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B-2016-1261 CITE'OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:13-2016-1261 6398 BLACKWOOD DR CUPERTINO,CA 95014-4617(369 17 046) SHENG 7'Y ONG CUPERTINO,CA 95014 OWNER'S NAME: HSIJ CHAU-WEN AND SHIOW-JTUTRUSTEE DATE ISSUED:03/3112016 OWNER'S PHONE:408-821-9834 PHONE NO:(408)517-9833 LICENSE'D CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTEACTOR Lic.#814019 ContractorSH_NG J YONG Date 10/31/2016 XBLDG _ELECT _PLUMB I hereby affirm that I am licensed under the provisions ofChapter 9(commencing MI;CH X RESIDENTIAL COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: CONSTRUCT ONE STORY ADDITIONS)(718 Q FT);REMODEL I hereby affirm under penalty of perjury one of the following two declarations: EXISTING PORTION OF RESIDENCE(1470 SQ FT),RBROOF(1990 i.have and will maintain a certificate of consent to self-insure for Worker's SQ FT), 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 -9r Section 3700 of the Labor Code,"for the performance of the work for which this permit is issued. Sq.Ft FIoor Area:1436 Valuation:$300000.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above Number: Occupancy Type: 4PNNum Information is correct.I agree to comply with all city and county ordinances 36917046 um Deferred Submittal(R-3),R-3(Custom) and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for Inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORD.IS NOT,STARTED may accrue against said City In consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE®R Additionally,the applicant understands and will comply with all non-point source regulations er the Cupertino Municipal Code,Section 9.18. 1$,g DAB'S FR L INSPECTION. Signature Date 0316 131/20Is b ate:0313112016 OWNER-BUILDRERDEC AR I hereby affirm that I am empt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed,If a roof is 1. 1,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for compensation,will do the work,and the stricture 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 of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:0 313 11201 6 I hereby affirm under penalty of perjury one of the following three declarations: ALLROOF COVERINGS 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 MATERIALS DISCLOSURE 2. I haveand will maintain Worker's Compensation Insurance,asprovided for by I have read the hazardous materials 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 Code,Sections 25505,25533,and 25534. I wlll permit is issued, maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 3. I certify that in the performance of the work for which this porn-at is issued,I Health&Safety Code,Section 25532(a).sbould I store or handle hazardous shall not employ any person in any manner se as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the flay Area Air Quality Management District I Worker's Compensation laws of California. If,atter 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 Code,S tlons 25505,25533 and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall CJ n be deemed revoked. Owner or authorized agent: V APPLICANT CERTIFICATION Date.03/3112016 1 certify that I have read this application and state that the above information is COMTRUCTION LE 'NY 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 L.ender's Address consequence of the granting of this permit. Additionally,the applicant understands ARCHITECT'S.CT'S DF L.RATION and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 1 understand my plans shall be used as public records, Licensed Signature Date 03/3112016 professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT+BUILDING DIVISION 10304 TORRE AVENUE CUPERTINO,CA 95094-3255 �JPERTIN C} (408)777-3228•FAX(408)7773333-bLAdinciftupertino.ora ?,0El NEW CONSTRUCTION M ADDITION ❑ALTERATION 7 TI ❑ REVISION I DEFEUM ORIGINAL PERMIT# PROJECT ADDRESS 670 CT ��aG•hA700d 1)<- APN# ?6 q— /'7-0q(, OWNER NAME f I 1 �'d'�G � �{ / 7LI P O If lv- E-MAIL �a�r'-G�1>°� 1 jet �` � ]/I"�j�s,�-- ��� STREET ADDRESS CITY,STATE,ZIP PAX 035 z 177dieViCA D� T&TM n 'q � � 7S-0 o CONTACT NAME 51'f m/e d»� PHONE_R ,F?1- G� S7" E-MAIL STREET ADDRESS J> CITY,STATE,Z1 FAX 7a / (� „t� j r FAX OWNER 0,OWNER43UILDER 11 OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT 13 ARCHITECT ❑aNGINHER CI DEVELOPER 13 TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPV IIUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS ! CITY,STATE,ZIP PRONE ARCHITECT7ENOINEERNAME Javil t LICENSENUMBER C 2 EUS,LIC# COMPANY t1AiNE !!` (�tetY E-MAIL ,1'C ,6 ja / [A FAX AA,pSTREETADDRESS ®J p CITY,ST TE,ZIP (J� /�f�v/.I/y��/�")I q 2N d! - � L7��t .;,f? ° Y� ,✓!' 