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11110105 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21165 LAURETTA DR CONTRACTOR:VALLEY HEATING& PERMIT NO: 11110105 COOLING OWNER'S NAME: HSUEH CHUN I AND LI Y 1171 N 4 TH ST DATE ISSUED: 11/18/2011 1 sR'S PHONE: 4088933076 SAN JOSE,CA 95112 PHONE NO:(408)294-6290 IFLICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r_1 PLUMB r se Clens C-20 Lic.4 2 595146 MECH r RESIDENTIAL r COMMERCIAL c Contractor vQ��Q� ' Nval•:m Date till$"At/ I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE&REPLACE FURNACE&COIL (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is In full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 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. Sq.Ft Floor Area: Valuation:$3517 1 have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:32655017.00 Occupancy Type: 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 and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply //��j with all non-point source regulations per the Cupertino Municipal Code,Section Issued by;�� — - Date: 9.18. 5� may- Signature />,s 1e- 2•�>. s��"ale RE-ROOFS: OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material berg installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for hereby affirm that I am exempt from the Contractor's License Lew for one of inspection. the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). 1 hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: 1 have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should 1 use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District 1 will permit is issued, maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's OAner or t euyrlZed egeng, Compensation laws of California. If,after making this certificate of exemption,I �,/��_�ir= Date: j become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save : nify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION and expenses which may accrue against said City in consequence of the V. ,ing of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18• Licensed Professional Signature Date • CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32655017. 00 DATE ISSUED. . . . . . . : 11/18/2011 RECEIPT #. . . . . . . . . : BS000015354 REFERENCE ID # . . . : 11110105 _ SITE ADDRESS . . . . . : 21165 LAURETTA DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : HSUEH CHUN I AND LI Y ADDRESS . . . . . . . . . . : 21165 LAURETTA DR CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1662 RECEIVED FROM . . . . : VALLEY HEATING & CO CONTRACTOR . . . . . . . : ATKINSON, THOMAS LIC # 141 COMPANY . . . . . . . . . . : VALLEY HEATING & COOLING ADDRESS . . . . . . . . . . : 1171 N 4 TH ST CITY/STATE/ZIP . . . : SAN JOSE; CA 95112 TELEPHONE . . . . . . . . : (408) 294-6290 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 1.00 41. 00 0 . 00 41.00 0. 00 1BCBSC VALUATION 3,517.00 1. 00 0 . 00 1.00 0. 00 1BSEISMICR VALUATION 3,517 .00 0.50 0 . 00 0.50 0. 00 1MFR=<100 UNITS 1 .00 130. 00 0.00 130.00 0. 00 1MPERMITFE FLAT RATE 1 .00 44 . 00 0.00 44 .00 0. 00 1TRAVDOC FLAT RATE 1.00 44 . 00 0.00 44.00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 260.50 0.00 260.50 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 260.50 #22891 --------------- TOTAL RECEIPT 260.50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL • GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION • 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 M ' /� CUPERTINO (408)777-3228•FAX(408)777-3333•building0cupertino.ore ■V_ El PLUMBING MECHANICAL ELECTRICAL MISCELLANEOUS PROTECT ADDRESS 21 / 5 rei'�-A Dr AP""JZ 5 C>^( OWNER NAME Tr/'L S H NEgD^'— / EM 3i7 1 LP STREET ADDRESS / � C ,STATE,ZIP�K /I A501� FAX STREET CONTACT NAME KLU', ,I D PHONE 0 '-21 J_&'2CYDT JE-MAIL STREET ADDRESS h CITY,STATE,ZIP l_( FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR CONIRACTORAGEN'T ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT COIjTRALTOR N ME LICENSE NUMBER LICENSE TYPE BUS.LIC b 1L I y 515 0o COMPANY NAME E-MAIL FAX gen f;jf STREET ADDRESS CITY,STATE,ZIP PHONE N. 4th S�. 