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 /'� /).-°
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CONTACT NAME `f PHONE E-MAIL'
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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 #
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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