B-2017-1199CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1199
11220 TERRA BELLA DR CUPERTINO, CA 9501414806 (356 21 007)
A PLUS GENERAL
CONTRACTORS INC
GARDEN GROVE, CA
92841
OWNER'S NAME: TSUEI YUH-SHENG AND CHAO MU HAN
DATE ISSUED: 07/24/2017
OWNER'S PHONE: 408-832-1245
PHONE NO: (714) 901-0500
LICENSED CONTE ACTOR'S DECLARATION
BUILDING PERNIIT INFO:
License Class C-20 Lic. #Z63154
Contractor A PLUS GENERAL CONTRACTORS INC Date 05/31/2019
X BLDG —ELECT _ PLUMB
X MECH X`RESIDENTIAL COMMERCIAL
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.
JOB DESCRIPTION:
REPLACE FURNACE (SAME LOCATION -GARAGE); REPLACE A/C
I hereby affirm under penalty of perjury one of the following two declarations:
(SAME LOCATION -BACKYARD)
m. have and will maintain.a certificate of consent to self -insure for Worker's
ompensation, as provided for by Section 3700 of the Labor Code, for the
performance ofthe work for which this permit is issued.
I have and willmaintain) Worker's Compensation Insurance, as provided for by
!
Section 3700 of the Labor Code, for the performance of the work for which this
Sq. Ft Floor Area:
Valuation: '$9998.00
permit is issued.
APPLICANT CERTIFICATION
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
Number:
Occupancy Type:
and state lawsirelating to building construction, and hereby authorize
35621 007
356
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 IFWORK IS NOT STARTED
may accrue against s ' ity in consequence of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the ap cant nderstands and will comply with all non -point
source regulations ert a upertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALE ED INSPECTION.
Si : � ure Date 7/24/2017
Issued by: Jasmine Archbold ;
Date: 07/24/2017
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
1. I, as owner of the property, or my employees with wages as their sole
installed without first obtaining an inspection,.1 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:7/24/2017j
i
I hereby affirm under penalty of1perjury, one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "Al- OR BETTER
i. I have and will maintainCertificate of Consent to self -insure for Worker's
•a
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. 1 have and willmain 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 L'ab6r,Code, for the performance of the work for which this
California Health &Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
s. 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
u.
material. Additionally, should I use equipment devices which emit hazardous
.1
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 become subject to the Worker's Compensation provisions of the
for
air contaminants as defined by the B Air Quality Management District I
will maintain compliance with the pertino unicipal Code, Chapter 9.12 and
t 'Health & Safety Co e, Sections 5505; 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked
Ow authorized agent:
APPLICANT CERTIFICATION
D t 724 2 a !
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
CONSTRUCTION LENDING AGENCY
I ereby affirm that there is a construction lending agency for the performance
issued
relating to building construction; and hereby authorize representatives of this city
097, Civ C.)
of work's for which this permit is (Sec. :1097,
to enter upon the above rientioyned propi rty 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,thisipermit. Additionally, the applicant understands
and will comply. with all non -point sI urce;regulations per the Cupertino Municipal
ARCHTIECT'SDECLARATION
Cade, Sections 9.18.
I understand my plans shall be used as public records.
Signature-- Date7/24/2017
Si gProfessional
Licensed
!
CUPERTINO
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-328 • FAX (408) 777-3333 • buildino(a cuoerdno.org
❑PLUMBING IVIECHANICA2
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F—IELECTRICAL F�MISCELLANEDUS
PROJECT ADDRESS
11.4,08
FAFN 2
OWNER NAME
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STREET ADDRESS
,STATE,
FAX
CONTACT NAME
PHONE �
EMAIL
STREETADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER-aurLDER
❑ OWNER AGENT ill CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHI'T'ECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR N p,
LICENSELICEN
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BUS. LIC OAk
COMPANY NAME
E-MAIL
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STREET ADDRESS
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CITY, STA
PH�1
ARCHTMCTIENGINtiEERNAIv1E
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LICENSE NUMBER
BUS. LIC R _
COMPANY NAME ' , ,
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PIiONE
USE OF ❑ sFD or DUPLEX❑
BURRING: [3COMMERCIAL
MULTI-FAbIILY
PROJECT IN WIT OLAND ElYES
URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
Is THE BLDG AN ElYES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
Al wii-vx
new
O ,
�O
Lifun
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TOTAL VALUATION.