5 /15117- NDS-Z49-(,Z�B ARCHITECUENGINEER NAME LICENSE NUMBER BUS.LIC M COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE I, USE OF FDar DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLOG AN ❑YES BUILDING. ❑COMMERCIAL URBAN INTERFACE AR CA No FLOODZONE 0 N EICHLER HOME? NO DESCRIPTION OF WORK f r �7 I(� Il TOTAL VALUATION: 35( �" 'RECEIVEDBY',' By my signature below,I certify to each of the following: 1 am the property owner or authorized agent to act on the property owner's behalL I have read Ibis application and the information 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 laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. I Signature of ApplicanUAgent'. Date: SUPPLEMENTAL Iver SUPPLEMENTAL INFORMATION REQUIRED tiePtce use ONLY . �;� ,. OVER•TH&COUNTER '�-,I i a ❑ EXPRESS 1 r "STANDARD ❑ LARGE t O MAJORS :I ' 'p •-,I • MEPMiscApp_2011,doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION • ADDRESS: 21165 lauretta dr. DATE: 11/18/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: $3,517 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: PERMIT TYPE: WORK a lace furnace and coil SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $130 TOTALS: $130.00 i Mech.Plan Check 0.0 hrs $0.00 Plumb.Plan Cbe(.k Idea Plan ChccA Mech. Permit Fee: IMPERMIT Plumb. Pm'mU Nee: !Ziac. Pe mil Fee: Other Mech. Insp. 0.0 hrs $44.00 prAar pimuh Insp, 0 inep. d/rdi. Inv). Fee: Pluurh, loj), /'r-t: Eler.Inapt Fee: NOTE. This estimate does not Include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These fees are based on the Prelindina In ormatlon available and are only an estimate. Contact the Dept for addn'I Infa FEE ITEMS (Fee Resolution 11-053 Eff 711/11) FEE QTY/FEE MISC ITEMS Plan Cheek, Fec: StrppL PCFire PME Plan Check: $0.00 Permit Tc,?: Suppl, hts/., Fee PME Unit Fee: $130.00 PME Permit Fee: $44.00 Construction Tac Administrative Fee: IADMIN $41.00 Work Without Permit? O Yes 0 No $0.00 1 dvanaed Planning Tees: Travel Documentation Fee: ITRA VDOC $44.00 Strone Motion Fee: IBSEISMICR $0.50 Select an Administrative Item • Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $260.50 $0.001' TOTAL FEE: $260.50 Revised: 10/01/2011 INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning Systems,Ducts and Fans Pae 1 of 2 Site Address: Enforcement Agency: Permit Number: • ZU65- Lav n bi, Space Conditioning Systems Heating Equipment Duct Efficiency Location Equip (AFUE, (attic, Type ART #of etc.), crawl- Heating Heating (package- CEC Certified Mfr.Name Reference Identical (2CF-I R space, Duct Load Capacity heat um and Model Number Number Z Systems valuel' etc.) R-value tuthr (Btwhr 8r�p$o "SIL wpu Cooling Equipment Efficiency Duct Equip (SEER Location Type and EER) (attic, (package #of 1'3 crawl- Cooling Cooling • heat. CEC Certified Mfr.Name ARI Reference Identical (2! -1 space, Duct Load Capacity um and Model Number Numbers systems value 4 etc. R-value Btuthr) (Btu/hr 1.Ifproject is new construction,see Footnotes to Standards Table 151-B and Table 151-Cfor duct ceiling alternative compliance. 2.ARI Reference Number can befound by entering the equipment model number at hitp://www.aridirectory.orglari/ac.php# 3.Listed efficiency on this page must be greater than or equal(>)to the value shown on the CF-I Rform. f''t 4. When CF-IR is reference it is also applicable to the CF-IR, CF-IR-AA or CF-IR-ALT ALL BOXES MUST BE CHECKED TO BE A VALID FORM §110-§113:HVAC equipment is certified by the California Energy Commission. §150(h): Heating and/or cooling loads calculated in accordance with ASHRAE,SMACNA,or AC §150(i):Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of§112(c). V§1506)2: Pipe insulation for cooling system refrigerant suction,chilled water and brine lines meets minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entirely in conditioned space. • 2008 Residential Compliance Forms N O V 18 2011 August 2009 BY: INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning Systems,Ducts and Fans (Page 2 of 2 Site Idtess: Enforcement Agency: Permlt Number: • Ducts and Fans §150(m):Duct and Fans 0 I.All air-distribution system ducts and plenums installed,sealed and insulated to meet the requirements of CMC Sections 601,602,603,604,605 and Standard 6-5;supply-air and retum-air ducts and plenums are insulated to a minimum installed level of R-4.2 or enclosed entirely in conditioned space. Openings shall be sealed with mastic,tape or other duct-closure system that meets the applicable requirements of UL 181,UL 181 A,or UL 181 B or aerosol sealant that meets the requirements of UL 723. If mastic or tape is used to seal openings greater than 1/4 inch,the combination of mastic and either mesh or tape shall be used;and 9 I.Building cavities,support platforms for air handlers,and plenums defined or constructed with materials other than sealed sheet metal,duct board or flexible duct shall not be used for conveying conditioned air. Building cavities and support platforms may contain ducts. Ducts installed in cavities and support platforms shall not be compressed to cause reductions in the cross-sectional area of the ducts. 