12030009 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: l l27 ELMSFORD DR CONTRACTOR:VALLEY HEATING& PERMIT NO: 12030009
COOLING
OWNER'S NAME: MYERS ROBERT L AND HELEN E 1171 N 4TH ST DATE I,SSUED:03/022012
OWNER'S PHONE: 4084464894 SAN JOSE,CA 95112 PHONE NO:(408)294-6290
k- LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL.
License Class C-,20 Lic.9 ? rj 8541& REPLACE FURNACE IN SAME LOCATION
Contractor Valli(. /124J..,q Date 3�2
hereby affirm tlmt I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business o-Professions
Code and that my license is in full farce and effect.
hereby affirm under penalty of perjury one of the following two declarations:
(have mid 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 th is permit is issued. Stip.Ft Flair Area: Valuation:$4176
1 have and will maintain Worker's Compensation Insurance,:is provided for by
Section 3700 of the Labor Code,for die performance of the work for which this
permit is issued APN Number:36208012.00 Occupancy Type :
APPLICANT CERTIFICATION
I certify that I have read ods application mid slide that the above inf natation is PERMIT EXPURES IF WORK IS NOT STARTED
cored.I agree to comply with all city aixl cowry ordinmhces and sulltlaws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,mid hereby audwrize representatives of this city to enter
upon the above mentiaed property fir inspection purposes. (We)agree to save 180 DAYS OM LAST CALLED INSPE T N.
indemnify and keep handless the City of Cupertino against liahilities,judgmenrs, /
costs,and expenses whidh may accrue against said City in consequence of the
lowering of this permit Additionally.the applicant understmhds and will conhply Issued by: But
with all non-point source regulations per the Culenino Municipal Code,Section
9.18. p
g -/ : Date -YZ�2 nyrROOFS:
Si nature ha..L is ss All roofs shall he 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 fix
inspection.
❑ OWNER-RLIILDER DECLARATION
hereby affirm that 1 hart exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the fullowing two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner of the property,or my enployees with wages as their sole compensation,
will do the work,and the smhcture is our intended or offered for sale(Sec.7044.
Business&Pi ofessimu Code)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct(lie projea(Sec.7044,Business&Professions Code). I hove read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code.Seetions 25505,25533,and 25534. 1 will
hereby affirm ander 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(x)should I more or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 use equipment or devices which emit hazardous
Compensation,ac provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Ray Area Air Quality Management District 1
perfomhmhce of the work for w•hichthi5 permit is issued. will maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and
I have and will maintain Workers Compensation Insurance,as provided for by the Health&Safety Code.Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for die performance of die work for which this 3�2 2
permit is issued. ! Owner or authorized agent: ate:
2„n.._ /t4..vim —T1
I certify that in the perforonnce of the work for which this permit is issued,I shall
not employ any person many manner so as to become stdiject to die Worker's
Compensation paws of Cal ifomia. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
become subject to die Worker's Conhpensaion provisions of the Labor Code,1 must I hereby affirm that there is a concoction lending agency for the performance of
forthwith comply with such provisions or this pemhit 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 thm I have read(hisapplication mid state that the above information is
correct.I agree to comply with all city ural county ordin:mces mid state Imus 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
indemnity and keep harmless the City of Cupertino against liabilities.judgments.
costs,and expenses which may accrue against said City in consequence of the 1 understand my plans shall be used as public records.
