11120023CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21690 RAINBOW CTI CON RNAGCTOR: VALLEY HEATING & I PERMIT NO: 11120023
OWNER'S NAME: BHALERAO PRAKASH AND SUJATA TRUSTEE 11171 N 4 TH ST j DATE ISSUED: 12IO2f2011 j
"ER'S PHONE: 4082554299 1 SAN JOSE, CA 95112 j PHONE NO: (408)294.6290
9 pLICENSED CONTRACTOR'S DECLARATION
License Class (.. ' �� Lic. q 75}i'
50i1`6
Contractor✓4�%/f ef�Datea/Z11,(
1 hereby affirm that I am licensedunderthe 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.
1 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.
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.
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
9.18.
i
BUILDING PERMIT INFO: BLDG r ELECT r' PLUMB r
MECH (— RESIDENTIAL r COMMERCIAL
JOB DESCRIPTION: REPLACE TWO(2) FURANCES AT SAME LOCATION
Sq. Ft Floor Area: I Valuation: $8590
APN Number: 36638003.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Date:/'2_ 2
• RE -ROOFS:
OWNER -BUILDER DECLARATION All roofs shall be inspected prior to any roofing materiel berg installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
I hereby affirm that 1 am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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
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, 1 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 l ia6ilities, judgments,
and expenses which may accrue against said City in consequence of the
ng of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
M&
Signature Date
inspection.
Signature of
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
1 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(x) should 1 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 Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505,25533, and 25534.
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
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
• 6 ITEMS OF 12
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CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 36638003.00
DATE ISSUED.......: 12/02/2011
RECEIPT #.........: BS000015480
REFERENCE ID # ...: 11120023
SITE ADDRESS .....: 21690 RAINBOW CT
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: patg
COPY # : 1
OWNER BHALERAO PRAKASH AND SUJATA TR
ADDRESS ..........: 21690 RAINBOW CT
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
RECEIVED FROM ....: VALLEY HEATING & CO
CONTRACTOR .......: ATKINSON, THOMAS LIC # 141
COMPANY ..........: VALLEY HEATING & COOLING
ADDRESS ..........: 1171 N 4 TH ST
CITY/STATE/ZIP ...: SAN JOSE, CA 95112
TELEPHONE ........: (408)294-6290
FEE ID
UNIT
QUANTITY
AMOUNT
PD -TO -DT
THIS REC
NEW BAL
----------
-ADMIN
-------------
HOURS
----------
1.00
----------
41.00
----------
0.00
----------
41.00
----------
0.00
1BCBSC
VALUATION
8,590.00
1.00
0.00
1.00
0.00
1BSEISMICR
VALUATION
8,590.00
0.86
0.00
0.86
0.00
1MFR=<100
UNITS
2.00
260.00
0.00
260.00
0.00
1MPERMITFE
FLAT RATE
1.00
44.00
0.00
44.00
0.00
1TRAVDOC
FLAT RATE
1.00
44.00
0.00
44.00
0.00
TOTAL PERMIT
----------
390.86
----------
0.00
----------
390.86
----------
0.00
METHOD OF PAYMENT
-----------------
CHECK-
TOTAL RECEIPT :
AMOUNT
---------------
651.36
---------------
651.36
VOICE ID DESCRIPTION
-------- ----------------------------
505 FINAL ELECTRICAL
508 FINAL MECHANICAL
REFERENCE NUMBER
--------------------
#22925
VOICE ID DESCRIPTION
-------- ----------------------------
507 FINAL PLUMBING
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I 11 ZC)cD Z3
GENERAL PERMIT APPLICATION M E P
Id
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 M I
CUPERT 0 (408) 777-322'8.,•, FAX (408) 777-3333 • buil�dingAcuoertino.ora
I W4I IIMRINI: VRMFfHANICAL 'IF7.F.CTRICAI. I—I SC
MISCELLANEOUS
PROJECTADDRESS ^�/ L)/I' JlO.1 /
APNN
„ C) C)
OWNER NAME�u/ r
PHONE E-MAIL
STREET ADDRESS 21 Al0 n�Ly
l
CITY, STATE, ZIP /n4/(50l�
1 J
FA%
CONTACT NAME
M-CL
PHONE
rJ .2q,q_ 24d
E-MAIL
STREET ADDRESS
CITY,STATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWIiERAGENF
❑ CONTRACTOR ONIRACIUR AGENF ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACT.0�4 �/� <r 47 ��r l DO ��n
�\N/AME/
LICE NfE NUR
LIONS E PE
C
BUS. Lie M
COMPANY
Va ��
E-MAIL'
FAX
STREET ADDRESS
/171 /d,'ff� Sfi.
