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14060140CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10922 NORTHFIELD SQ CONTRACTOR: HUSSEY BROS INC PERMIT NO: 14060140 OWNER'S NAME: LILY HUANG 903 GEORGE ST DATE ISSUED: 06/23/2014 OWNER'S PHONE: 6502007404 SANTA CLARA, CA 95054 PHONE NO: (408)733 -6360 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL 0 INSTALL (N) A/C UNIT IN REAR YARD & REPLACE (E) License Class C # %�� L �1 FURNACE IN THE SAME LOCATION q�Lic. Contractor US e V1 U i1D iti(Bate 'L �� 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: $7513 I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 31637046.00 Occupancy Type: Section 3700 of the Labor Code, for the performance of the work for which this 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 D ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter 180 ED INSPECTION. 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 may accrue against said City in consequence of the Date: 23 ! granting of this permit. Additionally, the applicant understands and will co y e with all non -point source regulations per the Cupertino Municipal Code, Sectio RE- ROOFS: 9 18. �J Signature Date rZ 1 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 -BUILD ECLARATION 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 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 Section 3700 of the Labor Code, for the performance of the work for which this the Health & Safety Code, Section 505, 25533, and 25534. Date: Owner or authorized agent: 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I 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 918. Signature Date GENERAL PER iT APPLICATION Q\ Mm E P COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014 -3255 (408) 777 -3228 - FAX (408) 777 -3333 - buildina a cuDeitno.ora V�, mist; i ❑PLUiJPIIQG AL "ELECTRICAL ❑MISCELLAATEOUS PROJsCf ADDRESS n b r ', I APN # I s 3. O tJ ! VVV OVJhERNA E-MIA.I .1 � PHONT. �� vas h wt -o STREETADDYESS Ia- lel Q I C7, S A'E' k� gSOI `F I FAx COINTTACT NA1,0 ( PHONE E -]✓iSII STF=ADDRFSS CITY, STATE, ZIP ( FAX ❑ OWI-t ❑ OW zR. - BLniDER ❑ OWI'M A ENT 1 - CON- M'kaOR ❑ CON-MACTOKAGENr ❑ ' RF, 1'ECT ❑ ENGINEER ❑ D:lr£LO ?ER ❑ TENiKI CONTF.ACfOR NAME S t I LITE NIJI �E I LIC ;S 1TYpE S. ` V I BUS. LIC .AE E -1J C0111P .NY NN �SS� ( ve �vtse �. FAX I S O t 'DI- 6l STR e f P DDRESS . ` Q I Cm fin. R IPL /C✓� L !l -IJ O� I FBI 7 a ).) 'G GD ARCHrfECTJENGIN'EERj NA1yM LICENSE NUbSER- I BUS. LIC 4 COMPANY NAlV—P B -MAIL FAX STREET ADDRESS CITY, STATE, ZIP I PHOTB USE OF ❑ SFD or DUPLEX MULTf- FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑ YES BLTILDING: ❑ CO1JMMCLAL I URBAN D,7.- tFACE AREA ❑ NO ( FLOOD ZONE ❑ NO IS TI-M BLDG AN ❑ YES I EICHLER HONE? ❑ NO DESCRIPTION OF WORK 4r-kcee D A h 21- 4- TOTP.LVP.LUATION: - .�x By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property o mer's behalf. I , 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 ,nth all applicable local ordinances and state laws relating tO&Ui ing construction. I authorize representatives of Cupertino to enter the above- identin"e1d/property for inspection purposes. S i --nature of Applicant/Agent: Date: SUPPLEV'F-N INFORMATION REQUIRED ' 0 -may WM- .,Mf�S�ILESS� R� OLMI IE-C_OL3a-TER_ MOM 1✓EP1Wjiscllpp_2011.doc revised 06121111 CITY OF CUPERTINO 1 F.V F.CTIMATnR — RITILDING DIVISION ialADDRESS: 10922 NORTHFIELD SQ QTY/FEE DATE: 06/23/2014 REVIEWED BY: MELISSA BP FEES APN: 316 37 046 BP #: 113REMAIR *VALUATION: 1$7,513 PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Du lex USE: p Furnace, Forced -Air PENTAMATION FURN /AC PERMIT TYPE: A WORK INSTALL N A/C UNIT IN REAR YARD & REPLACE E FURNACE IN THE SAME LOCATION SCOPE $139 APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES A/C Units ( < =1 OK cfm) 113REMAIR 1 # $70 Furnace, Forced -Air 1MFR = <100 1 # $139 PME Unit Fee: $209.00 PME Permit Fee: $47.00 Consit'Lzction lUV. Administrative Fee: IADMIN $44.00 Work Without Permit? 0 Yes (j) No $0.00 TOTALS: Travel Documentation Fee: ITRAVDOC $209.00 Strong- Motion Fee: IBSEISMICR NOTE: This estimate does not include fees due to other uepartments (i.e. manning, L'tivize vroms, c[re, Jaiuuery newer LtJlr[u, aunvoc na_._a _. _ ., T/. ..•... t ,. 6.... -4 fl........,n...l-, :.. fnrw,niinn nvn:lahlo and aro nnhl an o.wimato_ Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11 -053 Eff 7/1/13) FEE QTY/FEE MISC ITEMS Plan C_ he'cl' `:'tippil. [mil. ! 