granting of this pennit.Additionally,the agdicmd understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Sectiah Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36208012 .00
DATE ISSUED. . . . . . . : 03/02/2012
RECEIPT # . . . . . . . . . : SS000016171
REFERENCE ID # . . . : 12030009 '
SITE ADDRESS . . . . . : 1127 ELMSFORD DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MYERS ROBERT L AND HELEN E
ADDRESS . . . . . . . . . . : 1127 ELMSFORD DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4901
RECEIVED FROM . . . . : VALLEY HEATING
CONTRACTOR . . . . . . . : JEFF AND CINDY FAULKNER LIC # 141
COMPANY . . . . . . . . . . : VALLEY HEATING & COOLING
ADDRESS . . . . . . . . . . : 1171 N 4TH 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 4, 176 .00 1.00 0.00 1.00 0.00
1BSEISMICR VALUATION 4, 176 .00 0.50 0.00 0 .50 0.00
1MFR=<100 UNITS 1 .00 130.00 0.00 130 .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 260 . 50 0 . 00 260 .50 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 260.50 CHK
---------------
TOTAL RECEIPT 260. 50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
------- ----------------------- -------- ----------------------------
505
------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 1127 Elmsford Dr. DATE: 03/02/2012 REVIEWED BY: RDW
APN: BP#: "VALUATION: $4,176
•PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition /Repair
PRIMARY SFD or Duplex
PENTAIIIATION FURN/AC
USE: PERMIT TYPE: 10
WORK: Remove and replace furnace in same location.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced-Air 1MFR=<100 1 # $130
TOTALS: $130.00
Mech.Plan Check 0.0 hrs $0.00 Phanb Plan Cberk Elm.Plan CF,ce-A
hdech.Permit Fee: IMPERAUT I Pltmeh Permit Fre: Ek, Pernm F.e
Other Mech. I nsp. 0.0 hrs $44.00 Orher Phuuh hup. Othew Elea I 17,.
Plualb.Inrp.Fee: Flet./nyt Fee
NOTE: This estinutie does not include fees due to other Departments(ie. Planning, Public Works, Fire,Sanitan'.Sca-er District.School
District,etc.). Theo ees are bayed on the trehninanin nrnaition 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
Plan C lzo_l Fuc
Jnpp1 PcFet
PME Plan Check: $0.00
PC vn.tt i(e-
')uPpl hup Fe
PME Unit Fee: $130.00
PME Permit Fee: $44.00
('nttemerhon 70u
Administrative Fee: IdDAtIN $41.00
Work Without Pemtit? 0 Yes (� No $0.00
.I dt•ur.,ed Planning Pecs:
Travel Documentation Fee: ITR,tFDOC $44.00
Strong Motion Fee: 18SEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $260.501 $0.001 TOTAL FEE: $260.50
Revised: 1119/2012
(ENroRCEA-/ENT AGENC)'
CANCU.SMWIZF_ 41ITII LETTERHEAD/SEAL,),,
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 acontractor's license.
WIIEN 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 I, 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, FA U.or condenser
• Relocation of an existing HVAC unit
• Adding or replacing more than 40ft ducting in unconditioned space
2008 BUILDING ENERGY EFFICIENCY STANDARDS(Title 24, Part 6) REOUIREMFNTS INCLUDE:
I. Heating equipment must have a minimum 78%AFUE(Exception: Wall &Boor furnaces:room beaters).
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 li VAC system must be sealed.
• Only UL 181, UL 181 A,or UL 181 B 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 4ft.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 verifv that the model numbers are the same as the installed equipment.
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAlterndions CF-IR-ALT-HVAC
Climate Zones I and 3-7
Site Addrec.v:1127 Elmsford DR, Cupertino,CA 95014 hnforcemewAsencf'City of CUpertinot Dat`:2-27-2012 Permit N:
Conditioned Duct insulation
E ui ment'ry List Minimum Ef iciencv2 Floor\ren requirement Thermostat
F acAaged Unit Q o Over 40 0 or ducts Pumace
EIA SCOP ❑x Setback
Served by system added or replaced in
BIndoor Coil ❑Sli.liR HSTF_ 1900 (lfnar alrearhpresem,must be
Condensing Unit ❑ EER_ ❑Resistance s( unconditioned space ouralled)
❑Other
/. Equipment"type:Choose the equipment being installed:if more than one system.use another CI'-1 R-ALT-I1VAC for each system.
2.Minimum Equipment Efficiencies: 13 SEER,78%AFUE.7.711SPF for typical residential systems.
Contractor(Documentation Author's/Responsible Designer's Declaration Statement)
• I ecnify that this Certificate or 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 ofTille 24.farts I and G of the California Code of Regulations.
• the design features identified on this Certificate of Compliance are consistent with the infomtationdocumented on other applicable
compliance rooms.worksheets,calculations.plans and specifications submitted to the enforcement agency for approval with the permit
application.
