14080261 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10725 ORLINE CT CONTRACTOR:ONE HOUR HEATING PERMIT NO: 14080261
AND AIR
OWNER'S NAME:
SANTA ROSA,CA 95404 PHONE NO:(707)545-1800
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL ❑
//�y C 20 7 qo REPLACE(E)FURNACE&A/C(SAME LOCATIONS)
License ClasSrGd Lic.# �`Z
tfContractor Date 7. r
I hereby of that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$16245
JI 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:35922066.00 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 IT 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 F CALLED INSPECTION.
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 Issu Date: Z
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18.
. .7 ' RE-ROOFS:
Signature Date 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.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: 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. I 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 handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this g_2 7• q
Owner or authorized agent: Date:
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 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction 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
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting 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
GENERAL PERMIT f - A PPLICA i ION b \ MEP
. _
4..._,.. COMMUNITY DEVELOPMENT DEPARTIJENT- BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 O�
(408) 777-3228- FAX(408)777-3333-buildino ancugetno.oro m I S
❑pLLN3R! (3 - ❑W-- A2-�ICAL [IFLECTRIC'&-L ❑IZSCELLANhPOUS/
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STRs'ET ADDRESS C>I Y,STATE,ZIP I PHONE
USE Orr ❑sm or DUPLEX ❑ izqui-FA my I PROTr.CT LN WILDLA'\m ❑ 1 rS I PRO=W ❑YFS I IS TIM BLDG 1,q ❑y:S
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DESCPIPTION OrWORK V C 62N edv+ -�v f ► - op
TOTAL VA?UATION: 1-110
I- _Fik 3
By Try signature below,I certify to each of the-follo;;gn. I am the property o-ner or authorized went to act on the property o,mer's behalf. I have read this
application and the inforration I have provided is correct I have read the Description of Work and veay it is accurate. I agree to comply-Mth all applicable local
ordinances and state laws relating to buildinpe5on"sap-6mm I au' orize r epresenta ves of Cupertino to enter the above-ident{infed proper:},for rection purposes.
Si_nature0f AppIicart/Aeent: Date: (� 7
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1EP1«iscfpp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10725 ORLINE CT DATE: 08/27/2014 REVIEWED BY: MELISSA
APN: 359 22 066 BP#: 'EVALUATION: 1$16,245
YPERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Du lex PENTAMATION FURN/AC
USE: p PERMIT TYPE:
WORK REPLACE E FURNACE &A/C SAME LOCATIONS
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
A/C Units (<=10K cfm) 1BREMAiR 1 #
Furnace, Forced-Air 1MFR=<100 1 # $139
TOTALS: $211.00
, 3 f
Mech.Plan Check Fo.0 hrs $0.00 1";U b,1'"ter:£:.,s,f;
Mech.Permit Fee: IMPERMIT
Other Mech.Insp. 0.0 hrs L$48.00 Oth',I'7aimb
E3
El
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These fees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS(&e Resolution 11-053 F,ff 7,1/.13) FEE QTY/FEE MISC ITEMS
€'p•€ ' i 'Fe,"
PME Plan Check: $0.00
PME Unit Fee: $211.00
PME Permit Fee: $48.00
Administrative Fee: 1ADMIN $45.00
Work Without Permit? 0 Yes (F) No $0.00
Travel Documentation Fee: ITRA VDOC $48.00 i
Strong Motion Fee: IBSEISMICR $2.11 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
Sf�Y
' S TL $355.11 $0.00 TOTAL FEE: $355.11
Revised: 07/10/2014
359. I1
STATE OF CALIFORNIA
ALTERATIONS - HVAC
CEC-CFIR-ALT-03-E Revised 06/14 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CFIR-ALT-03-E
Alterations-HVAC CZ 1,3 to 7 and 16(formerly CF-IR-ALT-HVAC) (Page 1 of 1)
Site Address: Enforcement Agency: Date Prepared: Permit#:
1672-9 C�rlihe cf. g-27. 1
Equipment Type Equipment Efficiency New:Ducting,Plenums,Lineset Conditioned Thermostat
Required R-value Floor Area(sq ft)
❑ Packaged System ❑Evaporator Coil AFUE COP ❑R-6 (CZ 1,3-7)Ducts Served b system Setback
❑Split System ❑Condensing Unit SEER ❑R-8' (CZ 16)Ducts sq ft (If not already
HSPF ❑R-6(all CZs)Plenums present,must
❑Furnace ❑Lineset EER ❑R-5 or R7.5 Lineset3 be installed)
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this
form is allowed to be filled out by hand. For final inspection all forms are to be registered(no hand filled forms allowed)and a copy left on site.
