleacheek ONE of the following:perty is a singlefamily residential real property. See Civil Code Section 1101.4.
after January 1, 2014,building alterations or improvements shall require all no compliant plumbing fixtures
placed with water-conserving plumbing fixtures throughout the building.On orb fore January 1,2017,all non-
compliant plumbing fixtures shall be replaced with water-conserving plumbing futures (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 requir 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 wid. water-
conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or
improvements).
Cl My property 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 replac d with water- conserving
plumbing fixtures throughout the building(regardless of whether property undergoes alterations or unprovements)..
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 1101.8,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 equirements as indicated in the
table on the following page.
Owner or Owner Agent's Signature: Date-6--z
Upon completing and signing this Certificate,please return it to the Building Divisi,n in ord r to final your building permit.
SB407 2015.doe revised 08126115