Namc'Rob Minor Signature:
`"'"p°"''`Valley Heating Cooling and Electrical Date:2-27-2012
Address:1171 N. 4th ST License:258540
City/State/'Lip:san Jose, CA 95112 Phont:408-294-6290
2008 Residential Compliance Forms March 2010
Prescriptive Certificate of Compliance:,Residential CF-IR-ALT
Residential Alterations (Pagel of 5)
Project Name: Climate
Myers Climate Zone NJ) I N of Stories
General Information `'F
Site Address:1127 Elmsford DR, Cupertino,CA 95014 Enforcement Agency:City of Cupertino Date:2-27-20 1 2
BuildingType[D Single Family ❑Multi Family Circle the Front Orientation:N.L)-W.or degrees
Conditioned Floor Ansa(CFA): 1900 Project Type: 0 Alterations DEnvelopeo Fenestration Roofx HVAC
Replacement or Chane Out rl Duct Replacement❑Water Heater
NOTE:This form is not to be used for Nen-ly Constructed Buildings or Additions
Insulation Vulues For Opaque Surfaces(for Furring use the,class and Furring Strips Construction fable beton)
Assembh•Alteration
❑Opening of framed cavity alone-Alterations that involve the opening ofthe ftnmed cndpy ofa,wall,ceiling,orfloor must instill the
numdatory minimum insulation value per§150 for the altered assetnbli. Fill in Cohonns A—C and enter manrdaton insulation value in Column IL
❑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 Cahunns,l-J.
O 3 ue Surface Details For the furred portioned o0lass Wails see Furring Strips Construction Table bclme.
A R C ID E F G I 11 I 1 J
Pro used"`'°" Standard Values From JA4 Table
Framing 'Thickness. Framed Continuous JA4 Proposed
Tag/ Assembly Name Material Spacing, U- JA4 Table Cavity Insulation Assembly Assembiv
IIJ� or'I'v c' and Size' or OthcP factor' Nunbers R-value R-Value' Row/Col' U-factor"
Note:For fiurred assemblies.accounting for Continuants Insulation R-ralue,see Page JA4-3 and Equation 4.1. For calculating furred walls use the Mass and
Furring Contrucium table below.
1.For Togl1D indicate the identification name that matches the building plans.
2.Indicate the Assemhly Name or nye:RooflCeiling, walls,Floors.Slabs, Crnw/Space. Doors and etc...Indicate in column G the Frame
material and Sire:For Mood,Meal,Metal Buildings.,class,enter 2-r4,2y6,or etc...see JA4 for other possible frame q pe assemblies.
3. Enter the thickness for mass in inches or Spacing between framing members enter; 16"or 24"OC:or Other for all other assembly description
such as Concrete Sandwich Panel,Sprmcdrel Panel,Logs,Straw Bale Panel and etc....
4.Based on the Climate Zone;enter the equivalent U factor found in JA4 Table based on the R-Fahie from Table 151-B,C.or D
5..Enter the Table number that closely resembles the proposed assembly.
6. Einer the R-value that is being instilled in the wall cavit'v or between the framing;otherwise,enter "0".
7. Enter the Continuous Insulation R-valuefor the proposed assembly:othenwise,enter "0".
S.Enter the row and column of the U facar value based on Column F Table Number and enter the Assembly U factor in Column J
9.The Proposed Assembly U factor,Column J.must be equal to or less than the Standard U factor in Column F,to comply.
Furring Strips Construction Table for i\lass Walls Onl
A I It I C 1 D 1 I: J. I G 11
Proposed Properties of lasontr and Concrete Added Interior or Esterior Insulation
\Valls From Reference in Furring Space from Reference
.Joint A ppendixTable 4.3.5,4.3.6,4.3.7 .Joint A ppendixTahle 4.3.13
—
�- Final
Assembly
Mass Name or JA4 Table '" = vE 'n Assembh'
Thickness' Ty ' Number' .<,> ' - > ' < > _ �_ U-factor'.' Comment
.Registration a\'umber: Registration Daielrime: HERS Provider:
2008 Residential Compliance Forms Jlarch 2010
1
Prescriptive Certificate of Compliance: Residential CF-IR-ALT
Residential Alterations (Page 2 of 5)
Project Name: ' Climate Zone kof Stories
BOb Myers r
1
M1/ass and Furring Strips Construction(footnotes)
1. hrdicnte the ttpe ofassenibly to include:Hollow Unit Hasonty Walls,Solid Unit Afasouri%Solid Concrete Walls,Etc. Additional assemblies con
befound Reference Joint Appendix J:14.
2. This is the U-Factor based on the thickness of the assembly in inches.
. The R-rolue ofthe insulation to be added on the interior or exterior of the assembly.