CITY, STATE, ZIP. _
"PS,, o C� ]5// 2
PHO
Of/ -290-6240
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC N
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF FDm DUPLEX ❑ MULTI -FAMILY
BUILDING E] COMMERCIAL
PROJECT M WILDLAND ❑ YES
URBAN INTERFACE AREA ❑ NO
PROJECTM EI YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑YES
EICHLERHOME? ❑ NO
DESCRIPTION OF WORK rf JJ (2
L r e
TOTALVALUATION:590—
RECEIVED BY:
By my signature below, I certify to each of the following:
application and the information I have provided is correct.
ordinances and state laws relating to building construction.
Signature of Applicant/Agent
I am the property owner or authorized agent to act on the property owner's behalf. I have read this
1 have read the Description of Work and verify it is accurate. 1 agree to comply with all applicable local
I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Date:
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY.
VE R-TiIE-COCOUNTER }
6
_
❑ EXPRESS.
❑ STANDARD
ZZ
r
❑ LARGE...no.eJ
❑ MAJOR
MEPMiscApp_201 Ldoc revised 06121/11
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F����� CITY OF CUPERTINO
M_7 FEE ESTIMATOR - BUILDING DIVISION
APPLIANCE / EQUIP TYPE
ADDRESS: 21690 rainbow ct.
DATE: 12/02/2011
REVIEWED BY: bobs.
UNITS
APN:
BP#:
"VALUATION: $8,590
*PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
#
PENTAMATION FURN/AC
PERMIT TYPE:
WORK
re lace 2 furnaces at same location.
SCOPE
Srtpp7. Htap Fee
APPLIANCE / EQUIP TYPE
FEE ID
11h..... Mn C/rcck
QTY
UNITS
BP FEES
Flee' Pernrir
Furnace, Forced -Air
1MFR=<100
other Eh:c. Onp.
2
#
$260
pernlit Fare:
Srtpp7. Htap Fee
PME Unit Fee:
$260.00
PME Permit Fee:
$44.00
Construction Tac
Administrative Fee: ]ADMIN
$41.00
Work Without Permit? Q Yes G No
$0.00
TOTALS:
Travel Documentation Fee: ITRAVDOC
$260.00
Sironl 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, eta). These fees are based on the Prefinina information available and are only an estimate. Contact the De t or addn7 info.
FEE ITEMS (Fee Resolution 11-053 Elf 7/1,/11)
Mech. Plan Check 1 0.0 Ins $0.00
11h..... Mn C/rcck
Elec•. Pfnu Ch". -a
Mech. Permit Fee: IMPERMIT
Plumh. Pernrrr Nine:
Flee' Pernrir
Other Mech. Insp.0.0 Ins $44.00
UlGry Plum• 1'"P.
other Eh:c. Onp.
Mach. lnv>. Fee'
Plund,, Imp, I`("
Elec. tn¢. Fee:
NOTE. This estimate does not Include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, eta). These fees are based on the Prefinina information available and are only an estimate. Contact the De t or addn7 info.
FEE ITEMS (Fee Resolution 11-053 Elf 7/1,/11)
FEE
QTY/FEE
MISC ITEMS
Pion Cleclr Foe:
Snppl. PC Fee
PME Plan Check:
$0.00
pernlit Fare:
Srtpp7. Htap Fee
PME Unit Fee:
$260.00
PME Permit Fee:
$44.00
Construction Tac
Administrative Fee: ]ADMIN
$41.00
Work Without Permit? Q Yes G No
$0.00
'1 Jv0r1(Xo Planning Fe m'
Travel Documentation Fee: ITRAVDOC
$44.00
Sironl Motion Fee: IBSEISMICR
$0,66
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
, SUBTOTALS:
$390.861
$0.001 TOTAL FEE:
1 $390.86
Revised: 10/01/2011
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n ,\
Prescriptive Certificate of Compliance: Residential CF -IR -ALT
Residential Alterations a e 1 of 5
Project Name:Climate Zone# 4 #of2Stories
Su,ala Bhalerao
General Information
Site Address: 21690 Rainbow CT, Cupertino, CA 95014
Enforcement Agency:Clty of Cupertino
Date: 11-20-2011
Building TypeO Single Family ❑ Multi Family
Circle the Front Orientation 'Z, S, W, or degrees D W;' 0
Conditioned Floor Area (CFA): 7000 SQFT
Project Type: AlterationsR Envelope Fenestration Roof x HVAC
or T e2 and Size' or Other' factor' Numbers R-value6 R -Valuer Row/Cols U -factor
Replacement or Chane Out Duct Replacement 0 Water Heater
NOTE: This form is not to be used for Newly Constructed Buildings or Additions
insulation Values For Opaque Surfaces (for Furring use the Mass and Furring Strips Construction table below)
Assembly Alteration
❑ Opening of framed cavity alone—Alterations that involve the opening of the framed cavity ofa wall, ceiling, or floor must install the
mandatory minimum insulation value per §150 for the altered assembly. Fill in Columns A —C and enter mandatory insulation value in Column H.
