12010049 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7631 SHADOWHILL LN CONTRACTOR: ECONOMY PERMIT NO: 12010049
HEATING & AIR
OWNER'S NAME: WEN-CHENG CHANG 2351 SUNSET BLVD STE 170 DATE ISSUED:01/06/2012
OWNER'S PHONE: 4088918057 ROCKLIN, CA 95765 PHONE NO:(916)410-8477
LICENSED CONTRACTOR'S DECLARA'T'ION I
BUILDING PERMITINFO: BLDG ELECT PLUMB
License Class G—Z V Lic. 3
t
MECII RESIDENTIAL COMMERCIAL
Contractor-,
I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REPLACE PURNACG!w SAMG LOCATION
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
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. Sq.Ft Floor Area: Valuation:$4000
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 ofthe Labor Code,for the performance of the work for which this APN Number:36225012.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROLAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the /_ _ / Z
granting ofthis permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
,ry RF,-ROOFS:
Signature ,� zJl Date All roofs shall be inspected prior to any roofing material being installed. 11'a roof is
installed without first obtaining an inspection. I agree to remove all new materials for
inspection
❑ OWNER-BUILDER DECLARATION
Signature of Applicant Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGSTO BE CLASS"A"OR BETTER
1,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 sale(Sec.7044,
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the
California health&Safety Code,Sections 25505,25533,and 25534. 1 will
1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: health&Safety Code,Section 25532(a)should I store or handle hazardous
1 have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District 1
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized agent: Date: Z
I certify that in the performance of the work for which this permit is issued,I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the perfixmance of'
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
I certify that 1 have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating-
to
elatingto 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, ARCHITECT'S DECLARATION
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
Prescriptive Certificate of Compliance: Residential CF-IR-ALT
Residential Alterations age 5 of 5)
Project Name: Climate Zone# #of Stories
f!o
HERS VERIFICATION SUMMARY The enforcement agency should pay special attention to the HERS Measures specified in this
checklist below. A completed and signed CF-4R Form for all the measures specified shall be submitted to the building inspector before final
inspection.
Duct Sealing&Testing HERS verification is required for this measure.
❑YES ❑NO YES:In Climate Zones 2 and 9-16,if more than 40 linear feet of new or replacement ducts are installed in unconditioned
space,the ducts are to be sealed per§152(b)1Dii and the newly installed ducts are to be insulated per§151(f)10.
❑ EXCEPTION:Existing duct systems that are extended,which are constructed,insulated or sealed with asbestos.
❑YES ❑NO YES:In Climate Zones 2 and 9-16,if the existing space-conditioning system(HVAC equipment and ducting)is replaced,the
ducts are to be sea4ed per§152(b)1 Di.
ES l7 NO YES:In Climate Zones 2 and 9-16,if the existing HVAC equipment is replaced(including the replacement of the air handler,
outdoor condensing unit of a split system,cooling or heating coil,or the furnace heat exchanger)the ducts are to be
sealed per§152(ba1E.
❑ EXCEPTION:Duct systems that are documented to have been previously sealed confirmed through HERS
verification in accordance with procedures in the Reference Residential Appendix RA3.
❑ EXCEPTION:Duct systems with less than 40 linear feet in unconditioned space.
❑ EXCEPTION:Existing ducts stems constructed,'insbhft4fse th as#tCstos >;
Refrigerant Charge- Split System HERS verification is required for ii ls'biie'd3'uter A �:
❑YES ❑NO YES:In Climate Zones 2 and 8-15,when the existing HVAC equipment is replaced(including'the replacement of the air
handler,outdoor condensing unit of a split system A/C or heat pump,cooling or heating coil,or the furnace heat
exchanger)a refrigerant charge measurement shall be verified per§152(b)IF.
Central Fan Integrated(CFI)Ventilation System and Fan Watt Draw
The ventilation re uirements of§150(o)do not apply to existing residential homes.
Ducted Split Systems-Air Conditioners and Heat Pumps: Airflow HERS verification is required for this measure.
❑YES ❑NO YES:In Climate Zones 10 through 15,when the existing space-conditioning system(HVAC equipment and ducting)is
replaced,the airflow and fan watt draw shall be verified per§152(b)lCi to meet the requirements of§151(f)7B.
Documentation Author's Declaration Statement
• I certify that this Certificate of Compliance documentation is accurate and complete.
Name: `_ / Signature-
/ -e
Company: Date:
Address: If Applicable❑CEA or❑CEPE
(Certification#):
City/State/Z' Phone:
oc (o261- /d - $
Responsible Building Designer's Declaration Statement
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design identified on
this Certificate of Compliance.
• I certify that the energy features and performance specifications for the building design identified on this Certificate of Compliance conform
to the requirements of Title 24,Parts 1 and 6 of the California Code of Regulations.
a The building design features identified on this Certificate of Compliance are consistent with the information nrnvided to document this
building design on the other applicable compliance forms,worksheets,calculations,plans and specifications submitted to the enforcement
agency forapproval with this building permit application.
