15080083A
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21844 BENETTI CT
CONTRACTOR: PELLE HEATING & AC
PERMIT NO: 15080083
INC
OWNER'S NAME: HASSY KURT R ET AL
3751 D CHARTER PARK DR
DATE ISSUED: 08/10/2015
OWNER' PHONE: 4082213122
SAN JOSE, CA 95136
PHONE NO: (408)978-7060
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
���
REPLACE (E) FURNACE & A/C UNITS, SAME LOCATIONS
License Class C7 Lic. # T�� � /
Contractor'C 2 Date w -) —
1 hereby affirm that I am licensed under the provisions of C apter 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
Sq. Ft Floor Area:
Valuation: $6000
performance of the work for which this permit is issued.
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.
APN Number: 32649029.00
Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRES IF WORK ISNOT STARTED
correct. I agree comply with all city and county ordinances and state laws relating
WITHIN 180 DAYS OF SSUANCE OR
tr
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
{cul.
180 DAY AST ED INSPECTIO .
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
ate:
granting of this permit. Additionally, the applicant understands and will comp)
-
with all non-point source regulations per the Cupertino Municipal Code, Section
s
9.18.
RE-ROOFS:
�
Sign atur e v !'J
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 1
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 2 6, 25533, d 25534.
Section 3700 of the Labor Code, for the performance of the work for which thisD
�v
permit is issued.
Owner or authorized age Date:
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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 APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 Isc CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building(b)cupertino.org �/►��'J (% l,O
F-1PLUMBING
(PLUMBING nMECHANICAL I—IF.LFCTRWAT. I IM1.crFI I ANFn1
PROJECT ADDRESS I 'K! I 1@
oi-
APN # Q
OWNER NAME C
tV
PHONE
E-MAIL
STREET ADDRESS
{` ,,
em eA;
Cy IT.Y, STATE, ZIP
FAX
CONTACT NAME
PHONE
14 V
a
E -M IL
` e. S tr
STREET ADDRESS
CITY, STATE, ZIP
FAX
J' _
4
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT
CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CON-fRACTO� NAME
LICENSENUMBER
Oq St
LICENSE TYPE
BUS. LIC #
I1%.j
COMPANY
CL�tX
• A.
C' S t C
FAX
('1 .
STREET ADDRESS
53 �i I - b 2-4-e
TY, STATE, ZIP
PHONE
Q�t `� . Cy
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF SFD or DUPLEX ❑ MULTI-FAM11.Y
PROJECT IN WILDLAND ❑ YES
PROJECT IN❑YES
IS THE BLDG AN ❑ YES
BUILDING: ❑ COMMERCIAL -
URBAN INTERFACE AREA ❑ NO
FLOOD ZONE ❑ NO
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK O_d *j ,
�1C�
�^ ,,� ,n•�y,
PAC ILI SeQL,
TOTAL VALUATION: eN
RECE
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. read the Description of Work and
verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buildi egconstruction.
I aut on epresentatives of Cupertino to enter the above -i entified property for inspection purposes.
Signature of Applicant/Agent:
Date: 3
SUPPLEMEN
REQUIRED
7ORMATION
OFFICE USE ONLY
w
VER -THE -COUNTER
F'
❑ EXPRESS
❑ STANDARD
U
z
❑ LARGE
o.
