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B-2016-2917CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2917 20090 LA RODA CT CUPERTINO, CA 950144410 (369 34 033) ATKINSON CLIMATROLLERS INC SAN JOSE, CA 95112 OWNER'S NAME: CRAMB DALE S AND BILLIE R TRUSTEE DATE ISSUED: 10/13/2016 OWNER'S PHONE: 408-204-8424 PHONE NO: (408)294-6290 LICENSED CONTRACTOR'S L R TION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lic. #258540 Contractor ATKINSON CLIMATROLLERS INC Date 12/31/2016 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. 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. ,2' I have and will maintain Worker's Compensation Insurance, as provided for by t Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $4624.00 APPLICANT CERTIFICATION I 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 34 033 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 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 regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 10/13/2016 Issued by: Abby Ay OWNER -BUILDER DECLARATION Date: 10/13/2016 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 is 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 ofApplicant: contractors to constrict the project (Scc.7044, Business & Professions Code). Date: 10/13/2016 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 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 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 Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sections 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 255505, Owner or authorized agent: APPLICANT CERTIFICATION Date: 10/13/2016 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance correct. I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued (Sec. 3097, Civ C.) 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 Name to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments, costs, and expenses which may accrue against said City in 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 I understand my plans shall be used as public records. Code, Section 9.18. Licensed Signature Date 10/13/2016 Professional GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building alcupertino.arg MEP misc PROJECT ADDRESS Zft i p� �od /'� /).-° IV I�AY. IVA�A�fl�, �Qt,�WD APN # OWNER NAME t � + jI (�iQ/yy�/►Jn PHONEa�%}� 11Lf},/}j® E-MAIL STREET ADDRESS w�G V `lv CITY, STATE, • 4 YY'�'(/ FAX 200qo LK I4a c-�° W C lOt' CONTACT NAME `f PHONE E-MAIL' Y - ►____ ® NQS .�._ w�v v ° STREET ADDRES: - o U p rrT v rr n me ern IF 'OWNER ❑ OWNER -BUILDER. ❑ OWNER AGENT .CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER 11 DEVELOPER ❑ TENANT C N CT R N E LICENSE NUMBER /� �, t LI NS T P . BUS. LIC # M{F�,/��j�j�/, /Iq����/�/� �j1�`y�"(/Jj�/ �y�(�`� (/�� \�{•���,(����/,���/]j� �Y►/� A (V�INI UI U7 0 �Al UV1/I t//1 , �'11N.�G'Ii1r1A '. E-MAIi rl LI V f : ®6aL YI f �GWV IA/[ !YI ° 1/1%► e , FAX K,19 ARCHITECT/ENGINEER NAME 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 ,/I URBAN INTERFACE AREA 1 ❑ NO FLOOD ZONE ❑ NO EICHLER HOME? ❑. NO DESCRIPTION OF WORK f--. ,qW, n A f n A JAI fl fn, AA it n MEPMiscApp 2011.doc revised 06/21/11 CERTIFICATE OF COMPLIANCE CFIR-ALT 02-E Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 1 of 3 ) Project -Name: 2016- 0238 Billie Cramb T Date Prepared: 2016-10-12 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 CFIR-ALT-02 document for each dwelling unit. 01 Project Name 2016- 0238 Billie Cramb 02 Date Prepared 2016-10-12 03 Project Location 20090 La Roda Ct 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name 2016- 0238 Billie Cramb 07 Zip Code 95014 08 Dwelling Unit Conditioned 2622 entirely new entirely new Name Floor Area (ft2) System (ft2) system? component? components? feet of ducts? Number of space conditioning SC system? 09 Climate Zone 4 10 (SC) systems in this dwelling 1 Yes No No No unit. Replacement I I I �' 3 >�' �e-,, ?'