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15120191CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1128 KENTWOOD AVE CONTRACTOR: SERVICE CHAMPIONS PERMIT NO: 15120191 OWNER'S NAME: HILL KENNETH H AND BETSY 0 TRUSTEE 7020 COMMERCE DR DATE ISSUED: 12/22/2015 OWNER'S PHONE: PLEASANTON, CA 94588 PHONE NO: (925) 444-4444 ZA LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIALE] FURNACE REPLACEMENT IN SAME LOCATION (CLOSET) License Class �a.0 Lie. # ?0e' d Contractor'�i %-y Pt,✓1 54-, Date2—�4 t S 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 ormance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $4346 a ave and will maintain Worker's Compensation Insurance, as provided for by APN Number: 35931057.00 Occupancy Type: -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 PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITIIIN 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 DAYS FROM LAST 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 Issued by: ' Date: hr 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. RE -ROOFS: Signature - . DateR6 / 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 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 Section 3700 of the Labor Code, for the performance of the work for which this the Health & Safety Code, Sections 25505, 2553 nd 2 4. _ Owner or authorized agen : Date:% 02 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 CONSTRUCTION LENDING AGENCY 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 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 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(alcupertino.org LJ NEW CONSTRUCTION LJ ADDITION LJ ALTERATION / TI LJ REVISION/ DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS @� V 'wed �l APN # '55 Gi — 3 1 — OWNER NAIVE K J / PHONE ,�Dk X55 t)�e g E-MAIL STREET' ADDRESS ) / � �� O,WVC CITY, STATE, ZIP � E � 7 C* 1561 Sn1 ((- FAX CONTACT NAME �o n PHONE S'IRLLI' ADDRESS y� rrp G7'lY, S'C.4TL,L] ( 3 FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER R � � -n �,© LICENSE TYPE � A BUS. LIC # COMPANY NAME E-DLA[L D- l (� t �J FAX .tr STREETADDRESSCommCL CITY. STATE, l s�� I � 9N PHONI la 9 4m ARCHITECT/ENGINEL'-'R NAME LICENSE NUMBER �Cp BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE. ZIP PHONE DESCRIPTION OF WORK V. -'W -A dk ce- � q � �� /lam USE I I TYPE I OCC. I SQ.FT. I VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA I NET AREA BATHROOVI KITCI IEN OTHER REMODELAREA RE IODELAREA REMODEL AREA PORCHAREA DECK AREA TOTAL.DF;CK/PORCHARG4 GARAGEARFA: DETACH I ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? []NO ADDITION? []NO PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEW BY TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVALLETTER EICHLER HOME? ❑ NO /1 By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on th perty owner's behalf. I_h(a_ve read this application and the information I have provided is cormc ]ave read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to b ng cons c ' sentatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: ' BldgApp_2011.doc revised 06/21/11 . CQ-" CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 1125 Kentwood Ave FEE ID DATE: 12/22/2015 REVIEWED BY: Phuong APN: 35931057 BP#: A 'VALUATION: F$4,346 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair _T PRIMARY SFD or Dulex # $143 PENTAMATION FURN/AC PERMIT TYPE: USE: h"'sr F 22 A WORK Furnace replacement in same location (closet) PME Unit Fee: $143.00 PME Permit Fee: SCOPE L_ APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES A Furnace, Forced -Air 1MFR=<100 Ll 1 # $143 h"'sr F 22 . . .................. PME Unit Fee: $143.00 PME Permit Fee: $48.00 Administrative Fee: JADMIN $45.00 Work Without Permit? 0 Yes (@ No $0.00 TOTALS: A Travel Documentation Fee: I TRA VDOC $143.00 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 Thaw feet are havad n" the nraliminary information available and are only all estimate. Contact the Dept -for addli'l info. FEE ITEMS fl,ee Resolution] 1-053 U. -J.' 7,,1113) Mech. Plan Check 0.0 hrs $0.00 QTY/FEE MISC ITEMS Mech. Permit Fee: JAIPERMYT A $48.00 Other Mech. Insp. El hrsO "�ioo i.,hcp Ll PME Plan Check: $0.