❑ MAJOR
MEPMiscApp_2011.doc revised 06/21/11
M,
CITY OF CUPERTINO
rm__�FEE ESTIMATOR - BUILDING DIVISION
LMADDRESS:
21844 BENETTI CT
DATE: 08/10/2015
REVIEWED BY: MELISSA
UNITS
APN: 326 49 029
BP#:
`VALUATION: 1$6,000
*PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
#
PENTAMATION FURN/AC
PERMIT TYPE:
WORK
REPLACE E FURNACE & A/C UNITS SAME LOCATIONS
SCOPE
.Suppl. 117sp Fee
APPLIANCE / EQUIP TYPE
FEE ID
I'hurrb. Plan Cheek
QTY
UNITS
BP FEES
Elec. Permit Fee,
A/C Units (<=10K cfm)
16REMAIR
)liter Islec. Insp. Li
1
#
$72
Furnace, Forced -Air
1MFR=<100
.Suppl. 117sp Fee
1
#
$143
PME Unit Fee:
$215.00
PME Permit Fee:
$48.00
Construction Tux:
Administrative Fee: 1ADMIN
$45.00
Work Without Permit? 0 Yes 0 No
$0.00
TOTALS:
Travel Documentation Fee: ITRA VDOC
1 $215.00
Strong 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. etc). These fees are based on the Dreliminary information available and are onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Tee Resolution 11-053 E f.' 7%/%13)
Mech. Plan Check Fo.0 hrs $0.00
I'hurrb. Plan Cheek
:lec. Plan Check
Mech. Permit Fee: IMPERMIT
Plumb. Permit Fee:
Elec. Permit Fee,
Other Mech. Insp. 0.0 hrs $48.00
0/her Plumb Insp. Li
)liter Islec. Insp. Li
l.<h ,t;;
i'lumb. hist. Fee:
r.W. Insp. Fee
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 Dreliminary information available and are onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Tee Resolution 11-053 E f.' 7%/%13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
Suppl..PC Fee
PME Plan Check:
$0.00
Permit Fee:
.Suppl. 117sp Fee
PME Unit Fee:
$215.00
PME Permit Fee:
$48.00
Construction Tux:
Administrative Fee: 1ADMIN
$45.00
Work Without Permit? 0 Yes 0 No
$0.00
,Idvanced Planning Fees:
Travel Documentation Fee: ITRA VDOC
$48.00
Strong Motion Fee: IBSEISMICR
$0.78
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS:
$357.78
$0.00 TOTAL FEE:
1 $357.78
Revised: 07/02/2015
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC)
CF1R-ALT-02-E
(Page 1 of 3 )
Project Name: Hassy, Kurt I Date Prepared: 2015-08-03
A. General Information
MR -ALT -02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be
documented, use one MR -ALT -02 document for each dwelling unit.
01
Project Name
Hassy, Kurt
02
Date Prepared
2015-08-03
03
Project Location
21844 Benetti Court
04
Building Type
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
Hassy, Kurt
07
Zip Code
95014
08
Dwelling Unit Conditioned
2080
Installing
Installing
Installing
Floor Area (ft2)
Location or Area
by this SC
ducted
containing
system
Number of space conditioning
entirely new
09
Climate Zone
4
10
(SC) systems in this dwelling
1
component?
components?
feet of ducts?
duct system?
unit.
Alteration Type
B. Space Conditioning (SC) System Information
01
02
03
04
05
06
07
08
09
10
Is the SC
Installing a
SC System
SC System
CFA served
system a
refrigerant
Installing new SC
Installing
Installing
Installing
Identification or
Location or Area
by this SC
ducted
containing
system
more than 40
entirely new
entirely new
Name
Served
System (ft2)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
Entirely new or
complete
replacement duct
Hassy, Kurt
Whole house
2080
Yes
Yes
Yes
Yes
Yes
No
system with or
without equipment
changeout
C. Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b)1Diib)
This section does not apply to this project.
Registration Number: 215-A0213479A-000000000-0000 Registration Date/Time: 2015-08-03 08:47:38 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-08-03 08:53:07
Schema Version: 0.55SSDD
CERTIFICATE OF COMPLIANCE
CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT HVAC) (Page 2 of 3 )
D. Altered Space Conditioning System (Sections 150.2(b)lE and F)
This section does not apply to this project.
