B-2016-2865 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2865
10156 E ESTATES DR CUPERTINO,CA 95014-3304(369 07 033) ON-TIME AIR
CONDITIONING&
HEATING INC
PLEASANTON,CA
94588
OWNER'S NAME: BURNS ROBERT C AND SHERRY O TRUSTEE DATE ISSUED:10/05/2016
OWNER'S PHONE:408-839-1804 PHONE NO:(925)444-4444
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-2-20 Lic.# 18 7040
Contractor ON-TIME AIRCONDITIONING&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:
REPLACE FURNACE(SAME LOCATION)
I hereby affirm under penalty of perjury one of the following two declarations:
1. I ha}a and will maintain a certificate of consent to self-insure for Worker's
Cgfnpensation,as provided for by Section 3700 of the Labor Code,for the
erformanee of the work for which this permit is issued.
have and will maintain Worker's Compensation Insurance,as provided for by
l" Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$13170.00
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 369 07 033
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 conseqquence 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 regulations perthe Cuperti.6"Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 10%5/2016 Issued by:Abby Aygnde
d, Date: 10/05/2016
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: 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. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:10/5/2016
I hereby affirm under penalty of perjury one ofthe following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. 1 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
s. 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
shall not employ any person in any manner so as to become subject to the et hazardous
air contaminants as defined by the Bay Area Air Quality Mawgement District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal,�ode,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&SafetyCode,Sec'ons 25505, 5533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall j
be deemed revoked.
"Owner or authorized agent:
APPLICANT CERTIFICATION (bate:10/5/2016
certify that I have read this application and state that the above information is Core isRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws 1 hereby affirm that there s i 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
and will comply with all non-point source regulations per the Cupertino Municipal AR uDECLARATION
Code,Section 9.18. I understand my plans shall11 bbe e used
asas public records.
Licensed
Signature Date 1015/.2018
GENERAL PERMIT APPLICATIONMEF
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE CUPERTINO,CA 95014-3255
GUP'ER.TtN0 (408)777-3228• FAX(408)777-3333• building(c)cuoertino.org I
PLUI(DING e11IECILANIC.AL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS \ APN 7
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USE OF ❑SFD.,DUPLEX ❑ mmt.TJ-FAMILY PROJECT L\\3'ILDLA\TD ❑ ITS PROJECT IN ❑YES IS THE BLDG AN ❑YES
BT,=L'\'G: ❑C0I,11,1ERCI_AL I URBAN ATERFACE AREA ❑ NO I FLOOD ZONE ❑NO EICHLER HOME? ❑ NO
DESCRIPTION OF\\%ORR
449
TOTAL\%ALUATION: / ) RECEIVED T l
By my si=nature below,f certifi,teach of the following: I ami C property owner or authorized agent to act on the prop-r ovine's behal. I have read this
application and the information I have provides rrect. I ./'e read the Description of A%ork and verify It is accurate. I aCTee to comply with all applicable local
ordinances and state laws relating to build' g
,is
ction. authorize representatives of Cupertino to enter the above-identi ed pr erty for inspection purposes.
Signature of Applicant'Agent: Date:
SUPPLEIl2ENITAL INFORMATION REQUIRED
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,AIEP>!?isc.pp_?011.doc revised 06121/11
CERTIFICATE OF COMPLIANCE CFIR-ALT-02-E
Alterations to Space Conditioning Systems(formerly CF-1R-ALT-HVAC) (Page 1 of 3
Project Name: SHERRY BURNS Date Prepared: 2016-10-04
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 MR-ALT-02 document for each dwelling unit.
