15110059�9
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19512 HOWARD CT
CONTRACTOR: SERVICE CHAMPIONS
PERMIT NO: 15110059
OWNER'S NAME:.,POON DANIEL
7020 COMMERCE DR
DATE ISSUED: 11/10/2015
OWNER'S PHONE:, 4084808282
PLEASANTON, CA 94588
PHONE NO: (925) 444-4444
`I1 LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL F] COMMERCIAL F]
License Class Lic. # I -to `iU
Replace 2 furances, 1 A/C, and 2 coil split systems in same location; install 1 new
cutin A/C at rear
_
Contractor ' Per'D Lib amp I csx S Date L t 0 t %
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, asprovided for by Section 3700 of the Labor Code, for the
Sq. Ft Floor Area:
Valuation: $41092
performance of the work for which this permit is issued.
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
APN Number: 36916032
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
to building construction, and hereby authorize representatives of this city to enter
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
upon'the above, mentioned property for inspection purposes. (We) agree to save
180 DAYS FROM LAST 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/(s
V v Date:
granting of this permit: Additionally, the applicant understands and will comply
Issued by: I ` 1 V
with all non -point source, regulations per the Cupertino Municipal Code, Section
9.18.
1� �}�
Signature" V.J4 � . "' Date l i v� —t
RE -ROOFS:
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 he affirm thati 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 mainiain 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,lwill 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
JA (� , / ,� 1
Owner or authorized agent: Date:
permit is issued. .
I certify that in the performance of the work for which this permit is issued, I shall
not employ anyperson 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 meritioned property for inspection purposes. (We) agree to save
indemnify and keep harmless. the City. of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
costs, and, expe1.n'ses 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-poin6ource regulations per the,Cupertino Municipal Code, Section
Licensed Professional
9.18. � �: r, i. �� I"i ` •
Signature'' Date
CUPERTINO
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 950143255
(408) 777-3228 • FAX (408) 777-3333 • building0cupertino.org
MEP
MISC
- PLUMBING
OMMMICAL MISCELLANEOUS i J I I 005,
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ARCII<TEECP/FNcDmNAME
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COMPAWNAME
E-MAIL
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CITY. STATE, DZ'
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PROJECfINWAiDLAM ❑ YFS
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FIAODZONE ❑ NO
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ECHMHOMR ❑ NO
DESCRwnON OF WORK
A-1 C, c�- S QPW S
CUT I A L�)elc arC� �a L(A ✓1 S
TOTAL VALUATION: �^(� i7 q Z r W
...........:....--
RECEIV%DBY:
By my signature below, I cmft to each of the following: I am the property owner or mWu)r zed agent to act on the property ownees behirf I have read this
application and the information I have provided is correct I have read the Description of Work and verify itis accurate. I agree to comply with all applicable -local
ordinances and state laws relatin to building duction. lqqtharkerepresonm&wofCupatinotD enterthe above -identified property for figm:don purposes.
Signature ofApplicerdAgeat: Date:
RE IRED
SUPPLEMMUL INFORMATION U
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OFFA(USEONLY :.
"M&MW 2011.doc revised 001/11
1
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
W
ADDRESS: 19512 Howard Ct
DATE: 11/10/2015
REVIEWED BY: Phuong
UNITS
APN: 369-16-032
.
BP#:
*VALUATION: $41,092
*PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
#
PENTAMATION FURN/A
PERMIT TYPE: 19
WORK
Replace 2 furances 1 A/C and 2 coils lits stems in same location; install 1 new cut in A/C at rear
SCOPE
Szq)pl. 111sp Fee.
APPLIANCE / EQUIP TYPE
FEE ID
Nwnb. Plan Check
QTY
UNITS
BP FEES
Istec. Permit Fee:
A/C Units (<=10K cfm)
1BREMAIR
Ocher Elec. Insf.-�.
2
#
$144
Furnace, Forced -Air
1MFR=<100
Szq)pl. 111sp Fee.
2
#
$286
PME Unit Fee:
$430.00
PME Permit Fee:
$48.00
CohStruction Tax:
Administrative Fee: IADMIN
$45.00
Work Without Permit? 0 Yes (j) No
$0.00
TOTALS:
Travel Documentation Fee: ITRA VDOC
$430.00
Strong Motion Fee:' IBSEISMICR
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc). These fees are based on the preliminary information available and are only an estimate Contact the Dept_for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E .7/1/13)
Mech. Plan Check"00 $0.00
Nwnb. Plan Check
h7ec.. flan Check
Mech. Permit Fee: 1MPERMIT
Phvinb. Pernsit 1-'ee:
Istec. Permit Fee:
Other Mech. Insp. 0.0 hrs L$48.00
Other Phanb Insp.
Ocher Elec. Insf.-�.
tech. 112sp. Fee:
Phunb. hup. Fee:
Dec. 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 fees are based on the preliminary information available and are only an estimate Contact the Dept_for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E .7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fite:
S1�r1�l..PC"TeeL�j
PME Plan Check:
$0.00
Permit .Fee:
Szq)pl. 111sp Fee.