Name: Signature:
Company: Date:
Address: License:
City/State/Zip: Phone:
For assistance or questions regarding the Energy Standards,contact the Energy Hotline at.1-800-772-3300.
Registration Number: Registration Date/Time: HERS Provider:
2008 Residential Compliance Forms August 2009
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: -7(r,3 1 �j In, I I L a.,"e- PERMIT# 1201
00 9
OWNER'S NAME: �,+r .��:j�,per, -�- . PHONE# fle, — Vct 7
GENERAL CONTRACTOR: r BUSINESS LICENSE# 2 S'F?
ADDRESS: CITY/ZIPCODE: G
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. / lZ
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum /Wood
Glass / Glazing
eating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
O der[Contractor Signature Date
CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36225012 . 00
DATE ISSUED. . . . . . . : 01/06/2012
RECEIPT # . . . . . . . . . : BS000015692
REFERENCE ID # . . . : 12010049
SITE ADDRESS . . . . . : 7631 SHADOWHILL LN
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : WEN-CHENG CHANG
ADDRESS . . . . . . . . . . : 7631 SHADOWHILL LN
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : ECONOMY HEATING
CONTRACTOR . . . . . . . : TERRY DEAL LIC # 33220
COMPANY . . . . . . . . . . : ECONOMY HEATING & AIR
ADDRESS . . . . . . . . . . : 2351 SUNSET BLVD STE 170
CITY/STATE/ZIP . . . : ROCKLIN, CA 95765
TELEPHONE . . . . . . . . : (916) 410-8477
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------- ------ ---------- ---------- ---------- ----- ----- ----------
-ADMIN HOURS 1 . 00 41 . 00 0 . 00 41 . 00 0 . 00
1BCBSC VALUATION 4 , 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 4 , 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1MFR=<100 UNITS 1 . 00 130 . 00 0 . 00 130 . 00 0 . 00
1MPERMITFE FLAT RATE 1 . 00 44 . 00 0 . 00 44 . 00 0 . 00
1TRAVDOC FLAT RATE 1 . 00 44 . 00 0 . 00 44 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 260 . 50 0 . 00 260 . 50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 260 . 50 171
---------------
TOTAL RECEIPT 260 . 50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
Eli ADDRESS: 7631 shadowhill In. DATE: 01/06/2012 REVIEWED BY: bobs.
APN: BP#: "VALUATION: 1$4,000
°PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION FURN/AC
USE: PERMIT TYPE:
WORK furnace change out.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced-Air J 1MFR=<100 1 # $130
TOTALS: 1 $130.00
Mech.Plan Check0.0 hrs $0.00
Mech.Permit Fee: I MPERMIT
Other Mech.Insp. 0.0 hrs $44.00Li
NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . Thesefees are based on therelin ina information available and are only an estimate. Contact the De t or addn'l info,
FEE ITEMS (Pee Resohition 11-0531 jf. 1.;11 FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.00
PME Unit Fee: $130.00
PME Permit Fee: $44.00
Administrative Fee: ]ADMIN $41.00
Work Without Permit? Yes 0 No $0.00
Travel Documentation Fee: ITRA VDOC $44.00 A
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bld Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $260.50 $0.001 TOTAL FEE.-T $260.50
Revised: 1/01/2012
GENERAL PERMIT APPLICATION MEP
2 COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
10300 TORRE AVENUE -CUPERTINO, CA 95014-3255
(408)777-3228-FAX(408)777-3333- building(cDcupertino.org MISIC
CUPERTINO
[]PLUMBINGFi�ECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS v O
PROJECT ADDRESS l \ AFN# s O( ;�
OWNER NAME ` tt
STREET ADDRESS STATE ZIP FAX
L
MAIL
CONTACT NAME ONE E-
STREET ADDRESStip/- Q CI Y,STATE, ZIP C �! FAX
J - �//_ C
❑OWNER ❑ OWNER-BUIIDER ❑ OWNERAGENT f CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAM�.� LICENSE ER LICENSE T PE BUS.LIC# S
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COMPANY N `
E-MAIL FAX
cc / /Q G. C
STREET ADDRESSSTA Z1P C PHO XY 7
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ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME' E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES
BUILDING. ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK
�Gcrv/L. C� kL
TOTAL VALUATION: 6�/b c9z' RECEIVED BY: Y
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. re
,�i have ad 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 pu[poses.
Signature of Applicant/Agent: Date: �-
SUPPL AL INFORMATION REQUIRED OFFICE,USE ONLY
OVER-THE-COUNTER
❑ EXPRESS
Y
U
T_
❑ STANDARD
V
❑ LARGE
a
❑ MAJOR
MPPMrrcApp 201 Ldoc revised 06121111