B-2017-1104CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1104
21063 CHRISTENSEN DR CUPERTINO, CA 95014-1652 (326 54 005)
M / C HEATING &
COOLING
REDWOOD CITY, CA
94063
OWNER'S NAME: PEARLMAN DALE LAND DARA B TRUSTEE
DATE ISSUED: 07/11/2017
OWNER'S PHONE: 650-269-6421
PHONE NO: (650) 366-1122
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C-20 Lie. #828280
Contractor M / C HEATING & COOLING Date 12/31/2017
X BLDG —ELECT —PLUMB
X MECH X RESIDENTIAL COMMERCIAL
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.
JOB DESCRIPTION:
REPLACE AC UNIT (SAME LOCATION)
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
performance of the work for which this permit is issued.
2. 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
Sq. Ft Floor Area:
Valuation: $5735.00
permit is issued.
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
AFN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
326 54 005
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
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the ap licant understands and will comply with all non -point
source regul ns er the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature _ Date 7/11/2017
Issued by: JASMINE ARCHBOLD
Date: 07/11/2017
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
following two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
1. 1, as owner of the property, or my employees with wages as their sole
installed without fust obtainin an inspection, I agree to remove all new materials for
compensation, will do the work, and the structure is not intended or offered for
inspection.
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 7/11/2017 e 01
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
r. 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.
HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance, as provided for by
I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code, for the performance of the work for which this
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
permit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued, I
Health & Safety Code, Section 25532(a) should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sections 25505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 7/11/2017
1 certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
correct. I agree to comply with all city and county ordinances and state laws
I hereby affirm that there is a construction lending agency for the performance
relating to building construction, and hereby authorize representatives of this city
of work's for which this permit is issued (Sec. 3097, Civ C.)
to enter upon the above mentioned property for inspection purposes. (We) agree
Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in
Lender's Address
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
ARCHITECT'S DECLARATION
Code, Section 9.18.
1 understand my plans shall be used as public records.
Licensed
Signature Date 7/11/2017
Professional
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 misc
CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • build inclCa�cupertino.ong
—(PLUMBING ISIMECHANICAL I IELECTRICAL t IMISCELLANEOUS
PROJECT ADDRESS 21063 Christensen Dr., Cupertino
`,_ L ^
OWNER NAM a IZ
PHONE
E-MAIL
STREET ADDRESS 21063 Christensen Dr.
CITY, STATE, ZIP Cupertino, CA
FAX
CONTACT NAME
NOlaSCO
PHONE
(650) 269-6421
L
E-MAITOn
to @nolascoconstruction.com
STREET ADDRESS
530 Oak Grove Ave #101-A
CITY, STATE, ZIP
Menlo Park CA 94025
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT lig CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAM Miguel Buenrostro
LICENSE NUMBER 828280
LICENSE TYPE C-20
BUS. LIC n 403134
COMPANY NAMEM/C Heating and Cooling, Inc.
E-MAIL info@mcheatingcooling.com
FAX (650) 366-6621
STREET ADDRESS
419 Mac Arthur Ave
CITY, STATE, ZIP
Redwood City, CA 94063
PHONE 65O
( ) 366-1122
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS, LIC 9
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 ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
TOTAL VALUATION:
RECEIVED BY
By my signature below, I certify to each of the following: 1 am the property owner or authorized agent to act on the property owner's behall'. I have read this
application and the information 1 have ovided 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 relatinf i ding construction. I authorize representatives of Cupertino to enter the above -id e itied p operty for inspection purposes.
Signature of Applicant/Agent: k Date:
SUPPL NTAL INFORMATION REQUIRED
OFFICE USE ONLY
❑ OVER-THE-COUNTER
a
r
F'
❑ EXPRESS
U
w
5
❑ STANDARD
U
a
❑ LARGE
❑ MAJOR
MEPMiscApp_2011.doc revised 06/21/11
J I H I C Ur I.HLI r V KIV IH
ALTERATIONS - HVAC
ow
CEC-CFIR-ALT-03-E (Revised 01/16) CALIFORNIA ENERGY COMMISSION `MW -
CERTIFICATE OF COMPLIANCE CF1R-ALT-03-E
Alterations - HVAC CZ 1, 3 to 7 and 16 (Page 1 of 1)
Site Address:
Enforcement Agency:
Date Prepared:
Permit#:
Equipment Type
Equipment Efficiency
New: Ducting or Lineset
Required R -value
Conditioned Z
Floor Area (ft)
Thermostat
❑ Packaged System
53 -Evaporator Coil
AFUE
COP
❑ R-6 (CZ 1-10,12&13) Ducts
Served by system
Setback
❑ Split System
[condensing Unit
SEER
11R-8' (CZ 11, 14-16) Ducts
�` 8 ft2
(If not already
❑ Furnace
9Lineset
/C EER
HSPF
❑ >_ R-2.8 Lineseta
present, must
be 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)
A L '*-,� Cs----,- J
All Equipment,
CF113-ALT-02-E
Condenser Unit, Evaporator Coil,
CF2R: MCH -01, MCH -20-H
Air Handler/Furnace
CF3R: MCH -20-H
Installer Requirement: Duct leakage (< 15% or, 1510% to outside, or seal all accessible leaks)
Exempted from duct leakage testing if:
❑ 1. Duct system registered with HERS provider as previously sealed, or 112. 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 Ducts2
CF1R-ALT-02-E
CF2R-MCH-01-E, MCH -20-H, MCH -22-H, MCH -(23 or 24)-H
CF3R-MCH-20-H, MCH -22-H, MCH -(23 or 24)-H2
Installer Requirement: Duct leakage < 5%, Fan Efficacy (0.58W/CFM), Air Flow >_ 350 CFM/ton (or Standards Table 150.0-13 / C 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'
Ducts2 and one or more of the following:
CF2R-MCH-01-E, MCH -20-H, MCH -(23 or 24)-H
Condenser Unit, Evaporator Coil, Furnace
CF3R-MCH-20-H, MCH -(23 or 24)-H
Installer Requirement: Duct leakage < 5%, Air Flow >_ 350 CFM/ton (or Standards Table 150.0-13 / C alternative)
❑ Exempted from duct leakage testing if 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
CFIR-ALT-02-E
space but less than All New Ducts2
CF2R-MCH-20-H
CF3R-MCH-20-H
Installer Required to: Duct leakage (< 15% or, < 10% to outside, or seal all accessible leaks)
❑ Exempted from duct leakage testing if existing duct systems are constructed, insulated or sealed with asbestos.
' All new ducting requires R-8 insulationwhen more than 40 ft installed in CZs 11 & 14-16 and R-6 in CZs 1-10, 12 & 13, and R-6 insulation when less
than 40 ft installed. This includes in walls, between floors etc.
2 A New Duct system is when the duct system is constructed of at least 75 %new duct material, and up to 25%may consist of reused parts from the
dwelling unit's existing duct system (e.g., registers, grilles, boots, air handler, plenums, duct material.
a R-2.8 (1" thick insulation) for linesets 1" and less.
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.
3. 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 specifications submitted to the enforcement
agency for approval with this building permitApplication.
Re o ble Designer Name:
R o ible Designer Sign atur
Dateygned•
License: 7
companp
K C --.L1`4
Address:
tq - u j
Ci State/Zip: r
C wo 6 \ c
Phone:
6-S6 12-2.
For assistance or questions regarding the 1nergy Standards, contact the Energy Hotline at: -800-772-3300