15120096CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10572 CEDAR TREE CT
CONTRACTOR: CALIFORNIA DELTA
PERMIT NO: 15120096
MECHANICAL INC
OWNER'S NAME: SPILLER MARILYN C TRUSTEE & ET AL
6056 E BASELINE RD STE 155
DATE ISSUED: 12/10/2015
OWNER'S PHONE: 4082523311
MESA, AZ 85206
PHONE NO: (866) 692-5273
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
REPLACE (E) FURNACE, SAME LOCATION
License Class ,0 Lie. # 6 7
Contractor Daz
I here 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 tinder 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: $8218
rmance of the work for which this permit is issued.
ave 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: 31634026.00
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 DA 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 D 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
l
granting of this permit. Additionally, the applicant understands and will co
Issu Date: /
with all non -point source regulations er the Cupertino Municipal Code, Section
9.18.
Signature )�at :;4_6
RE -ROOFS:
All 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. 1 will
I hereby affirm tinder 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
1 have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Secti ; 25533, and 25534.
�t-
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorize _Z D,= f
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
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 pen -nit. 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
IR
CUP ERT IN0
GENERAL PERMIT APPLICA T ION
COMMUNITY DEVELOPIdENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 9501'-3255
(408) 777-3228 • FAX (408) 777-3333 • buildingQcuoeriino.org
/S/Z-00�-6
PLU�1BIIyG ,r1,ECHANTICAL, ❑ELECTRICAL ❑MIISCELLAKEEOUS
PRO=ADDRESS l ®7 2,2
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USE 0-r ❑ SFD or DU?= ❑ MULTI-FP=Y
PROJECT LN wIIDLA—ND ❑ Yrs
PROiLCT LN ❑ YES
IS = BLDG .Ah' ❑ ti =$
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FLOOD ZOITE ❑ I;0
EICP? ER HOME? ❑ NO
DESCRIPTION OF V'ORK
TOTgL VALUATION: �2 r
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By my signztw-e below, I ce ?ir-y to each of the following: I ana the grope. ty owner or zn`uorized a�
L 0 roperty oNwDer's behalf. I have read this
application and the irnformati0n I have provided is correct. I' ve read the Description ofWork aad verify H is accurate. I agree to comply Nvith all applicable local
ordinances and state laws relat ng to building cons
231` '7e representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applican'd-.gent:
Date: l Z
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_ OI�T REQUIRED
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-V2EP "isc.4pp_2011.doc revised 06/21/11
CITY OF CUPERTINO
W�ft7 FEE ESTIMATOR — BUILDING DIVISION
APPLIANCE / EQUIP TYPE
ADDRESS: 10572 CEDAR TREE CT
TDATE: 12/10/2015
REVIEWED BY: MELISSA
UNITS
APN: 31634026
BP#:
'VALUATION: 1$8,218
*PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
#
PENTAMATION FURN/A
PERMIT TYPE:
WORK
REPLACE E FURNACE SAME LOCATION
SCOPE
Sigy)l..Insp Fee
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
Furnace, Forced -Air
1MFR=<100
1
#
$143
Mech. Plan Check 10.0 I hrs $0.00 P,,`if=arr5_P1c,r (',7w .k z /er:. '1<,ra (- ieck
Mech. Permit Fee: IMPERMIT Flec, i':i`rrtii z°" ;.
Other Mech. Insp. 0.0 hrs $48.00
pit,`?er 1le":%
�3Jo)-ib, �lerre.af:PtzG';.
WE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). 71aesefees are based on the preliminary information available and are only an estimate. Contact the Deptfor aaan'l info.