01 Project Name SHERRY BURNS 02 Date Prepared 2016-10-04
- 03 Project Location - 10156 EAST ESTATES DRIVE 04 Building Type Single family
05 CA City Cupertino 06 Dwelling Unit Name SHERRY BURNS
07 Zip Code 95014 08 Dwelling Unit Conditioned 1374
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 ] w ^r a ti xa ,diRV
`T '
01 02 03' 048 ,05 �' , ,06& 07 f18 09 10
w s�
ng
the S
i essst m apt rnfrale' a t Instalhn nstalhInst
SC System SC System CFA served a°t y g 'g Irjstallirig dig ailing
�.�
s uw.r,
Identification or Location or Area by this SC ducted containing system a; more than 40 entirely new entirely new
Name Served System(ft2) system? component? components? feet of ducts? duct system? SC system? Alteration Type
System 1Location 1 1374 Yes No Yes Yes 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-A0372546A-000000000-0000 Registration Date/Time: 2016-10-04 12:16:14 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.008 Report Generated:2016-10-04 12:16:26
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 Replaced New Duct
or Name Type Components. Type Value System Type Components Type Value Type Duct Length R-Value
All new No cooling This field or This field or
Central gas Central split Greater than
System 1 AC 40 feet
heating AFUE 80 component section is not section is not Setback R-6
furnace components altered applicable applicable
Required Documentation:
CF211-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:515%,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 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 MCHy 20 Duct Leakage Testing requirements., F f
-Heating-only systems and Air Handler/Furnace changes do not require verification of Air Flow MCH 23x, r Refrlge giant Charge MEGH 25Ai
Existing duct systems constructed,insulated or sealed with asbestos•are exem�iYfrom MCH-20)JuctLealCage Testing;,reuirement5 �r t� � i�
.^*, zflr„s �vf, ,t•e`' ,�rrc '�`E � ,t,„. �A� �„� t'''z fi;4�' ��yi �gt„� ���'� �,M1�,
am s yrc t y7m „>, 1 a„ u111,14
E. Entirely New or Complete Replacement Duct System,wi}}h or without Equipment Cuhangeout(Sections,1501 2(;b)lDna and 1501(b)H F)
1 �.Mel1PY, x; �,i�ta
"Nm 11,”,
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-A0372546A-000000000-0000 Registration Date/Time: 20.16-10-04 12:16:14 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.008 Report Generated:2016-10-04 12:16:26
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:
Queen, Drew 96W Quem
Company: Signature Date:
i PERMIT E RATERS 2016-10-04 12:16:14
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 fort e building design o r system design identified on this Certificate of Compliance conform to the
requirements of Title 24,Part 1 and Part6 of the California Code of Regulations ff rf W " i'Y rix' p
4. The building design features or system design features identified oritthis Certificate,bf Cbm�liance are 1co,sistehit,w tt the ir}forma bnaprovided onrybth �appi cable compliance documents,worksheets,
p p g Y f�kp a g per it app lication. a
calculations, laps and specifications submitted to the enforcement a enc for,„a roval with this buildin m
ter; jx ,h w,lom� j. r! A �,.
S. I will ensure that a registered copy of thiis,Certificate 6&66, pliance shall he,ma€(e aiiail8hle with he 6, ldingipermit(s)issudd forithe�b`uilding,an ac(e avatiible to^they hforcement agency for all applicable
inspections.I understand that a registered copy of this Certificate of Conp4pnce is required to be jncluded v jth the,document tion the h t(Ider pr des tctl e bu d ng owner at occupancy.
t.,.u. F Res onsible Desi ner Si'natiiire: ¢'i:vf” �
Queen, Drew `
Responsible Designer Name: � p g' g �„." � �
� UC�P/l2
Company: Date Signed:
ON-TIME AIR CONDITIONING&HEATING INC dba SERVICE CHAMPIONS 2016-10-04 12:16:14
Address: License:
7020 COMMERCE DR 817040
City/State/Zip: Phone:,
PLEASANTON CA 94588 925-598-1911
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-A0372546A-000000000-0000 Registration Date/Time: . 2016-10-04 12:16:14 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1,008 Report Generated:2016-10-04 12:16:26
Schema Version:0.555SDD