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Thaw feet are havad n" the nraliminary information available and are only all estimate. Contact the Dept -for addli'l info. FEE ITEMS fl,ee Resolution] 1-053 U. -J.' 7,,1113) FEE QTY/FEE MISC ITEMS 01 "In A PME Plan Check: $0.00 h"'sr F 22 . . .................. PME Unit Fee: $143.00 PME Permit Fee: $48.00 Administrative Fee: JADMIN $45.00 Work Without Permit? 0 Yes (@ No $0.00 A Travel Documentation Fee: I TRA VDOC $48.00 Strong Motion Fee: IBSEISMICR $0.56 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 ,SUBTOTALS: $285.56 $0.00 TOTAL FEE: $285.561 Revised: 10/01/2015 CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 1 of 3 ) Project Name: KENNETH HILL Date Prepared: 2015-12-21 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 KENNETH HILL 02 Date Prepared 2015-12-21 03 Project Location 1128 KENTWOOD AVE 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name KENNETH HILL 07 Zip Code 95014 08 Dwelling Unit Conditioned 0 duct system? SC system? Alteration Type System 1 Floor Area (ft2) 0 Yes No Yes No Number of space conditioning No 09 Climate Zone 4 10 (SC) systems in this dwelling 1 unit. B. Space Conditioning (SC) System Information- 01 nformation 01 02 03 3, 04:4. 05xf 06 . 07 <i 0> 09 10 the a SC System SC System CFA served system a refrigerant Installirtg new�SC Instailirg A lnstallih� $-slnstalling In Identification or Location or Area by this SC ducted ' containing system more than 40� entirely new new Name Served System (ft2) system? component? components? feet of ducts? duct system? SC system? Alteration Type System 1 Location 1 0 Yes No Yes No No No Altered space 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-A6496103A-000000000-0000 Registration Date/Time: 2015-12-21 08:22:15 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-12-21 08:22:16 Schema Version: 0.555SDD CERTIFICATE OF COMPLIANCE CFiR-ALT 02-E Alterations to Space Conditioning Systems (formerly CF -1R -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 Central gas All new Central split No cooling This field or This field or Less than or System 1 furnace heating AFUE 0.78 AC 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. 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). CF2RCF3R-MCH-23 & CF3R-MCH-23 Air Flow X300 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 venficat�nri'of Air Flow MCH 23, nr` 12efrigerant Charge MECH 25, s ` -Existing duct systems constructed, insulated or sealed with asbestos;are exempti`from MCH=20 DuGtLekage Testing rettuiremetitis 1 41 E. Entirely New or Complete Replacement Duch System, with or wiithout,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)iC) This section does not apply to this project. Registration Number: 215-A6496103A-000000000-0000 Registration Date/Time: 2015-12-2108:22:15 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-12-21 08:22:16 Schema Version: 0.5555DD 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: Sar Salazar, Barbara ara a(azar Company: Signature Date: i PERMIT E RATERS 2015-12-21 08:22:15 Address: CEA/ HERS Certification Identification (if applicable): 31225 La Baya Drive #213 City/State/Zip: Phone: West Lake Village CA 91362 818-735-7876 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, mate11 rials, 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 x 4. The building design features or system design features identified ori this Certificate of C�gmpiiance are consistent with the WormAinnprovided on ether."appucable`compliance documents, worksheets, I.calculations, plans and specifications submitted to the enforcement agency forapproval,with this bwldtng permit application bi 5. 1 will ensure that a registered copy of, this Certificatehof Compliance sholl be made;available with;the buildilig pe mit(s);issued forthg ild riW and, made available tp•the enforcement agency for all applicable inspections. I understand that a registered copy of this Certlficate of Compliancejs,required to be ncluded with the documentationgthe builder provides to the building owner at occupancy. Responsible Designer Name: a >•4! - Responsible DesigriersignatUre. , , / Salazar, Barbara arbara a azar Company: Date Signed: ON-TIME AIR CONDITIONING & HEATING INC dba SERVICE CHAMPIONS 2015-12-21 08:22:15 Address: License: 7020 COMMERCE DR 817040 City/State/Zip: Phone: PLEASANTON CA 94588 925-598-1911 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-A6496103A-000000000-0000 Registration Date/Time: 2015-12-21 08:22:15 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-12-21 08:22:16 Schema Version: 0.555SDD