ITEMS (Fee Resolution 11-053 E . 711113]
FEE
QTY/FEE
MISC ITEMS
tFEE
1 )la,n. ("heck- Fee:
S-uppL.PC Fee
F7
PME Plan Check:
$0.00
perin it 1" ee:
Sigy)l..Insp Fee
PME Unit Fee:'
$143.00
PME Permit Fee:
$48.00
COnstruction'Tax:
Administrative Fee: IADMIN
$45.00
Work Without Permit? 0 Yes (D No
$0.00
,4V, WWA?&Phtnnh7,g T1
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: IBSEISMICR
$1.07
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$286.07
$0.00 TOTAL FEE:'
$286.07
Revised: 10/01/2015
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC)
Project Name:
10572 Cedar Tree Ct I Date Prepared:
CF1R-ALT 02-E
(Page 1 of 3 )
2015-12-08
A. General Information
CF1R-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
10572 Cedar Tree Ct
02
Date Prepared
2015-12-08
03
Project Location
10572 Cedar Tree Ct
04
Building Type
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
10572 Cedar Tree Ct
07
Zip Code
95014
08
Dwelling Unit Conditioned
1687
Floor Area (ft2)
SC System
SC System
``CFA served
system
refrigerantInstalling�nevu
Number of space conditioning
Installing
09
Climate Zone
4
10
(SC) systems in this dwelling
1
ducted
containing
system
more than 40'`
unit.
-
B. Space Conditioning (SC) System Information' 7
01
02
03
041,
06
07
OS*
09
10
is the SC
`Installing a
SC System
SC System
``CFA served
system
refrigerantInstalling�nevu
SC
Installing
Installing
Installing
Identification or
Location or Area
by this SC
ducted
containing
system
more than 40'`
entirely neve
entirely new
Name
Served
System (ft2)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
Altered space
90K BTU Furnace
Whole Home
1687
Yes
No
Yes
No
No
No
conditioning system
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-A6454077A-000000000-0000 Registration Date/Time: 2015-12-08 14:48:25
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006
Schema Version: 0.555SDD
HERS Provider: CaICERTS
Report Generated: 2015-12-08 14:48:27
CERTIFICATE OF COMPLIANCE CF111-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
90K BTU
Central gas
All new
No cooling
This field or
-This field or
Less than or
Furnace
furnace
heating
AFUE
0.96
No cooling
component
section is not
section is not
Setback
equal to 40
R-6
components
altered
applicable
applicable
feet
Required Documentation:
CF2R-MCH-01-E - Space Conditioning Systems Ducts and Fans
-Duct insulation requirement for new plenums: R6.
MR -MCH -20-1-1 & 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: 515%, or 510% leakage to outside; or seal all accessible leaks.
CF211-MCH-25-11 & 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,>_ 30&CF 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'venficati& of Air Flow MCH`23; o'r Refngera' t Charge MEC 25 ='
-Existing duct systems constructed, insulated or sealed with aslsestos are exempt from MCHI 20 Duct�Leakage Testing requirerpents
E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)1Diia andv150.2(b)1E, F)
,,,•a .
:a
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-A6454077A-000000000-0000 Registration Date/Time: 2015-12-08 14:48:25 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-12-08 14:48:27
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -1R -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:
Fiore, Stephen
.:�G�iGc°fl/ �LB�?i(%
Company:
Signature Date:
CALIFORNIA DELTA MECHANICAL INC
2015-12-08 14:48:25
Address:
CEA/ HERS Certification Identification (if applicable):
1235 GRAND AVE
City/State/Zip:
Phone:
SPRING VALLEY CA 91977
480-898-0007
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. I am eligible under Division 3 of=the Busin6` sand Professions Code to accepVresponsibility 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 Califorhia`6cle 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— ompliance documents, worksheets,
calculations, plans and specifications submitted to the enforcement agency for#approvalwith this building permlt"application.
5. 1 will ensure that a registered copy of this Certificate of Compliance shall be made av_ai(able withAhe building pe�rmit(s) issued forthe 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 budder provides to the building owner at occupancy.
Responsible Designer Name: NA`
Fiore, Stephen
Responsible Designer Signature..
Company:
Date Signed:
CALIFORNIA DELTA MECHANICAL INC
2015-12-08 14:48:25
Address:
License:
1235 GRAND AVE
811114
City/State/Zip:
Phone:
SPRING VALLEY CA 91977
480-898-0007
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-A6454077A-000000000-0000 Registration Date/Time: 2015-12-08 14:48:25 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-12-08 14:48:27
Schema Version: 0.555SDD