RECEIVED BY:
By my signature below, I certify
application and the informatio
ordinances and state laws Tela
Signature of Applicant/Agent.
g: I am the property owner or authorized agent to act on the property owner's behalf. I have this
c of the fLisco=rectj
ed have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
t oction` I authorize representatives of Cupertino to enter the above -identified property for inspection pu{poses.
Date: ' coo - I q
PLEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
L
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❑ OVER-THE-COUNTER
❑ EXPRESS
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❑ STANDARD
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❑ LARGE
❑ MAJOR
AjFPMisc,1pp_2011.doc revised 06121111
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF-IR-ALT-HIVAC)
Project Name:
A. General Information
CF1117ALT-02 is applicable to multiple space conditioning systems contained within, a.single dwelling unit. When multiple dwelling units -must be documented, . -use--one",
CF111-AJ-02'clocument for each dwelling unit.
01
Project Name
11220 TERRA BELLXDR. -TSUEI
02
Date Prepared
2017-07-20
03
Project Location:
11220 TERRA BELLA DR.
04
Building Type
Single family
05
CA City
Cupertino
.06
Dwelling Uhit Name
-T
11220 TERRA BELLA DR. SUEI
SC System
CFA.served
system a
,.refrigerant
Installing new SC
Installing
Installing
Installing
Identification or
Location or Area
Dwelling Unit Conditioned
ducted
07
Zip Code
95014
08
Floor Area .(ft 2)
2300
Served
System (ft2yl
system?
component?
Number of -Space
feet of ducts?
EO9
Climate Zone
4
10
Conditioning (SC) Systems in
1
Yes
Yes
N
No
this Dwelling Unit:
:Altered space
B -, Space Conditioning (SC) System Information
01
02
03
• 04
b 9`
0708
09 1. 10-
'Is the SC,.
Installing a
SCSystem
SC System
CFA.served
system a
,.refrigerant
Installing new SC
Installing
Installing
Installing
Identification or
Location or Area
by this SC
ducted
-containing
system
more than 40
entirely new
entirely new
Name
Served
System (ft2yl
system?
component?
components?
feet of ducts?
duct system?
SC system? -,Alteration Type
System 1
Location 1
2300
Yes
Yes
Yes
N
No
No
:Altered space
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b)lDiib)
This section does not apply to this project.
Registration Nurriber:.217-A020247930A-000-000-0000000=0000 Registratio.nDate/Time:,-, 2017-07-20 14:56:32 HERS Provider: CaICERTS
CA Building Energy. Efficiency Standards- 2016 Residential Compliance Report---Version--2016,.l-.006-- Report Generated: 2017-07-20-.14:56:17
Schema Version: -revJ0/16-
CERTIFICATE OF COMPLIANCE CF111-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 2 of 3)
D. Altered Space Conditioning System (Sections 150.2(b)lE and F)
01
02
03
04
05
06
07
08
09
10
11
12
Heating-
Cooling
System
Heatinig
Altered
Heating
Mini M—UM
Alteied-
--Cooling
Identification
System
Heating
Efficiency
-Efficiency—
-Cooling
Cooling_
Efficiency
Efficiency.
thermostat -
Replaced p la766cl
N e w Duct
or Name
Type
Components
Type
Value
Syftern Type
Components
Type--
Value
Type
Duct-Le-ngth
W-Valme
All new
All new
This field or -
This field or
System 1.
