B-2017-1734 •
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1734
1098 NOVEMBER DR CUPERTINO,CA 95014-4130(362 17 023) ON-TIME AIR
CONDITIONING&
HEATING INC
PLEASANTON,CA
94588
OWNER'S NAME: LIN DEKANG AND LIN-YUAN YIHUA LOU TRUSTEE DATE ISSUED: 10/09/2017
OWNER'S PHONE:408-688-4786 PHONE NO:(925)872-7326
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:,
License.Class INSULATION AND ACOUSTICAL Lic.#817040
Contractor 0 - I:C*ADI 10 I G : .E, I G ►C Date 09/30/2019 X BLDG _ELECT _PLUMB
I hereby affirm that.I am +censed under the provisions of Chapter 9(commencing X MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of D .'sion 3 of the Business&Professions Code and that my •
license is in full force:nd effect. 'JOB DESCRIPTION:
REPLACE FURNACE AND AC UNIT-SAME LOCATION -
I hereby affirm :der penalty,of perjury one of the following two declarations:
1. I ha -and will maintain a certificate of consent to self-insure for Worker's
C
C. .pensation,as provided for by Section 3700 of the Labor Code,for the
' 1 rformance of the work for which this permit is issued.
i�der , have and will.maintain Worker's Compensation Insurance,,as provided for by
i Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. • Sq.Ft Floor Area: Valuation:$15580.00
APPLICANT CERTIFICATION
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 APN Number: Occupancy Type:
and state laws relating,to building construction,and hereby authorize 362 17 023
representatives of this,city to enter upon the above mentioned p -.erty for
inspection purposes. (N/e)agree to save indemnify and kee•- armless the
City of Cupertino against liabilities,judgments,costs,an. -xpenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the.-nting of this permit.
Additionally,the applicant understands and will c., ply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source:regulations per,the Cupertino Municip ode,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
SI.e. ure ' / � Date 10/9/2017 Issued by:Abby Ayende
Date: 10/09/2017
ti's WNER=BUILDER DECLARATION
I hereby:affirm that I am exempt 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
i. I'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
inspection.
"compensation,will do the work,and the structure is not intended or offered for
•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:10/9/2017
I herebyl'affrm,under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
a ' I have and will maintain a Certificate of Consent to self-insure for Worker's
1 jp !Compensation,as provided for by Section 3700 of the Labor Code,for the
I I 1 performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2 I 1 I have and will.maintain Worker's Compensation Insurance,as provided 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,will
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 permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
I _! material. Additionally,should I use equipment or devices which emit hazardo
• 12 a• nd the employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management His ct I
,Worker.s Ci mpensation laws of California. If after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapte '.12,and
exemption,.:I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Section 25505,25533,and 2 . 4.
Labor Code,I must forthwith comply with such provisions or this permit shall op
be deemed revoked. ner or authorized agent: � -
APPLICANT CERTIFICATION r Date:10/9/2017
I certify,that I!nave reed'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 1 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 complyiwith"all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION ;
Code,Section''9.18'.' I understand my plans shall be used as public records.
IF .
Signature - Date 10/9/2017 Licensed
CONSTRUCTION PERMIT APPLICATION
. COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
_n 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 •
4°54; ' (408) 777-3228ungscupertno.Org - -
CUPERTINO REV a DEF#
❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS/0 0 r`� /2 A(..„P� APN# eL(0�_ 1.1.....4)zo
OWNER NAME , (/ . i / PHONE `J E-MAIL
(-Q Crvi `�i .cU� S�p- 6W- V7�.
STREE•ADDJI,ES$�+ fl � � * , CITY STATE,ZIP �` , 1
CONTRACTOR NAME 0 OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
�F_724/�Q ae 7i ( a"h 7.-in-e‘ t� %f/ �/�J U C— Z D
IST
( V `E0 "K�w`C�/ �^1 b- CITY ZIP `R k. `� `6C . / �J e I
MAIL' ( n PHONE `[��'+ BUS.LIC#
2�a (�`e2itc ea ,cep -.2-6-94(51.-- VV I
❑ARCHITECT 0 OWNER ❑OWNER AGENT S ILRACTOR AGENT ENGINEER❑DEVELOPER 0 TENANT
CONTACT NAME E AIL n t Y
STREET X .ST %( c'.2- O4- 6/ 6-3Ue-hd C I 3-?