[I Replacement of entire assembly—Replacement ofan entire wall, ceiling, orfloor assembly requires the installation of Component
Package- D insulation values in Table 151-C. Fill in Columns A —J
O ague Surface Details For the furred portioned of Mass Walls see Furring Stri s Construction Table below.
A B C D E F G 1 H I I I J
Proposed fe it Standard Values From JA4 Table '
L
Framing Thickness, Framed Continuous JA4 Proposed
Tag/
Assembly Name Material Spacing, U- JA4 Table Cavity Insulation Assembly Assembl
ID'
or T e2 and Size' or Other' factor' Numbers R-value6 R -Valuer Row/Cols U -factor
Walls From Reference
in Furring Space from Reference
Joint Appendix Table 4.3.5 4.3.6 4.3.7
-^yl
Note: Forfurredassemblies, accountingfor Continuous Insulation R -value, see Page J44-3 and Equation 4-1. For calculatingfurred walls use the 1WasstnU
Furring Construction table below.
1. For Tag/ID indicate the identification name that matches the building plans. -
1. Indicate the Assembly Name or type: Roof/Ceiling, Walls, Floors, Slabs, Crawl Space, Doors and etc... Indicate in column G the Fr r��C��,,,��
material and Size: For Wood, Metal, Metal Buildings, Mass, enter 2x4, 1x6, or etc... see JA4 jar other possible frame type assemb irs
3. Enter the thickness for mass in inches or Spacing between framing members enter; 16"or 24 -0C,- or Other for all other assembly flgse al n
such m Concrete Sandwich Panel, Spandrel Panel, Logs, Straw Bale Panel and etc.... �iJJ UU
4. Based on the Climate Zone; enter the equivalent U factor found in JA4 Table based on the R -Value from Table 151-B, C, or D
5. Enter the Table number that closely resembles the proposed assembly. d,J
6. Enter the R -value that is being installed in the wall cavity or between the framing; otherwise, enter "0 ".
7. Enter the Continuous Insulation R -value for the proposed assembly; otherwise, enter "0". �� ��.�✓
8. Enter U based 4jQ9or
the row and column of the factor value on Column F Table Number and enter the As bly in Co1Jh(n,.
`"-�_,,..
9. The Proposed Assembly Ufactor, Column J, must be equal to or less than the Standard Ufactor in ttnui E to cor pl ?q, '
Furring Strips Construction Table for Mass Walls Onl
A B C I D I E
F G H I J I K
L
"'x M
Proposed Properties of Masonry and Concrete
Added Interior or Exterior Insulation
Walls From Reference
in Furring Space from Reference
Joint Appendix Table 4.3.5 4.3.6 4.3.7
Joint Appendix Table 4.3.13
u
w�
u
v
Assembly
iS,
c o
F' `o
m-k�
U
�.v
=
Final
Mass
Name or
JA4 Table
@
e
Assembly'
Thickness
Type'
Number'
¢ >
e
< >
U -factor •
Comment
egixrtrationNnmber: = RegistrationDatelfiine: �-r,. HERS Provider:
2008 Residential Compliance Forms March 2010
•
11
C�
Prescriptive Certificate of Compliance: Residential CF -IR -ALT
Residential Alterations} a e 2 of 5
Project Name: SU�ata BhC�IPiraO Climate Zone it #of Stories
`F 2
1. Indicate the type of assembly to include; Hollow Unit Masonry Walls, Solid Unit Masonry, Solid Concrete Wails, Etc. Additional assemblies can
be found Reference Joint Appendix JA4.
. This is the U -Factor based on the thickness ofthe assembly in inches.
. The R -value ofthe insulation to be added on the interior or exterior of the assembly.
4. The Calculated R- Value is the R -value of the furred out section of the assembly.
.-6. The Final Assembly is calculated using Equation 4-2 or Equation 4-4ofthe Reference Joint Appendix JA4. The equation is the inverse of Column
added to Column I Column K is the inverse from column J.
7. Insert the calculated U factor value on to the Opaque Surface Details in Column J
FENESTRATION PROPOSED AREAS
❑ Replacing window alone — Replacement windows shall meet the U -Factor and SHGC Value requirements of Component Package D in
Table 151-C. The Total Fenestration and West facing Area requirements are not applicable.
❑ Adding 50ft' or less of window area — Newly installed windows shall meet the U -Factor and SHGC Value requirements of Component
Package D in Table 151-C.
❑ Adding more than 50ftz of window area — Newly installed windows shall meet the U -Factor and SHGC Value and the Fenestration
Area requirements of Component Package Din Table 151-C. Complete the Altered Fenestration Allowed Area Table on Page 2 of the CF -/R -ALT
F
Orientation
G
CFA of
Fenestration Type and Frame
(Window, Glass Dooror Skylight)
(North, East, PropsedAreal
South, West) W
Maximum
U-factorz•I
Maximum
SHGC'-'-'
NFRC or Default
Values
Entire
%of
Fenestration
Area
Fenestration
Area
Proposed Area"'
Dwelling
CFA'•'
Area°
Removed'
Area Added'
A x B
(E -D) + C
Total Fenestration
1. Fenestration area is the area of total glazed product (i.e. glass plus frame). Exception: When a door is less than 50% glass, the fenestration
area may be the glass area plus a "2 inch frame " around the glass.
