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11050180 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21876 HYANNISPORT DR CONTRACTOR:VALLEY HEATING& PERMIT NO: 11050180 COOLING OWNER'S NAME: YAN-QING WU 1171 N 4 TH ST DATE ISSUED:05/23/2011 ER'S PHONE: 4086157882 SAN JOSE,CA 95112 PHONE NO:(408)294-6290 ❑ LICENSED CONTRACTOR'S DECLARATION /'� 4 1 + BUILDING PERMIT INFO: BLDG ELECT PLUMB License Classy��y Lic.# _�c� ` `'I _ MECH F RESIDENTIAL r COMMERCIAL r Contractor Date3- I hereby affirm that I a lic nsed under the provisions of Chapter 9 JOB DESCRIPTION:ADD 4TON A/C ON LEFT SIDE OF HOUSE MINIMUM (commencing with Sectio 000)of Division 3 of the Business&Professions CLEARANCE OF 5' 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. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$5800 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:35614060.00 Occupancy Type: 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 and state laws relating to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comp -t with all non-point source regulations per the Cupertino Municipal Code,Secti - . .1 9.18. sued Date: Signature Date L OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. I,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, Signature of Applicant: Date: Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. 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 Owner ori d agent: become subject to the Worker's Compensation provisions of the Labor Code,I must Date: 'd3- i ' forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of"wrk's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address i-' -unify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION grouting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 5 ITEMS OF 10 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35614060. 00 DATE ISSUED. . . . . . . : 05/23/2011 RECEIPT #. . . . . . . . . : BS000013527 REFERENCE ID # . . . : 11050180 SITE ADDRESS . . . . . : 21876 HYANNISPORT DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . . YAN-QING WU ADDRESS . . . . . . . . . . : 21876 HYANNISPORT DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : VALLEY HEATING & CO CONTRACTOR . . . . . . . : ATKINSON, THOMAS LIC # 141 COMPANY . . . . . . . . . . : VALLEY HEATING & COOLING ADDRESS . . . . . . . . . . : 1171 N 4 TH ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95112 TELEPHONE . . . . . . . . : (408) 294-6290 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 5, 800 .00 1. 00 0. 00 1 .00 0. 00 1BSEISMICR VALUATION 5, 800 .00 0.58 0. 00 0 .58 0. 00 1MFR=<100 UNITS 1. 00 126. 00 0. 00 126 .00 0. 00 1MPERMITFE FLAT RATE 1. 00 42 . 00 0. 00 42 . 00 0. 00 1TRAVDOC FLAT RATE 1. 00 42 . 00 0. 00 42 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 211.58 0. 00 211.58 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 423 . 08 #22068 --------------- TOTAL RECEIPT 423 . 08 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL GENERAL PERMIT APPLICATION MEP `r COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 GUIPE.RTIN4 (408)777-3228• FAX(408)777-3333•,building ,cupertino.org MISC ❑PLUMBING MECHANICAL ELECTRICAL r� ❑MISCELLANEOUS PROJECT ADDRESS f 39Un i ^ ( ^ '�# J� jp l l( C, (} OWNERNAME AV 0_1 ' iu 7�V PHONELv-% _ -I 8� E-MAIL STREET ADDRESS 1^) G�'G C1TY, STA ZIP Tl'l (} , FAX CONTACT NAME tAkCAnt�� ) _ `�` P ONE, � - ^ E-MAILI STREET ADDRESS 1 C`` q�. j CrrY,STATE,ZIP 30n �'Y CA '1 51�� FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNEjR AAGENT X CONTRACTOR XCONTRACTOR AGENT ❑ ARCHrrECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER C c� LICENSE TYPE p 1 BUS.LIC# COMPANY NAMEl k l r^�lll E M`� FAX STREET ADDRESS ' N' y�` �� V CITY,STATE,ZIP c _ O J R `1 PHONE LrC/� / �4 �I V Cxj-f� ARCHTTECTIENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE SE OF OISFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ No DESCRIPTION OF WORK 1j Tv� A C� ✓� F or s� TOTAL VALUATION: 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 cons on. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. 