4. The Calculated R-Value is the R-valueeof the fivred out section of the assembly.
.-6.7he Final Assembly is calcutaled using Fgeatdon 4-2 or F-quatioh 4-4of the Reference Joint Appendix JA4. The equation is the inverse of Column
Undated to Colunnn 1: Colima K is the inverse fromrolunm J.
7. Insert the calculated U-factor value on to the Opaque Surface Details in Cohonn J
FENESTRATION PROPOSED AREAS
❑ Replacing window.alone—Replacement windows shall meet the U-1-actor and S11GC Valuerequirements of Component Package D in
Table I S1-C. The Taal Fenestration and Wes!facing Area requirements are not applicable.
❑ Adding 50ft2 or less of window area—Newly installed Irindoles shall meet dee U-Factor and SHGC Value requirements of Component
Package D in Table 151-C
❑Adding more than 50ft'of window area— Newly installed windowsshall meet the U-Factor and SHGC 6ahre and tine Fenestration
Area reyutremenls of Component Package D in Table 15I-C.Complete doe Altered Fenestration Allowed Area Table on Page 2 of the Cl--IR-ALT
Orientation
Fenestration Type and France (North.Fast. PropsedAreal Maximum Maximum NFRC or Default
(Window,Glass Dooror Skvli ht) South.West) (R'-) U-factor='' SIICC'-'''' Values
1. Fenestration area is the area oftoral glazed product(i.e.glassplusfiame). Frception: When a door is less than 50%glass.tie fenestration
area ato2 v be the glass area plus " inch frame"around the glass.
2. F,nter volue from Component Package D Requirements in Table 151-C.
3.Actual fenestration products installed and as indicated in CF-M-ENV Form shall be equivalent to or have aJover Ufactor and/or a lower
Sl/GC value than that specified on the CF-1 RALT Form.
4.Submit a completed IPS-3R Form ifa reduced SHGC is calculated with exterior shading.
5.Ifn licable at this stage enter'4Vl7RC-for NFRC Certified windoys or are CFC"Dehnit"values found in Table l/6,1 or R.
ALTERED FENESTRATION ALLOWED AREAS (Complete if more than 50fr'offenavtration is added)
A B C D E F G
CPA of Allowed Esisling Allowed
Entire %of Fenestration Area Fenestration Area Proposed Area 1''
Dwelling CFA2-1 Area' Removed' Area Added (A x B) (E-D)+C
Total.Fenestration
Aren''(0) —
West Fenestration Area
(Required In >
CZ's 2.4&7-U)
1. The Proposed(Pest Fenestration Area includes West-sloping skylight area and arry other skylight area with a pitch less than I:12.
2. Ener 20%when no (Vest orientation restriction or 15%when Hest fenestration is being installed in Clinate Zones J 4, R 7-15.Nore that the
mavimmnt allowedfenestraion can only be 5%ofihe CFA as indicated in Colrain F.Column G must be equal to or less than Column F.
3. In clinhnte canes 2, 4, 7-15, no more than 5%of the CFA is allowed for crest facing glazing.
4. Evisting Fenestration area must be counted toward the nuainntm allowed 15%or 20%often whole building and calculated in Column G. The
Proposes(Area must be less than or equal to Column F.
5..Finer the fenestration removed as part ofthe alteration ifanv in column D.
6. Enter the Fenestration area that is being added as rt of the alteration.
Registration
Number: Registration DateTinte.- HERS Prodder:
2008.Residential Compliance Porins March 2010
Prescriptive Certificate of Compliance: Residential CF-IR-ALT
Resideitlial Alterations (Page 3 of 5)
Project Name: Climate Zone# #of Stories
Bob Myers 4 1
ROOFING PRODUCTS(COOL ROOFS)§151(1)13
When the area of erlerior rot(surface to he replaced erceeds more than 5005 of the existing roof area,or more than 1.000f12,whichever is
less.the neiv roofing area nest meet the rooftng product"Cool Roof'requiren+entc of§151(b)l Hi, 151(6)l Hii,or 151(6)1 Hiii.
Check applicab/ealternative or ercep/ion below if the roofaheration is exempt from the roofingproduct "Cool Roof'requirements. Vote:/fmry
one of the ahernaiives.or erception below is checked, the Aged Solar Reflectance and 777ernial Emittance requirententsfor roofing products in
§118(i)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 I through 9 and 16 with a Steep-Sloped Roofs(pitch greater than 2:12)and product unit weight less
than 5lb/ft2.
