B-2017-2043 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-2043
20927 FAIRWOODS CT CUPERTINO,CA 95014-4200(359 13 110) SANDIUM INC
SAN JOSE,CA 95134
OWNER'S NAME: OU JIUNN-YEN AND CHIOU YAR-Al M TRUSTEE DATE ISSUED: 11/29/2017
OWNER'S PHONE:408-838-5705 PHONE NO:(408)894-9072,
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-20 Lic.4888119 -
Contractor SANDIUM INC Date 12/31/2018 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:
REPLACE FURNACE AND AC UNIT-SAME LOCATION
I hereby affirm under penalty of perjury one of the following two declarations:
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
,ft rformance of the work for which this permit is issued.
` I 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 this
permit is issued. Sq.Ft Floor Area: Valuation:$12000.00
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 359 13 110
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 WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit: WITHIN 180 DAYS OF PERMIT.ISSUAN.CE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
IEdzi.nature vim Date 11/29/2017 Issued by:,Abby Ayende
Date: 11/29/2017
OWNER-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
1. 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
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 of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:11/29/2017
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF 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 have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardousmaterials 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
shall not employ any person in any manner so as to become subject to the material. Additionally,should I use 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 Co ,Section 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall ,�°
be deemed revoked.
21,1Z'or authorized agent:
APPLICANT CERTIFICATION e:11/29/2017
I 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 constructionlending 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 ARCHITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Licensed
Signature Date 11/29/2017 Professional
• CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT •• BUILDING DIVISION
.•• , =l` 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
�.,> -�`" (408) 777-3228 • buil din cl a '' 'Cl CI—
__
-:cu>7ertino.or` PEMIT B-CUPERTINO REV# DEFT
❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION E T.I. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS 2.06i 87 *}-�`� � r Sc., I APN A 5s f ^ 1 10
OWNER NAME VL""�L� / e, _i PHONE j �g3� 570 E-MAIL )`'\l _, - yeq't i_oyct.c.v., ..
STREET ADDRESS ^ CITY, STATE,ZIP V
She- W.J -- - --- - — -- — - -- --
ja`CONTRACTOR NAME ❑OWNER-BUILDER OMPANY NAME LICENSE NUMBER LICENSE TYPE.
•
_• 1 c20
I5TREETESs (�I,7-23 ! r , CITY,STATE, ZIP �� �1 t 1 I
U �T5 19..E Ofk
zto
E-MAIL s BUS.LIC Ai �R.D S • ( rr g21C907.z....,' 0 ARCHITECT 0 OWNER.0
OWNER AGENT ❑CONTRACTOR AGENT 0 ENGINEER 0 DEVELOPER
0 TENANT
CONTACT NAME E-MAIL
STREET ADDRESS CITY,STATE,ZIP PHONE
DECRIPTON I/ k
SINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL I
EXISTING USE EXISTING SF NEW FLOOR.SF PORCH SF DECK SF DEMO SF STORIES I TOTAL NET USE TYPE OCC SQ.FT. VALUATION(S)
REMODEL I - REMODEL KITCHEN REMODELOTHR , GARAGE o ATTACHED
BATHROOM SF SF SF SF 0 DETACHED
EXISING ONO YES IEICHLER O ES SECOND STORY ADDITION ONO
FIRE SPRINKLERS NO
DWELLING SECOND,DWEIsLING 0 YES ❑ATTACHED❑DETACHED OTHER
UNITS A UNIT ADDITON:• D NO 5 F
I
POOLS ❑FIBERGLASS ;❑VINYL LINED 0 GUNITE 0 PREFABRICATED '
POOL-SF SPA-SF. 1 ,.SPA ATTACHED❑YES 0 NO I TOTAL-SF
• REC VED BY: iTOTAL VALUATION:
Commercial or Mull i-Familu Buildings with Public Swinmdne Pools requires Devnrlmeni of Envirmvvenlal Heathmammalual p-_- s I2 1
0173 ,
RE-ROOF EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES WOOD SHAKES WOOD SHING ES ' OTHER(SPECIFY)
REMOVE/REPLACE Q NO IF NO PLYWOOD ❑i E 3/8" ' PLYWOOD TYPE: PITCH: ROOF CLASS
❑YES A OF LAYERS THICKNESS E 5/Bi' OTHER ❑ose ❑CDX OTHER :12 A
PROPOSED ROOF TYPE:❑BLILT-UP ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES DWOOD SHINGLES 0 OTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy SF €of SQUARES
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 ins ct on purposes.' acknowledge and authorize all information contained•on this application form -
to be made available for:public record. i I. 2
Signature of Applicant/Agent: ' ' ' � Date:
A/ I f I -
SUPPLEMENTAL INFORMATION REQUIRED 1.