0 2D.Joints and seams of duct systems and their components shall not be sealed with cloth back rubber adhesive duct tapes unless such tape is used in combination with mastic and draw bands. 7.Exhaust fan systems have back draft or automatic dampers. 8.Gravity ventilating systems serving conditioned space have either automatic or readily accessible,manually operated dampers. kf9.Protection of Insulation.Insulation shall be protected from damage,including that due to sunlight,moisture, equipment maintenance,and wind.Cellular foam insulation shall be protected as above or painted with a coating that is star retardant and provides shielding from solar radiation that can cause degradation of the material. 10.Flexible ducts cannot have porous inner cores. • DECLARATION STATEMENT • I certify under penalty of perjury,under the laws of the State of California,the information provided on this form is true and correct. • I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction,or an authorized representative of the person responsible for construction(responsible person). • I certify that the installed features,materials,components,or manufactured devices identified on this certificate(the installation) conforms to all applicable codes and regulations,and the installation is consistent with the plans and specifications approved by the enforcement agency. • I reviewed a copy of the Certificate of Compliance(CF-IR)form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF-IR that apply to the installation have been met. • I will ensure that a completed,signed copy of this Installation Certificate shall be posted,or made available with the building permit(s)issued for the building,and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupuncy. Company Name: (Installing$ubcontmctor or Genenil Contractor or Builder/Owner) VA .-E Res onsible P on's Name:- Responsib n' CSLB License: • Date 'fined' Positio nh Company( rtle): Z�iy L` I r /k rlf�l1. Co C�'�5uL'Inn7'}, 2008 Residential Compliance Forms August 2009 Sim lifted Prescriptive Certificate of Compliance: 2008 Residential HVAC CF-IR-ALT-HVAC Climate Zones 16 Site Address: n Enforcement Agency: Dar Permit k: • Conditioned ' Equipment T ' List Minimum Efficiency° Floor Area Duct insulation reuiremeat Thermostat Packaged Unit Over 40 ft of ducts added or umace AFUI& r. COP replaced in unconditioned Setback Se ed b system Indoor Coil EER_ �HSPF_ ��7�..r sf s ace fnot already present, Condensing Unit EER_ Resistance —r_ R 8 (CZ 161 must be installed) Other I.Equipment Type:Choose the equipment being installed;if more than one system,use another CF-I R-ALT-HVAC for each system. 2.Minimum Equipment Efficiencies: 13 SEER,78%AFUE,7.7HSPF for typical residential systems. HERS VERIFICATION SUMMARY Listed below are four HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted.A copy of the forms shall be left on site for final inspection and a copy given to the homeowner. At final,the inspector verifies that the work listed on this form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF-6R and registered CF-4R forms(no hand filled CF-4Rs allowed)are filled out and signed. Beginning October 1,2010,a registered copy of the CF-1R and CF-6R shall also be on site for final inspection. 1.HVAC Changeout Required Forms: • All HVAC Equipment replaced CF-6R forms: MECH-04 and MECH-2I-HERS CF-4R forms: MECH-21 • Condenser Coil and/or CF-61tforms: MECH-2I-HERS door Coid/or CF-4R forms: MECH-21 uma or plit Systems:Duct leakage< 15 percent For Packaged Units: Duct leakage< 15 percent Exempted from duct leakage testing if, I.Duct system was documented to have been previously sealed and confirmed through HERS verification,or 2.Duct systems with less than 40 linear feet in unconditioned space,or 3.Existing ducts stems are constructed,insulated or sealed with asbestos • 2.New HVAC System Required Forms: • Cut in or Changeout with new ducts:(all CF-6R forms: MECH-04 and MECH-2I-HERS new ducting and all new a ui ment) I CF-4R forms: MECH-21 For Split Systems: Duct leakage<6 percent, For Packaged Units:Duct leakage<6 percent ❑ 3.New Ducts with Replacement Required Forms: • Includes replacing or installing all new ducting and/or outdoor condensing unit CF-6R forms: MECH-04 and MECH-20-HERS and/or indoor coil and/or furnace. Not all CF-4R forms:MECH-20 e ui ment chanced. For Split Systems: Duct leakage<6 percent For Packaged Units: Duct leakage<6 ercent ❑4.New Ductingover 40 feet Re uired Forms: • Includes adding or replacing more than 40 CF-6R forms: MECH-04 and MECH-2I-HERS linear feet of duct in unconditioned space. CF-4R forms: MECH-21 For splitstem