Central gas
heating
AFUE
96
Central split
cooling
SEER
18
Setback
section is not
section is not
furnace
components
AC
components
applicable
applicable
Required Documentation:
CF2R-MCH-01-E - Space Conditioning Systems
- Duct insulation requirement for the new portions of supply -air and return -air ducts or plenums: RG (CZ 1-10, 12 and 13) and R8 (CZ 11 and 14-16)
CF2R and CF3R-MCH-20-H - Duct Leakage Test required when heating or cooling components are installed in ducted systems, or when more than 40 ft of duct length is replaced
-Leakage rate compliance: <=15% or <= 10% leakage to outside, or seal all accessible leaks.
CF2R and CF3R-MCH-25-H Refrigerant Charge verification required. when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15).
CF2R and CF3R-MCH-23 Airflow Rate >= 300 CFM per ton required when MCH -25 is required.
Exceptions:
Duct systems registered with HERS provider as previously sealed are exempt from MCH -20 Duct Leakage Testing requirements.
CH-25-'i-
Heating -only systems and Air Handler Furnace changes do not require verification of Air Flow MCH -23ior Refrigeni6t Charge MCH 25 -
-Existing duct systems constructed, insulated.or sealed with asbestos are exemo'tfrom MCR-2`0,,'Duct,Leakage Testing requirements.
-Existing
E. Entirely Nevin or Complete Replacement Duct System, with or without.Equipment Changeout (Sections 1`50.2(b)1Diia_and,150.Z(b)1E, F)
This section does not apply to this project.
F. . Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)1C)
This section does not apply to this project.
Registration Number: 217-A020247930A-000-000-0000000-0000 Registration,Date/Time: - 2017-07-20 14:56:32 - HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.006 Report Generated: 2017-07-20 14:56:17
Schema Version: rev 10/16
CERTIFICATE OF COMPLIANCE CFVR7-ALT-02=E
Alterations to Space Conditioning Systems (formerly, CF -IR -ALT -HVAC) (Page 3 of 3)
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Compliance documentation is. accurate and. complete.
Documentation Author Name:
Documentation Author Signature:
AID, Jane
6
Company:
Signature Date:
A Plus General Contractors Inc
2017-07-20 14:56:32
Address:
CEA/ HERS Certification identification (if applicable):
11330 Knott St.
763154
City/State/Zip:
Phone:
Garden Grove CA 92841.
714-901-1958
Responsible Person'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 Businessand Professions Code to accept responsibility for the building design of system design identified on.this Certificate of Compliance (responsible designer).
3. 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 o the California Code of Regulations "
4. The building design features or system design features identified on3this Certifcate of Compliance are consistent with the mformarion provided on other applicable compliance documents, worksheets,
calculations, plans and specifications submitted to the enforcement;agency for approva[with this building permit application. "
5, 1 will ensure that a registered copy of this Certificate Af Lomplianceshall,be;m'ade'ayailable with the byiiding permit(s) issued forthe b6iidii6g, and'xavailable togtheenforcement agency for all applicable
inspections. I understand that a registered copy of this Ce; tsficate of Compliance is, required to be_included with the documentation the builder provides tgtthe building owner at occupancy.
Responsible Designer Name:
Responsible Designer Signature. :- w
Alo, Jane
Company:
Date Signed:
A Plus General. Contractors Inc
2017-07-20 14:56:32
Address:
License:
11330 Knott St.
763154
City/State/Zip:
Phone:
Garden Grove CA 92841
714-901-1958
Easy to Verify as
atCa10ERTS.com �— ' ~,
-
v lP-c
Digitally signed by CaICERTS. This digital signature is provided in order. to secure the content of this registered document, and hi no way implies Registration Praviderresponsibility f
the accuracy of the infor9A `•
Registration Number: 217-A020247930A-000-000-0000000-0000 Registration Date/Time: 2017-07-20 14.56:32 HERS provider: CaICERTS
CA,Buiiding Energy Efficiency Standards - 2016 Reside ntiai •Compliance Report Version 2015:1:006 Report Generated: 2017-07-20 14:56:17
Schema Version: rev 10/16