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15120136�: CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10202 PARISH PL CONTRACTOR: A & H HEATING PERMIT NO: 15120136 OWNER'S NAME: GAUTHIER DAVID T AND LIN VICKY Y 770 CHESTNUT ST DATE ISSUED: 12/15/2015 OWNER'S PHONE: 4087811469 SAN JOSE, CA 95110 PHONE NO: (408)279-0722 co"r LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E]COMMERCIAL REMOVE AND REPLACE FURNACE &a A/C UNIT, SAME Lic. #Ll �`— License Class Li,. LOCATION Contractor 17late `Z `J �✓� 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: 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: $5600 erformance of the work for which this permit is issued. 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: 31644039.00 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 D YS FROM LAST CALLED INSPEC4TI N. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the II f I /j.� j (5LatLL1 �S Issued b h'Z n'1 Date: / Y granting of this permit. Additionally, the applicant understands and will comply . with all nooint source regulations per the Cupertino Municipal Code, Section 9.18. p t,� 1;?C �-'� Date RE -ROOFS: is Signature All roofs shall be inspected prior to any roofing material being installed. If a roof 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 .1, 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(x) 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, Sectbons 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: _ `� //, Dated Z" 5 l 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 ri-M �c f CUPERTINO- GENERAL PERMIT APPLICATION 15G0136, COMNUNI —1Y DEVELOPIdiENT DEPART MIEN T • BUILDING DIVISION 10300 T ORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3226 • FAX (408) 777-3333 • buildinC( OUDerino.org ❑ PLUh/' 31 --TIG [ N1 Cy_kl\TICAL dLECTRICA? ❑ Ar'1SCELLA?��OUS PROJECTADDRESS 1 /1 � /rl Z 1A?N Ovv'hzR !T f �V{ r 1 g `� I PHOT -E gVig / V `'�' l 1 b j I ✓V -t [ I L STREETA.DDRESS Ciiy,�AT �i I FAX I�i � — CONTACT1\.i✓E E L P(�,� - Z 1 -62 Z z E_at r�c�r 14kee, 41' xq STREET ADDP.ESS y C _ % a Sr CITYt ", ZIP ✓C / - FAX ❑ Ow.."M ❑ ❑ 01 -N--1MAG-? COVI-FACTOR ❑ COR7P.I,CTORAG NT ❑ ARC_T�CT ❑ FvG -na ❑ DB1rLO? R ❑ T=K1J,7' C0hT14CTORT1.l,r LIC7=?�SE1gUb,0ER '2-- LICD\11z= YPB BUS. LIC- tj TZ,Y alp- �:� COIJ,PA2�Y TAIL b pwt z -LTL. ' ` r. STREETA1)DRESS �� ,moi v � c ll�(.CT ,�f CITY, Sit � Jl � 1Yfr �V/�' r/ I PHONE ^� A-RCIETECTIENGLN-EER NAME LICENSE NUMBER BUS. LIC f COW -ANY \l kIJ. E-IJhII FAX X STREET ADDRESS I CITY, STATE, ZIP I PHONE USE OF S:77 or DL?L ❑ muLTI-FAI"ELY . PROJECT N WE-DLAND ❑ YES ?ROT�CT IN ❑ : Fs IS = BLDG AN ❑ ti S Bu"MIDNIG: ❑CO1,G,=-?,cLkT- FACE AP,4 ❑ NO FI.00DZO?S ❑ NO I I LICHL=RHONE? NO DESCRIPTIO?\' OF 7VOTUC 1�11-716?v�� 6;;: &c�a2 TOTAL VALUATION: Le2(- By my signamue below, I certify to each of the following: I am the property owner or authorized agent to act on the pr-ope. y o;; per's behalf. I have read this application and the L-ifor-nation I have provided is correct. I have read the Description of'Work and verify it is accurate. I agree to comply;vith all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signat-reofA..oplicant/_kgent: Date: T � ; T t I SUPP_E?�i� i,� L Li\tO�vfATIOI� REQLL D = _ OR7qCE LSE.O�Ll ;...:... . ' .! 4. mow.: ...> n..:,- . 4...._..,:.:•.-.<+.nA..,: J-... 81 SZ�'D3RD s a z G S r. z '_ 11FF7�iscXpp_2011.doc revised 06/21/11 CITY OF CUPERTINO )519,013fo W -M FEEESTIMATOR — BUILDING DIVISION 191 ADDRESS: 10202 PARISH PLACE FEE ID DATE: 12/15/2015 REVIEWED BY: PAUL APN: 316 44 039 BP#: *VALUATION: 1$5,600 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: # $143 PENTAMATION FURN/AC PERMIT TYPE: A WORK Remove and replace Furnace & A/C Unit, Same Location SCOPE 1 # APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES Furnace, Forced -Air 1MFR=<100 1 # $143 A/C Units (<=10K cfm) 1BREMAIR 1 # $72 VOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). Thesefiees are based on the preliminary information available and are only an estimate. Contact the Dept.for aildn't info. FEE ITEMS ffee Resolution 11-053 fjff 7111131 FEE QTY/FEE MISC ITEMS PME Plan Check: -$0.00 PME Unit Fee: $215.00 PME Permit Fee: $48.00 Administrative Fee: ]ADMIN $45.00 Work Without Permit? 