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11100176
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21567 ROSARIO AVE CONTRACTOR:BROWN'S SERVICES PERMIT NO: 11100176 OWNER'S NAME: CHENG WIN S AND REI J 2210 MANCHESTER RD DATE ISSUED: 10/25/2011 OWNER'S PHONE: SAN LEANDRO,CA 94578 PHONE NO:(510)200-6641 L LICENSED CONTRACTOR'S DECLARATIONr c c BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class �Lic.# 15:2� q �}cs MECH RESIDENTIAL COMMERCIAL f- Contractor &UWAJ'S c`�'E�/'j�I_C�Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE FURNACE SAME LOCATION (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 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:$5600 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. APN Number:35619029.00 Occupancy Type: 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 and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Issued by Date-/G 2—r—, f 9.18. Sign Date Al RE-ROOFS: F OWNER-BUILDER DECLARATION 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 I is,.eby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(See.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the [certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Owner or an ho ' d �t Compensation laws of California. If,after making this certificate of exemption,I Date• 111241become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address 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 ARCHITECT'S DECLARATION ng of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. all non-point source regulations per the Cupertino Municipal Code,Section 9.18• Licensed Professional Signature Date CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35619029. 00 DATE ISSUED. . . . . . . : 10/25/2011 RECEIPT #. . . . . . . . . : BS000015140 REFERENCE ID # . . . : 11100176 SITE ADDRESS . . . . . : 21567 ROSARIO AVE SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER CHENG WIN S AND REI J ADDRESS . . . . . . . . . . : 21567 ROSARIO AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4756 RECEIVED FROM . . . . : LYNDON BROWN'S SERV CONTRACTOR . . . . . . . : LYNDON BROWN LIC # 33034 COMPANY . . . . . . . . . . : BROWN'S SERVICES ADDRESS . . . . . . . . . . : 2210 MANCHESTER RD CITY/STATE/ZIP . . . : SAN LEANDRO, CA 94578 TELEPHONE . . . . . . . . : (510) 200-6641 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 5, 600 . 00 1 . 00 0 . 00 1. 00 0. 00 1BSEISMICR VALUATION 5, 600. 00 0 . 56 0 . 00 0 .56 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 1TRAVDOC FLAT RATE 1 . 00 44 . 00 0. 00 44 .00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 260 .56 0. 00 260 .56 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 260 . 56 #1129 --------------- TOTAL RECEIPT 260 .56 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL I I ( w(-7 (z-,5 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333- building(Dcupertino.org MISIC ❑PLUMBING ECCHAMCAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS R IS G �© O APN# L / ' OWNER NAME PHONE i o 14 E.MAU- STREET ADDRESS CITY, STATE,ZIP ^ FAX CONTACT NAME PHONE y� E-MAIL STREET ADDRESS CITY,STATE, ZIP FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT M'CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHrrECr ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME �� LIC NUMBER LICENTYP BUS.LIC# COMPANY NAME r , E-MAIL FAX ry� Iry I L� STREET ADDRESS CITY,STATE,ZIP PHONEt ^ L ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME' E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ISE OF IRSFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROTECT IN ❑YES IS THE BLDG AN ❑YES 3UMI)ING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK rk�- C TOTAL VALUATION: 19(X00 RECEIVED BY: By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. j[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 building construction.. I authorize representatives of Cupertino to enter the/above dentified perry for inspection pi4oses. Signature of Applicant/Agent" Date:`� cS ,/5111��IIERTAL INFORMATION REQ=D �OFFICE USE ONLY 4l OVER-THE-COUNTER a x ❑ EXPRESS U ❑ STANDARD U ❑ LARGE a ❑ MAJOR MEPA&scApp_201 Ldoc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 21567 rosario ave. DATE: 10/25/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$5,600 ;iPE;RMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition / Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: FURN/A WORK re lace furnace at existinq location SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $130 TOTALS: 1 $130.00 _T_I Mech.Plan Check 0.0 hrs $0.00 Mech.Permit Fee: IMPERMIT Other Mech.Insp. 0.0 hrs $44.00 NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Thesefees are based on the prelhWdna information available and are only an estimate. Contact the De t or addn'l info, FEE ITEMS ( ee Resolution 11-053 Z .. %'1,'11) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $130.00 PME Permit Fee: _T_T $44.00 —7— Administrative Fee: 1ADMIN $41.00 Work Without Permit? 