or packaged units: Duct leakage< 15 percent EXCEPTION:Existing ducts stems constructed,insulated or sealed with asbestos. Contractor(Documentation Author's/Responsible Designer's Declaration Statement) I certify that this Certificate of Compliance documentation is accurate and complete. I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. • 1 certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24,Parts I and 6 of the California Code of Regulations. • The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms,worksheets,calculations,plans ands specifications submitted to the enforcement enc fora roval wit emit a lication. Name: i;_ Eta bJwx tum Signature: Company: 't Date: 1 1 l C Gell h l�.v AddII { License12 • City/State/Zip: N 4X�j,=-, 1 �s/1 2 Phone:GfAv 2008 Residential Compliance Farms March 2010 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC CF-IR-ALT-HVAC Climate Zones 16 Site Address: Enforcement Agency: .)11 'I Permit#. • ^ M Conditioned Eq ui ment Type' List Minimum Efficiency' Floor Area Duct insulation requirement Thermostat Packaged Unit Over 40 ft of ducts added or Furnace AFUE COP replaced in unconditioned Setback Inoor Coil EE �HSPF ✓S�e�rve�d�rby system s ace Qrmit a/readypresent, Condensing Unit EER_ Resistance sf �R8 (CZ 16) must be installed) Other I. Equipment Type:Choose the equipment being installed;if more than one system,use another CF-IR-ALT-HVAC for each system. 2.Minimum Equipment Efficiencies: 13 SEER,78%AFUE,7.7HSPF for typical residential systems. HERS VERIFICATION SUMMARY Listed below are four HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted.A copy of the forms shall be left on site for final inspection and a copy given to the homeowner. At final,the inspector verifies that the work listed on this forth was in fact the work completed by the installer. The inspector also verifies that each appropriate CF-6R and registered CF4R forms(no hand filled CF-4Rs allowed)are filled out and signed. Beginning October 1,2010,a registered copy of the CF-1R and CF-6R shall also be on site for final inspection. 1.HVAC Changeout Required Forms: • All HVAC Equipment replaced CF-61l.forms: MECH-04 and MECH-2I-HERS CF-411 forms: MECH-21 • Condenser Coil and/or CF-6R fors: MECH-2I-HERS • Indoor Coil and/or CF-411 fors: MECH-21 • Furnace For Split Systems: Duct leakage< 15 percent For Packaged Units: Duct leakage< 15 percent Exempted ftom duct leakage testing iF. 1.Duct system was documented to have been previously sealed and conftred through HERS verification,or 2.Duct systems with less than 40 linear feet in unconditioned space,or 3.Existing ducts stems are constructed,insulated or sealed with asbestos • 2.New HVAC System Required Forms: • Cut in or Changeout with new ducts:(all CF-61itfors: MECH-04 and MECH-2I-HERS new dueling and all new aqui I CF-4R fors: MECH-21 For Split Systems: Duct leakage<6 percent, For Packaged Units: Duct leakage<6 percent ❑ 3.New Ducts with Replacement Required Forms: • Includes replacing or installing all new ducting and/or outdoor condensing unit CF-6R fors: MECH-04 and MECH-20-HERS and/or indoor coil and/or furnace. Not all CF-4R fors:MECH-20 equipment char ed. For Split Systems:Duct leakage<6 percent For Packaged Units:Duct leakage<6 percent 4.New Ducting over 40 feet Required Forms: • Includes adding or replacing more than 40 CF-611fors: MECH-04 and MECH-2I-HERS linear feet of duct in unconditioned space. CF-4R fors: MECH-21 For split stem or packaged units: Duct leakage< 15 percent I,-f EXCEPTION:Existing duct systems constructed,insulated or sealed with asbestos. Contractor(Documentation Author's/Responsible Designer's Declaration Statement) I certify that this Certificate of Compliance documentation is accurate and complete. I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. 1 certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24,Parts 1 and 6 of the California Code of Regulations. The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance fortes,worksheets,calculations,plans ands specifications submitted to the enforcement agency f r 'th the permit application. Name: ' I'}tt'I.L Sign Company VA WAtl '►- � Date/ I �l A dr_ss: Licce se-�[ l N. � � STS V--<?;-�c� • City/State/Zip: <- Jd Lam, CA 1.i5-/I 'L Phone: C 2008 Residential Compliance Forms March 2010 Prescriptive Certificate of Compliance: Residential CF-IR-ALT Residential AlterationsPa e I of 5 • Project Name:21165 LAU R E ETA DR. Timate Zone a4 1"of Stories General Information SiteAddress:21165 LAUREETA DR. Enforcement Agency: Date:11/142011 Building Type[@ Single Family ❑Multi Family Circle the Front