Vfl.HVAC Changeout/Repair Required Compliance Documents to be left on site for Final:
Can include new ducting
All Equipment, CF1R-ALT-02-E
Condenser Unit,Evaporator Coil, CF2R:MECH-01,MECH-20-HERS
Air Handler/Furnace CF3R:MECH-20-HERS
Installer Requirement:Duct leakage C-5_15%or,<109 to outside,or seal all accessible leaks)
Exempted from duct leakage testing if:
❑1.Duct system registered with HERS provider as previously sealed,or❑2.There is less than 40 linear feet of duct in unconditioned
space,or ❑3.Existing duct systems are constructed,insulated or sealed with asbestos(list manufacture date of building-...
❑2.New HVAC System Required Compliance Documents to be left on site for Final:
All new equipment and All New Ducts' CFIR-ALT-02-E
CF2R-MECH-01,MECH-20-HERS,MECH-22-HERS,MECH-(23 or 24)-HERS
CF3R-MECH-20-HERS,MECH-22-HERS,MECH-(23 or 24)-HERS'
Installer Requirement:Duct leakage<6%,Fan Efficacy(.58W/CFM),Air Flow>_350 CFM/ton(or Standards Table 150.0-C/D alternative)
❑3.All New Ducts with Replacement Required Compliance Documents to be left on site for Final:
Includes replacing or installing All New CF1R-ALT-02-E
Ducts'and one or more of the following: CF2R-MECH-01,MECH-20-HERS,MECH-(23 or 24)-HERS
Condenser Unit,Evaporator Coil,Furnace CF3R-MECH-20-HERS,MECH-(23 or 24)-HERS
Installer Requirement:Duct leakage<6%,Air Flow�:350 CFM/ton(or Standards Table 150.0-C/D alternative)
❑Exempted from duct leakage testing I existing duct systems are constructed,insulated or sealed with asbestos.
❑4.New Ducting over 40 feet Required Compliance Documents to be left on site for Final:
Adding or replacing ducts in unconditioned CFIR-ALT-02-E
space but less than All New Ducts' CF2R:MECH-20-HERS
CF3R:MECH-20-HERS
Installer Required to:Duct leakage(:S.15%or,<10%to outside,or seal all accessible leaks)
❑ Exempted from duct leakage testing I existing duct systems are constructed,insulated or sealed with asbestos.
'All new ducting R-8 required when more than 40 ft installed and R-6 when less than 40 ft installed. This includes in walls,between floors etc.
'A New Duct system is when the duct system is constructed of at least 75 percent new duct material,and up to 25 percent may consist of reused
parts from the dwelling unit's existing duct system(e.g.,registers,grilles,boots,air handler,plenums,duct material.
3 R-5(1"thick insulation)for linesets 1"and less. R-7.5(1.5"thick insulation)for linesets over 1 inch. Most mfg will require Suction line Diameter
with insulation as the following 1.5-2T-2%",2.5-3T-2%",3.5 to 4T-2%',5T-4%"
Contractor(Documentation Author's/Responsible Designer's Declaration Statement)
I certify the following under penalty of perjury,under the laws of the State of California:
1. The information provided on this Certificate of Compliance is true and correct.
2. 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the information on this document.
3. That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24,Parts 1 and 6 of the California Code of Regulations(CCR).
4. That the energy features and performance specifications,materials,components,and manufactured devices for the building design or
system design identified on this Certificate of Compliance conform to the requirements of Title 24,Part 1 and Part 6 of the CCR.
