15070236V
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10421 LANSDALE AVE
CONTRACTOR: AIR QUALITY HEATING
PERMIT NO: 15070236
& AIR
OWNER'S NAME: XU WEN AND FANG HAI
720 NORTHRUP ST
DATE ISSUED: 07/31/2015
OWNER'S PHONE: 6502231922
SAN JOSE, CA 95126
PHONE NO: (408)293-7138
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL
INSTALL (N) A/C UNIT IN REAR YARD AREA
License Class Z�ALic.# /
Contractor Date
1 hereby a rm t t I am licensed under the provisions of hapter 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, as provided for by Section 3700 of the Labor Code, for the
Sq. Ft Floor Area:
aluation: S4000
-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
V'N Number: 36911006.00
Occupancc 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
WITHIN 180 DAY T 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 DA ED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
— - -
costs, and expenses which may accrue against said City in consequence of theJ
granting of this permit. Additionally, the applicant understands and will comply
Issued b _ - llate:
with all non -point sou ce regulations per the Cupertino Municipal Cod Section
9.18.
RE -ROOFS:
Signature Date
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:
1 hereby affirm that I 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)
1, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
1 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 maintain 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 will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 2. 05, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Owner or authorized agent: � Date:
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. 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 mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
costs, and expenses 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 -point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
Signature Date
GENERAL PERMIT APPLICATION M E FPA
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 Amok Anah,
C 5
CUPERTINO IL IM
(408) 777-3228 • FAX (408) 777-3333 • buildino(d)CUDertinO.OrQ
l�-0 H02-lz 1 %no
❑ PLUI`m1NG ❑ MECHANICAL ELECTRICAL ❑ AQISC.ELLANEOUS
PROTECT ADDRESS%
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CONTACT NAMEP
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STREET ADDRESS ^
CITY, ST.A ,ZIP
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❑ OR?.iR ❑ oAN--R--B/L(JTIIDEER
❑ ONVNERAGiNT
❑ CON-MICTOR ❑ CON7RACTORAGENT ❑ ARC-r'SECT ❑ ENGL'.rER ❑ DEItLOPER
❑ TEKXT
CONTRACTORNAMELICENSE
NUMBER LICENSE TYPE VM
BUS. LIC #
COMPANY NAME -
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E-MAIL 4174 PO � Ad;
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STREET ADDRESS
CITY, STATE IP
PHOA
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ARCHITECTFENGIKEER N.A1,4E
LICENSENUMBER
BUS. LIC n
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX
B=N-0: ❑CON4ERCLAL
❑ MULTI -FAMILY
I
. PROJECT LN WILDLAND ❑ YES PROJECT IN ❑ Yts
}JRBANWTE1tFACEAREA ❑ NO FLOOD ZONE ❑ NO
IS THE BLDG AN
I EICHLERHOmM
❑ YES
❑ NO
DESCRIPTION OF WORK
TOTAL VALUATION': 12
0
By my signature below, I certify to each of the following: I am the property owner or authorized a
application and the information I h ve vided is correct I have read the Description of Work an ve it is accurate. I afire to comply with a ap al
ordinances and state laves relating t construction. I authorize representatives of Cupertino to enter the above dentis property for inspection purposes.
Signature ofApplicant/Agent: Date:
UP MENTAL INFORMATION REQUIRED
-
-
ocE USE ONLY
Lj OVER -TE -E -C iI.2
_j F P :E-:
"J' SS'�J�hD
MEPMiscApp_2011.doc revised 06121/11
CITY OF CUPERTINO
Im FEE ESTIMATOR — BUILDING DIVISION
ialADDRESS:
10421 LANSDALE AVE
DATE: 07/31/2015
REVIEWED BY: MELISSA
UNITS
APN: 36911006
BP#:
`VALUATION: 1$4,000
*PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
#
PENTAMATION FURN/AC
PERMIT TYPE:
WORK
INSTALL N A/C UNIT IN REAR YARD AREA
SCOPE
.Sul,l)[ Irrsp Fee
APPLIANCE / EQUIP TYPE
FEE ID
Plumb. Plan Check
QTY
UNITS
BP FEES
Elec. Permit I'
A/C Units (<=1 OK cfm)
1BREMAIR
Other Elec. Insp.
1
#
$72
Permit Fee:
.Sul,l)[ Irrsp Fee
PME Unit Fee:
$72.00
PME Permit Fee:
$48.00
Construction Tax:
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? 0 Yes E) No
$0.00
TOTALS:
Travel Documentation Fee: ITRA VDOC
$72.00
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
Diverirt- etc 1_ Thece fees are haled on the nreliminary information available and are onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 711%13)
Mech. Plan Check0.0 hrs $0.00
Plumb. Plan Check
laec..Plan Check
Mech. Permit Fee: 1MPERMIT
Plumb. Permit Fee:
Elec. Permit I'
Other Mech. Insp. 1001hrs $48.00
Other Plumb Insp.
