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12010023 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7610 ORANGE BLOSSOM DR CONTRACTOR:VALLEY HEATING& PERMIT NO: 12010023 COOLING OWNER'S NAME: LI CHIN H AND PONE-JANE W 1171 N 4 TH ST DATE ISSUED:01/03/2012 0 R'S PHONE: 7742795561 SAN JOSE,CA 95112 PHONE NO:(408)294-6290 VLICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class (' W Lic.# ZSgWo 1 / MECH RESIDENTIAL COMMERCIAL Contractor 116�rll y a 7•a p Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOE&REPLACE FURNACE IN SAME LOCATION (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. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$3080 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:36611098.00 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 to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section J 9.18. Issued by: Date:` - Signature ,1.37 Date ❑ OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Date: Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I 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 Compensation laws of California. If,after making this certificate of exemption,I Owne r o iz d a nt: r 2 become subject to the Worker's Compensation provisions of the Labor Code,I must A�=.t Date:l�3/ forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter unman the above mentioned property for inspection purposes.(We)agree to save Lender's Address :nify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 6 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36611098. 00 DATE ISSUED. . . . . . . : 01/03/2012 RECEIPT #. . . . . . . . . BS000015656 REFERENCE I'D # . . . : 12010023 SITE ADDRESS 7610 ORANGE BLOSSOM DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER LI CHIN H AND PONE-JANE W ADDRESS 7610 ORANGE BLOSSOM DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5249 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 ---------- ------------- ---------- ---------- ---------- ---------- - 1ADMIN HOURS 1.00 41. 00 0. 00 41.00 0. 00 1BCBSC VALUATION 3, 080.00 1.00 0 . 00 1. 00 0. 00 1BSEISMICR VALUATION 3, 080 .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 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ----------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 7610 orange blossom dr. DATE: 01/03/2012 REVIEWED BY: bobs. APN: BP#: "VALUATION: $3,080 RPERMITTYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: p PERMIT TYPE: WORK replace furnace at same location SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1 MFR=<100 1 # $130 TOTALS: $130.00 Mech.Plan Check 0.0 hrs $0.00 Mech.Permit Fee: IMPERMIT Other Mech.Insp. Fo.0 hrs L$ NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Thesein-fees are based on the relimna in ormation available and are onlyan estimate. Contact the De t or addn'l o. FEE ITEMS (l ee Resolution 11-053 Ef. 'IL-11) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $130.00 PME Permit Fee: $44.00 Administrative Fee: (ADMIN $41.00 Work Without Permit? 0 Yes 0 No $0.00 Travel Documentation Fee: 1 TRA VDOC $44.00 i Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALST$260.50 $0.00 TOTAL FEE: $260.50 Revised: 12/04/2011 (ENFORCEMENTAGENCY CAN CUSTOMIZE WITH LETTERHEAD/SEAL) 2008 Building Energy Efficiency Standards Residential HVAC Alterations Climate Zones 1 and 3 through 7 BUSINESS AND PROFESSIONS CODE,SECTION 7110 Willful or deliberate disregard and violation of the building laws, including the California Building Code,and local permit requirements constitutes a cause for disciplinary action from the Contractors State License Board working in conjunction with the local building department. This action may consist of fines up to $5,000 per violation or suspension/revocation of a contractor's license. WHEN IS A PERMIT REQUIRED? A written construction permit shall be obtained from the enforcement agency prior to the erection,construction, reconstruction,installation,relocation,or alteration of any mechanical system,except as permitted in Appendix Chapter 1,Section 112.2 of the 2007 California Mechanical Code. Projects requiring permits include,but are not limited to: • New HVAC installation • HVAC Changeout • Replacement of furnace,coil,FAU,or condenser • Relocation of an existing HVAC unit • Adding or replacing more than 40ft ducting in unconditioned space 2008 BUILDING ENERGY EFFICIENCY STANDARDS (Title 24,Part 6) REQUIREMENTS INCLUDE: 1. Heating equipment must have a minimum 78% AFUE (Exception: Wall & floor furnaces; room heaters). 