Alternatives to§192(b)1lli and§I52(h)Ilii.Steep-slope roof(pitch>2:12)
❑ Insulation with a thermal resistance of at least 0.85 hrfl'0I7131u 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(1)10;or
❑ In climate zones 10. 12 and 13,with I ft'-of free ventilation area of attic ventilation for every 150 02 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(02:or
❑ Building has no ducts in die attic:or
❑ In climate zones 10. 11. 13 and 14,R-3 or greater roof deck insulation above vented attic.
Exception to§152(6)1 II iii,Low-slope roof(pitch<_3:13)
❑ Building has no ducts in the attic.
Other Exceptions
❑Rooling area covered by building integrated:photovoltaic panels and solar thermal panels are exempt front the below Cool Roof criteria.
El 12oof constructions that haveAtemnal mass over the roof membrane with at(cast 25 Ib/f1'is cxem t from the below Cool Roof criteria.
Note: If no CRRC-I label is available,this compliance method'cannot be used.use the Perfomnance Approach to show compliance.otherwise.
Check the applicable be\.below if Escm t from the Roofing Products-Cool Roof"Re uiremene
Roof Slope Product Weight Product Aged Solar Thermal
CRRC.Product ID Number' < 2:12 >2:12 < 5lb/ft2 > 51b/112 Tvpe2 ,.Rateflectance" Emittance SRI'
13 ❑ 1:1ff
❑ ❑ ❑ ❑ 13
❑ ❑ ❑ ❑ ❑t
❑ ❑ ❑ ❑ ❑t
❑ ❑ ❑ ❑ ❑t
1.The CRRC Product IDN,...ber can be obtained from the Coal Raaf Rating Council's Rated Product Directon,ai mum.coolydfy.orelprodnclsLrcarchphn
3.Indicate the type of product is being usedfor the roof top,i.e.single-ph,roof,asphalt roof,metal roof,etc.
. lfihe Aged Reflecrance is tot available in dee Cool Roof Rating Council's Rated Protlaci Direciom then use the Initial Reflectance value from the some
direct n, and rise the equation(01+a7(pmiuinl-22)to obtain a calculated aged value. Wherep is the Initial Solar Reflectance..
.Check box if the Aged Reflectance is a calculated value acing the equation above.
.Celndare the SRI value by ruing the SRI-Workcheei or biro:/lhvw.enerm,ca tuanale241 and enter the resulting value in the SRI Column above and attach amps of
the SRI-I Porksheer to the CF-I R.
To apply Liquid Field Applied Coatings,the coaling must be applied across the entire roof surface and meet the div mil thickness or coverage
recommended by the coatings manufacturer and meet minimum performance requirements listed in§I I8(i)4. Select the applicable coating:
Aluminum-Pigmented Asphalt Roof Coating ❑Cemau-Based Roof Coating Other
Registrnlion A'umber':_ Regisurniori Dut✓lime: PIERS Provider:
2008 Residential Compliance Forms March 2010
Prescriptive Certificate of Compliance: Residential CF-IR-ALT
Residential Allernliiotu (Page 4 of 5)
Project Name:BOLS Myers Climate Zone# A #of1tories
II VAC SYSTEMS- ]I EATING
Minimum Duct or Piping I Configuration
Beating I:yuipment Efficiency Distribution Insulation 'fhennoslat (Geniis/.Split,
'I\' e and Ca acitvI''-'t (AFUIi or IISPP) Type and Location' R-Value 'rYpe Space.Package or I lvdronic)
Central Furnace/71,000 Btu 95% AFUE Ducts/Crawl R-6 Setback Central
1.Indicate Henning Ttpe(Central Furnace. Wall Furnace, /lent pump. Boiler, Electric Resistance,etc.)
2.Electric resistance/tearing is allowed only in Component package C.or except where electric heating is supplemental(i.e., if total capacity
<2 KIV or 7.000 Bndhr electric heating is controlled by a time-limiting device not erceeding 30 minutes). See§/51(6)3 esceptiau.
3.Refer to the HERS Verification section on page a of the CF-1 R-ALT Form for additional requirements and check applicable bares.
a. Indicate 7ipe or Location(Ducts.Ilydronic in Floor. Radiators.etc.)