Orientation:N,E,S,W,or degrees Conditioned Floor Area(CFA): 2127 Project Type: Alterations Envelope Fenestration Roof x HVAC Replacement or Change Out Duct Re lacement❑Water Heater NOTE:This form is not to be used for Newly Constructed Buildings or Additions Insulation Values For Opaque Surfaces(for Furring use the Mass and Furring Strips Construction table below) Assembly Alteration ❑Opening of framed cavity alone-Alterations that involve the opening of the framed cavity ofa wall,ceiling,orfloor must install the mandatory minimum insulation value per§150for the altered assembly. Fill in Columns A-C and enter mandatory insulation value in Column N. [3 Replacement of entire assembly-Replacement ofan entire wall,ceiling,or floor assembly requires the installation of Component Package-D insulation values in Table 151-C. Fill in Columns A-J O a ue Surface Details For the furred portioned of Mass Walls see Furring Strips Construction Table below. A B C I D E F G H I I IJ Pro osed see a1, Standard Values From JA4 Table Framing Thickness, Framed Continuous JA4 Proposed Tag/ Assembly Name Material Spacing, U- JA4 Table Cavity Insulation Assembly Assembly ID' ore' and Size2 or Other' factor° Numbers R-valueE R-Value' Row/Cols U-factory Note:For furred assemblies,accounting for Continuous Insulation R-value,see Page JA4-3 and Equation 4-1. For calculatingfurred walls use the Mass and • Furring Construction table below. 1.For Tag/ID indicate the identification name that matches the building plans. 2.Indicate the Assembly Name or type:Roof/Ceiling, Walls, Floors,Slabs, Crawl Space,Doors and etc...Indicate in column G the Frame material and See:For Wood,Metal, Metal Buildings,Mass,enter 2x4,2x6,or etc... see JA4 for other possible frame type assemblies. 3. Enter the thickness for mass in inches or Spacing between framing members enter;16"or 24"OC;or Other for all other assembly description such as Concrete Sandwich Panel,Spandrel Panel,Logs,Straw Bale Panel and etc.... 4. Based on the Climate Zone;enter the equivalent U factor found in JA4 Table based on the R-Value from Table 151-B, C,or D 5.Enter the Table number that closely resembles the proposed assembly. 6. Enter the R-value that is being installed in the wall cavity or between the framing;otherwise,enter "0". 7. Enter the Continuous Insulation R-value for the proposed assembly,otherwise,enter "0". 8.Enter the row and column of the 11factor value based on Column F Table Number and enter the Assembly U factor in Column J 9.The Proposed Assembly U factor, Column J must be equal to or less than the Standard U factor in Column E to comply. Furring Stri Is Construction Table for Mass Walls Onl A B C D E F G H I J K L M Proposed Properties of Masonry and Concrete Added Interioror Exterior Insulation Walls From Reference in Furring Space from Reference Joint A ipendix Table 4.3.5,4.3.6,4.3.7 Joint Aovendix Table 4.3.13 o m U N a D d q Assembly -a �7 a `om F F v �„ = Final Mass Name or JA4 Table ,r m y 3 @ ii .E v m > Assembly Thickness' Type, Number' a > e X is ' Q > U-factora' Comment • 1 ... :-mt r-.,+,nin .",.}r". ,+'' ,eTu 1.?f^ �" Regls{i'at �„lSdtm® _...n� +HERsS,",P`o ;!' Regtsfrarron Number r t o,= 2008 Residential Compliance FormsMarch 2010, Prescriptive Certificate of Compliance: Residential CF-IR-ALT Residential Alterations Page 2 of 5 • Project Name:21165 LAU RE ETA DR. "of Stories Mass and Furring Strips Construction oolnotes 1. Indicate the type of assembly to include:Hollow Unit Masonry Walls,Solid Unit Masonry,Solid Concrete Walls,Etc. Additional assemblies can befound Reference Joint Appendix J44. . This is the U-Factor based on the thickness of the assembly in inches. . The R-value ofthe insulation to be added on the interior or exterior of the assembly. . The Calculated R-Value is the R-value of the furred out section of the assembly. .-6.The Final Assembly is calculated using Equation 4-2 or Equation 4-4of the Reference Joint AppendixJA4. The equation is the inverse of Column added to Column I Column K is the inverse from column J. 7. Insert the calculated U-actor value on to the Opaque Su ace Details in Column J FENESTRATION PROPOSED AREAS ❑Replacing window alone—Replacement windows shall meet the U-Factor and SHGC Value requirements of Component Package D in Table l5l-C. The Total Fenestration and West facing Area requirements are not applicable. [] Adding 50ft'or less of window area—Newly installed windows shall meet the U-Factar and SHGC Value requirements of Component Package D in Table 151-C. ❑ Adding more than 50ftz of window area— Newly installed windows shall meet the U-Factor and SHGC Value and