15080201S11
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22188 ORCHARD CT
CONTRACTOR: VALLEY HEATING &
PERMIT NO: 15080201
COOLING
OWNER'S NAME: NAKASUJI SHIRLEY AND JIMMIE
1171 N 4TH ST
DATE ISSUED: 08/27/2015
OWNER'S PHONE: 4084894189
SAN JOSE, CA 95112
PHONE NO: (408)294-6290
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
pp� ��jj
�kru
REMOVE AND REPLACE FURNACE; ADD AIR
License Class Lie. # ('0
CONDITIONING
I �" f2 %
AND REPLACE ALL DUCTS.
Contractor Date
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.
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:
Valuation: $23325
performance of the work for which this permit is issued.
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: 32617038.00
Occupancy 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 DAYS OF PERMIT 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 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of then/
7
Issued bye ��G Date: �- �/ �%�
granting of this permit. Additionally, the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code, Section
RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
9.18.
(
Signature Date /
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I 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
1, 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
I 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
Section 3700 of the Labor Code, for the performance of the work for which this
the Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized agent: Date:
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. 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
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
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
i
i
CUPERTINO
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building a0cupertino.org
F-1 PLUMBING CHANICAL 7 ELECTRICAL n 1\QISCELLANEOIIS
PROTECT ADDRES
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OWNER NAME E-MAIL
STREET.9DDRESS Q 0,� J _ CITY, STATE, ZIP/ .,�,�, Gi�o / (/ FAX
CONTACT NAME Coll �ra C hl-
l- PHONE E-MAIL
STREETADDRESS
CITY, STATE, ZIP
FAX
❑ OM?.ER ❑ OWI.'L-R-B=ER ❑ OWNER AGENT COI.'TRACTOR ❑ CONTRACTORAGENT ❑ ARCHITECT ❑ ENGNMR. ❑ DEVELOPER ❑ TENAI.TT
CONTRACTOR ITAriE
VJ! J LICENSE NUMBER < r �)U LICENSE TYPE C O
BUS. LIC #
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COMPANY NA'
E-MAIL✓� I �J 1 I! I W�
FAX
STREET ADDRESS
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CITY, STATE, ZIP�5 l �j^11 f //11—(SI�*�F�IC
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ARCETECTENGINTEER NAME LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
I FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF IPFD.,DUPLEX ❑ MULTI-FAACLY PROJECT LN'WILDL.AND ❑ YES PROJECT IN ❑ YES
BUIIDLNG: COND MCLAL I URBAN INTERFACE AREA NO FLOOD ZONE No
IS THE BLDG AN ❑ YES
MCHLER HOME? 0
DESCRIPTION OF WORK
TOTAL VALUATION:
By my signature below, ffertify to each df 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 I 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 b?gdiinjggconstruction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: ��' Date: / -712
SUPPLEMENTAL INFORMATION REQUIRED
MEPAfiscApp_2011. doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
iaADDRESS:
22188 Orchard Ct
DATE: 08/27/2015
REVIEWED BY: Sean
UNITS
APN:
BP#:
*VALUATION:
1$23,325
°PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
$72
PENTAMATION FURN/AC
PERMIT TYPE:
WORK
Remove and replace furnace; add air conditioning and replace all ducts.
SCOPE
1
APPLIANCE / EQUIP TYPE
FEE ID
Ptumb. Plan Check
QTY
UNITS
BP FEES
Elec. Permit Fee:
A/C Units (<=1 OK cfm)
1 BREMAIR
Other Flee. lrrsp.
1
#
$72
Furnace, Forced -Air
1MFR=<100
1,11pl. /nsp Pe"
1
#
$143
PME Unit Fee:
$215.00
PME Permit Fee:
$48.00
C `onstr uclion Mx.-
x:Administrative
AdministrativeFee: (ADMIN
$45.00
Work Without Permit? Yes (F) No
$0.00
TOTALS:
A
Travel Documentation Fee: ITRA VDOC
$215.00
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
District, etc.. Thesefees are based on the preliminar information available and are only an estimate. Contact the Dept for addn7 info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13,
Mech. Plan Check0.0 hrs $0.00
Ptumb. Plan Check
JJec, Placa Cheek
Mech. Permit Fee: 1MPERMIT
Plumb, Permit Fee:
Elec. Permit Fee:
Other Mech. Insp. 0.0 hrs $48.00
Other Pl100, 1;1s"nLL]
Other Flee. lrrsp.
PME Plan Check:
$0.00
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 preliminar information available and are only an estimate. Contact the Dept for addn7 info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13,
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
g upp[ PC Fee
PME Plan Check:
$0.00
['crillit Fee:
1,11pl. /nsp Pe"
PME Unit Fee:
$215.00
PME Permit Fee:
$48.00
C `onstr uclion Mx.-
x:Administrative
AdministrativeFee: (ADMIN
$45.00
Work Without Permit? Yes (F) No
$0.00
itIvaneed Planning Fees:
A
Travel Documentation Fee: ITRA VDOC
$48.00
Strong Motion Fee: IBSEISMICR
$3.03
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$360.03
$0.00 TOTAL FEE:
1 $360.03
Revised: 07/02/2015
ipb site daring, conotru tion; It i$ unlowfuj to make any
Changes or alteratii)ns on same, !or td deviate : ,A
therfrorri, without approval from the BuiOing Official. i
The st mpiIng of this plan and specifiotion's SHALL NOT
be h&d to permit dr to ba an approv t of the yiolat3on
Of any previsions df any City Or�Iinarice dr State Lsw
_ .
