13060185 CITY OF CUPETINO BUILDING PERMIT
BUILDING ADDRESS: 11135 LA PALOMA DR CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 13060185
CONDITIONING
OWNER'S NAME: JOHN XIAO 1712 STONE AVE DATE ISSUED:06/24/2013
OWNER'S PHONE: 4083094678 SAN JOSE,CA 95125 PHONE NO:(408)293-4717
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIALE]
License Class C 4(1 C?,0 Lic.# !M8A7/ INSTALL(N)3 TON A/C UNIT IN REAR YARD
Contractor AA& 6A()I a C.'%- Dale e`2V 15
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.
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:$4060
1 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 APN Number:35616035.00 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 FRO 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 7K
granting of this permit. Additionally,the applicant understands and will comply Issu ate:
ZZ,with all non-point source reg atio per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signatur .. Date ie�!��r 7 All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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,
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I 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
I 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 I
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,Se 'ons 2550 , 5533, n 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agen . ADate -2,q—13
permit is issued.
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 performance 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 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
upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
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
V
GENERAL PERMIT APPLICATION ()� ME p
COMMUNITY DEVELOPMENT DEPARTMENT- 6'UILDING DIVISION
10300 TORRE AVENUE ,CUPERTINO, CA 95014-3255
URERTINO (408)777-3228 - FAX(408)777-3333 ,building cupertino.org ' "/ M Is c
PLUNUC I`IG CHANICAL ELECTRICAL El MISCELLANEOUS
PROJECT ADDRESS
OWNERNAhtE \1105 G Q A0�(A Oy0 I PHONEA�^Q 2AP1N�GS .:nr�6� rlE6-h _ 03,S
O J
'„VACD
STRBFr ADDRESS 11 lW LO kwo N� ( S r (,Aq�k 4- FAX
CA
CONTACT NAME CITO\/vT� Y 1 .+- E �
STREI:I'ADDRESS. [j I2 C n at b � CrrUV1 Y (A gl� 1/• FAX
r o 1 �1 I ll IK/ `J I LCI
❑ OWNER ❑ OWNER•SUILDER ❑ OWNER AGENT CONTRACTOR ❑CON%Ac-rOR AGENT ❑ ARCHrIECT ❑ENGINEER ❑ OEYELOPER ❑ TENAMT
CONTRACTOR NAME �� 1V►A rA C� LICENSE NUMHER�( �I (F7UTAguo
BUS.LIC i qm
U
COMPANY NAME VY' I W" " E•h41II FAX LV.IC
STREET ADDRESS 1�12- n4 �1 C1Tt�4�{� PHONEvI
A tCHITZCT/ENOIt�1EER NAME /U �1 LICENSE NUhIBv EERR t BUS.LIC i
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF D or Duplex p Multi-Family PROJECT IN WILDLAND PROJECT P( C
STRUCTURE: ❑ Commercial URBAN Di ERPACE AREA ❑ Yes FLOOD ZONE ❑ Yes 1F10
DESCR1FT10NOFWORK
' s !!
TOTAL YALUATION:
By my signature below,I certiUpro
llowi I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the informatioco a 1 have read the Description of Work and Ycrify it is accurate. I agree to comply with all applicable Iocal
ordinances and state laws relats on, I authorize representatives of Cupertino to enter the pbov� dent�fpd property for Inspection purposes.
Signature of Applicant/Agent: Date;
SLWLEMENTAL INFORMATION REQUIRED
v=im
A4EPMIsalpp_1011.doe revised 03/101
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 11135 LA PALOMA DR DATE: 06/24/2013 REVIEWED BY: MELISSA
APN: 35616 035 BP#: "VALUATION: 1$4,060
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION FURN/AC
USE: PERMIT TYPE:
WORK INSTALL N 3 TON A/C UNIT IN REAR YARD
SCOPE
APPLIANCE/EQUIP TYPE FEE H) QTY UNITS BP FEES
A/C Units (<=10K cfm) 1BREMAIR 1 # $67
TOTALS: $67.00
n
Mech.Plan Check 0.0 hrs $0.00 Plumb.Plan Check Elec..Plan(....heck
Mech.Permit Fee: 1MPERMIT Plumb. Permit 1%e(e: flee. Permit Fee:
Other Mech.Insp. 0.0 hrs $45.00 01her Plumb Inrf)_ Clrher Elec,Insp. Lj
Aleck lnsp, Mize: Plumb. Insp.Fee: Elea.Insp. Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These-W are based on the prelimina information available and are only an estimate. Contact the Dept for addn'l info,
FEE ITEMS(Fee Resolution 11-053 Eff. 7/1112) FEE QTY/FEE MISC ITEMS
Plan. Check Fee:
;Supp/. Pl:'Fee
PME Plan Check: $0.00
Permit Fee:
Stippl, Insp Fee
PME Unit Fee: $67.00
PME Permit Fee: $45.00
Construction 1 ax:_
Administrative Fee: IADAffN $42.00
Work Without Permit? ® Yes (E) No $0.00
Advanced Planning Fees:
Travel Documentation Fee: ITRAVDOC $45.00
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
{ $200.501 $0.00 F TOTAV SEE $200.50
��'.e}: t �eakea':'Po}..�....