0 Yes (F) No $0.00 Travel Documentation Fee: ITRAVDOC $44.00 Stronp, Motion Fee: 1BSEISMICR $0.56 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $260.56 $0.00 TOTAL FEE: $260.56 Revised: 10/01/2011 Prescript;, le Certificate of Compliance: Residential CF-IR-ALT Residential Alterations (Pagge 4 of 5) Project Narine.* �� 1 Climate Zone# #of Stories HVAC SYSTEMS-HEATING Minimum Duct or Piping Configuration Heating Equipment Efficiency Distribution Insulation Thermostat (Central,Split, Type and Capacity 1,2,3 (AFUE or HSPF) Type and Location R-Value Tye Space,Package or Hydronic) CAU t�K D e Tv 1.Indicate Heating Type(Central Furnace, It Furnace,Heat pump,Boiler,Electric Resistance, etc.) 2.Electric resistance heating is allowed only in Component Package C, or except where electric heating is supplemental(i.e., if total capacity :S 2 KW or 7,000 Btu/hr electric heating is controlled by a time-limiting device not exceeding 30 minutes). See§151(b)3 exception. 3.Refer to the HERS Verification section on Page 4 of the CF-IR-ALT Form for additional requirements and check applicable boxes. 4. Indicate Type or Location(Ducts,Hydronic in Floor, Radiators, etc.) HVAC SYSTEMS-COOLING Minimum Efficiency Duct or Piping Configuration Cooling Equipment (SEER/EER or Distribution Insulation Thermostat (Central,Split, Type and Capacity" COP) Type and Location3 R-Value Tye Space,Package or Hydronic) 1.Indicate Cooling Type(A/C,Heat pump,Evap. Cooling, etc) 2.Refer to the HERS Verification section on Page 4 of the CF-IR-ALT Form for additional requirements and check applicable boxes. 3.Indicate Type or Location(Ducts,Hydronic in Floor,Radiators, etc.) WATER HEATING List water heaters and boilers for both domestic hot water(DHW)heaters and hydropic space heating. Individual dwelling DHW heaters must be gas or propane fired, and may not exceed 50 gallons. Hot water pipe insulation from the DHW heater to the kitchen(s)and on all underground hot water pipes is required in all com onent packages in all climate zones. Water Heater Type/Fuel Distribution Type Number In Tank Energy Factor or External TankInsulation Type' (Standard,Recirculating)' System Capacity(gal) Thermal EffItsiency R-Value3 I.Indicate Type(Storage Gas, Heat Pump,Instantaneous, etc.) 2.Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of§150(n). The Prescriptive requirements do not allow the installation of a recirculating water heating system for single dwelling units. 3. The external water heating tank and i es shall be insulated to meet the requirements o 150 ). SPECIAL FEATURES The enforcement agency should pay special attention to the Special Features specified in this checklist below. These items may require written 'usti ication and documentation and special verification. NEW ROOF ASSEMBLY-Radiant Barrier The radiant barrier requirement of§151(f)2 does not apply to roof alterations. Slab Edge(Perimeter)Insulation ❑YES ❑NO YES:In Climate Zone 16 in Component Packages D,R-7 insulation is required. Heated Slab Insulation ❑YES ❑NO YES:Slab edge insulation required for all heated slabs in all Climate Zones. See details in Table 118-A of the standards. Raised Slab Insulation ❑YES ❑NO YES:In Climate Zones 1,2, 11, 13, 14& 16,R-8 insulation is required; in Climate Zones 12& 15,R4 is required under component Package D. Thermal Mass To obtain Compliance Credit for the installation of thermal mass,use the Performance Approach. n Pd yY Registration Number: Registration Date/Time: HERS Provider: 2008 Residential Compliance Forms August 2009 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Lal Telephone: 408-777-3228 U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: PERMIT# 6 �� OWNER'S NAME: W N r� C, PHONE# c0 ActeLl GENERAL CONTRACTOR: 84^ ; ), -c-> BUSINESS LICENSE # ADDRESS: CITY/ZIPCODE: 7� *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum /Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date