the Fenestration Area requirements of Component Package D in Table 151-C.Complete the Altered Fenestration AllowedArea Table on Page 2 of the CF-IR-ALT Orientation Fenestration Type and Frame (North,East, PropsedArea Maximum Maximum NFRC or Default (Window,Glass Door orSkylight) South,West ft') U-factorz' SHGC2'1'4 Values • 1. Fenestration area is the area of total glazedproduct(i.e.glass plus frame). Exception: When a door is less than 50%glass,the fenestration area may be the glass area plus a "2 inch frame"around the glass, 2. Enter value from Component Package D Requirements in Table 151-C. 3.Actual fenestration products installed and as indicated in CF-6R-ENV Form shall be equivalent to or have a lower U factor and/or a lower SHGC value than that specified on the CF-IR ALT Form. 4.Submit a completed WS-31?Form if a reduced SHGC is calculated with exterior shading. 5.Ifapplicable at this stage enter "NFRC" or NFRC Certified windows or are CEC"Default"valuesfound in Table 116-A or B. ALTERED FENESTRATION ALLOWED AREAS(Co leteifmorethanSoft=ofenestradonisadded) A B C D E F G CFA of Allowed Existing Allowed Entire %of Fenestration Area Fenestration Area. Proposed Area,4 Dwelling CFA 2.1 Area4 Removed' Area Added' (A x B) (E-D)+C Total Fenestration Area=' ftz West Fenestration Area (Required In CZ's 2,4&7-15) 1. The Proposed West Fenestration Area includes West-sloping skylight area and any other skylight area with a pitch less than 1:12. 2. Enter 20%when no West orientation restriction or 15%when West fenestration is being installed in Climate Zones 2,4, &7-15.Note that the maximum allowed fenestration can only be 5%of the CFA as indicated in Column F Column G must be equal to or less than Column F. 3. In climate zones 2,4, 7-15,no more than 5%of the CFA is allowed for west facing glazing. 4. Existing Fenestration area must be counted toward the maximum allowed 15%or 20%of the whole building and calculated in Column G. The Proposed Area must be less than or equal to Column F. _ 5. Enter the fenestration removed as part of the alteration f any in column A 6.Enter the Fenestration area that is being added as Pori of the alteration. • RegisVationNumber RegistrationDate/Time:. s' •: NERSProvider:• _ _ 2008 Residential Compliance Forms March 2010 Prescriptive Certificate of Compliance: Residential CF-IR-ALT Residential Alterations Page 3 of 5 21o1�65t NLAUREETA DR. 4 IrmateZone N 10 of stories ROOFING PRODUCTS(COOL ROOFS)§1510912 When the area of exterior roof surface to be replaced exceeds more than 50%of the existing roof area,or more than 1,000 f ,whichever is less,the new roofing area must meet the roofing product"Cool Roof'requirements of§152(b)IHi, 151(b)IHIt,or 151(b)1HUL Check applicable alternative or exception below if the roafafteration is exemptfrom the roofing product "Cool Roof'requirements.Note:lfany one of the alternatives or exception below is checked, the Aged Solar Reflectance and Thermal Emittance requirements jar roofing products in §I 18(i)are not applicable.Do not fill table below. Cool Roofs Not Required in Climate Zones 1-12, 14,and 16 with a Low Sloped. Less or 2:12 pitch. ❑Cool Roofs Not Required in Climate Zones 1 through 9 and 16 with a Steep-Sloped Roofs(pitch greater than 2:12)and product unit weight less than 5lb/ft'. Alternatives to§152(b)IHi and§152(b)Hii,Steep-slope roof(pitch>2:11) ❑ Insulation with a thermal resistance of at least 0.85 hrft'-°F/Btu or at least a 3/4 inch air-space is added to the roof deck over an attic;or ❑ Existing ducts in the attic are insulated and sealed according to§151(f)10;or ❑ In climate zones 10, 12 and 13,with 1 ft'of free ventilation area of attic ventilation for every 150 ft'of attic floor area,and where at least 30 percent of the free ventilation area is within 2 feet vertical distance of the roof ridge;or ❑ Building has at least R-30 ceiling insulation;or ❑ Building has radiant barrier in the attic meeting the requirements of§151(02;or ❑ Building has no ducts in the attic;or ❑ In climate zones 10, 11,13 and 14,R-3 or greater roof deck insulation above vented attic. Exception to§152(b)I Hiii,Low-slope roof(pitch 51:12) ❑ Building has no ducts in the attic. Other Exceptions ❑Roofing area covered by building integrated;photovoltaic panels and solar thermal panelsare exempt from the below Cool Roof criteria. • Roof constructions that have thermal mass over the roof membrane with at least 25 lb/ft,is exec t from the below Cool Roof criteria. Note: If no CRRC-I label is available,this compliance method cannot be used,use the Performance Approach to show compliance,otherwise, Check theapplicable box below if Exem t from the Roofing Products"Cool Roof'Re uirern t: Roof Slope Product Weight Product Aged Solar Thermal CRRC Product ID Number[ < 2:12 >2:12 < 5lb/ft' > 5lb/ft= T ' r.Reeflectance''4 Emittance SRI, 13 13 [2off�.