5. The building design features or system design features identified on this Certificate of Compliance are consistent with the information
provided on other applicable compliance documents,worksheets,calculations,plans and specifications submitted to the enforcement
agency for approval with this building permit applicat'
Responsible
1 9J,7.1 Lf
Company: Address: City/State/Zip: I Phone:
pv�tkwjv v- Ihra-�N �p(r (ft fefa(vh,IA h•t II r:� ,S«Ρw{r. VCSQ ca qJC o 7o Z- 5�f S • l u�
For assistance or questions regarding the Energy Standards,contact the Energy Hotline t:1-800-772-3300
CERTIFICATE OF COMPLIANCE CFIR-ALT-02-E
Alterations to Space Conditioning Systems(formerly CF-IR-ALT-HVAC) (Page 1 of 4 j
Project Name: 10725 ORLINE CT I Date Prepared: 2014-08-25
A.General Information
CHR-ALT-02 is applicable to multiple space conditioning systems contained within a single dwelling unit.When multiple dwelling units must be
documented,use one CF1R-ALT-02 document for each dwelling unit.:
03 Project Name: 10725 ORLINE CT 02 Date Prepared: 2014-08-25
03 Project Location: 10725 ORLINE CT 04 Building Type: Single family
05 CA City: Cupertino 06 Dwelling Unit Name: 10725 ORLINE CT
07 Zip Code: 95014 08 Dwelling Unit Conditioned 1500
Floor Area(ft2):
Number of space conditioning
09 Climate Zone: 4 10 (SC)systems being altered in 1
this dwelling unit.:
PF
B.Space Conditioning(SC)System"t`#otinaiYon
MA
01 02 03 ' 04 OS` X06 07 08 09 10
01 Installing new Isthe entire
components? duct system
(packaged unit,or accessible Are all of the
condensing unit, Installing for sealing, system's
Is the altered Altering or or more than 40 and is more components
or installed Installing a cooling/heating linear feet of than 75%of and ducts new
SC System SC System CFA served system a refrigerant coil,or new or the duct or replaced?
Identification or Location or Area by this SC ducted containing air-handling unit, replacement system new (entirely new
Name Served System(ft2) system? component? etc) ducts? or replaced? system) Alteration Type
System 1 HOUSE 1500 Yes Yes Yes No No No Altered space
conditioning system
C.Extension of Existing Duct System,Greater Than 40 Feet(Section150.2(b)1Dllb)
This section does not apply to this project.
Registration Number:214-AO082189A-000000000-0000 Registration Date/Time: 2014-08-2508:05:56 HERS Provider:CalCERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2014-08-25 08:05:06
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems(formerly CF-1R-ALT-HVAC) (Page 2 of 4)
D.Altered Space Conditioning System(Sections 150.2(b)lE and F)
01 02 03 04 05 06 07 08 09 10 11 12
Heating Cooling
System Heating Altered Heating Minimum Altered Cooling Minimum Required New or
Identification System Heating Efficiency Efficiency Cooling Cooling Efficiency Efficiency Thermostat Replaced New Dud
or Name Type Components Type Value System Type Components Type Value Type Dud Length R-Value
All new All new This field or This field or
System 1 Central gas heating AFUE 0.78 Central split
furnace AC cooling SEER 16 Setback section is not section is not
components components applicable I applicable
Required Documentation:
CF2R-MCH-01-E-Space Conditioning Systems Ducts and Fans
-Duct insulation requirement for new plenums:R6.
CF2R-MCH-20-H&CF311-MCH-20-11—Duct Leakage testing required when heating or cooling components are installed in ducted systems,or when more than 40 ft of duct length is replaced.
-Leakage rate compliance:<_15%,or 5 10%leakage to outside,or seal all accessible leaks.
CF2R-MCH-25-H&CF3R-MCH-25-H Refrigerant Charge Verification required when refrigerant containing components are installed or altered(applicable in CZ 2,8-15).
CF2RCF3R-MCH-23&CF3R-MCH-23 Air Flow 2 300 CENI/,torrtqulred when HT is required.
r. ..'
Exceptions: "
-Duct systems registered with HERS provider as AOously sealed are exemptfrom MCH-20 Duct Leakage Testing requirements.
-Heating-only systems and Air Handler/Furnacerolfanges do notTeq tr�`ve0ftcation bf Air Flow MSH=23,or Refrigerant Charge MECH-25.
-Existing duct systems constructed,insulated_404,led
with re eRempC i[om MCH-20 Dura Leakage Testing requirements.
E.Entirely New or Complete Replacement Duct System,with or without Equipment Changeout(Sections 150.2(b)1Diia and 150.2(b)IE,F)
This section does not apply to this project.
