B-2016-2523 CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: CONTRACTOR: PERMI NO:B-2016-2523
22871 STONEBRIDGE ST CUPERTINO,CA 95014-5639(342 13 032) THUS HVAC
SAN JOSE,CA 95131
OWNER'S NAME: FONG BENJAMIN GIN ET AL DATE ISSUED:08/16/2016
OWNER'S PHONE:408-242-9239 PHONE P b:(408)839-9241
LICENSED CONTRACTOR'S DECLARATION ATION BUILDING PERMIT INFO:
License Class C--20:B Lic.#818268
Contractor THUS HVAC Date 03131/2017 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:
I hereby affirm under penalty of perjury one of the following two.declarations: REPLACE ROOF TOP HEAT P iMP(SAME LOCATION)
I have and will maintain.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.
2: I have and will maintain Worker's Compensation Insurance,as provided for by e
Section 3700 ofthe Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$4500.00
APPLICANT CERTIFICATION
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 APN Number: Occupa y Type:
and state laws relating to building construction,and hereby authorize 342 13 032
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 PERMIT EXPIRES WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS F PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source;regulations per the pertino Municipal Code,Section 9,18. 180 DAYS FROM LAST CALLED INSPECTION.
.Signature Date 8/16/2016 Issued by:Abby Ayende
Date:08/16/2016
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the OF
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. I,as owner of the property;or my employees with wages as their sole installed without first obtaining an it specfion,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature ofApplicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:8/16/2016
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINC S TO BE CLASS"A"OR BETTER
1. 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. HAZARDOUS IATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous mater'als requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Co e,Sections 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cul ertino Municipal Code,Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 5532(a)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material.Additionally,should I u e equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Cod e,, ectio 25505, 5533,an 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. -Owner or authorized agent:
APPLICANT CERTIFICATION ! Date:8/16/2016
certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal '
S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records..
Licensed
Signature Date 8/16/2016 Professional
GENERAL PERMIT APPLICATION mmm E N wpm L
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408),777-3228-FAX(408)777-3333-building(d)cupertino.org
CUPERTINOMISIC
El PLUMBING MEECHANICAL ❑ELECTRICAL ❑MISC LLANEOUS APN �" V
PROJECT ADDRESS / 6 I ,` (✓ C�/moi /°�
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OWNER NAME P�I.Nv E-M.AIL
STREET ADDRESS 15 A �A� CITY,STATE,ZIP FAX
CONTACT NAME �Y6 ��� ggggg9 �q p PHONE �/ /�
�F� FO v V� i s iT G4 v 1 4 E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑ OWNER ❑ OPdNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CON'TRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME e7 of LICENSE NUMBER' %, f t? /? LICENSE TYPE_ BUS.LIC
COMPANY NAMEE-MAIL y ` F g �pL�
% `�!�( V�iLT FAX
STREET ADDRESS �J1�^ CITY,STATE,ZIP PHONE ��
ARCHITECT/ENGINEER NAME / 7
LICENTSE NUMBER BUS.LIC
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF � SED or Duplex ElMulti-FamilyPROJECT IN WILDLAND PROJECT IN
STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ NO
DESCRIPTION OF WORK
TOTAL VALUATION: 4t En�
RECEIVED BY;
".:
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the propertyowner's behalf. I have read this
application and the information I have provide is co ct. I have read the Description of Work and verify it is accurate. I agr e to comply with all applicable local
ordinances and state laws relating to build' ons tion. I autho represe fives of Cupertino to enter the above-identifi A property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED dFFicE vsE ori w'
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ME MiscApp_2011.doc revised 03/16111
ALTERATIONS - HVAC
CEC-CFIR-ALT-03-E Revised 06/14 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF111-ALT-03-E
Alterations-HVAC CZ 1,3 to 7 and 16(formerly CF-IR-ALT-HVAC) (Page I of 1)
Site
Address-0 N)E:R, QJ rSCPif,- Enforcement Agency: Date Prepared: Permit#.
Equipment Type Equipment Efficiency New:Ducting,Plenums,Lineset i Conditioned
Required R-value Floor Area(sq ft) Thermostat
Packaged System 11 Evaporator Coil AFUE COP ❑R-6 (CZ 1,3-7)Ducts Servedbysystem Setback
❑Split System ❑Condensing Unit SEER ❑R-8' (CZ 16)Ducts sgft (If not already
HSPF 0 R-6(all CZ's)Plenums present,must
❑Furnace ❑Lineset EER ❑R-5 or R7.5 Lineset3 be installed)
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options E elow. AYpermit`application-this,
orm`is-allowed Abe fled out=by hand' For final inspection all forms are to be registered(no hand filled formsallowed)and a copy left on site.
13 1.HVAC GFiangeout/Repair Required Compliance Documents to be left on site for final:
Can-include new ducting
All Equipment, CF11-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,5.10%to outside,or seal all accessible teaks)
Exempted from duct leakage testing if:
0 1.Duct system registered with HERS provider as previously sealed,or 0 2.There is less than 40 linear feet of duct in unconditioned
space,or 0 3.Existing duct systems are constructed,insulated or sealed with asbestos(list manufacture date of building 1
❑2.New HVAC System Required Compliance Documents to be left on site for Final:
All new equipment and All New Ducts' CF1R-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)
0 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-MEC-H-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 wil h asbestos.
[14.New Ducting over 40 feet Required Compliance Documents to be left on site for Final:
Adding or replacing ducts in unconditioned CFIR-ALT-02-E
CF2R:MECH-20-HERS
space but less than All New Ducts' 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 wi h asbestos.
'All new ducting R-8 required when more than 40 ft installed and R-6 when less than 40 ft installed. This includ s 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 mat rial.
3 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-4%"
Contractor(Documentation Author's/Responsible Designer's Declaration Statement)
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. I 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 z nd Part 6 of the CCR.
S. 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 su mitted to the enforcement
gency or approval with this building permit application.
Resp-risible D signer Na Responsible Designer Signature: Date Signed: License:
Company: Address: City/State/Zip: ,Phone:
For assistance or questions regarding the Energy Standards,contact the Energy Hotline at:1-800-77 -3300