PME Unit Fee:
$430.00
PME Permit Fee:
$48.00
CohStruction Tax:
Administrative Fee: IADMIN
$45.00
Work Without Permit? 0 Yes (j) No
$0.00
Advanced Planning Fees:
Travel Documentation Fee: ITRA VDOC
$48.00
Strong Motion Fee:' IBSEISMICR
$5.34
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$2.00
SUBTOTALS:
$578.34
$0.00 TOTAL FEE:
F $578.34
Revised: 10/01/2015
� ) �uI1 Spat S(' &—tamS
STATE OF CALIFORNIA
AL ERATI®NS - HVAC CALIFORNIA ENERGY COMMISSION
CEC. FiR-ALT-03-E Revised 06/14
CFIR-ALT-03-E
CES TIFICATE OF COMPLIANCE
{page 1 of i)
AI aerations - HVAC al, 3 to 7 and 16 (formerly CF-iR-ALT HVAC)
Sits Address: Enforcement Agency: Date Prepared:
f�owGLrd bf ! t-�o-r
Permit#.-
I q s 12
New: Ducting, Plenums, Lineset Conditioned
Eq ipment Type Equipment Efficiency Required R -value Floor Area (sgft)
Thermostat
[3 R-6 (07 1,3-7) Ducts Served by system
CZ
0 Plackaged System 0 Evaporator Coil !o AFUE COP
Setback
(if not already
0 R-8' 16) Ducts sq ft
6 Slplit System 0 Condensing Unit _SEER HSPF 0 R-6 (all CZ's) Plenums
present, must
0 Fi rnace O Uneset EER 0 R-5 or R7.5 Uneset'
be installed)
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this
fo6 is allowed to be filled out by hand. For final inspection all forms are to be registered (no hand filled forms allowed) and a copy
left on site.
011. HVAC Changeout/Repair '
Required Compliance Documents to be left on site for Final:
Cain include nevi ducting
Al(- Equipment,
CFIR-ALT 02-E
denser Unit; Evaporator Coil,
CF2R: MECH-01, MECH-20-HERS
Handler/Furnace CF3R: MECH-20-HERS
taller Requirement: Duct leakage (<15%or, < 1(%to outside, or seal all accessible leaks)
:mpted from duct leakage testing if:
31. Duct system registered with HERS provider as previously sealed, or 0 2. There is less than 40 linear feet of duct in unconditioned
ice, or 0 3. E)isting ducts stems are constructed, insulated or sealed with asbestos list manufacture date of buildin
2. New HVAC System Required Compliance Documents to be left on site for Final:
new equipment and All New Ductsa CFIR-ALT 02-E
CF2R-MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS
CF311-MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24)-HERS2
taller Requirement: Duct leakage < 6%, Fan Efficacy (.58W/CFM), Air Flow a 350 CFM/ton (or Standards Table 150-0-C/ D alternative)
3. All New Ducts with Replacement Required Compliance Documents to be left ;;site for Final:
dudes replacing or installing All New CF1R-ALT-02-E
ucts= and one or more of the following: CF2R-MECH-01, MECH-20-HERS, MECH-(23 or 24) -HERS
Iler Requirement: Duct leakage:i 6%, Air Flow 2:350 CFM/ton (or Standards Table 150.0-C D alternative
0 Exempted from duct leakage testing 1 existing duct systems are constructed, insulated or sealed with
New Ducting over 40 feet Required Compliance Documents to be left on site for Final:
CF1R-ALT 02-E
Adding or replacing ducts in unconditioned CF211: MECH-20-HERS
spiace but less than All New Ductsz CF3R: MECH-20-HERS
Installer Required to: Duct leakage (<.15% or, < 10% to outside, or seal all accessible leaks)
® Exempted from duct leakage testing I existing ducts stems are constructed, insulated or sealed with asbestos.
' All new ducting R-8 required when more than 40 ft installed and R-6 when less than 40 ft installed. This includes in walls, between floors etc.
2 A New Duct system is when the duct system is constructed of at least 75 percent new duct material, and up to 25 percent may consist of reused
parts from the dwelling unit's existing duct system (e.g., registers, grilles, boots, air handier, plenums, duct material.
e R-5 (1" thick insulation) for linesets 1" and less. R-7.5 (l5" thick insulation) for linesets over 1 inch. Most mfg will require Suction line Diameter
with insulation as the following 1.5-2T 2%", 2.5-3T 2%", 3.5 to 4T-rAff, ST -434"
Contractor (Documentation Author's/Responsible Designer's Declaration Statement)
I 'ertify the following under penalty of perjury, under the laws of the State of California:
1 The information provided on this Certificate of Compliance is true and correct
2 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility. for the information on this document.
3.1 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 (CCR).
4 That the energy features and performance specifications, materials, components, and manufactured devices forthe building design or
system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the CCR.
5'. The building design features or system design features identified on this Certificate of Compliance are consistent with the information
provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement
agency for approval with this building permit application. Date caned. ilcense:
Responsible Designer Name: Responsibl Design signature: !
y1(� $ L'1 a L 0
1 " &'q'i n 6, , l� S / Ctty/ /AP: Phone:
Address: � Dr
j For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-80D-772-3300