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2016-2568
CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO:B-2016-2568 1071 NOVEMBER DIZ CUPERTINO,CA 95014-4129(362 16 015) ATKINSON CLDvIATROLLERS INC SAN JOSE,CA 95112 OWNER'S NAME: LIN RONALD AND WONG SHAN DATE ISSUED:08/23/2016 OWNER'S PHONE: o8-892-1937 i PHONE NO:(408)294-6290 LICENSED COMqACTOR'S DELL RATION BUILDING PERMIT INFO: License Class B.C Q Lic.#258540 Contractor ATKINSO A CLIMATROLLERS INC Date 92/31/2016 XBLDG _ELECT _PLUMB I hereby affirm that Ilam 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#nd effect. JOB DESCRIPTION: REPLACE(E)FURNACE;SAME LOCATION;ADD(I)A/C IN REAR I hereby affirm under penalty of perjury one of the following two declarations: YARD n. I have and vi•ill maintain a certificate of consent to self-insure for Worker's Compensatill n,as provided for by Section 3700 of the Labor Code,for the -performance of the work for which this permit is issued. 1.-; I have and will maintain Worker's Compensation Insurance,as provided for by Section 370 of the Labor Code,for the performance of the work for which this permit is iss aed. Sq.Ft Floor Area: Valuation:$9142.00 APPLICANT CERTIFICATION certify that I have red this application and state that the above information is'correct'I agree to comply with all city and county.ordinances "N Number: Occupancy Type: and state laws relat4 to building construction,and hereby authorize 36216 015 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 aganst 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 PE CE OR Additionally,the applicant understands and will comply with all non-point source regulations p r the Cupertino Municipal Code,Section 9.18. 180 DAYS F CTION. -: r Signature (r- l�/%J� Date 98/23/2016 Issued by:MELISSA NAMES Date:08/23/2016 OWNER-B MJ7 .RD . RATION 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 c f the propert3;or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for compensatio a,will do the work,and the structure is not intended or offered for inspection. sale(Sec.7044,Business&Professions Code) 2. I,as owner df the property,am exclusively contracting with licensed Signature of Applicant: contractors tJ� construct the project(Scc.7044,Business&Professions Code). Date:08/23/2016 I hereby affirm under�enalty 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 Compensatin,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 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 shall not emloy any person in any manner so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Conpensafion laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 255505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall ,•• � be deemed revoked. AOwner or authorized agent APPLICANT CERTIFICATION Date:08/23/2016 certify that I have re d this application and state that the above information is CONSTRUCTION LENDING A ENCY correct.I agree to cortIiply 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 abo te mentioned;property for inspection purposes. (We)agree Lender's Name to save indemnify anc keep harmless the City of Cupertino against liabilities, judgments,costs,anc expenses which may accrue against said City in Lender's Address consequence of the g anting of this permit. Additionally,the applicant understands and will comply with a I 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. I Signature Date 08/23/2016 Licensed Professional GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333 building(a)cupertino.org MISC f3 - Z_6 f 6 1 L PLUMBING L21,MECHANICAL ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS ® ^ DQ. APN# 36 Z OWNER NAME q/yy P ON L," EMAIL STREET ADDRESS k CI� �` * ^ FAX pp i\�1 6J1. CONTACT NAME \ APHONE yE-MAIL STREET ADDRESS f ,J J Y,STATE,ZIP �bs i] FAX cq Ii OWNER O OWNEI1-BUILDER ❑ OWNERAGENT CONTRACTOR ElCONTRACTOR AGENT ❑ ARCHITECT 1:1ENGINEER ElDEVELOPER ❑:TENANT CONTRACTOR NAME �GL✓E( DICNSE NUMBER LICENSE TYPE BUS.LIC# � I COMPANYNAME � E o A FAX r' C�C�LIN m, ; STREET ADD SS IC CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER DAME" LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK c i ul i I I TOTAL VALUATION: - a fLL t�. .»�.. 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 info tion I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state la s relating t uilding copstruction, huthorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: _ � — _. _ Date: SUPPLEMENTAL INFORMATION REQUIRED 14 YW 4;sr--t 31, MEPMiscApp 2011.doc revised 06121111 a CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E , Alterations to Space Conditioning Systems(formerly CF-IR-ALT-HVAC) (Page 1 of 3) Project Name: - - 2016-0084 Shan Wong Date Prepared: 2016-08-05 A.General Information CFIR-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 2016-0084 Shan Wong 02 Date Prepared 2016-08-05 03 ProjectLocation 1071 November Drive 04 Building Type Single family 05 " CA City Cupertino 06 Dwelling Unit Name 2016-0084 Shan Wong 07 Zip Code 95014 08 Dwelling Unit Conditioned 1200' 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 .