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11100119 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20833 FARGO DR CONTRACTOR:VALLEY HEATING& PERMIT NO: 11100119 COOLING OWNER'S NAME: NANCY A KATO 1171 N 4 TH ST DATE ISSUED: 10/18/2011 VNER'S PHONE: 4086552539 SAN JOSE,CA 95112 PHONE NO:(408)294-6290 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL[] COMMERCIALE] License Class Zk!5dr9D Lic,.# 2� 7� REPLACE FURNACE&A/C DUCT WORK REPLACEMENT Contractor / �iL �C L I hereby affirm that I am licensed der he provisi ns of C liter (commencing with Section 7000)of Division 3 of the Busine s&Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 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 whichthis permit is issued. Sq.Ft Floor Area: Valuation:$17871 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 APN Number:32630131.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which m gamst said City in consequence of the granting of this pe it. ditiona ,the applicant understands and will comply Issued y. -2 Date: with all non-point o cc per the Cupertino Municipal Co e,Sect' 9.18. /) RE-ROOFS: Signature Date /(J / l� All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. ER UILDER DECLARATION Signature of Applicant: Date: I hereby a nr h/asons: exempt from the Contractor's License Law for one of the following two ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will I hereby affirm under 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(a)should I store or I andle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment v' which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Ba Ar it Q ity Management District I performance of the work for which this permit is issued. will maintain compliance with the Cu tino Mu ' pal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: �L'11L--Date: /Or J— all permit is issued. I certify that in the performance of the work for which this permit is issued,I shall i 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 CONSTR LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a n coon lending agency for the performance of forthwith comply with such provisions or this permit 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 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 ARCHITECT'S DECLARATION "demnify and keep harmless the City of Cupertino against liabilities,judgments, ts,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. anting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: PERMIT# ' I o OWNER'S NAME: ��C PHONE# `� GENERAL CONTRACTOR: k,�qUSINESS LICENSE# ADDRESS: l\ \ t4 . 4 TY/ZIPCODE: QaQ r1 *Our municipal code requires all businesses working in the city to have a City of Cup4t&n usiness 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. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 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 CITY OF CUPERTINO 8 ITEMS OF 14 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32630131. 00 DATE ISSUED. . . . . . . : 10/18/2011 RECEIPT #. . . . . . . . . BS000015072 REFERENCE ID # . . . : 11100119 SITE ADDRESS 20833 FARGO DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER NANCY A KATO ADDRESS 20833 FARGO DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : VALLEY HEATING 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 17, 871 .00 1. 00 0 . 00 1.00 0. 00 1BREMAIRHA NO.UNITS 1.00 65. 00 0. 00 65.00 0. 00 1BSEISMICR VALUATION 17, 871 .00 1.79 0. 00 1.79 0 .00 1MECHINSP HOUR 1.00 130. 00 0 . 00 130. 00 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 456 .79 0. 00 456 .79 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 717.29 22728 --------------- TOTAL RECEIPT 717.29 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- --------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 20833 fargo dr. DATE: 10/18/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$17,871 ;'PEPI.MIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: PERMIT TYPE: WORK furnace a/c duct work replacement. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES A/C Units (<=10K cfm) 1BREMAIR 1 # $65 Furnace, Forced-Air 1MFR=<100 1 # $130 TOTALS: $195.00 Mech.Plan Check "00 $0.00 Mech.Permit Fee: 1MPERMIT Other Mech.Insp. 1.0 hrs $44.00 Mech.Insp.Fee: 1 MECHINSP $130.00 - NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). Theseees are based on the prefindina information available and are only an estimate. Contact the De t or addn'1 in o. FEE ITEMS (Ciee Resolution 11-055 Elf "1%I j FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $195.00 PME Permit Fee: $174.00 F-71 Administrative Fee: 1ADMIN $41.00 Work Without Permit? Q Yes 0 No $0.00 Travel Documentation Fee: ITRA VDOC $44.00 i Strong]Motion Fee: 1BSEISMICR $1.79 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $456.79 $0.00 TOTAL FEE: $456.79 Revised: 10/01/2011 4 i 01 I r� T _ I ` I 1 1 i 1 1 Oy i v° J f 1i Oa i i Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC CF-IR-ALT-HVAC Climate Zones 16 to A r Enforcement Agency: Date: Permit#: Conditioned E ui ment Type' List Minimum EfficienC312 Floor Area Duct insulation requirement Thermostat ackaged Unit Over 40 ft of ducts added or tc,41ther rnace Q rl COP replaced in unconditioned *ff tback door Coil SEER HSPF Served by system s ace ��/� alreadypresent, ndensing Unit EER Resistance 2.5 W sf Lj R 8 (CZ 16) must be installed) 1.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. HERS VERIFICATION SUMMARY Listed below are four HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted.A copy of the forms shall be left on site for final inspection and a copy given to the homeowner. At final,the inspector verifies that the work listed on this form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF-6R and registered CF-4R forms(no hand filled CF-4Rs allowed)are filled out and signed. Beginning October 1,2010,a registered copy of the CF-1R and CF-6R shall also be on site for final inspection. D 1.HVAC Changeout Required Forms: • All HVAC Equipment replaced CF-¢%foghs: MECH-04 and h4EQ&4*dW0 MECH-21 • Condenser Coil and/or • Indoor Coil and/or CF-6R forms: MECH-2I-HERS CF-4R forms: MECH-21 • Furnace For Split Systems:Duct leakage<15 percent For Packaged Units: Duct leakage<15 percent Exempted from duct leakage testing if: 1.Duct system was documented to have been previously sealed and confirmed through HERS verification,or 2.Duct systems with less than 40 linear feet in unconditioned space,or 3.Existing duct systems are constructed,insulated or sealed with asbestos 2.New HVAC System Required Forms: • Cut in or Changeout with new ducts:(all CF-6R forms: MECH-04 and MECH-2I-HERS new ducting and all new equipment) CF-4R forms: MECH-21 For Split Systems:Duct leakage<6 percent, For Packaged Units:Duct leakage<6 percent 3.New Ducts with Replacement Required Forms: • Includes replacing or installing all new ducting and/or outdoor condensing unit CF-6R forms: MECH-04 and MECH-20-HERS and/or indoor coil and/or furnace. Not all CF-4R forms:MECH-20 equipment chaned. For Split Systems:Duct leakage<6 percent For Packaged Units:Duct leakage<6 percent 4.New Ducting over 40 feet Required Forms: • Includes adding or replacing more than 40 CF-6R forms: MECH-04 and MECH-2I-HERS linear feet of duct in unconditioned space. CF-4R forms: MECH-21 For splits stem or packaged units: Duct leakage<15 percent EXCEPTION:Existing duct systems constructed,insulated or sealed with asbestos. Contractor(Documentation Author's/Responsible Designer's Declaration Statement) • I 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 C rtificate ompliance 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 ormatio oc ented on other applicable compliance forms,worksheets,calculations,plans ands specifications submitted to the enforcemen en a]with the permit app lication. Name: Signature: Z- ComPanY I �+ ` ate: ` 3 ` 00 r I � �ll� L �l- � t P.? !�, 1J 1 Address: ` ` /t S License: ` c;?t,,,9 4o City/State/Zip: Phone: "—1 2008 Residenal lance Forms March 2010 Prescriptive Certificate of Compliance: Residential CF-IR-ALT Residential Alterations Page 1 of 5 PrOct Name: Climate Zone# #of Stories General Information Site Address: �n, O r Enforcement Agency: Date: Building Type Single Family n Multi Family Circle the Front Orientation:N,E,S,W,or degrees Conditioned Floor Area(CFA): Project Type: 0 Alterations rl Envelope Fenestration Roof HVAC Replacement or Change Out Wbuct Replacement[I 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 El Opening of framed cavity alone—Alterations that involve the opening of the f amed cavity of a 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. 0 Replacement of entire assembly—Replacement of an entire wall,ceiling,or floor assembly requires the installation of Component Package-D insulation values in Table 151-C. Fill in Columns A—J. Opaque Surface Details For the furred portioned of Mass Walls see Furring Strips Construction Table below. A B 7 C D E F G I H I I J Proposed See Note Standard Values From JA4 Table Framing Thickness, Framed Continuous JA4 Proposed Tag/ Assembly Name Material Spacing, U- JA4 Table Cavity Insulation Assembly Assembly ID' or Type 2 and Size or Other factor4 Numbers R-value6 R-Value? Row/Co]8 U-factor9 Note:For furred assemblies,accounting for Continuous Insulation R-value,see Page JA4-3 and Equation 4-1. For calculating furred walls use the Mass and Furring Construction table below. 