2. Enter value from Component Package D Requirements in Table 151-C.
3. Actual fenestration products installed and as indicated in CF -6R -ENV Form shall be equivalent to or have a lower U factor and/or a lower
SHGC value than that specified on the CF- I R ALT Form. '
4. Submi! a completed WS -3R Form ifa reduced SHGC is calculated with exterior shading.
5.1 a licable at this stage enter "NFRC" or NFRC Certified windows or are CEC "Default " valuesfound in Table 116-A or B.
ALTERED FENESTRATION ALLOWED AREAS (Complete if more than 50J? offenestration Is added)
A
B
C
D
E
F
G
CFA of
Allowed
Existing
Allowed
Entire
%of
Fenestration
Area
Fenestration
Area
Proposed Area"'
Dwelling
CFA'•'
Area°
Removed'
Area Added'
A x B
(E -D) + C
Total Fenestration
Are ft
West Fenestration Area
(Required In
>_
CZ's 2,4&7-15
1. The Proposed West Fenestration Area includes West -sloping skylight area and any other skylight area with a pitch less than 1:12.
2. Enter 10% when no West orientation restriction or 15% when West fenestration is being installed in Climate Zones 2, 4, & 7-15. Note that the
maximum allowed fenestration can only be 5% of the CFA as indicated in Column F. Column G must be equal to or less than Column F.
3. In climate zones 2, 4, 7-15, no more than 5% of the CFA is allowedfor west facing glazing.
4. Existing Fenestration area must be counted toward the maximum allowed 15% or 20% of the whole building and calculated in Column G. The
Proposed Area must be less than or equal to Column F.
5. Enr lite fenestration removed as part ofthe alteration ifany in column D.
6. Entertethe Fenestration area that is being added as part of the alteration.
egistrutioh umber;" ". - -a RegisirarionDatelTinie: 4=I T. HERSProviden•
2008 Residential Compliance Forms March 2010
0
•
Prescriptive Certificate of Compliance: Residential CF -IR -ALT
Residential Alterations (Page 3 of 5
Project Name: Climate Zone # # of Stories
Sujata Bhalerao 4 2
ROOFING PRODUCTS (COOL ROOFS) §1510912
When the area of exterior roof surface to be replaced exceeds more than 50% of the existing roof area, or more than 1,000f?, whichever is
less, the new roofing area must meet the roofing product "Cool Roof" requirements of§152(6)1 Hi, 152(b) 11111, or 152(b) 111111,
Check applicable alternative or exception below ifthe roofalteration is exempt from the roofing product "Cool Roof' requirements. Note: If any
one of the alternatives or exception below is checked, the Aged Solar Reflectance and Thermal Emittance requirements for roofing products in
§118(1) are not applicable. Do not fill table below.
Cool Roofs Not Required in Climate Zones 1-12, 14, and 16 with a Low Sloped. Less or 2:12 pitch.
[]Cool Roofs Not Required in Climate Zones 1 through 9 and 16 with a Steep -Sloped Roofs (pitch greater than 2:12) and product unit weight less
than 5lb/ft
Alternatives to §152(b)1Hi and §152(b)Hii, Steep -slope roof (pitch >2:12)
❑ Insulation with a thermal resistance of at least 0.85 hrft2-°FBtu or at least a 3/4 inch air -space is added to the roof deck
over an attic; or
❑ Existing ducts in the attic are insulated and sealed according to §151(f)10; or
❑ In climate zones 10, 12 and 13, with I if of free ventilation area of attic ventilation for every 150 ft' of attic floor area, and
where at least 30 percent of the free ventilation area is within 2 feet vertical distance of the roof ridge; or
❑ Building has at least R-30 ceiling insulation; or
❑ Building has radiant barrier in the attic meeting the requirements of § 151(f)2; or
❑ Building has no ducts in the attic; or
❑ In climate zones 10, 11, 13 and 14, R-3 or greater roof deck insulation above vented attic.
Exception to §152(b)1Hill, Low -slope roof (pitch <_ 2:12)
❑ Building has no ducts in the attic.
Other Exceptions
❑ Roofing area covered by building integrated; photovoltaic panels and solar thermal panels are exempt from the below Cool Roof criteria.
Roof constructions that have thermal mass over the roof membrane with at least 25 lb/ft is exem t from the below Cool Roof criteria.
Note: If no CRRC-1 label is available, this compliance method cannot be used, use the Performance Approach to show compliance, otherwise,
Check the applicable box below if Exem t from the Roofing Products "Cool Roof' Re uirement:
Roof Slope
Product Weight
Product
Aged Solar
Thermal
CRRC Product ID Number
< 2:12 > 2:12
< 5lb/ft? > 5lb/ft2
Type2
Reflectance"4
Emittance
SRI
❑
❑
❑
❑
u��t
❑
❑
❑
❑
L!