1 ce PME Plan Check: $0.00 1'cr °tnat I�aa�r: PME Unit Fee: $209.00 PME Permit Fee: $47.00 Consit'Lzction lUV. Administrative Fee: IADMIN $44.00 Work Without Permit? 0 Yes (j) No $0.00 Travel Documentation Fee: ITRAVDOC $47.00 Strong- Motion Fee: IBSEISMICR $0.75 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $348.75 $0.00 TOE" EE: $348.75 Revised: 04/01/2014 Aaled I;I Lsf-,% '[f] 0 � QRJ I Iff Please indicate below which modification(s) are planned for your property. Provide brochure(s) if possible and a copy of any proposal(s), including the contractor's license number. Any modification not expressly listed herein, or not conforming to the restrictions and requirements listed herein for that modification will require an Architectural Review Application to be submitted to the Grounds and Architectural Committee and the Board of Directors for approval. Satellite Dish installation has a separate form to be completed and submitted for approval. Modification Restrictions and Requirements Air conditioning unit Unit will be designed for quiet residential use. Unit will be located within the enclosed yard of the property. There will be no part of the unit visible to common areas. Installed by a licensed contractor. Replacement window/ Must be same size aperture and Sliding door location of existing window or sliding door. Any necessary touch-up painting is the responsibility of the Homeowner. Installed by a license contractor. Garage door Must be windowless and in conformity with general architectural style of the complex. Repainting to conform to exterior color scheme is responsibility of the Homeowner. Installed by a licensed contractor. Any damages caused to property as a result of modifications will be the homeowner's responsibility. All prohibitions, restrictions, conditions, and rights of the Association enumerated under Article V of the amended and restated Covenants, Conditions and Restrictions of the Northpoint Homeowners Association are applicable to modifications Contained, herein. City permits may be required. Homeowners Property Address: Phone: 61ye)2 Date of Notification: 131 Date of Completion: Homeowner has 6 months to complete the designated modifications and is responsible for notifying management upon project completion. Office Use Only n Notification received by: . 44,111Y'4(�, Date:_ L Completion verified & appro 4ed by: Date: Form adopted 8/10/1999 Revised 5/00 a ��a :tss HVAC ALTERATIONS ENERGY COMPLIANCE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O:, BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • buildina@cupertino.oro WHEN IS A PERMIT REQUIRED A construction permit shall be obtained from the enforcement agency prior to the erection, construction, reconstruction, installation, relocation, or alteration of any mechanical system, except as permitted in Chapter 1, Section 112.2 of the 2010 California Mechanical Code. Projects requiring permits include, but are not limited to: • New HVAC installation • HVAC Changeout • Replacement of furnace, coil, FAU or condenser? • Relocation of an existing HVAC unit • Adding or replacing more than 40ft ducting in uncon6tioned space BUSINESS AND PROFESSIONS CODE, SECTION 7110 Willful or deliberate disregard and violation of the building laws, including the California Building Code, and local permit requirements constitutes a cause for disciplinary action from the Contractors State License Board working in conjunction with the local building department. This action may consist of fines up to $5,000 per violation or suspension/revocation of a contractor's license. 2008 BUILDING ENERGY EFFICIENCY STANDARDS (Title 24, Part 6) REQUIREMENTS INCLUDE: 1. Heating equipment must have a minimum 78% AFUE (Exception: Wall & floor furnaces; room heaters). 2. Central air conditioners & heat pumps less than 65,000 Btu/hr must have a minimum 13 SEER. 3. Newly installed or replaced ducts must have a minimum insulation value of R -4.2. 4. A setback type thermostat (24 hr clock with four set points) is required for all alterations. 