B-2016-2407 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2407
10345 NORWICH AVE CUPERTINO,CA 95014-2445(316 29 082) A R S AMERICAN
RESIDENTIAL
SERVICES OF
CALIFORNIA INC
MEMPHIS,TN 38120
OWNER'S NAME: TREAT STEPHEN P AND BARBARA W TRUSTEE DATE ISSUED:07/28/2016
OWNER'S PHONE:408-252-7431 PHONE NO:(408)286-8931
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class WARM-AIR HEATING VENTILATING AND AIR-CONDITIONING
Lic.#742039 X BLDG _ELECT _PLUMB
ContractorA R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC X_MECH X RESIDENTIAL—COMMERCIAL
Date 10/31/2017
1 hereby affirm that I am licensed under the provisions of Chapter 9(commencing JOB DESCRIPTION:
with Section 7000)of Division 3 of the Business&Professions Code and that my REPLACE FURNACE(GARAGE)&A/C UNIT(REAR YARD)
license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
1. 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
I of the work for which this permit is issued.
JL' .
, I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$13885.00
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION APN Number: Occupancy Type:
I certify that I have read this application and state that the above 316 29 082
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 PERMIT EXPIRES IF WORK IS NOT STARTED
inspection purposes. (We)agree to save indemnify and keep harmless the WITHIN 1$0 DAYS OF PERMIT ISSUANCE OR
City of Cupertino against liabilities,judgments,costs,and expenses which
may accrue against said City in consequence of the granting of this permit. 180 DAYS FROM L SPECTION.
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18.
Iss y:MELISSAN
Date:07/28/2016
Signature-',/ Date 07/28/2016 - -
RE-ROOFS:
R-B DERDECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of the installed without first obtaining an inspection,I agree to remove all new materials for
following two reasons: inspection.
1. I,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 Signature of Applicant:
sale(Sec.7044,Business&Professions Code) Date:07/28/2016
2. I,as owner of the property,am exclusively contracting with licensed
contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three declarations:
1. 1 have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will
a 1 have and will maintain Worker's Compensation Insurance,as provided for by maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Section 3700 of the Labor Code,for the performance of the work for which this Health&Safety Code,Section 25532(a)should I store or handle hazardous
permit is issued. material. Additionally,should I use equipment or devices which emit hazardous
3. I certify that in the performance of the work for which this permit is issued,I air contaminants as defined by the Bay Area Air Quality Management District I
shall not employ any person in any manner so as to become subject to the will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
the Health&Safety Code,Sections 25505,25533,and 25534.
Worker's 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 forthwith comply with such provisions or this permit shall Owner authorized agent:
Date:077//28/2016
be deemed revoked. I CONSTRUN LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance
I certify that I have read this application and state that the above information is of work's for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws Lender's Name
relating to building construction,and hereby authorize representatives of this city
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Address
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in ARCHITECT'S DECLARATION
consequence of the granting of this permit. Additionally,the applicant understands I understand my plans shall be used as public records.
and will comply with all non-point source regulations per the Cupertino Municipal
Code,Section 9.18. Licensed
GENERAL PERMIT APPLICATIONMEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildingP-cupertino.orqCUPERTINO misc
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OWNERNAME E / / Ff—en-�- PHONE�Org2�f @ E-MAIL
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❑OWNER ❑ OWNER-BUII,DER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER-7 tZo LICENSE TYPE BUS.LIC#
COMPANY NAME (CAS. Tr l l EMAIL - FAX
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ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF LOISFDorDuplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes El No FLOOD ZONE ElYes ElNO
DESCRIPTION OF WORK I /� P/ V-
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TOTAL VALUATION:
By my signature below,I certify 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 provi correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to bu' m nstruction. I authorize representatives of Cupertino to enter the above-identifieQd grope for inspection purposes.
Signature of Applicant/Agent: Dater r' `✓
PLE NTAL INFORMATION REQUIRED -'
OF;ITCE USE ONLY
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MEPMiscApp_2011.doc revised 03116111
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems(formerly CF-IR-ALT-HVAC) (Page 1 of 3)
Project Name: Steve Treat Date Prepared: 2016-07-25
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 CF1R-ALT-02 document for each dwelling unit.
