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B-2016-1269
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1269 10460 RAMPART AVE CUPERTINO,CA 95014-4577(369 25 012) (CALIFORNIA DELTA MECHANICAL INC) MESA,AZ 85206 OWNER'S NAME: WU QIURONG AND YU NI DATE ISSUED:01/27/2016 OWNER'S PHONE:408-981-0921 PHONE NO:888-8280707 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C20 Lic.# 18 1114 Contractor.(CALIFORNIA DELTA MECHANICAL INC)Date 01/27/2015 X BLDG —ELECT —PLUMB X MECH X RESIDENTIAL_COMMERCIAL 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. JOB DESCRIPTION: Remove and replace forced air furnace. I hereby affirm under penalty of perjury one of the following two 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. F s 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. Sq.Ft Floor Area: Valuation:$4000.00 APPLICANT CERTIFICA'T`ION 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 69 Number: Occupancy Type: 3 ordinances and state laws relating to building construction,and hereby 369 25 012 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 PERMIT EXPIRES IF WORK IS NOT STARTED expenses which may accrue against said City in consequence of the WITHIN 180.DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal 180 DAYS FROM LAST CALLED INSPECTION. Code,Section 9.18. Issued by: 1421 wry All S4# ignature Date 01/27/2015 Date:01/27/2015 OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed.If a roof is following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1. 1,as owner of the property,or my employees with wages as their sole inspection. compensation,will do the work,and the structure is not intended or offered for sale(Sec.7044,Business&Professions Code) Signature of Applicant: 2. I,as owner of the property,am exclusively contracting with licensed Date:01/27/2015 contractors to construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the z. I have and will maintain Worker's Compensation Insurance,as provided for California Health&Safety Code,Sections 25505,25533,and 25534. I will by Section 3700 of the Labor Code,for the performance of the work for which maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the this permit is issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous 3. I certify that in the performance of the work for which this permit is issued,I material. Additionally,should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the 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 Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code,Sections 2550-5;2'3383 nd 25534. -- exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shal-Nate: or authorized aggl}t:1 be deemed revoked. ''Ffjate:01/27/2015 APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance correct.I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued(Sec.3097,Civ C.) relating to building construction,and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments,costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant ARCHITECT'S DECLARATION understands and will comply with all non-point source regulations per the I understand my plans shall be used as public records. Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date 01/27/2015 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333• building Ca--) CUPERTINa cupertino.org MISC ❑PLUMBING Z MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS � � �-� APN# OWNER ME PHONE E-MAIL 1 �. w� /(��d h D -0�2. STREET AD RES CF, STATE,ZIP / O S� FAX 3 �' CONTACT NAMEPHO E-MAIL ';� �© D STVET SS CITY STATE, 'LIP FAX /y-rtes 2 2C' ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR LWCONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACT R NAM LICEFE NUMBER LICENSE TYPE BUS.LIC# -575 COMP NA E E-MAIL FAX G�1 ESS CITY,STATE,ZIP P ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ElYES IS THE BLDG AN ❑ YES BUILDING: YFD OMMERCIAL URBAN INTERFACE AREA NO FLOOD ZONE 0 EICHLER HOME? 0 DESCRIPTION OF WORK TOTAL VALUATION: RECEIVED BY:I By my signature below,I certi 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 corre I ha read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building co ction authorize representatives of Cuperti n er the above-identified property for inspe tion purposes. Signature of Applicant/Agent:_ Date: Z2- SUPPLFEN FORMATION REQUIRED OFFICE USE ONLY .. !� W OVER-THE-COUNTER. ❑ EXPRESS U '; ❑ STANDARD v. 0.. ❑'MAJOR. - MEPMiscApp_2011.doc revised 06/21/11 CERTIFICATE OF COMPLIANCE CF111-ALT 02-E Alterations to Space Conditioning Systems(formerly CF-1R-ALT-HVAC) (Page 1 of 3) Project Name: 10460 Rampart Ave Date Prepared: 2016-01-25 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 10460 Rampart Ave 02 Date Prepared 2016-01-25 03 Project Location 10460 Rampart Ave 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name 10460 Rampart Ave 07 Zip Code 95014 08 Dwelling Unit Conditioned 1518 Floor Area(ft2) Number of space conditioning 09 Climate Zone 4 10 (SC)systems in this dwelling 1 unit. B.Space Conditioning(SC)System Information 01 02 03 04 05 06 07 08 09 10 lls the SC Ins#ailing a SC System SC System CFA served syefu stem rge ang n nt :.Installieve, �Installing Installing Installing Identification or Location or Area by this SC ducted containing _ system. more than 40entirely new entirely new Name Served System(ft2) system? component? components? feet of ducts? duct system? SC system? Alteration Type 70K BTU Furnace Whole Home 1518 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. :i v Registration Number:216-A0030292A-000000000-0000 Registration Date/Time: 2016-01-25 09:58:00 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013-1.006 Report Generated:2016-01-25 07:58:36 Schema Version:0.555SDD 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)IE 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 70K BTU Central gas All new No cooling This field or This field or This field or This field or Furnace furnace heating AFUE 0.8 No cooling component section is not section is not Setback section is not section is not components altered applicable applicable applicable applicable 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:<_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&CF3R-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-23Jr Refrig&anfCharge MECH=25:1 -Existing duct systems constructed,insulated.or sealed with asbestos are exempt.from MCH 20`Duct,Leakage Testing requirements. r y. a, E. Entirely New or Complete Replacement Duct System,with or without,Equ,ipment 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:216-A0030292A-000000000-0000 Registration Date/Time: 2016-01-25 09:58:00 HERS Provider:CalCERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013-1.006 Report Generated:2016-01-25 07:58:36 Schema Version:0.555SDD CERTIFICATE OF COMPLIANCE CF111-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: .:��/,GP.jI/ �Gd'LP/ Fiore,Stephen Company: Signature Date: CALIFORNIA DELTA MECHANICAL INC 2016-01-25 09:58:00 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. 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 0art,6-of the CaliforniaCode of Regulations. 4. The building design features or system design features identified on this Certificate of Compliance are consistent with the ioformation,provided on other applicable,compliance documents,worksheets, __n. calculations,.plans and specifications submitted to the enforcement agency forjapproval with this building permit application. S. I will ensure that a registered copy of this Certificate of,Compliance shall be made available with_the building permit(s),issued for the:buiIding,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. r ,r Responsible Designer Name: ' Responsible Designer Signature. >" Fiore,Stephen Company: Date Signed: CALIFORNIA DELTA MECHANICAL INC 2016-01-25 09:58:00 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 noway implies Registration Provider responsibility for the accuracy of the information. Registration Number:216-A0030292A-000000000-0000 Registration Date/Time: 2016-01-25 09:58:00 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013-1.006 Report Generated:2016-01-25 07:58:36 Schema Version:0.555SDD