❑
❑
❑
❑
❑
❑
❑
❑
L3
❑
❑
❑
❑
L1
1. The CRRC Product ID Number can be obtained from the Cool Roof Rating Council's Rated Product Directory at www coolroofs.ore/aroducts/search.aha
2. Indicate the type of product is being used for the roof top, i.e. single -ply roof, asphalt roof, metal roof, etc.
. If the Aged Reflectance is not available in the Cool Roof Rating Council's Rated Product Directory then use the Initial Reflectance value from the same
directory and use the equation (0.2+0.7(p,ei1101— 0.2) to obtain a calculated aged value. Where p is the Initial Solar Reflectance.
4. Check box if the Aged Reflectance is a calculated value using the equation above.
. Calculate the SRI value by using the SRI- Worksheet at hypWwww.enerev.ca.fov/title24/and enter the resulting value in the SRI Column above and attach acopy of
the SRI- Worksheet to the CF -IR.
To apply Liquid Field Applied Coatings, the coating must be applied across the entire roof surface and meet the dry mil thickness or coverage
recommended by the coatings manufacturer and meet minimum performance requirements listed in §1 18(i)4. Select the applicable coating:
Aluminum -Pigmented Asphalt Roof Coating
❑ Cement -Based Roof Coating
Other
egislydtionNuinb'eri' '' "" Registradein DatelTimei' i . HERSProvider.' ' ,. ^7.'
2008 Residential Compliance Forms March 2010
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0
Prescriptive Certificate of Compliance: Residential CF -IR -ALT
Residential Alterations} { a e 4 of 5
Project Name: SUJaIa B�alPiraO Climate Zone �1 #of Stories
`F 2
HVAC SYSTEMS - HEATING
List water heaters and boilers for both domestic hot water (DHW) heaters and hydronic space heating. Individual dwelling DHW heaters must be
Minimum
Duct or Piping
Configuration
Heating Equipment
Efficiency
Distribution Insulation Thermostat
(Central, Split,
Type and Capacity""
(AFUE or HSPF)
Type and Location' R -Value Type
S ace, Packa a or H dronic
Central Fumace/100000 btu
80%
Ducts R-6 Setback
Central
Central Fumace/80000 btu
80%
Ducts R-6 Setback
Central
1. Indicate Heating Type (Central Furnace, Wall Furnace, Heat pump, Boiler, Electric Resistance, etc)
2. Electric resistance heating is allowed only in Component Package C, or except where electric heating is supplemental (i.e., if total capacity
< 2 KW or 7,000 Btulhr electric heating is controlled by a time -limiting device not exceeding 30 minutes). See §151(6)3 exception.
3. Refer to the HERS Verification section on Page 4 of the CF- IR -ALT Form for additional requirements and check applicable boxes.
4. Indicate Type or Location (Ducts, Hydronic in Floor, Radiators, etc)
HVAC SYSTEMS - COOLING
Minimum
Efficiency
Duct or Piping
1. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of§150(n). The Prescriptive requirements do
Configuration
Cooling Equipment (SEER/EER or
Distribution
Insulation
Thermostat
(Central, Split,
Type and Capacity"' COP)
type and Location'
R -Value
Type
Space, Package or H dronic
1. Indicate Cooling Type (AIC, Heat pump, Evap. Cooling, etc)
2. Refer to the HERS Verification section on Page 4 ofthe CF -IR -ALT Form far additional requirements and check applicable boxes.
3. Indicate Type or Location (Ducts, H dronic in Floor, Radiators, etc.)-
WATER HEATING
List water heaters and boilers for both domestic hot water (DHW) heaters and hydronic space heating. Individual dwelling DHW heaters must be
gas or propane fired. Hot water pipe insulation from the DHW heater to the kitchens) and on all underground hot water pipes is required in all
component packages in all climate zones.
External Tank
Water Heater Type/Fuel
Distribution Type
Number In
Tank
Energy Factor or
Insulation
Type'
(Standard, Recirculating)'
System
Capacity (al)
Thermal Efficiency
R -Value
1. Indicate Type (Storage Gas, Heat Pump, Instantaneous, etc)
1. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of§150(n). The Prescriptive requirements do
not allow the installation of a recirculating water heating system for single dwelling units.
3. The external water heating tank and i es shall be insulated to meet the requirements o $150 ' .
SPECIAL FEATURES The enforcement agency should pay special attention to the Special Features specified in this checklist below.
These items may require written 'ustt tcation and documentation and special verification,
NEW ROOF ASSEMBLY - Radiant Barrier
The radiant barrier requirement of § 151( 2 does nota 1 to roof alterations.
Slab Edge (Perimeter) Insulation YES NO
YES: In Climate Zone 16 in Component Packages D, R-7 insulation is required..