1 Signature of Applicant/Agent: Date: ✓ — tot SUPPLEMENT ORMATION REQUIRED w MEPMiscApp 2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 21876 hyannisport dr. DATE: 05/23/2011 REVIEWED BY: bobs. APN: BP#: 'VALUATION: 1$5,800 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: PERMIT TYPE: WORK sfd add new a/c unit for sfd. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $126 TOTALS: $126.00 Mech.Plan Check 0.0 1 hrs $0.00 Mech.Permit Fee: IMPERMIT F 77- - ------- Other Mech.Insp. 0.0 hr---L$42.00 NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addh 7 info, FEE ITEMS tree Resolution 09-051 f't'. '-1%10Z FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $126.00 PME Permit Fee: $42.00 Work Without Permit? 0 Yes No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 Strom Motion Fee: IBSEISMICR $0.58 Select an Administrative Item g Stds BldCommission Fee: 1BCBSC $1.00 SUBTOTALS: $211.58 $0.00 TOTAL FEE: $211.58 Revised: 04/29/2011 1 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC C&IR-ALT-HVAC Climate Zones 16 Site Address: Enforcement Agency: Date: Permit#: l ?i� �s .0p Conditioned Equipment T e' List Minimum Efficient z Floor Area Duct insulation requirement Thermostat Packaged Unit Over 40 ft of ducts added or Furnace Served by system COP replaced in unconditioned etback ndoor Coil JAFUE EERy� HSPF ,✓ s ace (If not already present, Condensing UnitEER B Resistance ° sf R 8 (CZ 16) must be installed) Other 1.Equipment Type:Choose the equipment being installed;if more than one system,use another CF-IR-ALT-HVAC for each system. 2.Minimum Equipment Efficiencies: 13 SEER,78%AFUE,7.7HSPF for typical residential systems. HERS VERIFICATION SUMMARY Listed below are four HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted.A copy of the forms shall be left on site for final inspection and a copy given to the homeowner. At final,the inspector verifies that the work listed on this form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF-6R and registered CF-4R forms(no hand filled CF-4Rs allowed)are filled out and signed. Beginning October 1,2010,a registered copy of the CF-111 and CF-6R shall also be on site for final inspection. .HVAC Changeout Required Forms: • All HVAC Equipment replaced CF-6R forms: MECH-04 and MECH-2I-HERS CF-4R forms: MECH-21 • Condenser Coil and/or CF-6R forms: MECH-2I-HERS • Indoor Coil and/or CF-4R forms: MECH-21 • Furnace For Split Systems:Duct leakage< 15 percent For Packaged Units: Duct leakage< 15 percent Exempted from duct leakage testing if: 1.Duct system was documented to have been previously sealed and confirmed through HERS verification,or rl 2.Duct systems with less than 40 linear feet in unconditioned space,or 3.Existing ducts stems are constructed,insulated or sealed with asbestos 2.New HVAC System Required Forms: • Cut in or Changeout with new ducts:(all CF-6R forms: MECH-04 and MECH-2I-HERS new ducting and all new equipment) CF-4R forms: MECH-21 For Split Systems:Duct leakage<6 percent, For Packaged Units:Duct leakage<6 percent 3.New Ducts with Replacement Required Forms: • Includes replacing or installing all new ducting and/or outdoor condensing unit CF-6R forms: MECH-04 and MECH-20-HERS and/or indoor coil and/or furnace. Not all CF-4R forms:MECH-20 equipment thaned. For Split Systems:Duct leakage<6 percent For Packaged Units:Duct leakage<6 percent Q 4.New Ducting over 40 feet Required Forms: • Includes adding or replacing more than 40 CF-6R forms: MECH-04 and MECH-2I-HERS linear feet of duct in unconditioned space. CF-4R forms: MECH-21 For splits stem or packaged units: Duct leakage< 15 percent EXCEPTION:Existing duct systems constructed,insulated or sealed with asbestos. Contractor(Documentation Author's/Responsible Designer's Declaration Statement) 1 certify that this Certificate of Compliance documentation is accurate and complete. • 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. • I certify 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. • The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms,worksheets,calculations,plans and specifications submitted to the enforcement agency for approval with the permit application. Name: ++� � R � Signature: LIU Company: Gil lt1/1 COV t.l Date: Address: C (�( fJ `'11 /T�1 U_ 6) License: �L-- U max) S � City/State/Zip: O �j�(�, Phone: q0&,O??W—&,-_5 P 0 2008 Residential Compliance orms March 2010