B-2016-1515 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1515
10555 CORDOVA RD CUPERTINO,CA 95014-3906(342 44 041) ON-TIME AIR
CONDITIONING&
HEATING INC
PLEASANTON,CA
94588
OWNER'S NAME: DON DIEHLS DATE ISSUED:03/14/2016
OWNER'S PHONE:4089967602 PHONE NO:(925)444-4444
LICENSED COnRACTOR'S DECLARATION BUILDING PERMIT INFO:
i
i
License Class C-20 Lic.# 17 4
Contractor ON-TIME AIR CONDITIONING&HEATING INC Date 09/30/2017 X BLDG —ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing X MECH X RESIDENTIAL COMMERCIAL
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(E)FURNACE;SAME LOCATION
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
n performance of the work for which this permit is issucd.
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. 5q.Ft Floor Area: Valuation:$19349.00
APPLICANT CERTIFICATION
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 34244 041
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 CupertJapplica
bilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue ay inconsequence of the granting of this permit. WITHIN 1S0 DAYS OF PERMIT ISSUANCE OR
Additionally,tnderstands and will comply with all non-pointsource regulaCupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 3/14/2016 Issued by:PAUL O'SULLIVANf
Date:3/14/2016
OWNER-BUILDER ARAT
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS-
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. I,as owner of the property,or my employees with'wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation;will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contrasting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:3/14/2016
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
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued;I Health&Safety Code,Section 25532(a)should I store or handle hazardous
material. Additionally,should I use equipmen.4 devices which emit hazardous
shall not employ any person in any manner so as to become subject to the r
air contaminants as dermed by the Bay Area Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with tWunicipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety C 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:3/14/2016
1 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 I hereby affirm that there is a constr i n lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of works for which this permit is iss (Stec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per`the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18, 1 understand my plans shall be used as public records.
Licensed
Signature Date 3/14/2016
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION MEV
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CItP RT(NC1 ( ) FAX(408)777-3333 buildingQcupertino orgmist;
408 777-3228
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PROTECT ADDRESS� APN � - i
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CONTRACTOR NAME LICENSE NUABER LIC TYPE I BUS.LIC
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USE OF i k�„�.SFD or DUPLEX ❑ ANLTI-FAMILY I, PROJECT N-PJILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑l.'ES
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TOTAL VALUATION: -3 Vq
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By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the opertyowner s bel
alf I hay e read this
application and the infonnation I have provided is cone' I have read the Description of'Work and verify it is accurate. I agree to comp]`y with all applicable local`
ordinances and state laws relating to building co • con. I authorize representatives of Cupertino to enter the above-idem fled 1.i' inspection purposes.
Signature of Applicant/Agent:— 1
Date: � I
N TFORMATION REQUIRED
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CERTIFICATE OF COMPLIANCE CF111-ALT 02:E
Alterations to Space Conditioning Systems(formerly CF-IR-ALT-HVAC) (Page 1 of 3)
Project Name: Dort Diehls Date Prepared: 2016-03-13
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 CF1R-ALT-02 document for each dwelling unit.
01 Project Name Don Diehls 02 Date Prepared 2016-03-13
03 Project Location 10555 Cordova Rd 04 Building Type Single family
05 - CA City_- - _-- -- - Cupertino _-- - --_ -- -___-. __ -__ 06 6wellingl7nitName -Don-Di e-fifs
-- - - --
Dwelling Unit Conditioned
07 Zip Code 95014 08 Floor Area(ft2) 2048
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�
� 10
As the SC"" " Installing a -
SC System SC System " CFA served ystem a",," s refrigerant installing new SC ^Ipstal iiig 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
System 1 Location 1 2048 Yes No Yes Yes 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. v
MAR 141
BY
Registration Number:216-A0097645A-000000000-0000 Registration Date/Time: 2016-03-13 21:53:02 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-03-13 21:53:12
Schema Version:0.555SDD
w
AN
CERTIFICATE OF COMPLIANCE CF111-ALT-024
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
Central as All new No cooling This field or This field or
g Central split. Greater than
System 1 heating AFUE 0.78 component section is not section is not Setback R-6
furnace AC ___-_ 40-feet-
- ----- - --------components-s _- -___ __ _ __ ___ altered _ 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&CF3R-MCH-23 Air Flow?3010 CFM/ton required when MCH-25 is required.
Exceptions:
-Duct systems registered with HERS provider as previously sealed are exempt from MCV 20 Duct Leakage Te,,,Yn requiremer ,
-Heating-only systems and Air Handler/Furnace changes do not require verification of Air Flow MCH 23 r'Refngerant Chatge MI CAH 25 A �
Existing duct systems constructed,insulated or sealed with asbestos are exempffrom MCA-'20 Qu4t Le age Test' ,require As.
E. Entirely New or Complete Replacement Duct`S�teen with or without Eggipment Change ut(Sections 150.2(b)1Dua 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-A0097645A-000000000-0000 Registration Date/Time: 2016-03-1321:53:02 HERS Provider:CalCERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Versions 2013 Rev 1.007 Report Generated:2016-03-13 21:53:12
Schema Version:0.555SDD
CERTIFICATE OF COMPLIANCE CF111-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: n/ o
Rodriguez,April L C51
Company: Signature Date:
i PERMIT E RATERS 2016-03-13 21:53:02
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,materials components,and[manufactured devices for tie building design„osystem design identified on this Certificate of Compliance conform to the
requirements of Title 24,Part 1 and Part 6 ofthe Califorri�ia-£ode ofogulattons. "
4. The building design features or system design features identified on-this Certif cate�of CSfmpliance are�onststeh�ith the mformatin provided orrothe apjl ca„ a compliance documents,worksheets
calculations,plans and specifications submitted to the entorcementagency farapprova with this buiAng perrviit apphcatiors,. `'f
S. I will ensure that a registered copy of this Certificd�of C4jiftpliance shaltbe:mr'' a a' I, le wlti khe bdtfid3fr petmit(s)issued for the bii'ildl?g,and rade avafjabl b,the?` nforcement agency for all
g y applicable
inspections.J understand that a registered copy of this rtifiicate of Co;,npPriceej�required to be,included with the{��cum�Pption thesbifider provides tg.the building owner at occupancy,
Responsible Designer Name: Responsible DesigYrer Signature.
saa;,s
Rodriguez,April L
Company: Date Signed:
ON-TIME AIR CONDITIONING&HEATING INC dba SERVICE CHAMPIONS 2016-03-13 21:53:02
Address: License:
7020 COMMERCE DR 817040
City/State/Zip: Phone:
PLEASANTON CA 94588 925-598-1911
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:216-A0097645A-000000000-0000 Registration Date/Time: 2016-03-13 21:53:02 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-03-13 21:53:12
Schema Version:0.555SDD