- �� Jv F a. k AO 01 02 03 04 OS 06.<r 0T 09 10 Is the SC" I'stalhrig a AAM 3 SC System SC System CFA served systema reMgq�t nstalli g heW Sid I" taAling Jnstallmg installing Identification or Location or Area by this SC ducted containing system �or than 40 entirely new entirely new Name Served System(ft2) system? component? components? feet of ducts? duct system? SC system? Alteration Type Furnace replacement add whole house 1200 Yes Yes Yes No No No Altered space A/C 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:216-AO29334OA-000000000-0000 Registration Date/Time: 2016-08-05 14:35:22 HERS Provider:CaICERTS CA Building Energy Efficiency Standards=2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-08-05 14:35:39 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 ReplacedNew Duct or Name Type Components Type Value System Type Components, Type Value Type Duct Length R-Value Furnace Central gas Centralsplit All new All new This field or This field or e replacement AC heating AFUE 80 cooling SEER 14 Setback section is not section is not add A/C furnace components components applicable applicable Required Documentation: CF211-10CH-01-E-Space Conditioning Systems Ducts and Fan's -Duct insulation requirement for new plenums:R6. CF2R-MCH-20-H&MR-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 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 installedoraltered(applicable in CZ 2,8-15). MRMR-MCH-23&MR-MCH-23 Air Flow;!300'CFM/ton reg6ired,when MCH-25 is required. Exceptions: -Duct systems registered with HERS provider as"previously sealed are exempt from Mr H,20 Duct Le age sJE ting re m, -Heating-only systems and Air Handler/Furnace changes do not require verificatit r of Air Flo MC 3 t Refrige' 'a e Existing duct systems constructed,insulated or sealed with ashesto are exempfrom MC'- u Le kage Test. quir �rtts. fs ''' tr E. Entirely New or Complete Replacement Duc S em,with or itho t ua m �l ,. � � q p ant Ch�ngut actions 15A,.2(b)IDiia and, 0.2(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-AO29334OA-000000000.0000 Registration Date/Time: 2016-08-05 14:35:22 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-08-05 14:35:39 Schema Version:0.555SDD` 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: Faulkner,Cindy (?�yLZGULP/L Company SignatureDate: ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING&ELECTRICAL 2016-08-05 14:35:22 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, i 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;cora onents,and ,anufactured devices for the buildinf de ign gr,system design identified on this Certificate of Compliance conform to the requirements of Title 24,Part 1 and Part 6'of the CalGforrjfa Cbde of Rbu at ons 4. The building design features or system design features identified o "his Certif C f Com` f fiance are 9W t&)steha ith=the i ormatioh,provided onioth "p it W of ipU nce documents,worksheets, calculations,plans and specifications submitted to the efvrcemen ency fo ava w this butt ng pernai ap,licati 5. J will ensure that a registered'copy of this Certific f Cn phance s ilti mat♦elat+aii�le`'ttki fikte tib 1t![tYg p mrtj�,issu fort " d ,g,an a#- avaIII eOnforcement agency for all applicable inspections.I understand that a registered copy oft 4 .••.Icate of Compliance i regq'r d to be„included vvath thN cumentatioRlhe wilder provides to,the bg•I ing,owner at occupancy. Responsible Designer Name: ; m"y 'Responsible Desigher Slip re:'i I Faulkner,Cindy vl Company: Date Signed: _ ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING&ELECTRICAL 2016-08-05 14:35:22 Address: License: 1171 NORTH 4TH STREET 258540 City/State/Zip: Phone: SAN JOSE CA 95112 408-294-6290 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-AO29334OA-000000000-0000 Registration Date/Time: 2016-08-05 14:35:22 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-08-05 14:35:39 Schema Version:0.555SDD Fn T / Q- W + E G CO W,� V t C �' -u Q mAUG p, CD ju , coy N� �Irr a v rc�P��ET o A7R 7 E �; BULDING DiVISKoN-oUIPERT O, s�p� '� Er D This set of Pians and specifications N,c�J,,3'r be i Opt at the joie 8111c,during constrUctiotl. it is uniei��."Ll. to rJy �� o�3angss or c'ito E"clOrla 0-1 same,or to dev �'� tt therefrom,without approval from the Buliding Kid y --LA�� N CKEC Thi stamping�f this ins m specific'nuons SFIA1 L iNO _... !°�'41 ld`tlG3 °a<<Ctr to bo vii tae the io c5c;.on WttT�_ ofa l errBii"larlce r ate PLANNING DEp-- CUI:jq i 0*0 k ERT� 0, DxrE P ��i r iso t'3Zv WATER-CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUPERTIN`O 1 10300 TORRE AVENUE a CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333 buiidincaCaD-cupertino.oro e Owner Name M Permit Noll Address 1I2-71 ffXe� L`V!V 1. Is your real property a registered historical site? El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. ` No Go to Question 2. 2. Does your real property have a licensed plumber certifying that,due to the age or configuration of the property or its plumbing,installation of water-conserving plumbing fixtures is not technically feasible? Yes Civil Code Sections 1101.1 through 1101.8 do not apply. El The licensed plumber's certification has been provided to the Building Division. Skip the rest of the form and sign bottom of form. No Go to Question 3. 