�p ❑ 13 ❑ IJ ❑ ❑ ❑ ❑ In, ❑ ❑ ❑ ❑ 174 1.The CRRC Product/D Number can be obtainedfrom the Cool Roof Rating Council's Rated Product Directory at www.coolroofs.ore/products/search.oho 2.Indicate the type ofproduct is being used for the roof rap,i.e.single-ply roof,asphalt roof,metal roof,etc. . /fthe Aged Reflectance is not available in the Cool Roof Rating Council's Rated Product Directory then use the Initial Reflectance value from the same directory and use the equation(0.2+0.7(piaiiial-0.2)to obtain a calculated aged value. Where p is the Initial Solar Reflectance. .Check box if the Aged Reflectance is a calculated value using the equation above. .Calculate the SRI value by using the SRI-Worksheet at him://www.enem,ca.¢ov/tiael4/and enter the resulting value in the SRI Column above and attach atopy of the SRI-Worksheet to the CF-I R. To apply Liquid Field Applied Coatings,the coating must be applied across the entire roof surface and meet the dry mil thickness or coverage ecommended by the coatings manufacturer and meet minimum performance requirements listed in§118(i)4. Select the applicable coating: Aluminum-Pigmented Asphalt Roof Coating ❑Cement-Based Roof Coating Other • P.I Re tstranon Ddte!/$me n ?RegtstraotCNymtier;, i ,-. :�. �_8;__.�_� _,: P�'rowder, ' 1008 Residential Compliance Forms March 2010 Prescriptive Certificate of Compliance: Residential CF-IR-ALT Residential Alterations Page 4 of 5 • Project Name:21165 LAU RE ETA DR. Climate z°"`a4 �N of Stories HVAC SYSTEMS-HEATING Minimum Duct or Piping Configuration Heating Equipment Efficiency Distribution Insulation Thermostat (Central,Split, Type and Capacity 1'23 AFUE or HSPF Type and Location' R-Value Type Spam,Package or H dronic FURNACE - 90K BTU 80% OOWNFLM IO1n000RCLOSE PROGRAMMABLE CENTRAL 1.Indicate Heating Type(Central Furnace, Wall Furnace, Heat pump,Boiler, Electric Resistance,etc.) 2.Electric resistance heating is allowed only in Component Package C,or except where electric heating is supplemental(i.e.,if total capacity <2 KW or 7.000 Btu/hr electric heating is controlled by a time-limiting device not exceeding 30 minutes). See§/51(6)3 exception. 3.Refer to the HERS Verification section on Page 4 of the CF-IR-ALT Form for additional requirements and check applicable boxes. 4. Indicate Type or Location(Ducts,Hydropic in Floor, Radiators,etc.) HVAC SYSTEMS-COOLING Minimum Efficiency Duct or Piping Configuration Cooling Equipment (SEER/EER or Distribution Insulation Thermostat (Central,Split, Type and Capacity"' COP) Type and Location' R-Value Type Spam,Package or H dronic) 1.Indicate Cooling Type(A/C,Heat pump,Evap. Cooling,etc) Z Refer to the HERS Verification section on Page 4 of the CF-I R-ALT Form for additional requirements and check applicable boxes. 3. Indicate Type or Location(Ducts, Hvdromc in Floor, Radiators,etc.) • WATER HEATING List water heaters and boilers for both domestic hot water(DHW)heaters and hydropic space heating. Individual dwelling DHW heaters must be gas or propane fired. Hot waterpipe insulation from the DHW heater to the kitchens)and on all underground hot water pipes is required in all component packages in all climate zones. External Tank Water Heater Type/Fuel Distribution Type Number In Tank Energy Factor or Insulation Type' (Standard,Recirculating)' System Capacity( al Thermal Efficienc R-Value' 1, Indicate Type(Storage Gas,Heat Pump,Instantaneous,etc.) 1. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of§150(n). The Prescriptive requirements do not allow the installation of a recirculating water heating system for single dwelling units. 3. The external water heating tank and i es shall be insulated to meet the requirements of§1500). SPECIAL FEATURES The enforcement agency should pay special attention to the Special Features specified in this checklist below. These items may require written'esti(cation and documentation andspecial verification. NEW ROOF ASSEMBLY-Radiant Barrier The radiant barrier requirement of151 2 does nota I to roof alterations. Slab Edge(Perimeter)Insulation YES NO YES:In Climate Zone 16 in Component Packages D,R-7 insulation is required. Heated Slab Insulation ❑YES NO YES:Slab ed a insulation re uired for all heated slabs in all Climate Zones. See details in Table I I8-A of the standards. Raised Slab Insulation YES NO YES: In Climate Zones I,2, 11, 13, 14& 16,R-8 insulation is required;in Climate Zones 12& 15,R-4 is required under component Package D. Thermal Mass To obtain Compliance Credit for the installation of thermal mass,use the Performance Approach. [Regls[rgtioh'INumber". '"�' 1�.r1''Y"`r'i i�r til at Date.