Heated Slab Insulation El YES NO
YES: Slab edge insulation re aired for all heated slabs in all Climate Zones. See details in Table 118-A of the standards.
Raised Slab Insulation YES NO
YES: In Climate Zones 1, 2, 11, 13, 14 & 16, R-8 insulation is required; in Climate Zones 12 & 15, R-4 is required under component Package D.
Thermal Mass
To obtain Compliance Credit for the installation of thermal mass, use the Performance Approach.
gistr4jlon+Numbe i RegistrationDateLTime: "'t ': HERS Provider:
2008 Residential Compliance Forms March 2010
f`J
•
is For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.
Prescriptive Certificate of Compliance: Residential CF -IR -ALT
Residential Alterations (Page 5 of 5
Project Name: Climate
Bhalerao Climate Zone A kroLfStories
HERS VERIFICATION SUMMARY The enforcement agency should pay special attention to the HERS Measures specified in this
checklist below. A completed and signed CF -4R Form for all the measures specified shall be submitted to the building inspector before final
inspection.
Duct Sealing & Testing HERS verification is requiredfor this measure.
❑ YES NO YES: In Climate Zones 2 and 9-16, if more than 40 linear feet of new or replacement ducts are installed in unconditioned
space, the ducts are to be sealed per §152(b)1Dii and the newly installed ducts are to be insulated per §151(f)l0.
❑ EXCEPTION: Existing duct systems that are extended, which are constructed, insulated or sealed with asbestos.
DYES ONO YES: In Climate Zones 2 and 9-16, if the existing space -conditioning system (HVAC equipment and ducting) is replaced, the
ducts are to be sealed per §152(b)] Di.
[]YES i]NO YES: In Climate Zones 2 and 9-16, if the existing HVAC equipment is replaced (including the replacement of the air handler,
outdoor condensing unit of a split system, cooling or heating coil, or the furnace heat exchanger) the ducts are to be
sealed per §I52(b)IE.
❑ EXCEPTION: Duct systems that are documented to have been previously sealed confirmed through HERS
verification in accordance with procedures in the Reference Residential Appendix RA3.
❑ EXCEPTION: Duct systems with less than 40 linear feet in unconditioned space.
rl EXCEPTION: Existing ducts stems constructed, insulated or sealed with asbestos.
Refrigerant Charge -Split System HERS verification is required for this measure.
❑ YES 0 NO YES: In Climate Zones 2 and 8-15, when the existing HVAC equipment is replaced (including the replacement of the air
handler, outdoor condensing unit of a split system A/C or heat pump, cooling or heating coil, or the furnace heat
exchanger) a refrigerant charge measurement shall be verified per 152(b)l F.
Central Fan Integrated (CFI) Ventilation System and Fan Watt Draw
The ventilation requirements of §150 o do not apply to existing residential homes.
Ducted Split Systems -Air Conditioners and Heat Pumps: Airflow HERS verification is required for this measure.
❑ YES i] NO YES: In Climate Zones 10 through 15, when the existing space -conditioning system (HVAC equipment and ducting) is
replaced, the airflow and fan watt draw shall be verified per 152(b)1Ci to meet the requirements of 151(f)7B.
Documentation Author's Declaration Statement
• I certifythat this Certificate of Compliance documentation is accurate and complete.
Name: Rob Minor Signature: 211111.
4<2
Company: Valley Heating, Cooling, and Electrical
Date:11-30-2011
Address: N . 4th ST
If
If Applicable CEA or CEPE
(Certification 4):
City/State/Zip:San Jose, CA 95112
Phone: 408-294-6290
Responsible Building Designer's Declaration Statement
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design identified on
this Certificate of Compliance.
• I certify that the energy features and performance specifications for the building design identified on this Certificate of Compliance conform
to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations.
• The building design features identified on this Certificate of Compliance are consistent with the information provided to document this
building design on the other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement
aeencv for approval with this building permit application.
Name: Rob Minor
Signature:
Company: Valley Heating, Cooling, and Electrical
Date: 11-30-2011
Address: 1171 N. 4th ST
License: 258540
City/State/Zip:San Jose, CA 95112
Phone 408-294-6290
(ENFQRCEMENTAGENCY
CANCUSTOMIZE WITHLETTERHEADISEALL)
2008 Building Energy Efficiency Standards Residential HVAC Alterations
Climate Zones 1 and 3 through 7
• BUSINESS AND PROFESSIONS CODE, SECTION 7110
Willful or deliberate disregard and violation of the building laws, including the California Building Code, and
local permit requirements constitutes a cause for disciplinary action from the Contractors State License Board
working in conjunction with the local building department. This action may consist of fines up to $5,000 per
violation or suspension/revocation of a contractor's license.
WHEN IS A PERMIT REQUIRED?