Registration Number:214-A0082189A-000000000-0000 Registration Date/Time: 2014-08-25 08.05:56 HERS Provider:CalCERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2014-08-25 08:05:06
CERTIFICATE OF COMPLIANCE CFIR-ALT-02-E
Alterations to Space Conditioning Systems(formerly CF-IR-ALT HVAC) (Page 3 of 4)
F.Entirely New or Complete Replacement Space Conditioning System(Section 150.2(b)1C)
This section does not apply to this project.
r`+ r
Registration Number:214-A0082189A-000000000-0000 Registration Date/Time: 2014-08-25 08:05:56 HERS Provider:CalCERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2014-08-25 08:05:06
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems(formerly CF-IR-ALT HVAC) (Page 4 of 4)
Documentation Author's Declaration Statement
1.1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name: Documentation Author Signature:
Wilson,Candace C,- dam V i1 sm
Company: Signature Date:
The Energuy CA LLC 2014-08-25 08:05:56
Address: - CEA/HERS Certification Identification(if applicable):
1215 K St.,17th Floor
City/State/Zip: Phone:
Sacramento CA 95814 1-877-600-0123
Responsible Person's Declaration statement
I certify the following under penalty of perjury,under the laws ofthe State of`Callfornia:
1. The information provided on this Certificateof Compliance istrue and correct.
2. 1 am eligible under Division 3 of the Business-and Professions code to accept responsiblllty for the building,design or system design identified on this Certificate of Compliance(responsible designer).
3. That the energy features and perform `� specifica6ons,materfgh comf�p"'ponents;=`a`nd manufactured devices'for the building design or system design identified on this Certificate of Compliance conform to the
requirements of Title 24,Part 1 and hof the CahformaCadeof Re'gula6ons
4. The building design features or sy xlesign feature edor thta Certficate o'C`ompliance aretonsistent with the Information provided on other applicable compliance documents,worksheets,
calculations,plans and specificatio�,ubmrned,the .lnenca(;ency for approVat with this bullding.permrt app)itaGon. -,
S. I will ensure that a registered copy oi"0ert1la�f 5pftance sTt i oemade Mileble wtth�thebuilding ermit(s(Issued for the building,and made available to the enforcement agency for all applicable
Inspections.I understand that a registered copy of this Certificate'of Compliance is required to be included with the documentation the builder provides to the building owner at occupancy.
Responsible Designer Name: Responsible Designer Signature: ,n, i)
Wilson,Candace LIGE 1 V V
Company: Date Signed:
The Energuy CA LLC 2014-08-25 08:05:56
Address: License:
1215 K St.,17th Floor
City/State/Zip: Phone:
Sacramento CA 95814 1-877-600-0123
Digitally signed by CaICERTS_This digital signatureis provided in order to secure thecontent of this registered document,and in no way implies Pegistration Provider responsibility for the accuracy of the
information.
Registration Number:214-A0082189A-000000000-0000 Registration Date/Time: 2014-08-25 08:05:56 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2014-08-25 08:05:06
CUPERTINO
Address
FILE
SMOKE / CARBON MONOXIDE ALARMS Tf
OWNER CERTIFICATE OF COMPLIANCE 7� 1`7
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • buildingCa cupertino.org r� ' qosoUl
Prmit Nn
/07ZS- 69
PURPOSE
This affidavit is a
compliance with
inspections are re
CI,- #
certification for the installation of all required Smoke and Carbon Monoxide Alarms for
CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
GENERAL INFORMATION
Existing single - family and multi- family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds
$1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and /or Carbon
Monoxide Alarms be installed in the following locations:
AREA
SMOKE ALARM
CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the
bedroom(s)
X
X
On ever level of
a dwelling unit including basements
X
X
Within each sleeping
p room
X
Carbon Monoxide allarms are not required in dwellings which do not contain fuel- burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply: Iii dwelling units with no commercial power supply, alarm(s) may be solely battery operated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl
space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for
alarms which must The connected to the building wiring.
As owner of the above- referenced property, I hereby certify that the alarm(s) referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms have been tested and are operational, as of the date signed
below.
d d t om 1 with th terms an cond ons of is ate ent
I have a an agree -
Smoke and CO form.doc revised 03118114
c y
O (or, Owner Agent's) Name:
OnSignature
................. ............................... ............... ............................... Date: ......:............
Contractor N me:
Sinature .................................... ............................... Lic.# ....... ............................... Date: ...................
Smoke and CO form.doc revised 03118114