-rme; �� - !:r� HERSProbider:' � 2008 Residential Compliance Forms _._—�.._ March 2010 Prescriptive Certificate of Compliance: Residential CF-IR-ALT Residential Alterations Pape 5 of 5) • Project Name'21165 LAUREETA DR. Climate Zone#4 1#of Stories HERS VERIFICATION SUMMARY The enforcement agency should pay special attention to the HERS Measures specified in this checklist below. A completed and signed CF-4R Form for all the measures specified shall be submitted to the building inspector before final inspection. Duct Sealing&Testing HERS verification is requiredfor this measure. ❑YES ❑x NO YES:In Climate Zones 2 and 9-16,if more than 40 linear feet of new or replacement ducts are installed in unconditioned space,the ducts are to be sealed per§152(b)IDii and the newly installed ducts are to be insulated per§151(010. ❑ EXCEPTION: Existing duct systems that are extended,which are constructed,insulated or sealed with asbestos. []YES ❑X NO YES:In Climate Zones 2 and 9-16,if the existing space-conditioning system(HVAC equipment and ducting)is replaced,the ducts are to be sealed per§152(6)1 Di. []YES IMNO YES:In Climate Zones 2 and 9-16,if the existing HVAC equipment is replaced(including the replacement of the air handler, outdoor condensing unit of a split system,cooling or heating coil,or the furnace heat exchanger)the ducts are to be sealed per§152(b)I E. ❑ EXCEPTION: Duct systems that are documented to have been previously sealed confirmed through HERS verification in accordance with procedures in the Reference Residential Appendix RA3. ❑ EXCEPTION: Duct systems with less than 40 linear feet in unconditioned space. rl EXCEPTION: Existing ducts stems constructed,insulated or sealed with asbestos. Refrigerant Charge- Split System HERS verification is requiredfor this measure. ❑YES X❑NO YES: In Climate Zones 2 and 8.15,when the existing HVAC equipment is replaced(including the replacement of the air handler,outdoor condensing unit of a split system A/C or heat pump,cooling or heating coil,or the fumace heat exchanger)a refrigerant charge measurement shall be verified per§152(b)I F. Central Fan Integrated (CFI)Ventilation System and Fan Watt Draw The ventilation requirements of§150(o)do not apply to existing residential homes. Ducted Split Systems-Air Conditioners and Heat Pumps: Airflow HERS verification is requiredfor this measure. ❑YES Q NO YES: In Climate Zones 10 through 15,when the existing space-conditioning system(HVAC equipment and ducting)is • replaced,the airflow and fan watt draw shall be verified per 152(6)1 Ci to meet the requirements of§151(t)7B. Documentation Author's Declaration Statement • 1 certify that this Certificate of Compliance documentation is accurate and complete. Name: RENT H HUGILL I Signature: Company:VALLEY HEATING & COOLING Date:11/142011 Address:1171 N. 4TH STREET If Applicable CEA or CEPS (Certification#): City/S`at`/ZIp:SAN JOSE, CA 95112 Phone:408-294-6290 Responsible Building Designer's Declaration Statement • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design identified on this Certificate of Compliance. I certify that the energy features and performance specifications for the building design identified on this Certificate of Compliance conform to the requirements of Title 24,Parts I and 6 of the California Code of Regulations. • The building design features identified on this Certificate of Compliance are consistent with the information provided to document this building design on the other applicable compliance forms,worksheets,calculations,plans and specifications submitted to the enforcement agency for approval with this building permit application. Name: Signature: Company: Date: Address: License: City/State/Zip: Phone: • For assistance or questions regarding the Energy Standards,contact the Energy Hotline at: 1-800-772-3300. Fglatrati"onNumber: r�.:. i Regisrrmiofi:D Time:7- -r HERSProJlder: • ,.'_ 2008 Residential Compliance Farms March 2010 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 O U P E RT I N O Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOBADDRESS: 2 066 La r ar, PERMIT# OWNER'S NAME: T,-,,4PHONE # g6?—y0 _ GENERAL CONTRACTOR: 1/ (( Co BUSINESS LICENSE# ! ADDRESS: '¢ q'0'A 5+' & 4CITY/ZIPCODE: '5r, *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/ Carpeting Linoleum/Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal • Sheet Rock Tile Owner/Contractor Signature Date