A written construction permit shall be obtained from the enforcement agency prior to the erection, construction,
reconstruction, installation, relocation, or alteration of any mechanical system, except as permitted in Appendix
Chapter 1, Section 112.2 of the 2007 California Mechanical Code. Projects requiring permits include, but are not
limited to:
• New HVAC installation
• HVAC Changeout
• Replacement of furnace, coil, FAU, or condenser
• Relocation of an existing HVAC unit
• Adding or replacing more than 4011 ducting in unconditioned space
2008 BUILDING ENERGY EFFICIENCY STANDARDS (Title 24. Part 6) REOUIREMENTS INCLUDE:
1. Heating equipment must have a minimum 78% AFUE (Exception: Wall & floor furnaces; room heaters).
2. Central air conditioners & heat pumps less than 65,000 Btu/hr must have a minimum 13 SEER.
3. Newly installed or replaced ducts must have a minimum insulation value of R-4.2.
4. A setback type thermostat (24 hr clock with four set points) is required for all alterations.
5. New or replacement ducts must meet the mandatory requirements of Section 150(m):
• All joints and openings in the in the HVAC system must be sealed.
• Only UL 181, UL 181A, or UL 181B approved tapes or mastic shall be used to seal duct openings.
• • Connections of metals ducts and the inner core of flex ducts shall be mechanically fastened. Flex ducts
must be connected using a metal sleeve/coupling.
• Flex ducts that are suspended must be supported every 41 max for horizontal runs with no more than 2"
of sag between supports and 6 ft. max for vertical runs.
6. The CF-6R-MECH-04 must be completed and signed by the installing contractor. The Inspector will collect
this form and verify that the model numbers are the same as the installed equipment.
•
•
E
Simpli¢ed Prescriptive Certificate of Compliance: 2008 Residential HVA C Alterations CF -IR -ALT -HVAC
Climate Zones 1 and 3 - 7
Site Address: 21690 Rainbow CT, Cupertino,CA 95014
EnjorcememAgencytity of Cupertino
Dole: 11-30-2011
Perrmt
Conditioned
Duct insulation
t Type'
List Minimum Efficient z
Floor Area
requirement
Thermostat
Unit
o
Q AFUE80 /u
COP_
Over 40 ft of ducts
❑x Setback
FFumwe
oil
Unit
❑SEER
❑ EER
HSPF
❑ Resistance
Served by system
2200 sf
added or replaced in
unconditioned space"tailed)
(ljnot already present, must fie
ng
❑ R 6 (CZ 1, 3-5)
/. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -IR -ALT -HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78%AFUE, 7.7HSPF for typical residential systems.
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
• I certify that this Certificate of Compliance documentation is accurate and complete.
• 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this
Certificate of Compliance.
• 1 certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24, Parts I and 6 of the California Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable
compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit
application.
Name:Rob Minor
Signature:
Company: Valley Heating, Cooling, and Electrical Date:11-30-2011
Address: 1171 N. 4th ST License: 258540
City/state/Zipsan Jose, CA 95112 Phone:408-294-6290
2008 Residential Compliance Forms
March 2010
•
•
•
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAlterations CF -IR -ALT -HVAC
Climate Zones 1 and 3 - 7
Site Address:21690 Rainbow CT, Cupertino,CA 95014
EnjorcementAgencytity Of Cupertino
DO1e:11-30-2011
permit #:
Conditioned
Duct insulation
E ui ment Type'
List Minimum Efficienc x
Floor Area
requirement
Thermostat
Packaged Unit
x Furnace
��
❑x AFUE80o
COP
Over 40 ft of ducts
0 Setback
Indoor Coil
❑ SEER_
_
HSPF
❑
Served by system
1600 sf
added or replaced in
unconditioned space
(If already present, must be
Condensing Unit
❑ EER _
Resistance
❑ R 6 (CZ 1, 3-5)
'nslalled)
lied)
Other
/. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -I R -ALT -HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78%AFUE, 7.7HSPF for typical residential systems.
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
• 1 certify that this Certificate of Compliance documentation is accurate and complete.
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this
Certificate of Compliance.
• I certify 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.
• The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable
compliance forms, worksheets, calculations, plans and specifications submitted to the enforcment agency for approval with the permit
application.
Name:Rob Minor Signature:
Company:Valley Heating, Cooling, and Electrical
"11-30-2011
Address: 1171 N. 4th ST
License: 258540
City/State/Zip:san Jose, CA 95112
Phone408-294-6290
2008 Residential Compliance Forms
March 2010
CJ
11
INSTALLATION CERTIFICATE CF-6R-MECH-04
Space Conditionin S stems, Ducts and Fans (Page 1 of 2
Site Address: �?/6 5'u ,ti bz7r.1/ tJT Enforcement Agency: Permit Number:
6
Space Conditioning Systems
Heating Equipment
Equip
Type
(package-
heat um
CEC Certified Mfr. Name
and Model Number
ARI
Reference
Number 2
# of
Identical
Systems
Efficiency
(AFUE,
etc.)1,3
(2CF-IR
value °
Duct
Location
(attic,
crawl-
space,
etc.
