12050184 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDREss: 22423 ST ANDREWS AVE CON I'RAC'IOR:TIFF HEATING AND PERMIT NO: 13050184
AIR CONDITIONING
OWNER'S NAME: YUJING ZENG 299 CORNING AVE DA'Z'E ISSUED:05/24/2012
OWNER'S PRONE: 4083682158 MILPITAS, CA 95035 PI ION F,NO:(408)786-8120
LY LICENSED CONTRACTOR'S DECLARA f10N r r r
Bt,11,DIN'G PFRAII'I INFO: BlAU; ELECI1'1,0?111
License Class G — ZO Lic.N S0 r r I—
T _ ,�,/A� ?IECII RF.SIDF..C'1'IAL COMMERCIAL
Contractor / 7 /r Y/I(f_ [)at'
1 hereby affirm that I am licensed under the provisions of Chapter 9 306 DESCRIPTION'_ RI2PLACIi FIIRNACP:AND A/C
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
1 hereby affirm under penally 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.FI Flair Area: Valuation:$61,10
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the labor Code,for the performance of the work for which this
APN Number:75604017,00 Occupancy'I'ype:
permit is issued
I ceriif) that I have read this application and state that the above information is PERM 17 EXPIRES IF WORK IS NOTSTARTED
correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERM IT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAY$ 'I;:eM LAST CALLED INSP ,CTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the
granting nl'Ihis permit. Additionally,the applicant understands and will comply Issued by: A Z 7 G Uate:
with all non-point source regulations per the Cupertino Municipal Code.Section
9.18.
Lam_ RE-ROOFS:
7
Signature Dale Z_ -V(L All roofs shall be inspected prior to an)'roofing material being installed Ifa ruin'is
�— - - - installed within first oblaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant Date
1 hereby affirm that 1 am exempt from the Contractor's License Law for one of
the following two reasons: \1.1.ROOF COVERINGS TO BE CLASS"A"Olt BE ITER
L 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 IIAZ:\RDOUS MATERIALS DISCLOSURE:
conduct the project(Sec.7D74,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safely Code,Sections 25505,25533,and 25534. 1 will
hereby affirm under penally of perjury one or the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: I Iealth&Safely Code,Section 25532(;)should I store or handle hazardous
I have and will maintain a Cenillcale 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:u defined by the Bar Area Air Quality Management District 1
performance of the work lir which this permit is issued. will maintain compliance with the Cupertino Municipal(:ode.Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Ilealth&Safely Cndc,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code, for the performance ollhe work for which this Z
Owner or authorized agent: Dale:
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
Compensation laws of California. 11',after making this certificate of exemption,I CON'STRtiC flON LENDING A(;FN'CY
become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a cons ruction lending agency for the perlimnunce o1'
forthwith comply with such provisions or this permit shall be deemed revoked w'ork's Ibr 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 ,U(CI I1'I'F.C'I"S DF.CL:\R:\'1lON
indemnify and keep harmless the City of Cupertino against liabilities,judgments.
costs,and expenses which may accrue against said City in consequence ofthe I understand my plans shall be used as public records,
granting ollhis permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Dale
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 22433 Saint Andrews Ave DATE: 05/24/2012 TREVIEWED BY: Sean
APN: BP#: -VALUATION: $6,140
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION FURN/AC
USE: PERMIT TYPE:
WORK Remove and Replace furnace and add A/C.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
A/C Units (<=1 OK cfm) 1BREMAIR 1 # $65
Furnace, Forced-Air 1MFR=<100 1 # $130
TOTALS: F $195.00
Mech.Plan Check 0.0 hrs $0.00 Phmrb. Plan Cheek (Jeri. PI.. Chrck
Mech. Permit Fee: IMPERM/T Plumh. Ponta F,,v lilac. Permit I'i•c:
Other Meeh. Insp. 1 0.0 hrs $44.00 011ier Plumb Imp. Uchvr/i/cr, br,cp.
.Ilrrh. Imp. Fire: Plumb. hr.rp. Fra: Eler.hup.Pian:
NOTE:This estimate does not include fees due to other Departments(Le.Planning, Public Works, Fire,Sanitary Sewer District,School
District,etc. . Thesefees are based on the preflatina information available and are only an estimate. Contact the Dept for addn7 info.
FEE ITEMS (Fee Resohnion 11-053 Eft 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Chuck Pec:
Suppl. PC Pee
PME Plan Check: $0.00
Permit Fee:
Supp/. /l?.sp Fee
PME Unit Fee: $195.00
PME Permit Fee: $44.00
Consn-eclion Tax.
Administrative Fee: IADMIN $41.00
Work Without Permit? 0 Yes 0 No $0.00
Advanced Phinnin", Peas:
Travel Documentation Fee: ITRAVDOC $44.00
Stron¢ Motion Fee: IBSEISMICR $0.61 Select an Administrative Item
Blda Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $325.61 $0.00 TOTAL FEE: $325.61
Revised: 05/01/2012
CITY OF CUPERTINO
7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35604017 . 00
DATE ISSUED. . . . . . . : 05/24/2012
RECEIPT # : ... . . . . . . : BS000016902
REFERENCE ID # 12050184
SITE ADDRESS 22423 ST ANDREWS AVE
SUBDIVISION. . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . .
OWNER YUJING ZENG
ADDRESS . . . . : . . . . . : 22423 ST ANDREWS AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED .FROM . . . . : TONY FERREIRA
CONTRACTOR . . . . . . . : TONY FERREIRA LIC # 31778
COMPANY TFF HEATING AND AIR CONDITIONI
ADDRESS 299 CORNING AVE
CITY/STATE/ZIP . .'. : MILPITAS, CA 95035
TELEPHONE (408) 786-8120
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- - ---- - - - - ----- - ----
-ADMIN HOURS 1 . 00 41 . 00 0 . 00 41 . 00 0 . 00
1BCBSC VALUATION 6, 140 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 6, 140 . 00 0 . 61 0 . 00 0 . 61 .0 . 00
1MFR= 100 UNITS 1 . 00 130. 00 0 . 00 130 . 00 0 . 00
1MPERMITFE ,FLAT RATE _ 1 . 00 44 . 00 0 . 00 44 . 00 0 . 00
1MRRAA UNITS 1 . 00 65. 00 0 . 00 65 . 00 0 . 00
1TRAVDOC FLAT RATE 1 . 00 44 . 00 0 . 00 44 . 00 0 . 00
TOTAL PERMIT 325 . 61 0 . 00 325 . 61 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
---- ------------ --------------- -- - -----------------
CREDIT CARD 325 . 61 me
---------------
TOTAL RECEIPT 325 . 61
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
--- ----- --------------------------- - --- ------------------ - -- - ---
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
Simplified Prescriptive Certificate of.Compliauce:2008 Residential EIVACAlterations CF-IR-ALT-HVAC
Climate Zona 1 and 3-7
SiteAddrawF Enforcameuu A��T�hp Dafe`Ly Pkrm&q:
Z Z S+✓7- /Eon/ `s 4✓ G 7
Conditioned Pact insdatim
Equipment Type' fist Minimum EfficieacY2 Floor Am t Thermostat
LI igod= Unit ��orty� Over 40 it of ducts
P
Serv�system added or rep m L
il L Rf� . - �sf unconditioned spas fYwaeQd'AeSO4 mat be
ng Unit 13 EER_ Resiitanm R 6 (CZ 1,3-SJ �`4
1.Equipment Type:Choose the equipment being Installed;if more than one system,use another CF-1 R-ALT-HVAC fm each system
2.Alinimum Equipment Ef cleoeies: 13 SEER,78%AEUE,7.7HSPF for typical residential systems.
Contractor(Documentation Amtbor's/Responsible.Designer's Declaration Statement)
• I certify that this Certificate of Compliance documentation is accurate and complete.
• I am eligible under Division 3 of the California Business and Pmtasions Code to accept responsibility for the design identified on this
Certificate of Comrpliance.
• I certify that the energy features;and performmce specifications fm 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.
• The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable
compliance forms,worksheets,calculations,plans and specifications submitted to the caformoeat agency for approval with the perrmit
application.
Name: -r0,�Y Signature: '
Company: Data:
Address: c7 co/t-+%a X&/G !�''��� License: 9>f3.5-0
City/StatelLip: Phone: z/ds
2008 Residential Compliance Forms.doc revised 04110/11
GENERAL PERMIT.APPLICATION M E P
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
MIS
CUPERTINO (408)777-3228•FAX(408)777-3333•buildinG(5cuoertino.orDIC
2 C 1
❑PLUMBING MECHANICAL EIFLECMCAL MISCELLANEOUS
PROJECT ADDRESS C-L(yZ3 ArAJ 1 rV^'�^'--r'-VVs FI V� �R W 04- D I-1
OWNER NAME T� I {J } .f� J�� PHONE�Ir'. Z-1Sv E-MAIL
N-�Lyb EaM
STREET ADDRESS (�/ CITY, STATE,L� (JJPFAX
G Oft -rr.-�o
CONTACT NAME i PHONE -7( EMAIL
STREETADDRESS S� G CITY,STATE,ZIP 7 p FAX
❑OWNER ❑ OWNER-BUDDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ T ANT
CONTRACTOR NAME �r! LICENSE 1 F�3�O LICENSE TYPE O BUS.LIC a
COMPANY NAME r r E MAIL,/ u.V� FAX
Tom- v�- ,m 9?5--90 q
STREET ADDRESS �/ p CO>�'PI�.T��✓ CITY,STATE ZIP PHONE
(/19 A-✓� Lt_ LT/t�S �(o"WILD
ARCHRECTIENGINEER NAME LICENSE NUMBER BUS.LIC 4
COMPANY NAME FAX
STREET ADDRESS ITY,STATE,ZIP PHONE
USE OF FD at DUPr Dt ❑ MULTI-FAMILY PROJECT IN WRDLAND ❑ YES PROTECT DT ❑YES IS THE BLDG AN ❑ YES
BURDDIG: ❑COMMERCIN. URBAN INTERFACE AREA NO FLOOD ZONE O EICTO.ER HOME? O
DESCRIPTION OF WORK
TOTAL VALUATION: 0 O RECEIVED BY: tgrw
By my signature below,I certify w each of the following: I am the property owner cr authorimd agent to act on the property owner's behalf. 1 have read this
application and the information I have provided is correct. 1 have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to bu' onstmction. I autho srnratives of Cupertino to enter the aboveid ified pmry for inspection pu(poses.
Signature of AppliwndAgrnL Date:
/ Z
"PLEMENTAL INFO TION REQUIRED OFFICE USE ONLY
d OVER-THE-COUNTER
❑ EXPRESS
Y
u
m ❑ STANDARD
U
❑ LARGE
a
❑ MAJOR
AL EpMueApp_2011.doc revised 0612111