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B-2016-2332 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2332 21291 MILFORD DR CUPERTINO,CA 95014-1359(326 41 095) ATKINSON CLIMATROLLERS INC SAN JOSE,CA 95112 OWNER'S NAME: CHAN EDWARD H AND TERESA B DATE ISSUED:07/18/2016 OWNER'S PHONE:650-948-3321 PHONE NO:(408)294-6290 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lie.#258540 X BLDG ELECT _PLUMB Contractor ATKINSON CLIMATROLLERS INC Date 12/31/2016 I hereby affirm that I am licensedunder the provisions of Chapter 9(commencing X MECH X RESIDENTL&L_COMMERCIAL_ — with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: REPLACE FURNACE(SAME LOCATION);(l)A/C-REAR SIDE I hereby affirm under penalty of perjury one of the following two declarations: i. 1 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. 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:$5920.00 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 326 41 095 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 expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and will comply with all non-point source regulatio er a Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. ,./,Signature— Date 7/18/2016 Issued by:Abby vende Date:07/18/2016 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: I All roofs shall be inspected prior to any roofing material being installed.If a roof is i. 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 contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:7/18/2016 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 6.95 of 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 maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 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 Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cuper' ounicipal Code;Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code, ec ons n 5505,25533,,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall ? be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION f Date:7/18/2016 I certify that I have read this application and state that the.above information is CONSTRUCTION LENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.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 ARC'HITECT'S DECLARATION and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. i understand my plans shall be used as public records. Licensed Signature Date 7/18/2016 Professional GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 M (408)777-3228• FAX(408)777-3333•buildingCcDcupertino.org in 'Zft CUPERTINO ISC [:]PLUMBING 21MECHANICAL ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS 2'. q ' e APN# ( i OWNER NAME,-, and l 5 er a UvPHONE )';K)-9 3-332-1 EMAIL STREETADDRESS CITY, STATE,ZIP LOS FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTPACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME 1€a i. R', _ „„:(.-_R LICENSE NUMBER LICE SE TYPE BUS.LIC#14 � COD PA EMAILC C � }n YB,,�, � FAX STREET ADDRESS i --p 1 CITE-/�l f Ey, .se �� q S-I k� PHONE 103-^ - o ARCHITECT/ENGINEER NAME LICENSE NUMBER (J� BUS.LIC# /j COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE r- USE OF 12 y KFD or DUPLEX ❑. MULTI-FAMILYPROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN El BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK 1(n CA V- t C-e-Y-nen- , TOTAL VALUATION: a �� IVEDBY: By my signature below,I certify to each of the f lowing: I am the property owner or authorized agent to act on the property Aner's Aehalf I have read this application and the information I have Tirojideds correct. I have read the Description of Work and verify it is accurat . I agree to comply with all applicable local ordinances and state laws relating to b 1 ng struction. I authorize representatives of Cupertino to enter the ab ov identifi'd property for inspection purposes. Signature of Applicant/Agent: Date: 4-116 SUPPLEMENTAL INFORMATION REQUIRED L jalI IiP1ts � ;IATAITB s 0 .11A ,s MEPMiscApp 2011.doc revised 06121111 - YRECEIVED JUL- ffil CERTIFICATE OF COMPLIANCE 1 lP-ALT-O -E Alterations to Space Conditioning Systems(formerly CF-IR-ALT-HVAC) BY° j Project Name: 2016-0021 Theresa and Edward Chan Date Prepared: 2016-06-30 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 CF1R-ALT-02 document for each dwelling unit. 01 Project Name 2016-0021 Theresa and Edward Chan 02 Date Prepared 2016-06-30 03 Project Location 21291 Milford Drive 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name 2016-0021 Theresa and Edward Chan Dwelling Unit Conditioned 07 Zip Code 95014 OS 1500 Floor Area(ft2) Number of space conditioning " 09 Climate Zone 4 10 (SC)systems in this dwelling 1 unit. zs � B.Space Conditioning(SC)System Infprmaticim 01 02 03' N 04 d�05 06 07 0 09 10 Is the SC lnstallmg a SC System SC System CFA served "'49,$ystem a efrigeta�t �ristallirSg neu lid tailing ' lnstalh"'g. installing Identification or Location or Area by this SC ducted containing system more than 40 entirely n entirely new Name Served System(ft2) system? component? components? feet of ducts? duct system? SC system? Alteration Type Furnace Altered space replacement add whole house 1500 Yes Yes Yes No No No conditioning system A/C 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:216-AO245201A-000000000-0000 Registration Date/Time: 2016-06-30'14:27:14 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-06-30 14:27:05 Schema Version:0.5555DD 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 Furnace All new All new This field or This field or AC replacement Central gas heating AFUE 80 Central split cooling SEER 14 Setback section is not section is not add A/C furnace components components 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&CF311-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 2 300 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 T Igg requirements -Heating-only systems and Air Handler/Furnace changes do not regUireverificat,jn`of Air Flow MCH 23,�h fr(ger�nt 8harge MI CH 25 Existing duct systems constructed,insulated or sealed with asbestos7are exemoY,from MCI0uC Lecage Test requi fiNN, y, "( i?� �•L,°•�s._ 't _ : E. Entirely New or Complete Replacement Duct System,with or ou4cluiipment Changegut(Sections, 0 2(b):1Dn 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-A0245201A-000000000-0000 Registration Date/Time: 2016-06-30 14:27:14 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-06-30 14:27:05 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: (?�% C1r000ICIt�/I2P/L Faulkner,Cindy Company: Signature Date: ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING&ELECTRICAL 2016-06-30 14:27:14 Address: CEA/HERS Certification Identification(if applicable): 1171 NORTH 4TH STREET City/State/Zip: Phone: SAN JOSE CA 95112 408-294-6290 Responsible Person's Declaration statement,', 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. lam eligible under Division 3 ofthe 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;compo�n�.ents and manufactned devices for the building design or system design identified on this Certificate of Compliance conform to the requirements of Title 24,Part land Part 6 of the California Code of li4iGlatlon5 4. The building design features or system design features identified on this Certificate of Compliance areI onsistent withthe i {ormat[o Provided o other api4licable'compliance documents,worksheets, g B Y g calculations,plans and specifications submitted+to the e(lforcement>pgency fo{44 1pfova w[th this bwlng perrilit application. 5. I will ensure that a registered copy of this Certificat f,Compliance s�ialkbp,mbd, -Vit "he huildtttg permit(5),issUP, forthe bt�ildpg an rade avalleble tcYthe,,nforcement agency for all applicable inspections.I understand that a registered copy of this Ceg icate of Compl;Iancejs required to be include with the„documep ation the„p°ilder pr4�!.�des t�,�t�e buticfmg ownerat occupancy. Responsible Designer Name: Responsible Deiign'er Signature. ruM- C�LZf,GY�i�I2P�L Faulkner,Cindy Company: Date Signed: ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING&ELECTRICAL 2016-06-30 14:27:14 Address: License: 1171 NORTH 4TH STREET 258540 City/State/Zip: Phone: SAN JOSE CA 95112 408-294-6290 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-AO245201A-000000000-0000 Registration Date/Time: 2016-06-30 14:27:14 HERS Provider,:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-06-30 14:27:05 Schema Version:0.555SDD Y 1" Y ' L 7 y, * 1 +u.'Ir.Tt:...ts:�ew.i,W..r R,s,wu9tvflra�.�.w:-,:nvedtiPUf!tiarawayµwe^Rwz�iwaoYhrst�N.Y.':�. i! PLOT PLANS CHECKED BY O w aflWAM �� —i � ,, 9 DATE _ to PLANNING DEFT � �`�� CUPERTINO d r: r m S a r �c (4- 1W% 1 �a NY; 413 rr s r, t x�� , xuemn�roarwa+xuo�'.e�+r*�..s,..�,3M*xwa,w,. �. ..,:..�lx �v..:.:> .ie .n .�. „oS:";,.r 1.r: ,�. � ,x,rr��::..,:�& ....,.. ,�,.—srs�.-:r,�sn»...,..^...,,��.r..�„•r�-^s .w,wb-t<^�..w.ra.,_r...,...zi5�� r E..;��i"UNITY DEVELOPNIENT;GEPARTMENT ;„ BUILDING DIVISION - CUPERTiNO `'. APPROVED This set of pians and specifications MUSTbe kept at the ;cb site (4 luring construction Itis unlawful to make ai y changes or, alterations on sanne, or to deviate , ' e efrom vvitinc.ut approval from the Building Official. rB e C-I ar^r;.in,cf,r,, pian and specifications SHALL NOT I ,e held to permit or to be an approver of the violation cf any pr visionsof any City Ordinanco or State Law. J' BY ODATEFFIC'O' E, � e �wnc "-S%.o-uw�aw.::•r,�.s_.a;ht:r�,,�...ae�e."�,.y h�,+:srt�;q...xsrva.,»,-iut'few«Baa.,y�.rsca:Maxx«�r�"wavz.z.=R'wv:�nwekuv�z*.r:-x�L2atasunv��.•rvW+:.�w. •x._.:::, � ......�.....,.T:-,...®-. .,..; �1