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13100055 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10681 LA RODA DR CONTRACTOR:RESCUE AIR SERVICE PERMIT NO: 13100055 OWNER'S NAME: SEONG LEE 6007 MAJORCA CT DATE ISSUED:10/08/2013 OWNER'S PHONE: 4086886478 SAN JOSE,CA 95120 PHONE NO:(408)655-9916 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL B COMMERCIALE] License Class G�® Lic.# 82foZ0 It REPLACE(E)FURNACE,SAME LOCATION.ADD(N)A/C UNIT IN SIDE YARD AREA.SUPPLY DUCTWORK FOR Contractor Re%CkkP_ kvo Date ` BOTH 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:$9290 Ghave and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the wor�C for which this APN Number:36933050.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the abiovr 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 F M 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 1p granting of this permit. Additionally,the applicant understands and will comply �by. Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. / It/ f RE-ROOFS: C� Signature - �� Date I r o 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 Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's Li tense Law for one of 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 th lir sole compensation, will do the work,and the structure is not intended or offered fol sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with li I nsed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code)l 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 follows g three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(x)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,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: 6L , ev Date. 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 Ideemed 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 understa.n s and will comply with all non-point source regulations per the Cupertino Munilipal Code,Section Licensed Professional 9.18. Signature Date j GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION VO 0 TOR E8A AVENUE•CUPERTINO,CA 95014-3255 /ANO +�UPERTIf+IQ (408) ( 08)777-3333•buildingCo)cupertino.org `"1 MISC e ❑PLUMBING MMECHANICAL ❑ELECTRICAL / [—]MISCELLANEOUS PROJECT ADDRESS 1®GI Lq. h► ti r APN# 2 r_ 4) — � 1 '3 - I G i OWNER NAME �p • S40 �V� PHO _G � +�� E-MAIL e STREET ADDRESS Sf�q Li CITY, STATE,ZIP GQA • ��(No i r k; SOX FAX CONTACT NAME Se�•.�e PHONE qtr ro55 nU1`i�lr STREET ADDRESS J CITY STATE,ZIP FAX \U� 11OWNER ElOWNER-BUILDER 1-1OWNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER -2.( LICENSE TYPE BUS.LIC# e tt � 2 1 COMPANY NAMEC, ` _QrYCr EMAB,C�U� ` ����1• � FAX STREET ADDRESS � `', CITY,STATE,ZIP_ o `LO PHONE arc(h Cj A RC'Ii ITECTIFNGI NEER NAME LICENSE NUMBER ` BUS LIC# ` COMPANY NAME E-MALL 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 ❑�/Yfi�S BUILDING: E]COMMERCIAL URBAN INTERFACE AREA '4 NO FLOOD ZONE \VNO EICHLER HOME? VO DESCRIPTION OF WORK scone i TOTAL.VALUATION: ,Z RECEIVE B my signature below,I certify to each of the following: I a By g fY g: m the property owner or authorized agent to act on the property o er's be,batf 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 ply 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 purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED [crssoNl _ 4 w VER T COUNTER 3 :STANDARD, rc © T n s �E;iNA.IOR i MEPMiscApp_2011.doc revised 06121.111 CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 10681 LA RODA DR DATE: 10/08/2013 REVIEWED BY: MELISSA APN: 369 33 050 BP#: *VALUATION: 1$9,290 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Du lex PENTAMATION FURN/AC USE: p PERMIT TYPE: wORK REPLACE E FURNACE SAME LOCATION. ADD N A/C UNIT IN SIDE YARD AREA SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES A/C Units (<=10K cfm) 16REnnAIR 1 # $70 Furnace, Forced-Air 1MFR=<100 1 # $139 TOTALS: $209 00 _ � aki 'ua - Mech.Plan Check 0.0 hrs $0.00 Phanb.Plan Check Elec.Plan L7heck Mech.Permit Fee: IMPERMIT Plumb.Permit Fee: laec.Permit Fee: LOther Mech.Insp. 0.0 hrs $4T.00 Other Plumb Insp, Li I tither Flee.Insp. Li . Insp. Fe.': Plumb. Insp.Fee, Elec.Insp. Fee: NOTE:This estimate does not include fees due to other Departments(i.e Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These ees are based on the prefindna information available and are only an estimate Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff.' 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check 1*cue: Supy)LPC Fee PME Plan Check: $0.00 Perinit.Fee: suppl. lrtsp Fie PME Unit Fee: $209.00 PME Permit Fee: $47.00 Construction Tax. Administrative Fee: IADAffN $44.00 Work Without Permit? ®Yes 0 No $0.00 Advartced PIM117ing Fees: Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: IBSEISMICR $0.93 Select an Administrative Item Bldy Stds Commission Fee: IBCBSC $1.00 k 4 $348.93 $0.00 °°' ,� : "T� ' n, $348.93 Revised: 10/01/2013 Fro iprj 1-4 yve 0 IJ- Cl dkAo-S DEV DEPARTMENT CUPERTINO gar-, BUILDING D� de, A P p CEvl E D Th!5;set of plans andspecificadOnS MUST be kept at thE unlawful to make any -ristructiOn. .1 is unlaw job 0r ajtcjawns oil same,or to deviaie thoreimoffl,WiLhOut approval from the Building official. The stamping of I this plan and specifications SHALL NO" be