DECRIPIONI re—C-
/a—46e./ S (iC
?0kCG .ieet52)4/'C ✓ / '-'
IN MILY/DUPLEX ❑MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL I
EXISTING USE EXISTING SF 'NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES S TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION(S)
•
REMODEL' ' REMODEL KITCHEN REMODELOTHR GARAGE ❑ATTACHED
BATHROOM SF SF SF SF ❑DETACHED
EXISTNG ❑YES EICHLER ❑ YES SECOND STORY ADDITION El YES
FIRE SPRINKLERS❑ No ❑ NO 0 NO
DWELLING-' SECOND DWELLING ❑YES ❑ATTACHED DETACHED OTHER
UNITS ti .UNIT ADDITON: 0 N SF
POOLS ,❑,FIBERGLASS ❑VINYL-LINED ❑GUNITE El PREFABRICATED
POOL;'SF'. SRA-SF I SPA ATTACHED❑YES ❑ NO I TOTAL-SF
d =ECVED BY: �//�,,, 1y4,I TO L V� U,19�Ty�I�OeN��
Commercial vi:Mulh Family Buildings with Public Swimming Pools requires Deportment of Environmental Heath approval I ] Dy�BY W VAV•WL �.d174/
RE-ROOFI>EXISTING;ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES❑TILE 'OTHER(SPECIFY)
REMOVE/REPLACE Q NO IF NO PLYWOOD 0'1" ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
I]YES S OF LAYERS THICKNESS❑5/8" OTHER ❑OSB ❑CDX OTHER :12 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES❑WOOD SHINGLES ❑OTHER
*Provide a signed'Copy of the Cupertino's Tear-Off Policy SF Sof SQUARES
By my signature below I certify to each of the following: I am the property owner or aut .rized 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 •'e Description of Work:and verify it is accurate. I agree
to comply with all applicable local ordinances and state laws relating to buildi .: construction. I authorize'representatives of Cupertino to
enter the,above-identified property for inspection purr.se knowledge -, authorize all information contained o his a plication form
to be made available for public record. n
Signature;of Applicant/Agent: 4��7 Date: �/ -
SUPPLEMENTAL INFORMATION REQUIRED
*New SED/Second Dwelling Units/Multifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildi• ngs: Provide a completed Hazardous,Materials Disclosure form if any Hazardous Materials are being used as part of this project.
*Copylof Plannng'Approval Letter or Meeting with Planning prior to submittal of Building Permit application.
*HOA,Provide a letter of approval from the Home Owner's Association
Bld APP_2017.doc revised 08/01/17
8
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems(formerly CF-1R-ALT-HVAC) (Page 1 of 3)
Project Name: LOU LIN YUAN Date Prepared: 2017-10-09
A.General Information - - - -
CF1R-ALT-02 is applicable to multiple space conditioning systems contained within a single dwelling unit.When multiple dwelling units must be documented,use one
CF1R-ALT-02 document for each dwelling unit.