01 Project Name Steve Treat 02 Date Prepared 2016-07-25
03 Project Location 10345 Norwich Ave 04 Building Type Single family
05 CA City Cupertino 06 Dwelling Unit Name Steve Treat.
07 Zip Code 95014 08 Dwelling Unit Conditioned 1500
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 O8 09 10
As the SC installing a
SC System SC System CFA served system a-== reyige afit -Installing t ewi& Installing Installing p'Installing
Identification or Location or Area by this SC ducted containing system more than 40 entirely new entirely new
Name Served System(112) system? component? components? feet of ducts? duct system? SC system? Alteration Type
System 1 Location 1 1500 Yes Yes Yes No No No Altered space
conditioning system
C.Extension of Existing Duct System,Greater Than 40 Feet(Section150.2(b)1Diib)
This section does not apply to this project.
Registration Number:216-A0276226A-000000000-0000 Registration Date/Time: 2016-07-25 10:25:18 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-07-25 10:24:48
Schema Version:4.555SDD
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
All new All new Less than or
Central gas Central split
System 1 furnace heating AfUE 80 AC cooling SEER 14 Setback. equal to 40 R-6
components components feet
Required Documentation:
CF2R-MCH-01-E-Space Conditioning Systems Ducts and Fans.
-Duct insulation requirement for new plenums:R6.
MR-MCH-20-11&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 outs I tde,,6r seal all accessible leaks.
CF2R-MCH-25-H&MR-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 x.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 Tasting requirements
-Heating-only systems and Air Handler/Furnace changes do not require verification of Air Flow,MC 23 ar Refrigeri3nt Chae MECH 2 ;'
-Existing duct systems constructed,insulated or sealed with asbestosare exempffrom MCH 2ffr u Lea age Tastmgrequi estfs. %"
x
E.Entirely New or Complete Replacement Duct Syskem with or withoui-Equipment Changeaut(Sections 150.2(h)iDna 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-A0276226A-000000000-0000 Registration Date/Time: 2016-07-25 10:25:18 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-07-25 10:24:48
Schema.Version:0.555SDD
CERTIFICATE OF COMPLIANCE CFIR-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:
Hawkins,Stephanie
Company: Signature Date:
A R 5 AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC 2016-07-25 10:25:18
Address: CEA/HERS Certification.Identification(if applicable):
965 RIDGE LAKE BLVD STE 201 742039
City/State/Zip: Phone:
MEMPHIS TN 38120 408-286-8931 X123
Responsible.Person's Declaration statement
I certify the following under penalty of perjury,under thelaws 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 devicesfor the building ds
egn or system design identified on this Certificate of Compliance conform to the
requirements of Title 24,Part 1 and Part ix of the Califorhla Code of I(eufations .,
his Certificate"0 Campfiance are,vpnststen$;wjth the!;forma n provided ori<atheerapocab,Te`compliance documents,worksheets,
4. The building design features or system design features identified oli
calculations,plans and specifications submitted to the etfforcement%agency for apprbvi(wlth this buif&g per¢�eialicatign. 5
5.. 1 will ensure that a registered copy of this Certificatry,f Compliance shall be;m�sle'auaiiable wiitttha buildutrg Permrt(s,)JssUed fort q�,ib6ild&g,andmade available,,to theanforcement agency for all applicable
inspections.I understand that registered copy of this0*4,ficate of Compliance is to beincluded with the documen, tion the boulder provides to,the building owner at occupancy.
Responsible Designer Name: -,'I Responsible Designer Signature; �r U�GfLIy
Hawkins,Stephanie
Company: Date Signed:
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC 2016-07-25 10:25:18
Address: license:
965 RIDGE LAKE BLVD STE 201 742039
City/State/Zip: Phone:
MEMPHIS TN 38120 408-286-8931 X123
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 theinformation.
Registration Number:216-A0276226A-000000000-0000 Registration Date/Time: 2016-07-25 10:25:18. HERS Provider:CaICERTS
CA Building Energy Efficiency Standards 2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-07-25 10:24:48
Schema Version:0.555SDD