hield to permit e an approval of the violation �xp of an - IsI01 City Ordinance or State Law. RV l0 8 DATE 0 S- P RIMIT NO. CE COP INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning Systems,Ducts and Fans (Page 1 of 2 Site Address: . Enforcement Agency: Permit Number: 1®c :L-o,, R d or. i 3000SS Space Conditioning Systems Heating Equipment Duct Efficiency Location Equip (AFUE, (attic, Type ARI #of etc.)1,3 crawl- Heating Heating (package- CEC Certified Mfr.Name Reference Identical (zCF-1R space, Duct Load Capacity heat um and Model Number Number 2 Systems value a etc.) R-value Bm/hr) (Btu/hr Sw V3c\ 1 0%-1M6 ��� RG-o 1o0.00 Cooling Equipment Efficiency Duct Equip (SEER Location Type and EER) (attic, (package #of 1'3 crawl- Cooling Cooling heat CEC Certified Mfr.Name ARI Reference Identical (2CF-1R space, Duct Load Capacity um and Model Number Number 2 -Systems value)' etc. R-value (Bhi/hr) (Btu/hr spk- 1.If project is new construction, see Footnotes to Standards Table 151-B and Table 151-C for duct ceiling alternative compliance. 2.ARI Reference Number can be found by entering the equipment model number at http:1Avww.aridirectory.org/ari/ac.php# 3.Listed efficiency on this page must be greater than or equal(>_)to the value shown on the CF-IR form. 4. When CF-IR is reference it is also applicable to the CF-IR, CF-IR-AA or CF-IR-ALT IL BOXES MUST BE CHECKED TO BE A VALID FORM H §110-§113:HVAC equipment is certified by the California Energy Commission. §150(h):Heating and/or cooling loads calculated in accordance with ASHRAE,SMACNA,or ACCA. ® §150(i): Setback Thermostat on.all applicable heating and/or cooling systems meet the requirements of§112(c). §1500)2:Pipe insulation for cooling system refrigerant suction,chilled water and brine lines meets minimum requirements of Table 150=13-and includes a vapor retardant or is enclosed entirely in conditioned space. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R=MECH-04 Space Conditioning Systems,Ducts and Fans '(Page 2 of 2 Site A dress: Enforcement Agency: Permit Number: 10 '3 I L11- U PA 1p1R- 1310 0 0 s "S- Ducts and Fans §150(m):Duct and Fans ❑ 1.All air-distribution system ducts and plenums installed,sealed and insulated to meet the requirements of CMC Sections 601,602,603,604;605 and Standard 6-5;supply-air and return-air ducts and plenums are insulated to a minimum installed level of R-4.2 or enclosed entirely in conditioned space. Openings shall be sealed with mastic,tape or other duct-closure system that meets the applicable requirements of UL 181,UL 181A,or UL 181B or aerosol sealant that meets the requirements of UL 723. If mastic or tape is used to seal openings greater than 1/4 inch,the combination of mastic and either mesh or tape shall be used;and ❑ 1.Building cavities,support platforms for air handlers,and plenums defined or constructed with materials other than sealed sheet metal,duct board or flexible duct shall not be used for conveying conditioned air. Building cavities and support platforms may contain ducts. Ducts installed in cavities and support platforms shall not be compressed to cause reductions in the cross-sectional area of the ducts. ❑ 2D.Joints and seams of duct systems and their components shall not be sealed with cloth back rubber adhesive duct tapes unless such tape is used in combination with mastic and draw bands. ❑ 7.Exhaust fan systems have back draft or automatic dampers. ❑ 8.Gravity ventilating systems serving conditioned space have either automatic or readily accessible,manually operated dampers. ❑ 9.Protection of Insulation.Insulation shall be protected from damage,including that due to sunlight,moisture, equipment maintenance,and wind.Cellular foam insulation shall be protected as above or painted with a coating that is water retardant and provides shielding from solar radiation that can cause degradation of the material. ❑ 10.Flexible ducts cannot have porous inner cores. DECLARATION STATEMENT • I certify under penalty of perjury,under the laws of the State of California,the information provided on this form is true and correct • I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction,or an authorized representative of the person responsible for construction(responsible person). • 1 certify that the installed features,materials,components,or manufactured devices identified on this certificate(the installation) conforms to all applicable codes and regulations,and the installation is consistent with the plans and specifications approved by the enforcement agency. • I reviewed a copy of the Certificate of Compliance(CF-1R)form approved by the enforcement agency that identifies the specific requirements for the installation. 1 certify that the requirements detailed on the CF-1R that apply to the installation have been met. • I will ensure that a completed,signed copy of this Installation Certificate shall be posted,or made available with the building permit(s)issued for the building,and made available to.the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) CZeSc.vke.. Avr I Sprvct2 Responsible Person's Name: Responsible Person's Sign tures Z0,1rVe.S V—t^-\ , CSLB Licenseb,.Z.C) 1 Date Signed Position With Company(Title): 2008 Residential Compliance Forms August 2009