1.For Tag/ID indicate the identification name that matches the building plans. 2.Indicate the Assembly Name or type:Roof/Ceiling, Walls,Floors,Slabs,Crawl Space,Doors and etc...Indicate in column G the Frame material and Size:For Wood,Metal,Metal Buildings,Mass,enter 2x4,2x6,or etc... see JA4 for other possible frame type 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,Spandrel 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-Value from Table 151-B, C or D 5.Enter the Table number that closely resembles the proposed assembly. 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 the row and column of the U factor 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 E to comply. Furring Strips Construction Table for Mass Walls Onl A I B C I D I E F G H I J 1 K L 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 b Assembly F"- ° eu a �e ? a Final Mass Name or JA4 Table �, roc � Assembly Thickness' Type Number° d > i " c ¢ > U-factor6'7 Comment Registrar#vr�.tVumber Igstratr , 3rt>p2 se lml 1'rc�vtdr': 2008 Residential Compliance Forms" March 2010 Prescriptive Certificate of Compliance: Residential CF-IR-ALT Residential Alterations Page 2 of 5 Project Name: r Climate Zone# #of Stories Mass and Furring Strips Construction(footnotes) 1. Indicate the type of assembly to include;Hollow Unit Masonry Walls,Solid Unit Masonry,Solid Concrete Walls,Etc. Additional assemblies can be found Reference Joint Appendix JA4. 2. This is the U-Factor based on the thickness of the assembly in inches. 3. The R-value of the 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 4-4of the Reference Joint Appendix J44. The equation is the inverse of Column added to Column I. Column K is the inverse from column J. 7.Insert the calculated U-actor 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. Q Adding 50ft2 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. Q Adding more than 50ft2 of window area— Newly installed windows shall meet the U-Factor and SHGC Value and the Fenestration Area requirements of Component Package D in Table 151-C. Complete the Altered Fenestration Allowed Area Table on Page 2 of the CF-IR-ALT Orientation Fenestration Type and Frame (North,East, PropsedArea' Maximum Maximum NFRC or Default (Window,Glass Door orSkylight) South,West) (ft) U-factor,' SNGC2,3,4 Value' 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-IR ALT Form. 4.Submit a completed WS-3R Form if a reduced SHGC is calculated with exterior shading. 5.tfapplicable at this stage enter "NFRC" or NFRC Certified windows or are CEC"Default"values found in Table 116-A or B. ALTERED FENESTRATION ALLOWED AREAS(Complete if more than 50ft2 of fenestration is added) A B C D E F G CFA of Allowed Existing Allowed Entire %of Fenestration Area Fenestration Area Proposed Area' 4 Dwelling CFA"' Area4 Removed Area Added (A x B) (E-D)+C Total Fenestration Area"(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 20%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 allowed for 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. J.Enter the fenestration removed as part of the alteration if any in column D. 6.Enter the Fenestration area that is being added as part of the alteration. Registrattvtt,�?'unher: � . ` + �: .. .. '1Re�Zst�ttota.l�itt '"trtl�,: H.1J'lLS`Prx��t • 2008 Residential Compliance Forms March 2010 Prescriptive Certificate of Compliance: Residential C&IR-ALT Residential Alterations Page 3 of 5 Project Name: Climate Zone# #of Stories AC V\4-Tb ROOFING PRODUCTS(COOL ROOFS)§151(1)12 When the area of exterior roof surface to be replaced exceeds more than 50%of the existing roof area,or more than 1,000f12,whichever is less,the new roofing area must meet the roofing product"Cool Roof'requirements of§152(b)1Hi,152(b)1Hii,or 152(b)IHiii. Check applicable alternative or exception below if the roof alteration is exempt from the roofingproduct "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 I through 9 and 16 with a Steep-Sloped Roofs(pitch greater than 2:12)and product unit weight less than 51b/ft2. Alternatives to§152(b)1Hi and§152(b)Hii,Steep-slope roof(pitch>2:12) rl Insulation with a thermal resistance of at least 0.85 hr-ft'-'F/Btu or at least a 3/4 inch air-space is added to the roof deck over an attic;or n Existing ducts in the attic are insulated and sealed according to§151(f)10;or Q In climate zones 10,12 and 13,with 1 ftof 