E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)lDiia and 150.2(b)1E, F)
01
02
03
04
05
06
07
08
09
10
it
Heating
Cooling
System
Heating
Minimum
Cooling
Minimum
Required
Identification or
Heating
Altered Heating
Efficiency
Efficiency
Cooling
Altered Cooling
Efficiency
Efficiency
Thermostat
New Duct
Name
System Type
Component
Type
Value
System Type
Component
Type
Value
Type
R -Value
Hassy, Kurt
Central gas
All new heating
AFUE
0.96
Central split AC
All new cooling
SEER
14
SetbackTher
R 6
furnace
components
components
mostat
Required Documentation:
CF2R-MCH-01-E - Space Conditioning Systems Ducts and Fans
-Duct insulation requirement for new plenums: R6.
CF2R-MCH-20-H & CF3R-MCH-20-H Duct Leakage Verification required.
-Leakage rate compliance: <_ 6%.
CF2R-MCH-22 & CF3R-MCH-22 Fan Efficacy Verification
CF2R-MCH-23 & CF3R-MCH-23 System Air Flow Rate Verification
-Compliance: Fan Efficacy 5 0.58 W/cfm and System Airflow >_ 350 cfm/ton.
- Alternative Compliance: CF2R-MCH-28 & CF3R-MCH-28 Return Duct Design Verification is an alternative to MCH -22 and MCH -23 verification.
CF2R-25-H & CF3R-MCH-25-H Refrigerant Charge Verification required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15).
Exceptions:
Heating -only systems are exempt from the 0.58 W/cfm and 350 cfm/ton requirements.
Note:
An "entirely new or replacement duct system" means at least 75 percent of the duct system is 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, coil, plenums, duct material) if the reused parts are accessible and can be sealed to prevent leakage
F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)1C)
This section does not apply to this project.
Registration Number: 215-A0213479A-000000000-0000
Registration Date/Time:
2015-08-03 08:47:38
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-08-03 08:53:07
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 3 of 3 )
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
Sanchez, Rafael
�kFl!i�alGC,il
Company:
Signature Date:
PELLE HEATING & AIR INC
2015-08-03 08:47:38
Address:
CEA/ HERS Certification Identification (if applicable):
179 SAN RAMON DRIVE
City/State/Zip:
Phone:
SAN JOSE CA 95111
(408) 978-7060
Responsible Person's Declaration statement
I certify the following under penalty of perjury, under the laws of the State of California:
1. The information provided on this Certificate of Compliance is true and correct.
2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible designer).
3. That the energy features and performance specifications, materials, components, and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the
requirements of Title 24, Part 1 and Part 6 of the California Code of Regulations.
4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents, worksheets,
calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application.
5. 1 will ensure that a registered copy of this Certificate of Compliance shall be made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable
inspections. I understand that a registered copy of this Certificate of Compliance is required to be included with the documentation the builder provides to the building owner at occupancy.
Responsible Designer Name:
Responsible Designer Signature: j��J-�
Sanchez, Rafael
%,j4�RlLC�
v
Company:
Date Signed:
PELLE HEATING & AIR INC
2015-08-03 08:47:38
Address:
License:
179 SAN RAMON DRIVE
809887
City/State/Zip:
Phone:
SAN JOSE CA 95111
(408) 978-7060
Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered document, and in noway implies Registration Provider responsibility for the accuracy of the information.
Registration Number: 215-A0213479A-000000000-0000 Registration Date/Time: 2015-08-03 08:47:38 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-08-03 08:53:07
Schema Version: 0.555SDD
r
OFFICE COPY
('OM%I NITY DEVELOPMENT DEPAR MENT
EUI DING DIVISION - CUPERTI O
APPROVED
This set of pl ns a -d soecficaticns MUST be k(pt at the
job site durin, construction. It is unla.,rful to ke any
changes or Iterations on same, or to eviate
therefrom, with ut approval from the Building Official.1411
The Stamping ef',, s plan and specifications SH LI_ NOT
be held to perin: proval of the iolation
of anv, _ .. mance or St to Law.
DATrE -
PERMIT #
!AN
H
lJ 'Y')h
F wv+'A�-
V
PLOT P N ED By
DATE � ° Z �'r*PLANNING
P�TIN4 T
c)u
Clip
p ley.
�1Up�' ttQSd(/Y
4Vguy bpm