Duct
R -value
Heating
Load
Btu/hr
Heating
Capacity
Btu/hr
oP V:S
x Yr 7b
'
�J%
�rTiC
(L
L �9Tvq
�p ✓'/c A2
.,./ � •
-rn" eV O
— +.. c� b t!c D'
n XJ'TJ
�
�D �
nTI v
iL' (o
/
-f - b7/
Er Y'�rr),'L
Cooling Equipment
Equip
Type
(package
heat
um
CEC Certified Mfr. Name
and Model Number
ARI Reference
Number 2
# of
Identical
Systems
Efficiency
(SEER
and EER)
1.3
(2CF-1 R
value °
Duct
Location
(attic,
crawl-
space,
etc.)
Duct
R -value
Cooling
Load
Btu/hr
Cooling
Capacity
Btu/hr
1. lfproject is new construction, see Footnotes to Standards Table 151-B and Table 151-Cfor duct ceiling alternative
compliance.
2. ARI Reference Number can be found by entering the equipment model number at hitp://www. aridirectory.org/ari/ac. php#
3. Listed efficiency on this page must be greater than or equal (>_) to the value shown on the CF -1 R form.
4. When CF -JR is reference it is also applicable to the CF -JR, CF -IR -AA or CF -IR -ALT
ALL BOXES MUST BE CHECKED TO BE A VALID FORM
§ 110-§ 113: HVAC equipment is certified by the California Energy Commission.
§ 150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA, or ACCA.
§ 150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of § 112(c).
• § 1500)2: Pipe insulation for cooling system refrigerant suction, chilled water and brine lines meets minimum
requirements of Table 150-B and includes a vapor retardant or is enclosed entirely in conditioned space.
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE CF-6R-MECH-04
Spa e Conditionin Systems, Ducts and Fans (Page 2 of 2
Site Address: „1/(� qp A,.J(od :•/ `7-- Enforcement Agency: Permit Number:
• Ducts and Fans
•
•
§ 150(m): Duct and Fans
M 1. All air -distribution system ducts and plenums installed, sealed and insulated to meet the requirements of CMC
Sections 601, 602, 603, 604, 605 and Standard 6-5; supply -air and return -air ducts and plenums are insulated to a
minimum installed level of R4.2 or enclosed entirely in conditioned space. Openings shall be sealed with mastic, tape
or other duct -closure system that meets the applicable requirements of UL 181, UL 181A, or UL 181B or aerosol
sealant that meets the requirements of UL 723. If mastic or tape is used to seal openings greater than 1/4 inch, the
combination of mastic and either mesh or tape shall be used; and
b1. Building cavities, support platforms for air handlers, and plenums defined or constructed with materials other
than sealed sheet metal, duct board or flexible duct shall not be used for conveying conditioned air. Building cavities
and support platforms may contain ducts. Ducts installed in cavities and support platforms shall not be compressed to
irca
a reductions in the cross-sectional area of the ducts.
2D. Joints and seams of duct systems and their components shall not be sealed with cloth back rubber adhesive
duct tapes unless such tape is used in combination with mastic and draw bands.
P7. Exhaust fan systems have back draft or automatic dampers.
q8. Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually
operated dampers.
Rj 9. Protection of Insulation. Insulation shall be protected from damage, including that due to sunlight, moisture,
equipment maintenance, and wind. Cellular foam insulation shall be protected as above or painted with a coating that is
water retardant and provides shielding from solar radiation that can cause degradation of the material.
0 10. Flexible ducts cannot have porous inner cores.
DECLARATION STATEMENT
1 certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct.
1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized
representative of the person responsible for construction (responsible person).
• 1 certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation)
conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the
enforcement agency.
• I reviewed a copy of the Certificate of Compliance (CF -1R) form approved by the enforcement agency that identifies the specific
requirements for the installation. 1 certify that the requirements detailed on the CF -IR that apply to the installation have been met.
• I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or 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 signed copy of this Installation Certificate is required to be included with the documentation the builder provides to
the building owner at occupancy.
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
VAaey flee /c— Grit t „,!.- .t
Responsible Person's Name:
Respo^ i e Per on's Signature:
Z6
CSLB LicenseeJ
Dale Signed:
Position With Company (Title):
2r� O `S 4/&�
/ -_�) -'le)J'l
i y
2008 Residential Compliance Forms
August 2009
OFUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
C
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: 216M Rar-nbatd-F,
PERMIT#
OWNER'S NAME: S,t'
PHONE # 0 — 5-jl
GENERAL CONTRACT R: V111,,V
BUSINESS LICENSE # !'{
ADDRESS: 1/1 S
CITY/71PCODE: S4.c ,,oe 112
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
1 am not using any subcontractors: �ir��r 5' "" , 2 �2�(
Signature Date
Please check applicable subcontractors and complete the following information:
Owner / Contractor Signature
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner / Contractor Signature
Date