5. New or replacement ducts must meet the mandatory requirement of Section 150(m). • All joints and openings in the HVAC system must be sealed. • Only UL 181, UL 181A, or UL 181B approved tapes or mastic shall be used to seal duct openings. • Connections of metal ducts and the inner core of flex ducts shall. be mechanically fastened. Flex ducts must be connected using a metal sleeve /coupling. • Flex ducts that are suspended must be supported every 4 ft. max for horizontal runs with no more than 2" of sag between supports and 6 ft. max for vertical runs. 6. The CF- 6R- MECH -04 must be completed and signed by the installing contractor. The Inspector will collect this form and verify that the model numbers are the same as the installed equipment. 2008 Residential Compliance Forms.doc revised 04110112 Me m: �` �tf Enforcement Agency: ; �..� p1� �L � L u0 �T !�r e S io i�'1 l Conditioned Duct insulation Egnigment Type' U;k Nfinimiitn'Erriciency2 'FIOOr 1 TC8 " Thar�ostat Packaged iim t' .:' ace �_AFIJE: �� ,. COP �HS l ti 1 t ed t,,; �;� - -i�� Over of duck added or rep iaced in Vindo Coil PF Z Sf unconditioned space... (Th,ota,hnzadypm&:or x.0 -qbe Condensing L nit EER Resist ce E3 R 6 (CZ 1, 3 -S) ; Other 1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -IR ALT- HVAC.for each system. 2. Maniuium Equipment Efficiencies: 13 SEER, 78 %AFUE, 7.7HSPF for typical residential systems. Contractor (Doctmaentaton Author's /Responsible Designer's Declaration Statement) • I certify that this Certificate of Compliance documentation is accurate and complete. s I 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 featw es and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Tide 24, Parts I and 6 of the California Code of Regulations. • The design features identified on this Certificate of Compliance are consistent with the infomnation documented on other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for appirn'al with the pewit ; lica5ou. Name: eVC N� sac Si, Company ss( lvS Date: Address License: / 7S k65 1 city /stateCZip:l fir. c Wk ' s Phone: tr(Fd f - )33,6j&a 2008 Residential Compliance Forms.doc revised 04110112 1 SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION FIL E 10 TORRE AVENUE • CUPERTINO, CA 95014 -3255 �. (408) 777- 28 • FAX (408) 777 -3333 • building a)- cupertino.org Permit No. /O1P ZZ PURPOSE This affidavit is a self - certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections are required. GENERAL INFORMATION Existing single- family and multi- family dwellings shall be provided with Smoke Alarms and Carbon Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds $1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and /or Carbon Monoxide Alarms be installed in the following locations: AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the bedroom(s) X X On every level of a dwelling unit including basements X X Within each sleeping room X Carbon Monoxide alarms are not required in dwellings which do not contain fuel- burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated. In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for alarms which must be connected to the building wiring. As owner of the above - referenced property, I hereby certify that the alarm(s) referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes. The alarms have been tested and are operational, as of the date signed below. I have read and aaree to comply with the terms and conditions of this statement Owner (or Owner Agent's) Name: / /G Z�y 414 Sign ture ........ ....... ................... ................. ............................... Date:4 -..4 l . Contractor Name: Signature.................................... ............................... Lic.# ....... ............................... Date: ................... Smoke and CO form.doc revised 03118114 CC;��pr:,UNITY DG1/El_OpM -, ^3T D�PAPTr1-NT vuILDING DIVISION - C"JPERTIND Ap " "q Vq y° w § ns I11AUST be. kept. -.t ,,le PAt o-, nlnns and sp Y + o It i._ unla�{�i to to r .r, z iris constructin ^�1e or to c =. -s or alterations on without app roval frcm the nec �fications (ft^ �r+inn of this plan and, st, ',Oval ic?Of permit or to be an a, , ,- 'ovislons of any Cit &3 y�rte' PUP d4. 1 01 Lill, NuA%&5 l b� Zi No SQ CV per l wo t ch 9156 IV &s -0 200 - -14001 PLOT PLAN CHECKED BY DATE • j LANNIN T. DATE RT,DG. DEPT. u nevi 1,, 10 "000� CUPERTINO p �3uilding Department 1- � 10 Ser re kk fV UNr} �� REV(EVu� =�' FOR CODE COMP 33'ic 3e)c ��'' Revievyea f3 COMPLIANCE 30 R .41 .t3ov JVrV (?FI (UtAs-r -it ��ce w V w` v wf` pg RECE'E jUN 2 3 2014 �rb wV DY _--- --