Other Elec. Insp.
st .,
...t, r`, _ ..
r 1;.� t ,'p
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Diverirt- etc 1_ Thece fees are haled on the nreliminary information available and are onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 711%13)
FEE
QTY/FEE
MISC ITEMS
Plan Check 1,'z .
Suppl. PC P'ee
PME Plan Check:
$0.00
Permit Fee:
.Sul,l)[ Irrsp Fee
PME Unit Fee:
$72.00
PME Permit Fee:
$48.00
Construction Tax:
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? 0 Yes E) No
$0.00
Advonced Plarming I CTS.
Travel Documentation Fee: ITRA VDOC
$48.00
Strong Motion Fee: IBSEISMICR
$0.52
Select an Administrative Item
1
Bldg* Stds Commission Fee: IBCBSC
$1.001
SUBTOTALS:
$214.52
$0.00 TOTAL FEE:
$214.52
Revised: 07/02/2015
STATE OF CALIFORNIA
ALTERATIONS - HVAC
M
CEC-CFIR-ALT-03-E Revised 06/14 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CFIR-ALT-03-E
Alterations - HVAC CZ 1, 3 to 7 and 16 (formerly CF -IR -ALT -HVAC) (Page 1 of 1)
Site Address: 1 ' �
1�
Enforcement Agency:
Date Prepared:
Permit#:
Equipment Type o
Equipment Efficiency
New: Ducting, Plenums, Lineset
Conditioned
Thermostat
rQt �-SL
Required R -value
Floor Area (sq ft)
❑ Packaged System
'Evaporator Coil
AFUE
COP
❑ R-6 (CZ 1,3-7) Ducts
Served by system
XZetback
Split System
`fCCondensing Unit
L` SEER
❑ R-8' (CZ 16) Ducts
1 »s ft
q
(If not already
HSPF
❑ R-6 (all CZ's) Plenums
�
present must
Furnace
Lineset
EER
❑ R-5 or R7.5 Lineset'
Ibe
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.
1. 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: MECH-01, MECH-20-HERS
Air Handler/Furnace
CF3R: MECH-20-HERS
Installer Requirement: Duct leakage (:5_15% or, < 10% to outside, or seal all accessible leaks)
Exempted from duct leakage testing if:
❑ 1. Duct system registered with HERS provider as previously sealed, or ❑ 2. There is less than 40 linear feet of duct in unconditioned
space, or ❑ 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 Ducts'
CFIR-ALT-02-E
CF2R-MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS
CF3R-MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS'
Installer Requirement: Duct leakage < 6%, Fan Efficacy (.58W/CFM), Air Flow >_ 350 CFM/ton (or Standards Table 150.0-C / D alternative)
❑ 3. All New Ducts with Replacement Required Compliance Documents to be left on site for Final:
Includes replacing or installing All New CFIR-ALT-02-E
Ducts' and one or more of the following: CF2R-MECH-01, MECH-20-HERS, MECH-(23 or 24) -HERS
Condenser Unit, Evaporator Coil, Furnace CF3R-MECH-20-HERS, MECH-(23 or 24) -HERS
Installer Requirement: Duct leakage < 6%, Air Flow_ 350 CFM/ton (or Standards Table 150.0-C / D alternative)
❑ Exempted from duct leakage testing I existing duct systems are constructed, insulated or sealed with asbestos.
❑ 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 Ducts'
CF2R: MECH-20-HERS
CF3R: MECH-20-HERS
Installer Required to: Duct leakage (:S.15% or, < 10% to outside, or seal all accessible leaks)
❑ Exempted from duct leakage testing I existing duct systems 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.
' 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 handler, plenums, duct material.
3 R-5 (1" thick insulation) for linesets 1" and less. R-7.5 (1.5" 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-2%", 5T-4%"
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. 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the information on this document.
B. 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 specificati ns su mitted to the enforcement
agency for approval w'th this building permit application.
Responsible D i ner Narpe.
Resp 'b signer Signature:
Date Si ed:
License:
YY,6
company:
Address: V
City/State/Zip:
Phone:
rJ
q b*'— ZV- l/ v
For assistance or ql1lestions regarding the Energy Standards, ontact the Energy Hotllle at: 1-800-772-3300
C1 -1g26
I V
Ak. ((Air Z#A
RECEIN D
JUL 31 2( t
yi
BY
-)PN1EN-',-,EPARTrMENT
,/isioN - (-LiPERTINO
CUPAL APPROVED
#� -(I N 0 jns and s:,ec.jjcatjrrs miuST be kept at the
3wilding Department -;urin^ r action. it is to make any
-,,iges or �,-,,3rations on same, or to deviate
2015 therefrom, v,,-mout irproval from the Building Official.
The Stac,-,�ing -�,s pian and 'HALL NOT
REVIIPI-� CODE COMP' ANCE be held to 'c� to the violation
n, I r State Law.
wed By ct any pro'. 1
BY
ATE
# r 0 0
E Copy
I ("(f 2.1 LAAja t),KI-te-
PLOT �L� S HEC ED E�Y
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DATE
PLANNING DEFT
CUPERTINO