BY
DATE 7 -51
PEP MIT N i
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za AUG 27 2195;
'LOT PAVC EC ED BY
' PLANNING DEPT
CUPERTINO
CERTIFICATE OF COMPLIANCE
CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 1 of 3 )
Project Name:
2015- 0151 Jim Nakasuji I Date Prepared:
2015-08-26
A. General Information
CF1R-ALT-02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be
documented, use one CF11R-ALT-02 document for each dwelling unit.
01
Project Name
2015- 0151 Jim Nakasuji
02
Date Prepared
2015-08-26
09
10
Is the SC
03
Project Location
22188 Orchard C
04
Building Type
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
2015- 0151 Jim Nakasuji
07
Zip Code
95014
08
Dwelling Unit Conditioned
2400
by this SC
ducted
containing
system
Floor Area (ft2)
entirely new
entirely new
RY
Served
Number of space conditioning
system?
09
Climate Zone
4
10
(SC) systems in this dwelling
1
Furnace
unit.
B. Space Conditioning (SC) System Information
01
02
03
04
05
06
07
08
09
10
Is the SC
Installing a
SC System
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 (ft2)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
Furnace
Altered space
replacement add
whole house
2400
Yes
Yes
Yes
Yes
No
No
conditioning system
A/C
C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)1Diib)
Registration Number: 215-A6304686A-000000000-0000
This section does not apply to this project.
Registration Date/Time: 2015-08-26 15:09:05
HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-08-26 15:08:35
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CF111-ALT-024
Alterations to Space Conditioning Systems (formerly CF -1R -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
Heating
Altered
Heating
Minimum
Altered
Cooling
Minimum
Required
New or
Identification
System
Heating
Efficiency
Efficiency
Cooling
Cooling
Efficiency
Efficiency
Thermostat
Replaced
New Duct
or Name
Type
Components
Type
Value
System Type
Components
Type
Value
Type
Duct Length
R -Value
Furnace
Central gas
All new
Central split
All new
Greater than
replacement
furnace
heating
AFUE
0.96
AC
cooling
SEER
16
Setback
40 feet
R-6
add A/C
components
components
Reouired Documentation:
CF2R-MCH-01-E - Space Conditioning Systems Ducts and Fans
-Duct insulation requirement for new plenums: R6.
CF2R-MCH-20-H & CF3R-MCH-20-H — Duct Leakage testing 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: 5 15%, or15 10% leakage to outside, or seal all accessible leaks.
CF2R-MCH-25-H & CF3R-MCH-25-H Refrigerant Charge Verification required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15).
CF2RCF3R-MCH-23 & CF3R-MCH-23 Air Flow z 300 CFM/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.
-Heating-only systems and Air Handler/Furnace changes do not require verification of Air Flow MCH -23, or Refrigerant Charge MECH-25;
-Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH -20 Duct Leakage Testing requirements.
E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)1Diia and'150.2(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: 215-A6304686A-000000000-0000
Registration Date/Time:
2015-08-26 15:09:05
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-08-26 15:08:35
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -1R -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:
�_ /j�
Documentation Author Signature: (?�%
Faulkner, Cindy
C1'L000C/i/�2P/G
Company:
Signature Date:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL
2015-08-26 15:09:05
Address:
CEA/ HERS Certification Identification (if applicable):
1171 NORTH 4TH STREET
City/State/Zip:
Phone:
SAN JOSE CA 95112
(408) 294-6290
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. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or 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 of the California Code of Regulations.
4. The building design features or system design features identified on this Certificate of Compliance are consistent with the info rmation,provided on other applicable compliance documents, worksheets,
calculations, plans and specifications submitted to the enforcement agency forapprovalwth this building permit application.
5. 1 will ensure that a registered copy of this Certificate of Compliance shall be made available with the building permit(s) issued for the building, and made avaiiableto the enforcement agency for all applicable
inspections. I understand that a registered copy of this Certificate of Compliance is required to be included with the documentation the builder provides to the building owner at occupancy.
Responsible Designer Name:
Responsible Designer Signature: r np�
96
Faulkner, Cindy
�
Company:
Date Signed:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL
2015-08-26 15:09:05
Address:
License:
1171 NORTH 4TH STREET
258540
City/State/Zip:
Phone:
SAN JOSE CA 95112
(408) 294-6290
Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document, and in noway implies Registration Provider responsibility for the accuracy of the information.
Registration Number: 215-A6304686A-000000000-0000 Registration Date/Time: 2015-08-26 15:09:05 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-08-26 15:08:35
Schema Version: 0.555SDD