*New SFD/Second Dwelling Units/Multifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings:,Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
*Copy of Planning Approval Letter or Meeting with Planning,pribr to submittal of Building Permit application.
*HOA-Provide a letter olapproval from the Home Owner's Association
r
Bldg,9pp_2017.doc revised 08/01/17
ALTERATIONS - HVAC
CEC-CF1R-ALT-03-E(Revised 01116). CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ALT-03-E
Alterations-HVAC CZ 1,3 to 7 and 16 (Page 1 of 1)
Site Address: Enforcement Agency: Date Prepared: Permit#:
Equipment Type Equipment Efficiency New:Ducti g or Lineset Conditioned Z Thermostat
Required R-value Floor Area(ft2)
❑ Packaged System 0 Evaporator Coil C�i AFUE COP 0 R-6 (CZ 1-10,12&13)Ducts Served by system 0 Setback
Split System 0 Condensing Unit rt SEER 0 R-8' (CZ/1,14-16)Ducts tcoo ftz (If not already
HSPF 0>_R-2.8 Lineset3 present,must
❑ Furnace ❑ Lineset EER be installed)
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below.At permit application this
form is allowed to be filled out by hand.For final inspection all forms are to be registered(no hand filled forms allowed)and a copy left on site.
HVAC Changeout/Repair Required Compliance Documents to be left on site for Final:
(Can include new ducting)
All Equipment, CF1R-ALT-02-E •
Condenser Unit,Evaporator Coil, CF2R:MCH-01,MCH-20-H
Air Handler/Furnace CF3R:MCH-20-H •
Installer Requirement:Duct leakage(5 15%or,510%to outside,or seal all accessible leaks)
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
❑ 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-MCH-01-E,MCH-20-H,MCH-22-H,MCH-(23 or 24)-H
CF3R-MCH-20-H,MCH-22-H,MCH-(23 or 24)-H2
Installer Requirement:Duct leakage<5%,Fan Efficacy.(0.58W/CFM),Air Flow>_350 CFM/ton(or Standards Tablei 150.0-B/C alternative)
❑ 3.All New Ducts with Replacement Required Compliance Documents to be left on site for Final:
Includes replacing or installing All New CF1R-ALT-02-E
Ducts'and one ormore of the following: CF2R-MCH-01-E,MCH-20-H,MCH-(23 or 24)-H
Condenser Unit, Evaporator Coil,Furnace .CF3R-MCH-20-H,MCH-(23 or 24)-H
Installer Requirement:Duct leakage<5%,Air Flow>_350 CFM/ton(or Standards Table 150.0-B/C alternative)
❑Exempted from duct leakage testing if'existing duct systems are constructed,insulated or sealed with asbestos.
❑ 4.New Ducting over 40 feet Required Compliance Documents to be left on site for Final: ,
Adding or replacing ducts in unconditioned CF1R ALT 02 E
space but less than All New Ducts' CF2R MCH 20 H
CF3R-MCH-20-H
Installer Required to:Duct leakage(<15%or,<10%ito outside,or seal all accessible leaks)
0 Exempted from duct leakage testing if existing duct systems are constructed,insulated or sealed with asbestos.
'All new ducting requires R-8 insulationwhen more than 40 ft installed in CZs 11&14-16 and R-6 in CZs 1-10,12&13,and R-6 insulation when less
than 40 ft installed.This includes in walls,between floors etc.
2 A New Duct system is when the.duct system is constructed of at least 75%new duct material,and up to 25%may consist of reused parts from the
dwelling unit's existing duct system(e.g.,registers,grilles,boots,air handler,plenums,duct material.
R-2.8(1"thick insulation)for linesets 1"and less.
Contractor(Documentation Author's/Responsible Designer'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. 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 manufactureddevicesfor 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 CCR.
5. 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.
Responsible Designer Name: Responsible Desi n �i^gnat�ure,:: Date Signed• License:
Company: Address: ' City/Sta Zip: Phone:
� G�zz3 � Com, � � ,� � 4'a�z
For assistance or questions regarding the Energy•St`3ndards,contact the Energy Hotline at:1-800-772-3300