B-2017-1900 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1900
21370 VAI AVE CUPERTINO,CA 95014-4986(362 05 028) ATKINSON
CLIMATROLLERS INC
SAN JOSE,CA 95112
OWNER'S NAME: KADOKURA KEITH AND MOSCHEL DATE ISSUED: 11/03/2017
OWNER'S PHONE:408-446-5478 PHONE NO:(408)294-6290
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C20 Lic.#258540
Contractor ATKINSON CLIMATROLLERS INC Date 12/31/2018 X BLDG _ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing X MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
REPLACE FURNACE AND AIR CONDITIONER(SAME LOCATION)
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
• Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
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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
permit is issued. Sq.Ft Floor Area: Valuation:$11087.00
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 362 05 028
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 applicant understands and will comply with all non-point
source regulations per
the
�Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature £ U2 U!/N— l /D"rt 4z Date 11/3/2017 Issued by:Jasmine Archbold
Date: 11/03/2017
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. I,as owner of the property,or my employees with wages as their sole installed without first obtaining 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: 11/3/2017
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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. HAZARDOUS MATERIALS DISCLOSURE
2. 1 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. 1 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 25��505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent: G���Q/CbfY
APPLICANT CERTIFICATION Date: 11/3/2017
I 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. I understand my plans shall be used as public records.
Licensed
Signature Date 11/3/2017 Professional
CONSTRUCTION PERMIT APPLICATION
\\t //( COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO,CA 95014-3255
S-Ips
s (408) 777-3228 • building@cupertino.org PEMIT#B- 2.0 11- - VA 00
CUPERTINO REV# DEF#
PROJECT AD❑DR EW CONSTRUCTION 111ADDITION ALTERATION 111 T.I. AP❑MEP 1=1 RE-ROOF 1=1 SWIMMING POOL/SPA
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t►. INGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL •
XIS'NG USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES I TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
'
REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE 0 ATTACHED
BATHROOM SF SF SF SF 0 DETACHED
•
EXISING ❑YES YES
EICHLER ❑YES SECOND STORY ADDITION ONO
FIRE SPRINKLERS 0 NO 0 NO
DWELLING SECOND DWELLING DYES 0 ATTACHED DETACHED OTHER
UNITS# UNIT ADDITON: ❑NO S F
POOLS 0 FIBERGLASS ❑VINYL-LINED 0 GUNITE 0 PREFABRICATED
POOL-SF SPA-SF I SPA ATTACHED❑YES 0 NO I TOTAL-SF , 1FCA �/
Wita-.�Y.Tom/\.P I I[ VALUATION:
7 ON:
Commercial or Multi-Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval P 00
RE-ROOF EXISTING ROOF TYPE: 0 BUILT-UP ROOF 0 ASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 TILE OTHER(SPECIFY)
REMOVE/REPLACE 0 NOI IF NO PLYWOOD ❑ ❑3/8" PLYWOOD TYPE: PITCH: 12 ROOF CLASS
❑YES #OF LAYERS THICKNESS❑5/8" OTHER ❑OSB 0 CDX OTHER A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF DASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES 0 OTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy SF /of SQUARES
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. 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 building construction. I authorize representatives of Cupertino to
enter the above-identified property for inspection purposes. I acknoledge and authorize all informationilcontained on this application form
to be made available for public recordG � "---‘,€)Z
6 ` l ,5/ 1
Signature of Applicant/Agent: / Date:
SUPPLEMENTAL INFORMATION REQUIRED
*New SFD/Second Dwelling Units/Multifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
*Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application.
*HOA-Provide a letter of approval from the Home Owner's Association
BldgApp_2017.doc revised 08/01/17
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems(formerly CF-1R-ALT-HVAC) (Page 1 of 3)
Project Name: 2017-0348 Moschel Kadokuna Date Prepared: 2017-10-25
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
CF1R-ALT-02 document for each dwelling unit.
01 Project Name 2017-0348 Moschel Kadokuna 02 Date Prepared 2017-10-25
03 Project Location 21370 Vai Ave 04 Building Type Single family
05 CA City Cupertino 06 Dwelling Unit Name 2017-0348 Moschel Kadokuna
07 Zip Code 95014 08 Dwelling Unit Conditioned 1908
Floor Area(ft2)
Number of Space
09 Climate Zone 4 10 Conditioning(SC)Systems in 1
this Dwelling 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 and A/C Altered space
whole house 1908 Yes Yes Yes No No No
replacement conditioning system
C. Extension of Existing Duct System,Greater Than 40 Feet(Section150.2(b)1Diib)
This section does not apply to this project.