1�".l PIIONE.''Y� DESCRTPTION OF WORK Add['.h EXiSTINGUSE PROPOSEDUSH V CGN�SlTR.TYPE #STORIES , - e5° �� -J ) USE TYPE OCC. SQ,FT. VALUATION($) EXISTO NRIY FLOOR DEMO TOTAL ! - - AREA AREA Q AREA NET AREA `T { BATHROOM KITCHEN ISS OTHER r REMODELAREA - REMODELAREA REMODEL AREA l�Fq 0 PORCH AREA DECKARrA 'rOTALDECK/PORCHAREA I GARAGEAREA: DETACH FVATTACH tf DWELLING UNrI'S: - IS A SECOND UNITYF.S SECOND STORY []YES - - BEING ADDED? WO ADDITION? 'IVO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF ISTHEBLDGAN ®YES TOTALVALUATION: PLANNINOAPPLb O PLANNTHO APPROVAL LETTER ETCHLERHONTR? y �. By my signature below,I certify to each of the following: I aln tIle property owner or authorized ct on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and State laws relating to buildi g construction..i aut ze representatives of Cupertino to enter the above-i entifieroperty for inspection purposes. P / Signature of ApplieantlAgerlt: _ a.�`t Date: � f b/' �J SUPPLEMENTAL INFORMATION REQUIRED PLAN CI3a:C[C TYPE R®u'rIM1sLIr - New SFD or Multifiamily dwellings; Apply for demolition permit for ❑ OVER-THE COUNTERBUILDIYGPLANRF,VIESV existing building(s). Demolition permit is required prior to issuance of building permit for new building, ❑ EXPRESS PLANNING PLAN RiEVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD El PUBLIC'*VORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE I] FERE DEPT _Copy of Planning Approval.Letter or Meeting with Planning prior to © MAJOR El8A,IITARYSENVERD1$TRICT. submittal of Building Permit application. ❑ ENVIRONMENTAL W:XA TII., BldgApp_Ol Ldoe revised 06121111 Il_ FILE "(6 l CERTIFICATE OF VERIFICATION CF3R-MCH-23-H Space Conditioning System Airflow Rate (Page 1 of 4) Project Name Hsu Chauwen Enforcement Agency: Cupertino Permit Number: B-2016-1261 Building Department Dwelling Address: 6398 Blackwood Dr City: Cupertino Zip Code: 95014 A. Ducted Cooling System Information 01 System Identification or Name System 1 02 System Location or Area Served Whole house 03 System Installation Type Replacement 04 Nominal Cooling Capacity(tons)of Condenser 4.0 05 Condenser Speed Type Single Speed 06 Cooling System Zonal Control Type Not Zonal 07 Central fan Integrated(CFI)Ventilation System Status Not a CFI system 08 System Byp Duct Stag Bypas uc low 09 Date of Sys . ,Airflow FjlMft t 2016 08 1fi= w IT 10 Airflow Rat- tocol u ` d _ -_ � RA3 3 pWcedures dor airflow rate measurement B. Hole for the placement of a Static Pressure Probelf?) nIMi UQ&be(PSPP) in the supply plenum. Procedures for installing HSPP or PSPP are specified in RA3.3.1,1. 01 Method used to demonstrate compliance with the HSPP installed and labeled consistent with figure RA3.3-1 HSPP/PSPP requirement C.Airflow Rate Measurement Apparatus and Procedure Information Instrument Specifications are given in RA3.3.1.1,and system airflow rate measurement apparatus information is given in RA3.3.2. 01 Airflow Rate Measurement Type used for this airflow rate Traditional Flow Capture Hood according to procedure in verification. RA3.3.3.1.4 02 Manufacturer of Airflow Measurement Apparatus Alnor 03 Model number of Airflow Measurement Apparatus 634-513-044 Certification Status of the Airflow Measurement Apparatus Certified by Manufacturer and listed on CEC Website at 04 Accuracy http://www.energy.ca.gov/title24/equipment—cert/ama—fas /index.html Registration Number:316-A103162SA-M23009999A-M23A Registration Date/Time:2016-08-18 19:22:59 HERS Provider:USERA CABuildingEnergy Efficiency Standards Report Version:2013 Rev 1.007 Report Generated:2016-08-18 19:23:19 2013 Residential Compliance Schema Version:0.555SDD n CERTIFICATE OF VERIFICATION CF3R-MCH-23-H Space Conditioning System Airflow Rate (Page 2 of 4) MCH-23a Forced Air System Airflow Rate Measurement-Newly Installed Non-Zoned Systems or Zoned Multi-Speed Compressor D. Forced Air System Airflow Rate Measurement The procedures for System Airflow Rate Verification are specified in Reference Residential Appendix RA3.3. 01 Required Minimum System Airflow Rate(cfm/ton) 350.0 02 Required Minimum System Airflow Target(cfm) 1400 03 Actual System Airflow Rate Measurement(cfm) 1420 04 Compliance Statement: System airflow rate complies E.Additional Requirements 01 Air filters that meet the applicable requirements of Standards Section 150.0(m)12 or 150.0(m)13 were properly installed in the system during system air flow rate measurement identified on this Certificate of Verification. :•:F... v The airfloas measurement Latus use> o perform the airflow rate measurement identifiedn this Certificate of 02 Verificatio calibrate r iii aci h the apparatus manufactus and conforms to the instrument=n specific - _ns give r -z. A visual ins fir cts ti t=de3 tlitianedisupply air airectlyM the space onclitioning system return uc ai -ware not use on newly constructed zonally controlled systems urless-the Performance Certificate 03 of Compliance indicates an allowance for use of a b udElqr p . r ormance Certificate of Compliance,the airflow rate shall conform to the specifications listed on the Certificate of Compliance. 