B-2016-1834CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1834
10141 STERN AVE CUPERTINO, CA 95014-3666 (375 1106 1) ATKINSON
CLIMATROLLERS INC
SAN JOSE, CA 95112
OWNER'S NAME: LIU CHI H AND YIM K ET AL
OWNER'S PHONE: 408-667-4804
LICENSED CONTRACTOR'S DECLARATION
License Class GENERAL BUILDING CONTRACTOR Lic. #258540
Contractor ATKINSON CLIMATROLLERS INC Date 12/31/2016
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:
1. I have and will maintain a certificate of consent to self -insure for Worker's
DATE ISSUED: 04/26/2016
PHONE NO: (408) 294-6290
BUILDING PERMIT INFO:
X BLDG —ELECT —PLUMB
X MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
REPLACE (E) A/C - SAME LOCATION
Compensation, as provided for by Section 3700 of the Labor Code, for the
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
permit is issued. Sq. Ft Floor Area: Valuation: $7100.00
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 to building construction, and hereby authorize
representatives of this city to enter upon the above mentioned propeity 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 granting of this permit.
Additionally, the applicant understands and will comply with all non -point
souse regulatiorls ppr the Cupertino Municipal Code, Section 9.18.
Date 4/26/2016
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. 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)
2. 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
1. 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.
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.
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 become 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.
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 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, 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 9. 8.
Signature rL Date 4/26/2016
APN Number: Occupancy Type:
375 11 061
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Abby AXende
Date: 04/26/2016 qn Q�4&
RE -ROOFS:
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.
Signature of Applicant:
Date: 4/26/2016
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Letionj25505,
Municipal Code, Chapter 9.12 and
the Health & Safety Code 25533, and 25534.
94ner or authorized agent:
Date: 4/26/2016
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 MISIC
(408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.org
[:]PLUMBING ❑ MECHANICAL ❑ ELECTRICAL ❑ MISCELLANEOUS
PROJECT ADDRESS p O � � �Ie&v
Ao
APN # ` q - j _ ou
OWNER NAME J
PHONE y0 n
E-MAIL
STREET ADDRESS n S �R O C (_
CITY, STATE, ZIPo, &�
FAX
CONTACT NAME n- (�
PHONEI'yo (fq / o
E-MAIL (`
STREET ADDRESS
CITY, STATE, ZIP ) __. , 6A /► �//
t
FAX GZ EcA
7 [
11 OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT
CONTRACTOR 11CONTRACTOR AGENT ❑ ARCHITECT 11ENGINEERER 11 DEVELOPER ❑ TENANT
CONTRACTOR NAME S'vVf✓
LICENSE NUMBER Q C (`j�o
LICENSE TYPE�!f
BUS. LIC #
COMPANY NAME V60<C/ (
c
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC # C
_l
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY
BUILDING: ❑ COMMERCIAL
PROJECT IN WILDLAND ❑ YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN
FLOOD ZONE
❑ YES
❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
,,00
TOTAL VALUATION: 16 O m ��Lt�
RECEIVED BY:
By my signature below, I certify to each of the follo ing: I am the property owner or authorized agent to act on the property ow er's be alf. I have read this
application and the information I have pr i d is orrect. 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 bui i co truction. I authorize representatives of Cupertino to enter the abov -id tified property for inspection purposes.
Signature of Applicant/Agent: Date: L
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE.USE, ONLY
�+
U .
s
❑' OkA-THE-COUNTER .
D EXPRESS _
❑ 'STANDARD
LARGE
❑ MAJOR
MEPMiscApp_2011.doc revised 06/21/11
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 1 of 3 )
Project Name: 2015- 0691 Kevin Tam Date Prepared: 2016-04-22
A. General Information
MR -ALT -02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented,
use one CF1R-ALT-02 document for each dwelling unit.
01
Project Name
2015- 0691 Kevin Tam
02
Date Prepared
2016-04-22
03
Project Location
10141 Stern Ave
04
Building Type
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
2015- 0691 Kevin Tam
07
Zip Code
95014
08
Dwelling Unit Conditioned
2800
duct system?
SC system?
Alteration Type
Add A/C
Floor Area (ft2)
2800
Yes
Yes
Yes
No
Number of space conditioning
No
09
Climate Zone
4
10
(SC) systems in this dwelling
1
unit.
B. Space Conditioning (SC) System Information
01 02 03 04 05 Wy06. 07 ' a 08 09 10
the
a
SC System
SC System
CFA served
system a
refrigerant
Installing new=SC
Installing
Insfallmg
;Installing
Identification or
Location or Area
by this SC
ducted i`
containing
system
more than 40a
entirely. new
entirely new
Name
Served
System (ft2)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
Add A/C
whole house
2800
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b)1Diib)
This section does not apply to this project.
Registration Number: 216-AO14963OA-000000000-0000 Registration Date/Time: 2016-04-22 10:03:12 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-04-22 10:03:48
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CF1R-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)1E 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
Central gas
No heating
This field or
This field or
Central split
All new
This field or
This field or
Add A/C
furnace
component
section is not
section is not
AC
cooling
SEER
14
Setback
section is not
section is not
altered
applicable
applicable
components
applicable
applicable
Required Documentation:
CF2R-MCH-01-E - Space Conditioning Systems Ducts and Fans
-Duct insulation requirement for new plenums: R6.
CM -MCH -20-H & CF313-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: <_ 15%, or 510% 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 & CF311-MCH-23 Air Flow >_ 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 A'ir Flow,MCH,-23; &'Wrigera,nt`Charge MECH 25.
Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH 20 DuctLeakage 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)
q
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: 216-A0149630A-000000000-0000 Registration Date/Time: 2016-04-22 10:03:12 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-04-22 10:03:48
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CF1R-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:
Faulkner, Cindy
Company:
Signature Date:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,CCIOLING & ELECTRICAL
2016-04-22 10:03:12
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 informatian,,provided on other applicable compliance documents, worksheets,
calculations, plans and specifications submitted to the enforce ment,age ncy fori approvafwith this building permitappl1cation .
5. 1 will ensure that a registered copy of this Certificate, of Compliance shall be:rriade°available with; the building permit(' 'issued for the.bwldirig, and`made availableao thd;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 bujldng owner at occupancy.
E, .,
Responsible Designer Name: w -R
Responsible Designer Signature.
CVL7
Faulkner, Cindy
Company:
Date Signed:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL
2016-04-22 10:03:12
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 Providerresponsibility for the accuracy of the information.
Registration Number: 216-AO14963OA-000000000-0000 Registration Date/Time: 2016-04-22 10:03:12 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-04-22 10:03:48
Schema Version: 0.555SDD