0 Yes (F) No $0.00 g'.Fees: Travel Documentation Fee: ITRATIDOC $48.00 Strong Motion Fee: IBSEISMICR $0.73 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 ",'SIIJATOTALSo:� $357.73 ......... . , L $0.00 TOT A FEE:, $357.73 Revised: 10/01/2015 Cupertino Village Homeowners' Association Architectural Control Request Form Complete form and mail to: Community Management Services 1935 Dry Creek Road, Campbell, CA 95008 or email to: djohnson@communitymanagement.com Requestor(s):. David Gauthier and Yicky Lin Re uest Date: 11-08-201.5 Property Address: 10202 Parish Place Home Phone: - Cell Phone: 408-781-1469 E-mail: dave.gauthier@gmail.com Description of Proposed Change: Replace existing air conditioning unit in the same location and replace the furnace in the same location. Owner Signature: Please include full details, drawings, photos, etc. Architectural Control Committee Action: 9 Approved ❑ Denied Signature: Date: /j Print Name: RECEIVED BY CERTIFICATE OF COMPLIANCE Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) Project Name: [GAUTHIER I Date Prepared: CFIR-ALT 02-E (Page 1 of 3 ) 2015-12-15 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 CF111-ALT 02 document for each dwelling unit. 01 Project Name [GAUTHIER 02 Date Prepared 2015-12-15 03 Project Location 10202 PARISH PLACE 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name [GAUTHIER 07 Zip Code 95014 08 Dwelling Unit Conditioned 1800 ;r Floor Area (ft2) SC System SC System "CFA served system i"—' ' refrigerant Number of space conditioning Installing 09 Climate Zone 4 10 (SC) systems in this dwelling 1 ducted containing t_ more than 40 unit. entirely new B. Space Conditioning (SC) Systern Information ;T * 01 02 ' 03 4 04j 05 ' (� "06 i (" 07 `: 08 09 10 ,- FIs the SC In, a ;r SC System SC System "CFA served system i"—' ' refrigerant "-,,installing new:SC Installing InstallingInstailing 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 Altered space System 1 Location 1 1800 Yes Yes Yes No No No conditioning system C. Extension of Existing Duct System, Greater Than 40 Feet (Section1S0.2(b)1Diib) This section does not apply to this project. i BY Registration Number: 215-A6480692A-000000000-0000 Registration Date/Time: 2015-12-15 12:39:59 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-12-15 12:40:01 Schema Version: 0.555SDD a CERTIFICATE OF COMPLIANCE CFIR-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 it 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 Central gas. Gas furnace Central split All new This field or This field or System 1 furnace AHU AFUE 0.8 AC cooling SEER 14 Setback section is not section is not . components applicable applicable Reauired Documentation: CF2R-MCH-01-E - Space Conditioning Systems Ducts and Fans -Duct insulation requirement for new plenums: R6. 's 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: 515%, or 510% 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). F CF2RCF3R-MCH-23 & CF3R-MCH-23 Airflow z-300;C_FM/ton requ_ired,,when MCH -25 is required._. _ Exceptions: -Duct systems registered with HERS provider as -previously sealed are exempt from MCH,r20 Duct Leakage Testing requirements.._ . -Heating-only systems and Air Handler/Furnace changes do not. requi4e'rificatio_n'iif Air Flow MCH 23, or"Refrigerant Charge MECH -Existing duct systems constructed, insulated or sealed with asbesfos_are exempt,from MCH -20 Ductieakage Testing requirements J - A. E. Entirely New or Complete Replacement Duct System, with or withoutEquipment Changeout (Sectlon5.150.2(b)Wil, and 150.2(b)1E, F) t' `':,1. 1 it`s .it i ;z}r:-:r...y,',r:?'"•.r,'. '` %...,'�`� ;,e 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-A6480692A-000000000-0000 Registration Date/Time: 2015-12-15 12:39:59 HERS Provider: CaiCERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-12-15 12:40:01 Schema Version: 0.555SDD CERTIFICATE OF COMPLIANCE CFIR-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: Phelps, Dale Company: Signature Date: A & H HEATING & AIR CONDITIONING SERVICE INC 2015-12-15 12:39:59 Address: CEA/ HERS Certification Identification (if applicable): 770 CHESTNUT STREET City/State/Zip: Phone: SAN JOSE CA 95110 408-279-0722 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. S. I will ensure that a registered copy of -this Certificate of Compliance shall be- with the buildingp'ermit(4 issued for.`the.buildir g, and made availableto.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. `- I $A Phelps, Dale Company: Date Signed: A & H HEATING & AIR CONDITIONING SERVICE INC 2015-12-15 12:39:59 Address: License: 770 CHESTNUT STREET 304472 City/State/Zip: Phone: SAN JOSE CA 95110 408-279-0722 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-A6480692A-000000000-0000 Registration Date/Time: 2015-12-15 12:39:59 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-12-15 12:40:01 Schema Version: 0.555SDD