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 n Building has no ducts in the attic;or E] In climate zones 10,11,13 and 14,R-3 or greater roof deck insulation above vented attic. Exception to§152(b)1Hiii,Low-slope roof(pitch<_2:12) E] Building has no ducts in the attic. Other Exceptions El 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/ftZ is exempt 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 RoofRequirement: Roof Slope Product Weight Product Aged Solar Thermal CRRC Product ID Number < 2:12 >2:12 < 5lb/ft2 > 5lb/ft2 Type 2 Reflectance3A Emittance SRIS n ® U U 0 U U, 0 1. The CRRC Product ID Number can be obtained from the Cool Roof Rating Council's Rated Product Directory at www.coolroofs.oMIproducts/search.php 2.Indicate the type of product is being used for the rooftop,i.e.single ply roof,asphalt roof,metal roof,etc. 3. 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(pi,,;uiot—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. 5.Calculate the SRI value by using the SRI-Worksheet at http:llwww.energy.ca.Qov/title24/and enter the resulting value in the SRI Column above and attach acopy of the SRI-Worksheet to the CF-I R. To apply Liquid Field Applied Coatings,the coating must be applied across the entire roof surface and meet the dry mil thickness or coverage ecommended by the coatings manufacturer and meet minimum performance requirements listed in§118(i)4. Select the applicable coating: Aluminum-Pigmented Asphalt Roof Coating Cement-Based Roof Coating Other ate istrcrltart 1 X3u11+� r� sd k U.w., 2008 Residential Compliance Forms March 2010 Prescriptive Certificate of Compliance: Residential CF-IR-ALT Residential Alterations (Pa e 5 of5) Project Name: Climate Zone# #of Stories HERS VERIFICATION SUMMARY The enforcement agency should pay special attention to the HERS Measures specified in this checklist below. A completed and signed CF-41?Form for all the measures specified shall be submitted to the building inspector before final inspection. Duct Seali & Testing HERS verification is required for 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§I52(b)1Dii and the newly installed ducts are to be insulated per§151(f)10. EXCEPTION: Existing duct systems that are extended,which are constructed,insulated or sealed with asbestos. OYES 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)IDi. OYES ONO 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§152(b)IE. O 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. O 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 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)1F. 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. O YES O 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§I52(b)ICi to meet the requirements of§151(f)7B. Documentation Author's Declaration Statement • I certify that this Certificate of Compliance documentation is accurate and complete. Name: Signature: Company: Date: Address: If Applicable CEA or 1 CEPE (Certification#): City/State/Zip: Phone: 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 agency for approval with this building permit application. Name Signature: Q Comp4n.. \ ` Date* 6 ® \ I Address: i1 ._; V Licetrse,:ko C.,54S Jl City/Sta gyp: 6C- J�1 Phon For assist nce oqu stions regArding the Energy Standards,contact the Energy Hotline at:1-800-772-3300. It egistratton, nbrr :.,;! egtstrafprt latti'rne_ HERS 1'rt�viiler 2008 Residential Compliance Forms March 2010 GENERAL PERMIT APPLICATIONMEP fr COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228 • FAX(408)777-3333•buildinge-cupertino.org MISC CUPE.RTINO I ( 1 UMBING CHANICAL LECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS 0 � APN# 0- h(� OWNER NAIv1E PHONE E-MAIL STREET ADDRESS CTY, STATE,ZIP FAX LW 4�� l Ly CONTACT NAME U PHONEgt%. E-MAIL STREET ADDRESS CITY,STATE, ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT I&CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER ^ LICENSE BUS.LIC# . - COMPANY NAMEo4 )SrE-MAIL (� FAX . (7n _Ncu A�fA STREET ADDRESS j 1 , `�n CITY,STATE,Z ( PHONE ARCHITECT/ENGINEE`R NAME 1 Y 1 LIC SE NUMBER 1 BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ No DESCRIPTION OF WORK TOTAL VALUATION: By my signature below,I certify to ea of the followi m the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I hav rovl a is hav;read the Description of Work and ve*ify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to ilding,ns I authorize representatives of Cupertino to enter the above-id tiff o erty for inspection purposes. Signature of Applicant/Agent: — Date: /0 S �' ORMATION REQUIRED NMS MEPMiscApp 2011.doc revised 03/16/11