IIVAC SYSTEMS-COOLING
Minimum
Efficiency Duct or Piping Configuration
Cooling Igdpmint (SL•G E.ElR or Distribution Insulation Thermostat (Central.Split.
'f• e and Cn acil•�'� COI') 'I' and Location} R-Value 'f• Space.Package or I lvdronic)
1.Indicate Cooling Type(A/C Heat pump. Evap.Cooling,etc)
2.Refer to the HERS Verification section on Page J of the CF-1 R-,I LT Form for additiatal requirements and check applicable boxes.
3. Indicate Type or Location(Ducts. Ht•dronic in Floor.Radiators,etc.)
WATER HEATING
List water heaters and boilers for both domestic Trot water(DRIP)heaters and hvdronic space heating. Individual dwelling DHIV heaters must be
gas or propane fired. Hot water pipe insulation front the D111V heater to the kitchen(s)and on all underground hot water pipes is required in all
component packages in all climate-ones.
External Tank
Water I leater Type)fuel Distribution l'ype Number In 'rank EnerEy Factor or Insulation
Type t (Standard. Recirculaiin ) System Capacity(gal) Thermal Efficiency R-Value
1. Indicate%ipe(Storage Cas, Hear Ptanp, Instantaneous,etc.)
2. Recirculating systems serving nadiiple dwelling units shall meet the recirculation requirements of§150(n). The prescriptive requirements do
not allow the installation oft,recirculating water)eating system frm single dwelling units.
3. The external water heatin•took and rites shall be insulated to meet the requirements ai§1500.
SPECIAL FEATURES The enforcement agency should ptrspecial attention to the Special Features specified in this checklist below.
These items Wray require written justification and doaarenation and special verfcation.
NEN\'ROOF ASSEMBLY- Radiant Barrier
The radiant barrier rc uir:ment of§15I(Q2 does nota Ir to roof alterations.
Slab Edge(Perimeter)Insulation \'IiS x NO
YES: In Climate"Lone 16 in Component Packages D. R-7 insulation is required.
Ilealed Slah Insulation 0 US x No
YES:Slab ed a insulation re uircd for all heated slabs in all Climate Zones. See details in Table 118-A of the standards.
Raised Slab Insulalian 1'ES LxjNO
YES: In Climate Zones L 2. 11. 13. 14& 16.R-8 insulation is required:in Climate Zones 12& 15.R4 is required under component Package D.
'I'hernial Maus
To obtain Compliance Credit for the installation of thermal mass.use the Perfomtance Approach.
Registration Number: Registration Date,17-ume: HERS Provider:
2008 Residential Compliance Forms Aharch 2010
Prescriptive Certificate of Comliance: Residential CF-IR-ALT
Residential Alterations (Page 5 of 5)
Project Name:Bob Myers I Climate Zone A Not 1 Stories
�F
11 E RS V E RI FI CAII ON SUS\1 MARY The enforcement agencv should pgn.rpecial attention to the HERS Heasures specified in this
checklist below, d completed and signed Cl--4R Foran for all the measures specifier)shall be submitted to the building inspector before final
inspection.
Duct Sealing& Testing HERS verification is requiredfor this measure.
❑ YES 0 NO YES:In Climate Zones 2 and 9-16.if more than 40 linear feel of new or replacement ducts arc installed in unconditioned
space,the ducts are to be sealed per§152(6)1 Dii and the newly installed ducts arc to be insulated per§151(010.
❑ EXCE.PIION: Existing duct systems that are extended,whichare constructed,insulated or scaled with asbestos.
El YES x❑NO YTS:In Climate Zones 2 and 9-I6,if the existing space-conditioning system(II VAC equipment and ducting)is replaced,the
ducts are to be sealed per§152(6)I Di.
❑YES ❑O NO vlFs:In Cl inmle Zones 2 mid 9-16.if the existing Ii VAC equipment is replaced(including the replacement ofthe air handler.
outdoor condensing unit of a split system,cooling or heating coil,or the furnace heat exchanger)the ducts am to be
sealed per§152(6)I E.
❑ li\CEPIION: Duct systems that are documented to have been previously scaled confirmed through I1 ERS
verification in accordance with procedures in the Reference Residential Appendix RA3.
❑ EXCEPTION: Duct s}:stems with less than 40 linear feet in unconditioned space.