04 All registers were fully open during the diagnostic test. 05 System fan was set at maximum speed during the diagnostic test. 06 If fresh air duct is part of the HVAC system it was not closed during the diagnostic test. 07 Airflow rate and fan watt draw shall be simultaneous measurements when used to calculate the Fan Efficacy tested value. Multi-speed compressor space cooling systems or variable speed compressor systems shall verify air flow(cfm/ton)and fan 08 efficacy(Watt/cfm)with system operating in cooling mode at the maximum compressor speed and the maximum air handler fan speed. 09 Verification Status Pass-all applicable requirements are met 10 Correction Notes The responsible person's signature on this compliance document affirms that all applicable requirements in this table have been met unless otherwise noted in the Verification Status and the Corrections(Votes in this table. Registration Number:316-A1031625A-M23009999A-M23A Registration Date/Time:2016-08-18 19:22:59 HERS Provider:USERA CA Building Energy Efficiency Standards Report Version:2013 Rev 1.007 Report Generated:2016-08-18 19:23:19 2013 Residential Compliance Schema Version:0.555SDD CERTIFICATE OF VERIFICATION CF3R-MCH-23-H Space Conditioning System Airflow Rate (Page 3 of 4) F.Determination of HERS Verification Compliance All applicable sections of this document shall indicate compliance with the specified verification protocol requirements in order for this Certificate of Verification as a whole to be determined to be in compliance. 01 Complies:All specified verification protocol requirements on this document are met. 3 , ZA.. U.S. Energy Raters Association Registration Number:316-A1031625A-M23009999A-M23A Registration Date/Time:2016-08-18 19:22:59 HERS Provider:USERA CA Building Energy Efficiency Standards Report Version:2013 Rev 1.007 Report Generated:2016-08-18 19:23:19 2013 Residential Compliance Schema Version:0.555SDD CERTIFICATE OF VERIFICATION CF3R-MCH-23-H Space Conditioning System Airflow Rate (Page 4 of 4) Documentation Author's Declaration Statement 1. 1 certify that this Certificate of Verification documentation is accurate and complete. Documentation Author Name: Documentation Author Signature Minxuan Liu J Company: Ek Date Signed: - —= Santa Clara HERS 2016-08-18 Address: CEA/HERS Certification Identification(if applicable): 1181 Sundown Ln 410231431 City/State/Zip: Phone: San Jose CA 95127 408-883-3865 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 Verification is true and correct. 2. 1 am the certified HERS Rater who performed the verification identified and reported on this Certificate of Verification(responsible rater). 3. The installed features,materials,components,manufactured devices,or system performance diagnostic results that require HERS verification identified on this Certificate of Verification comply with the applicable requirements in Reference Appendices RA2,RA3,and the requirements specified on the Certificate of Compliance for the building approved by the enforcement agency. 4. The info? reported�l p`plicabl 1 1b„ e Certlf�ate+(s)W f tta`staflatlon(OFM ret anti submitted by the p�rsan(s)responsible for the construct�r3m' err installatioAc orm t ti {k'r, nts specif€ed tin the Cert ficatei(s)n Ctrmphaneez(CF1R)approvedby the enforcement agency. MOMA 5. I will ensuat a registeropy Certificate f VerifMn shall be.,posted of it ode available the buildl'rfgertrtit(s)issued for the building, ade availab ithe cyfor,a€1apfpfablel spections l unrlenat hi tli8> 'registereif cz yoftWertificate of Verificati E required to luded wi e_tationt(Se tiuifder providest c thy'buildinwner at occupancy, Builder Or Instal e _ n A ec�t�ficate Of llristallatlon Company Name(Installing Subcontractor,General Contractor,or Builder .r . Energy Association Shengs Construction Inc Responsible Builder or Installer Name: CSLB License: Sheng Yong 13814019 HERS Provider Data Registry Information Sample Group Number(if applicable): Dwelling Test Status in Sample Group(if applicable) 316-23810 Tested HERS Rater Information HERS Rater Company Name: Santa Clara HERS Responsible Rater Name: Responsible Rater Signature: Minxuan Liu Minxuan Liu(Aug 18,2010 Responsible Rater Certification Numberw/this HERS Provider: Date Signed: 410231431 2016-08-18 7ttis digital signature is provided in order to secure U-- the content of this,egistored clrocarrr enit and in no ERA wad implies Registrailon Provider responsibility for the accuracy of the infbnnatidn" Registration Number:316-A1031625A-M23009999A-M23A Registration Date/Time:2016-08-18 19:22:59 HERS Provider:USERA CA Building Energy Efficiency Standards Report Version:2013 Rev 1.007 Report Generated:2016-08-18 19:23:19 2013 Residential Compliance Schema Version:0.555SDD