Registration Number:217-A020369997A-000-000-0000000-0000 Registration Date/Time: 2017-10-25 11:29:52 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2016.1.006 Report Generated:2017-10-25 14:29:51
Schema Version:rev 10/16
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems(formerly CF-1R-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
Furnace and All new All new This field or This field or
Central gas Central split
A/C furnace heating AFUE 96 AC cooling SEER 16 Setback section is not section is not
replacement components components applicable applicable
Required Documentation:
CF2R-MCH-01-E-Space Conditioning Systems
-Duct insulation requirement for the new portions of supply-air and return-air ducts or plenums:R6(CZ 1-10,12 and 13)and R8(CZ 11 and 14-16)
CF2R and CF3R-MCH-20-H-Duct Leakage Test 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<=10%leakage to outside,or seal all accessible leaks.
CF2R and CF3R-MCH-25-H Refrigerant Charge verification required when refrigerant containing components are installed or altered(applicable in CZ 2,8-15).
CF2R and CF3R-MCH-23 Airflow Rate>=300 CFM per 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 MCH-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:217-A020369997A-000-000-0000000-0000 Registration Date/Time: 2017-10-25 11:29:52 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2016.1.006 Report Generated:2017-10-25 14:29:51
Schema Version:rev 10/16
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. I certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name: Documentation Author Signature: `/���`_�/., I�CG�'
Faulkner,Cindy '/l�al�
Company: Signature Date:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING& ELECTRICAL 2017-10-25 11:29:51
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. I 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 information provided on other applicable compliance documents,worksheets,
calculations,plans and specifications submitted to the enforcement agency for approval with this building permit application.
5. I 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 available to 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.
lvOy
Responsible Designer Name: Responsible Designer Signature: /���'Gdy C1 LZGGC���/yLP/li
Faulkner,Cindy
Company: Date Signed:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING& ELECTRICAL 2017-10-25 11:29:52
Address: License:
1171 NORTH 4TH STREET 258540
City/State/Zip: Phone:
SAN JOSE CA 95112 408-294-6290
Easy to Verify : :13
at CaICERTS.com '
1L�
S•.
•
Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document,and in no way implies •'�o
Registration Provider responsibility for the accuracy of the information. •~ {—
Registration Number:217-A020369997A-000-000-0000000-0000 Registration Date/Time: 2017-10-25 11:29:52 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2016.1.006 Report Generated:2017-10-25 14:29:51
Schema Version:rev 10/16
•
i / SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
4, COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO
(408)777-3228•FAX(408)777-3333•buildin.•cu•ertino.or.
PERMIT CANNOT BE F'IN.LED I.TNtIL THIS CERTIFICATE HAS BEEN
COMPLETErkaci4D,AND JTURNEP TO TIM BIIILDING DIVISION
PURPOSE
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2016 CRC Section R314,R315,2016 CBC Sections 420.6 and 907.2.11.2 where no interior access
for inspections are required.
GENERAL INFORMATION
Existing single-family and multi-family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions,alterations,or repairs to existing dwelling units exceeds
$1000.00,CRC Section R314,R315, and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or
Carbon Monoxide Alarms be installed in the following locations:
AREA SMOKE ALARM CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the X X
bedroom(s)—(Smoke alarms shall not be located within 3 feet of bathroom door)
On every level of a dwelling unit including basements and habitable attics X X
Within each sleeping room X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply In dwelling units with no commercial power supply, alarm(s)may be solely battery operated.
In existing dwelling units,alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic,basement or crawl
space.Refer to CRC Section R314 and CBC Sections 907.2.114 and 420.6.2.An electrical permit is required for
alarms which must be connected to the building wiring.
As owner of the above-referenced property,I hereby certify that the alarm(s)referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms specified below have been tested and are operational, as of the
date signed below
Address: %LAI ��'��(G 0 f C"-- Permit No. itk ,J Ct- <9 00
Specify Number of Alarms #Smoke Alarms I I #Carbon Monoxide Detectors. II 3-
/have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name: �/�
!< i eai I ! KLA I 1 Signature. . . ...Date:a/C I?
Contractor Name:
Signature Lic.# Date:
Smoke and COform.doc revised 01/10/2017