Revised: 04/29/2013
-1R-ALT
Prescriptive Certificate of Compliance: Residential CF F(Page 4 of 5)
Residential Alterations #of Stories
Climate Zone#
Project Name: „a e,+
S O 2
HVAC SYSTEMS- HEATING Configuration
Minimum Duct or Piping
Heating Equipment Efficiency Distribution Insulation Thermostat (Central,Split,
Type and Capacity''2.3 ( \FUE or HSPF) Type and Location R-Value T e Space,Package or H dronic)
1.Indicate Heating Type(Central Furnace,.Wall Furnace, Heat pump, Boiler. Electric Resistance, etc.)
2.Electric'resistance treating is allowed only in Component Package C, or except where electric heating is supplemental(i.e., ijtotal capacity
�• , < 2 KW or 7,000 Btu/hr electric heating is controlled by a time-limiting device not exceeding 30 minutes). See§151(b)3 exception.
3.Refer to the HERS Verification section on Page 4 of the CF-1 R-ALT Form for additional req crirements and check applicable boxes.
4. indicate Type or Location (Duets, Hvdronic in Floor, Radiators, etc.)
HVAC SYSTEMS-COOLING
Minimum Configuration
Efficiency Duct or Piping g
Cooling Equipment (SEER/EER or Distribution Insulation Thermostat (Central,Split,
Type and Capacity SOP) Type and Location3 R-Value T pe Space,Packa a or H dronic
a
1. Indicate Cooling Type(A/C. Heat pump, Evap. Cooling, etc)
2. Refer to the HERS Verification section on Page 4 of the CF-1 R-ALT Form for additional requirements and check applicable bores.
3. Indicate-Type or Location (Ducts, H dronic in Floor, Radiators, etc.)
WATER HEATING
List water heaters and boilers for both domestic hot water(DHW)heaters and hydronic space heating. Individual dwelling DHW heaters must b
gas or propane fired, and may not exceed SO gallons. Hot water pipe insulation from the DHW heater to the kitchen(s)and on all underground
hot water pipes is required in all tom onent packages in all climate zones. External Tank
Water Heater Type/Fuel Distribution Type
Number in Tank Energy Factor or insulation
Tye (Standard, Recirculatin , S stem Ca aciry(gal) Thermal Efficient R-Value3
1. Indicate Type(Storage Gas, Heat Pump, instantaneous, etc.)
2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of¢I50(n). The Prescriptive requirements do
not allow the installation of a recirculating water heating system for single dwelling units.
3. The external water heating tank and i es shall be insulated to meet the requirements of§1506f).
SPECIAL FEATURES The enforcement agencv should pay special attention to the Special Features specified in this checklist below.
These items may re hire written justification and documentation andspecial verification.
NEW ROOF ASSEMBLY-Radiant Barrier
The radiant barrier requirement of§,1.5 1(f)2 does not apply,to roof alterations.
Slab Edge(Perimeter)Insulation ❑ YES ❑NO
YES: In Climate Zone 16 in Component Packages D, R-7 insulation is required.
Heated Slab Insulation ❑ YES ❑ NO
YES:Slab edge insulation required for all heated-slabs in all Climate Zones. See details in Table 1 18-A of the standards.
Raised Slab Insulation ❑ YES ❑ NO _
YES:In Climate Zones I,2, 11, 13, 14& 16,R-8 insulation is required; in Climate Zones 12& 15,:R-4 is required under tom onent Pa O
Thermal Mass
To obtain Compliance Credit for the installation of thermal mass,,t+se thcTerforman.ce A roach.
Registration Date/Time: HERS Provider:
Registration Number: August 20
2008 Residential Compliance Forms
a
P
/ 1 / 3s'' l-� iAt-O44,4
9�roc�
bw���-•' Satin J< �a � �`��� �
�y.
3136~ L 035) ^^r��\yN §41
Clf� mo r4` Oro
F>1 CPN` '`1
I,n\
Pr.�\oe
5p•=u \�\s e oC r• �Ft
ofi \anti cQ a�C� <: °`� the g�\Xdo� `
.�.�\c,5'•t C�UC\r�` ?.\`i�''i� ' n�f�z\its ��5`z�,� `a-�UC�
°it'u
e§tai` ' , ,ova oC a
e �Cva�`oe
UPERTINO
.„liliina Deeartrnent
0
203
P S( ; 7 COMPLIANCE
v�
Y
N A0- .
'(tr a•, l s1 S''^ !13 �h 03 6
cxE cKED By
3 -�^ y -f• -� �
AaS DATE Z4 /
PLANN DEPT.
DATE
Ri.IIG. DEPT.