B-2017-0306 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0306
22250 VARIAN WAY CUPERTINO,CA 95014-1065(326 17 042) ABC COOLING&
HEATING SERVICES
INC
HAYWARD,CA 94545
OWNER'S NAME: ONG KENNETH C AND CHEN JOAN J DATE ISSUED:02/24/2017
OWNER'S PHONE:408-219-3057 PHONE NO:(559)292-9240
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class 13 C20 Lic.#382383
Contractor ABC COOLING&HEATING SERVICES INC Date 05/31/2017 X BLDG _ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing X MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
REPLACE FURNACE(GARAGE);REPLACE A/C UNIT(REAR YARD)
I hereby affirm under penalty of perjury one of the following two declarations:
i. 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
rz'j''performance of the work for which this permit is issued.
2. 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
permit is issued. Sq.Ft Floor Area: Valuation:$3246.00
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 32617 042
representatives of this city to enter 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 PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue againstsaidCity in stands and e the hg oo this WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal ode,Section 9.18. 180 DAYS FROM LAST C
_ ' 4,,. ION..
Signature Date 02/24/2017 Issued by: vl LI Y_ 7.` =
Date:02/24/2017 --\
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS;,
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:02/24/2017
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. ' 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. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
a. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code, apter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code ctions 25505,25533,and 5534. .
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agenti�
APPLICANT CERTIFICATION Date:02/24/2017
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
° to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Licensed
Signature Date 02/24/2017 Professional
\ ' ' GENERAL PERMIT APPLICATION MEP
t.,ook
ii, COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
.J, 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•buiidingtcupertino.orq '
S C
C_ 2 O 1 ?-. - 0 30-6
#�❑,�P�LUMBING MECHANICAL ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS D (j(Ja-n ( /fir APN# ( O, q/
OWNER NAME E Oil l i/ PHO
D>�EI,7 m 3 1 7 EMAIL
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STREET ADDRES(� /�f 7 ��r� ft I JATE,� �, r FAX
CONTACT NAME 1 - bare
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E-MAIL
STREET ADDRE {/ CITY,S •T ..A.• / J ('"2 / FAX
❑OWNER 0 OWNER-BUILDERJJJ ( o/
❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME , LI9 iv 3 Sg� /L BUS.LIC . U 3
COMPANY NAME ,, , E-MAIL FAX `� 1
STREET ADDRESS 6 1.---.,,n
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ARCHITECT/ENGINEER NAME LIICCENSE BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP
PHONE
USE OF �iSFD or DUPLEX 0 MULTI-FAMILY PROJECT IN WILDLAND 0 YES PROJECT IN 0 YES IS THE BLDG AN 0 YES
BUILDING: 0 COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE 0 NO EICHLER HOME? 0 NO
DESCRIPTION OF WORK
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TOTAL VALUATION: RECEIVED
By my signature below,Ice ' to each of the following: I am the property owner or authorized agent to act on the property-,•'behalf. I have read this
application and the information I have prov' d is correct. I have read ascription of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buil g construction. I au e eIY'z reeprpesentatives of Cupertino to enter the ab e-ider2._.-"rntiifie rope, for inspection purposes.
Signature of Applicant/Agent: Date: ` !/
SUPPLEMENTAL INFORMATION REQUIRED o USE ONLY.
H
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" ❑ EXPRESS
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❑.MAJOR
MEPMiscApp_2011.doc revised 06/21/11
1
STATE OF CALIFORNIA
ALTERATIONS - HVAC .
CEC-CF1R-ALT-03-E(Revised 01(16) CALIFORNIA ENERGY COMMISSION - ---
CERTIFICATE OF COMPLIANCE CF1R-ALT-03-E
Alterations-HVAC CZ 1,3 to 7 and 16 (Page 1 of 1)
Site Address q52 d Enforcement Agency: Date Preared: Permit#:eevi c7/ 2- 'r /
New:Ducting or Lineset ConditionedEquipment TyPe Equipment Efficiency
Required R-value Floor Area(ft2) Thermostat
❑Packaged System 0 Evaporator Coil —1 AFUE COP 0 R-6 (CZ 1-10,12&13)Ducts Se ed by system `Setback
❑Split System 0 Condensing Unit 9 SEER 0 R-8' (CZ11,14-16)Ducts ft2 (If not already
HSPF ❑>_R-2.8 Lineset3 present,must
0 Furnace 0 Lineset EER be installed)
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below.At permit application this
form 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.
HVAC Changeout/Repair Required Compliance Documents to be left on site for Final:
(Can include new ducting)
All Equipment, CF1R-ALT-02-E
Condenser Unit,Evaporator Coil, CF2R:MCH-01,MCH-20-H
Air Handler/Furnace CF3R:MCH-20-H
Installer Requirement:Duct leakage(5_15%or,510%to outside,or seal all accessible leaks)
Exempted from duct leakage testing if:
0 1.Duct system registered with HERS provider as previously sealed,or 0 2.There is less than 40 linear feet of duct in unconditioned
space,or 0 3.Existing duct systems are constructed,insulated or sealed with asbestos(list manufacture date of building )
❑2.New HVAC System Required Compliance Documents to be left on site for Final:
All new equipment and All New Ducts2 CF1R-ALT-02-E
CF2R-MCH-01-E,MCH-20-H,MCH-22-H,MCH-(23 or 24)-H
CF3R-MCH-20-H,MCH-22-H,MCH-(23 or 24)-H2
Installer Requirement:Duct leakage<5%,Fan Efficacy(0.58W/CFM),Air Flow>_350 CFM/ton(or Standards Table 150.0-B/C alternative)
❑3.All New Ducts with Replacement Required Compliance Documents to be left on site for Final:
Includes replacing or installing All New CF1R-ALT-02-E
Ducts'and one or more of the following: CF2R-MCH-01-E,MCH-20-H,MCH-(23 or 24)-H
Condenser Unit,Evaporator Coil,Furnace CF3R-MCH-20-H,MCH-(23 or 24)-H
Installer Requirement:Duct leakage<5%,Air Flow>_350 CFM/ton(or Standards Table 150.0-B/C alternative)
0 Exempted from duct leakage testing if existing duct systems are constructed,insulated or sealed with asbestos.
0 4.New Ducting over 40 feet Required Compliance Documents to be left on site for Final:
Adding or replacing ducts in unconditioned CF1R-ALT-02-E
space but less than All New Ducts2 CF2R-MCH 20 H
CF3R-MCH-20-H
Installer Required to:Duct leakage(<15%or,<10%to outside,or seal all accessible leaks)
0 Exempted from duct leakage testing if existing duct systems are constructed,insulated or sealed with asbestos.
'All new ducting requires R-8 insulationwhen more than 40 ft installed in CZs 11&14-16 and R-6 in CZs 1-10,12&13,and R-6 insulation 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%new duct material,and up to 25%may consist of reused parts from the
dwelling unit's existing duct system(e.g.,registers,grilles,boots,air handler,plenums,duct material.
3 R-2.8(1"thick insulation)for linesets 1"and less.
Contractor(Documentation Author's/Responsible Designer's Declaration Statement)
I certify 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. I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the information on this document.
3. 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 for the 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.
Responsible Designer Name:/� /� Responsible Designer Signature: 6,1s_,
J te5igned tey�ye,3
//]/� '�}�/ � �� G ��ALL//.�, CC77// ` j syr`/ ,l {S/j/
Company: ,rL�v�' �%Yi/1/9 / City/Sta_te/Zip:e4 q q� P e(J 7/ g /
For assistance or questions regarding the Energy Standards,conta he Energy Hotline at:1-800-772-3300