01 Project Name LOU LIN YUAN 02 Date Prepared 2017-10-09
03 Project Location 1098 NOVEMBER DRIVE 04 Building Type Single family
05 CA City Cupertino -06 Dwelling Unit Name HOUSE
:Dwelling Unit Conditioned
07 Zip Code 95014 08 Floor Area(ft2) 2932
Number of Space
09 Climate Zone 4 10' Conditioning(SC)Systems in 1
this Dwelling Unit:
B.Space Conditioning(SC)System Information
01 02 03 04 ,�, 05 06 07 08 09 10
Is the Sc. Installing a t.. ',,
SC System SC System CFA served system a' ` ' refrigerant Installing new SC" Installing Installing Installing
Identification or Location or Area by this SC ducted containing system more than 40 entirely new entirely new
Name Served System(ft2) system? component? components? feet of ducts? duct system? SC system? Alteration Type
SYSTEM 1 LOCATION 1 2932 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:417-A020120979A-000-000-0000000-0000 Registration Date/Time:2017-10-09 08:12:40 HERS Provider:CHEERS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2016.1.006 Report Generated:2017-10-09 08:12:41
Schema Version:rev 10/16
CERTIFICATE OF 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 08 I 09 10 11 12
Heating Cooling
System Heating Altered Heating Minimum Altered Cooling Minimum Required New or
Identification System Heating 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
All new All new This field or This field or
SYSTEM 1 Central gas heating AFUE 0.8 Central split cooling SEER 18 Setback section is not section is not
furnace components AC components applicable applicable
Required Documentation:
CF2R-MCH-01-E-Space Conditioning Systems
-Duct insulation requirement for the new portions of supply-air and return-air ducts or plenums R6,(CZ 1 10,12 and 13)and R8(CZ 11 and 14-16)
CF2R and CF3R-MCH-20-1-1-Duct Leakage Test required when heating or cooling components are installed intducted'systems,or when more than 40 ft of duct length is replaced
-Leakage rate compliance:<=15%or<=10%leakage to outside,or seal all accessible leaks. ,:'..n
CF2R and CF3R-MCH-25-H Refrigerant Charge verification required when refrigerant containing components are installed or altered(applicable in CZ 2,8-15).
CF2R and CF3R-MCH-23 Airflow Rate>=300 CFM per ton required when MCH-25 is required \,, .,'
Exceptions:
-Duct systems registered with HERS provider as previously sealed are exempt from MCH-20 Duct Leakage Testing requirements.
-Heating-only systems and Air Handler Furnace changes do not require verification of Air Flow MCH-23,or'Refrigerant Charge MCH-25.
-Existing duct systems constructed,insulated or sealed with asbestos are exempt from MCH-20 Duct Leakage Testing requirements.
I
E. EntirelyNew or Complete Replacement Duct System,with or without E ui {ment Chan eoiat(Sections 150.2 b 1Diia and 150.2(b)1E,
p p Y q p g ( 1F)
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:417-A020120979A-000-000-0000000-0000 Registration Date/Time:2017-10-09 08:12:40 HERS Provider:CHEERS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2016.1.006 Report Generated:2017-10-09 08:12:41
Schema Version:rev 10/16 ,
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems(formerly CF-1R-ALT HVAC) (Page 3 of 3)
Documentation Author's Declaration Statement
1. I certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name: _ -_ Documentation Author-Signature: =
April Rodriguez Apra7Zaciriguers,
Company: Signature Date:
I Permit E Raters _ 2017-10-09
Address: CEA/HERS Certification Identification(if applicable):
31225 La Baya Drive
City/State/Zip: Phone:
�> z
Westlake Village CA 91362 "
_ 818.435-7876 I _
Responsible Person's Declaration statement - -
•
I certify the following under penalty of perjury,under the laws of the State of California:
1. The informationrovided on this Certificate of Compliance is true and correct.
P P
2. I 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,approvalwith this building permit applicd..tion.
5. I will ensure that a registered copy of this Certificate of Compliance shall be made available with the buildingpermit(s)issued for the building,and made available to the enforcement agency for all applicable
inspections.I understand that a registered copy of this Certificate of Compliance is required'to"be'induded-with"the documentation the builder provides to the building owner at occupancy.
Responsible Designer Name: Responsible Designer,5ignature:
Y Y
L nil Rose ,"_"._ x lynd3'.Roa�€.,¥
Company: Date Signed:
On-Time Air Conditioning&Heating Inc dba Service Champions 2017-10-09
Address: License:
7020 Commerce Drive 817040
City/State/Zip: - - - - - - Phone:-
Pleasanton CA 94588 925-444-4444
Digitally signed by CHEERSTM. 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:417-A020120979A-000-000-0000000-0000 Registration Date/Time:2017-10-09 08:12:40 HERS Provider:CHEERS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2016.1.006 Report Generated:2017-10-09 08:12:41
Schema Version:rev 10/16