IiSCEPIION: Existing duct systems constructed,insulated or sealed e'ith asbestos.
RefrigerantCharge-Split System HERS verification is requiredfor this measure.
❑ YES E) NO 1'F:S:In Climate Zones 2 and 8-15,when the existing IiVAC 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(6)1 F.
Central Fan Integrated (CFI)Ventilation System and Fan Watt Draw
The ventilation requirements of§150(o)do not apply toexisting residential homes.
Ducted Split Systems-Air Conditioners and Pleat Pumps: Airflow HERS verification is requiredfor this measure.
❑ YES ❑NO YES: In Climate"Zones 10 through 15,when the existing space-conditioning system(IIVAC equipment and ducting)is
replaced.the airflow and fan watt draw shall be verified er$152(6)1 Ci to meet the requirements of§151(f)7B.
Documentation Author's Declaration Statement
certify that this Certificate of Compliance documentation is accurate and complete.
Name:Rob Minor Signature: Y —
ompany:Valley Heating, Cooling, and Electrical Date:2-27-2012
Address: If N. 4th ST If Applicable CEA or CEDE
(Certification H):
C``y's'a'el7`p:San Jose, CA 95112 ''h°"e408-294-6270
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 or 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.Pau I 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
agency for approval with this building pemit application.
Na"teRob Minor Signature: 1
Company:Valley Heating, Cooling, and Electrical Dat"2-27-2012
Address:1171 N. 4th ST hiC1115e258540
Clt''sta1C"`p San Jose, CA 95112 Phone:408-294-6270____j
For ass'isiance or qutwitnts regarding the Energy Standards,contact the Enerkr Hotline at: 1-300-772-3300.
Regis'natinn Number: Regisnntion Uuterl'ime: ITERS Provider:
2008 Residential Compliance Forms ddorch 2010
GENERAL PERMIT APPLICATION M E P
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO,CA 95014-3255 MIA
CUPERTINO (408)777-3228• FAX(408)777-3333•buildine(cDcuoertino.org II ��jj /v\^^
❑PLUMEING MECPIAN ICAI. ❑EI.IiCTRICAI- ❑NIISCELLANIiOU'0Urwo
rnaecr ADOlerssT / Arve /r1 O
OWNER NAAII�H Pf10NE E-MAIL
l I-'( trs i{OSr�YG�l89N
STREET ADDRFSS ` CITY,STATE,LIP FAX
/ rz ar Vr G - 5a/'t
CONTACT'NAN/c PHONEe-n1Aa
N� l(e C o - o
STREETADDRESS CITY,STAATE,LIP FAX
13OWNER ❑ OWNER-BUILDER E] {
OWNER AGENT ❑ CONTRACTOR Ig CONr0.ALT00.AGF\T ❑ ARCIMECr ❑ENGINEER ❑ DEVELOPER ❑TENANT
CO\TRACTOR NAME LICHN NUNmER LICENMi TYPE BUS,LICM
! � Ca Sri LlO C-2G l /
COMPANY NAME E-NINE FAX
V
STREET ADDRESS CIT\'.STAT[LIP PHONE
59. Sa 2 0,4 95/12 03-2v4- 190
ARCHITECDENGINEER NANIE LICENSE NUMBER PUS.LIC n
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE.LIP PHONE
USE OF SFO.DUPLE\ 0AIu1.T1-FAMILY' PROIEQWN'11.D1.\Nn ❑ \'IS PROIER IN ❑YES IS THE DLDG AN 01'ES
BUILDING: COMMERCIAL URBAN INTERFACE,\0.E\ ❑ NO FLOOD"LONE ❑NO T:ICIILF.0.HONE? ❑ NO
DF.SCRIFI ION OF MORN
TOTAL VALUATION: I L/ 1-76 — RECEIVRDBY:
Hy my Signature below,1 cenily to each of the following: I am the property owner or authorized agent to act on the properly 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.
��I9authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of ApplicandAgem: &5C—c Date: 3AZIZ
SUPPLENIENT,U,INFORMATION REQUIRED OFFICEIisr.ONIs
❑ OVER-THD}Cf111.\44'.It
❑ EXPRESS
1
❑ STANDARD
i
❑
LARGE
❑ MA.IOR
d1EAWscdpp_201 Ldoc revised 06121111