3. Is water service permanently disconnected for your building? Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. Fj IS No Go to Question 4. 4. Is your real property built and available for use or occupancy on or before January 1, 1994? ❑ No My real property is built and available for use or occupancy after January'l, 1994. Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. Yes My real property is,built and available for use or occupancy on or before January 1, 1994. Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign bottom of form.. �5. Please check ONE of the following: LJ 1VIy property is a single family residential real property. See Civil Code Section 1101.4.. On and after January 1, 2014,building alterations or improvements shall require all non-compliant plumbing fixtures to be replaced with water-conserving plumbing fixtures throughout the building.On or before January 1,2017,all non compliant plumbing fixtures shall be replaced with water-conserving plumbing fixtures (regardless of whether property undergoes alterations or improvements). My property,is:a multifamily residential real property. See Civil Code Section 1101.5. On and after January 1,.2014,specified building alterations or improvements shall require non-compliant plumbing fixtures to be replaced with water-conserving plumbing fixtures. On or before January 1,2019,all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvements). 0 My property is a commercial real property. See Civil Code Section 1101.5. On and after January 1,2014,specified building alterations or improvements shall require non-compliant plumbing,fixtures to be replaced with water-conserving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced: with water- conserving. plumbing fixtures throughout the building(regardless of whether property undergoes alterations or,improvements),. I,as the owner or owner's.agent of this property,certify under penalty of perjury that non-compliant plumbing fixtureswill be replaced prior to date specified above with water-conserving plumbing fixturesin accordance with Civil Code Sections 1101.1 through 1101.8,the current California Plumbing:Code and California Green Building,Standards Code,and manufacturer'_s. installation-requirements,,and that the water-conserving plumbing fixtures comply with the requirements as indicated in the table on the following page. Owner or Owner Ag_ent's.Signature,, Dat6: Upon completing and,signing this Cel tate,please re i o the Building Division in,order to finalyour building permit., SB407 2015.dac revised 08126115 SMOKE ]CARBO , MONOXIDE ALARMS if COMMU'MITI''D�EIUEL="OPMLNT'DEPARTNMENT m BUI:L�DING�DIVIS�ION 1 10300 TORR-AVENUE,GU'PERTINO,CIA 95014-3255 (408)777-32-28m FAX,-C408)777-3333, ��rlf€rae�taerIno ora �1f:J�.1�E1S T21s affidavit rs a self-Certification for the tstallatioil Of SII required Smoke and Carboni Mon axide Alarms for _ compliance with 2015 CT'C Section 8314 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access fdr uzspecto-ns are required. GEUXTRAL INFORMATION Exrsfi�ig sln e-fafntIy aid multi-family dwellings-shah be provided.wrtl,Smoke Alarms and Carbmt l-o'no Bide alarms When,the valuation,of addit-'1o`ns, alfe-fatiorZs,Or repairs to exiskmig dwelling omits exceeds 0061601,CSC Section 1314 and CSC S�ectia'ris 907.2.11.5 aid 420.6-require that Smoke Alla-mm amd/©�Caz��a Mono-Aide Alair,ms be izistalled in the following Iacafioy,s: AMA SIMURE ALAR14 COQ Al A Out`s de of eatch,separate keeplil,Atex in the immecfiiati<e vii of the ` Q�n4 e�e� level al a dweTiPmun'it imckudi:n basements i � � � Ca b m.I onoxlde alarms aqre mot r'e q razed in clwellmngs win-fch a k,, , t o riot coz�tarxl fcrel-b-amimg appTnan =ees atRdt a�. d=o�nroE I1a�,e an€asfit�a�cTiecl gasrage Ca�nb�i�n € aonO��icle al'a�rm�s,co�m�imned with=s ��o�e ala�rs s�natll�co�=p�-��j�� CICK.Seek oil?420F 6,amd,slialjl he a=proved by the(DYfrce of t`he°Rate Fire IVIG=shat,.. 'ower S��plgy.;It€u dwel�l`.nrng,un�tts�?i�h nud co�mnme�ciral power sr�p.;ply,,alar: !�(�s);mai,be solleliy b��texy Ram eAMH} AVe-I'�ni ;uq jts� alarr�n=s aret ex f : ' } g p i€tted to be sollelty lattery operated where repamrs.ox aij%ez'a€ mode not resift hru ffike,remme l of wall airdl ceill -rg i'MI&IM or Simm,ins vm�access,by morns,of attic,bvise en 0m•emwlt space,L�e�ex�tot CT�,C'Sectnor1.1�311.4'=_a21CSC Sect�a�s 9'QI`.2.11.�anal 420f 6.21..Azo eleet�xtrcal pe t:¢pit rsrregecls k0z€• al{a}rinse w1r=m&t b eoim,ected tai the hurldzmg, As owner o1 the above-referenced p-ifuperty;Ihl ereby certify tlhtat tl e>alazreferenceet ahm,e has/,kfie b e l,: instal€1€ed irm accord€once with the manr�u1Iaetwer's.ins::,uc =r _ , # ,1 _ , US, ncomlrli4amce with the CalrEornaia lfiu€z€1'd,Rg amd,Calif -mm-a Residenfi=al Codes.Thke altarrsms,lka=ve ke 1,tes•ted aird,ante Operational;,as o>l tghe date sigLled� Welow., v R Ijbawe read;anda:3reetfo:corra , ;with,Phe t rms;and condiffons ci#thi.s;W-3i.me, LL Lig ' <Dt