^ B. Space Conditioning (SC) System Information d �asQ s 01 02 03 0 zOS s. ' 11"R7" 1 4a '^' ' 0� % 09 10 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-A0382941A-000000000-0000 Registration Date/Time: 2016-10-12 14:41:13 HERS Provider: CaICERTS CA Building Energy Efficiency Standards 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-10-12 14:41:39 Schema Version: 0.555SDD Is the SC Installing a s : �., SC System SC System CFA served 1�� System a � r�fingd t lnstallir g�`'new S - I stalls g �ris alliPg Installing Identification or Location or Area by this SC iucted containing system more than 40r entirely new entirely new Name Served System (ft2) system? component? components? feet of ducts? duct system? SC system? Alteration Type Furnace Whole House 2622 Yes No Yes No No No Altered space Replacement I I I I 1 1, 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-A0382941A-000000000-0000 Registration Date/Time: 2016-10-12 14:41:13 HERS Provider: CaICERTS CA Building Energy Efficiency Standards 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-10-12 14:41:39 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 Replaced New Duct or Name Type Components Type Value System Type Components Type Value Type Duct Length R -Value Furnace Central gas All new Central split No cooling This field or This field or This field or This field or Replacement furnace heating AFUE 80 AC component section is not section is not Setback section is not section is not components altered applicable applicable applicable applicable Required Documentation: CF2R-MCH-01-E - Space Conditioning Systems Ducts and Faris. -Duct insulation requirement for new plenums: R6. CF2R-MCH-20-H & CF3R-MCH-20-H — Duct Leakage testingrequired 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 <_ 10% leakage to outside, or seat all accessible leaks. MRWCH-25-1­1 & 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 ,FlpW ? 300,,CFM ,ton , jeorwhen MCH -25 is required., Exceptions: C ,20 Duct Leakage -Duct systems registered with HERS provider as previously sealed are ztetnof4rom,, gejestiqg req Air OWN q, -Heating-only systems and Handler/Furnace changes do not require Ver ificaticio"cif Air Flow MC 4.23,Vf Refrigerant Cha 1111 -Existing duct systems constructed, insulated or seat' from M lu UM Leakage Test�,,n with agbvstos�are exemo: All t Nqg ?0F 7T, E. Entirely New or Complete Replacement Duc i t 1 h jpment.?,yng em, w r i�lthout,�q out (SqctiQnsA0.2(4.)1Dii,, anO, 150.2(b)lE, 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-A0382941A-000000000-0000 Registration Date/Time: 2016-10-12 14:41:13 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-10-12 14:41:39 Schema Version: 0.555SDD CERTIFICATE OF COMPLIANCE CFIR-ALT 02-E Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 3 of 3 ) Documentation Author's Declaration Statement 1. l certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Faulkner, Cindy (?�%' (/ C1'a'/%�/L Company: Signature Date: ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL 2016-10-12 14:41:13 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:, I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certlflcate,of Compliance is,true and.correct. 2. ]am eligible under Division 3'dithe Russihesss and Professions' Code to.accept re ponsiis)lity for the building design or system design identified on this Certificate of Compliance (responsible designer). 3. That the energy features and pierfoiiri rice specifications,,mate'rials; tom orients, and rpanufa t d de ces for the build design ,system desi n identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of R�:u�aons � ��°�� �� i 4. The building design features or system design feature ntified on".;his Certificate of Ctam lance are intent with the c orm `. rovided o th ap(� ica,� bFnpliance documents, worksheets, , �, a calculations, plans and specifications submitted to the a orcemen gency for' this this buil rtgperrtt alicati, f3.� 'tl ',issu 5. I will ensure that a registered copy of thlssl ertificat f CrYiripliance s m a iaila> le t h the b ,itling pgtmit('s d fore Idi`r�g, and( a avajif;)bl b forcementagency for all applicable w. inspections. I understand that a register, d"copy of this t tficate of Compliance required to be iUncluded y�ith the documeptatio the guilder pC,tiYEdes tq..the b ung owner at occupancy. ate, Responsible Designer Name:; p g Responsible Designer S nature: Faulkner, Cindy Company: Date Signed: ATKINSON CLIMATROLLERS INC dba'VALLEY HEATING,COOLING & ELECTRICAL 2016-10-12 14:41:13 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-A0382941A-000000000-0000 Registration Date/Time: 2016-10-12 14:41:13 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-10-12 14:41:39 Schema Version: 0.555SDD