15100221Lool
RECEIVED
NOV 0 4 201-5
CITY OF CUPERTINO BUILDING PERMIT INSPECTION CARD
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11843 SHASTA SPRING CT CONTRACTOR: VALLEY HEATING & PERMIT NO: 15100221
COOLING
OWNER'S NAME: SITYAMSUNDAR CHAKRAVARTHI R AND VASU
1171 N 4TH ST
DATE ISSUED: 10/28/2015
OWNER'S PHONE: 4083339777 1 SAN JOSE, CA 95112 1 PHONE NO: (408)294-6290 1
Jam LICENSED CONTRACTOR'S DECLARATION
License Class C�-, / Lic. #
Contractor Z", Date 1��2 D fr1
I hereby affirm 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:
t. 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.
2. I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply with
all non -point so(ur��e regulations per the Cupertino Municipal Code, Section 9.18.
Signature Date /Dl 2-W/ r
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
t. 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)
2. 1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
1. 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.
2. I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
3. I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I
must forthwith comply with such provisions or this permit shall be deemed
revoked.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply with
all non -point source regulations per the Cupertino Municipal Code, Section 9.18.
Signature Date
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
REPLACE FURNACE AND A/C AT SAME LOCATION O
Sq. Ft Floor Area: \\ 1 Valuation: $6940
APN Number: 36655030.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by:
Date: 10 2 2�//
RE -ROOFS:
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.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owner ora orized apart: Date: (0/2 Ir//f
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
GENERAL PERMHT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
_. 10300 T ORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 • buildinaftcuoertino.org
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PHONE,
USE OFSFD or DUPLEX ❑ MULTI-FALNhM-Y PROJECT )XMML.AND El YES PROTECT IN El YES
BUIDNO: �CONAAMCLALT I URBAN' LNTERFACE AREA NO I FLOOD 7.01�� NO
IS TIE BLDG AX Y S
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TOTP.LVA-UATION:
By my signature below, I ce. ify to each of the following: I am the property owner or authorized agent to act on the prop- L Vner'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 relatin to bu/iJing construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: ��f�`� �jt� Date: I D17 V 11 f
SU-PPLEbiENTAL IivTFORMATION REQUIRED
C'u,T
A,fEPdliscXPp_2011.d6c revised 06/21/11
CITY OF CUPERTINO
Eft
FEE ESTIMATOR - BUILDING DIVISION
APPLIANCE / EQUIP TYPE
ADDRESS: 11843 SHASTA SPRING CT
DATE: 10/28/2015
REVIEWED BY: PHUONG
UNITS
APN: 366-55-030
BP#:
*VALUATION: 1$6,940
xPERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
#
PENTAMATION FURN/AC
I PERMIT TYPE: 14
WORK
REPLACE FURNACE AND A/C AT SAME LOCATION
SCOPE
'pr)[ hisp 1"Ce
APPLIANCE / EQUIP TYPE
FEE ID
Plumb. Plan Check
QTY
UNITS
BP FEES
Glee. Permit 1:
A/C Units (<=10K cfm)
1BREMAIR
Other Elec. Insp.
1
#
$72
Furnace, Forced -Air
1MFR=<100
'pr)[ hisp 1"Ce
1
#
$143
PME Unit Fee:
$215.00
PME Permit Fee:
$48.00
� 11'110i017 T`na:
Administrative Fee: 1ADMIN
$45.00
Work Without Permit? ® Yes Q) No
$0.00
TOTALS:
Travel Documentation Fee: ITRA VDOC
$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 Pees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ef 711./13)
Mech. Plan Check 0.0 1 hrs $0.00
Plumb. Plan Check
Elec. Plan Check
Mech. Permit Fee: IMPERMIT
Glee. Permit 1:
Other Mech. Insp. 0.0 hrs $48.00
Other Plumb Insp
Other Elec. Insp.
tlech. Insp. Pipe
Plumb. lisp. Fec
Elec. 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 Pees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ef 711./13)
FEE
QTY/FEE
MISC ITEMS
,(in Check Fee:
PME Plan Check:
$0.00
Permit Fee:
'pr)[ hisp 1"Ce
PME Unit Fee:
$215.00
PME Permit Fee:
$48.00
� 11'110i017 T`na:
Administrative Fee: 1ADMIN
$45.00
Work Without Permit? ® Yes Q) No
$0.00
Travel Documentation Fee: ITRA VDOC
$48.00
Strong Motion Fee: IBSEISMICR
$0.90
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS:
$357.90
$0.00 TOTAL FEE:
$357.90
Revised: 10/01/2015
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC)
Project Name:
2015- 0317 C.R. Shymsundar I Date Prepared:
CF1R-ALT-02-E
(Page 1 of 3 )
2015-10-27
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
2015- 0317 C.R. Shymsundar
02
Date Prepared
2015-10-27
03
Project Location
11843 Shasta Spring Court
04
Building Type
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
2015- 0317 C.R. Shymsundar
07
Zip Code
95014
08
Dwelling Unit Conditioned
2300
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
Furnace and A/C
whole house
2300
Yes
Yes
Yes
No
No
No
Altered space
conditioningsystem
y
replacement
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-A6372508A-000000000-0000
Registration Date/Time:
2015-10-27 13:33:28
HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-10-27 13:33:32
Schema Version: 0.555SDD
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)1E 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 Duct
or Name
Type
Components
Type
Value
System Type
Components
Type
Value
Type
Duct Length
R -Value
Furnace and
Central gas
All new
Central split
All new
This field or
This field or
A/C
heating
AFUE
0.8
cooling
SEER
13
Setback
section is not
section is not
replacement
furnace
components
AC
components
applicable
applicable
Required Documentation:
CF2R-MCH-01-E - Space Conditioning Systems Ducts and Fans
-Duct insulation requirement for new plenums: RE.
CF2R-MCH-20-H & CF3R-MCH-20-H — 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 <_ 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 & MR -MCH -23 Air Flow >_ 300 CFM/ton required when MCH -25 is required.
Exceptions:
-Duct systems registered with HERS provider as previously sealed are exempt from MCH -20 Duct Leakage Testing requirements.
-Heating-only systems and Air Handler/Furnace changes do not require verification of Air Flow MCH -23, or Refrigerant Charge MECH-25.
-Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH -20 Duct 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)1E, F)
This section does not apply to this project.
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-A6372508A-000000000-0000
Registration Date/Time:
2015-10-27 13:33:28
HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-10-27 13:33:32
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:
Faulkner, Cindy
C1'000GCIi�ILP/L
Company:
Signature Date:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL
2015-10-27 13:33:28
Address:
CEA/ HERS Certification Identification (if applicable):
1171 NORTH 4TH STREET
City/State/Zip:
Phone:
SAN JOSE CA 95112
408-294-6290
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 enforcementagency 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 trade 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:ewc�,,Q�
Faulkner, Cindy
C�,i20LP/t'
Company:
Date Signed:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL
2015-10-27 13:33:28
Address:
License:
1171 NORTH 4TH STREET
258540
City/State/Zip:
Phone:
SAN JOSE CA 95112
408-294-6290
Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document, and in no way implies Registration Provider responsibility for the accuracy of the information.
Registration Number: 215-A6372508A-000000000-0000 Registration Date/Time: 2015-10-27 13:33:28 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-10-27 13:33:32
Schema Version: 0.555SDD