2. Central air conditioners& heat pumps less than 65,000 Btu/hr must have a minimum 13 SEER. 3. Newly installed or replaced ducts must have a minimum insulation value of R-4.2. 4. A setback type thermostat(24 hr clock with four set points)is required for all alterations. 5. New or replacement ducts must meet the mandatory requirements of Section 150(m): • All joints and openings in the in the HVAC system must be sealed. • Only UL 181,UL 181A,or UL 181B approved tapes or mastic shall be used to seal duct openings. • Connections of metals ducts and the inner core of flex ducts shall be mechanically fastened. Flex ducts must be connected using a metal sleeve/coupling. • Flex ducts that are suspended must be supported every 4ft. max for horizontal runs with no more than 2" of sag between supports and 6 ft. max for vertical runs. 6. The CF-6R-MECH-04 must be completed and signed by the installing contractor. The Inspector will collect this form and verify that the model numbers are the same as the installed equipment. 1 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-HVAC Climate Zones I and 3-7 Site Address: 7610 Orange B I O S S O M Enforcement Agency: Date: Permit#: Conditioned Duct insulation Equipment T el List Minimum Efficienc ` Floor Area requirement Thermostat Packaged Unit Over 40 ft of ducts ®x Furnace El AFUE820/6 [ICOP------ ®x Setback Served by system added or replaced in l not already Indoor Coil SEER_____ HSPF____ 1400 (1 yPresent,must be RCondensing Unit Q EER----- --------sf unconditioned space Other installed) 0 R 6 (CZ 1,3-5) 1. 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. Contractor(Documentation Author's/Responsible Designer's Declaration Statement) • I certify that this Certificate of Compliance documentation is accurate and complete. • 1 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 forms,worksheets,calculations,plans and specifications submitted to the enforcement agency for approval with the permit application. Name: Signature: Company:Valley Heating and Cooling Date: Address:1171 N4Th Street License:258540 City/State/Zip:San JOse,CA 95112 Phone:408-294-6290 2008 Residential Compliance Forms March 2010 Prescriptive Certificate of Compliance: Residential CF-IR-ALT Residential Alterations Page i of 5 Project Name:Chin hIn L I Climate Zone#A 1#of Stories General Information Site Address:761 0 Orange Blossom Enforcement Agency: Date: Building Type Single Family E]Multi Family Circle the Front Orientation:N,E,S,W,or degrees Conditioned Floor Area(CFA): 1400----------- Project Type: 0 Alterations[]Envelope[]Fenestration Roof x'HVAC ' Replacement or Chane Out MDuct Replacement[]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 of a wall,ceiling,or floor must install the mandatory minimum insulation value per§150 for the altered assembly.Fill in Columns A -C and enter mandatory insulation value in Column H. Replacement of entire assembly-Replacement of an entire wall, ceiling,or floor assembly requires the installation of Component Package-D insulation values in Table 151-C. Fill in Columns A -J. 0 pag ue Surface Details For the furred portioned of Mass W ails see Furring Strips Construction Table below. A B C D E F G H I J Proposed ee:ate Standard Values From JA4 Table Framing Thickness, Framed Continuous JA4 Proposed Tag/ Assembly Name Material Spacing, U- JA4 Table Cavity Insulation Assembly Assembly iD' or Type 2 and Size or Other factor' I Numbers R-value6 R-Value? Row/Cola U-factor9 Note:For furred assemblies,accounting for Continuous Insulation R-value,see Page JA4-3 and Equation a-1. For calculating furred 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 Size: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 U factor 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 Strips Construction Table for Mass Walls Onl A I B C I D I E F G H I J I K L M Proposed Properties of Masonry and Concrete Added interior or Exterior insulation Walls From Reference in Furring Space from Reference Joint Appendix Table 4.3.5,4.3.6,4.3.7 Joint Appendix Table 4.3.13 N UU U w .-1 0 k ❑ t T Assembly >� c o On v >a Final Mass Name or JA4 Table ;, y c Assembly Thickness' T e2 Number' Q > c x ❑ ' Q > U factorb'� Comment 2008 Residential Compliance Forms March 2010 Prescriptive Certificate of Compliance: Residential CF-IR-ALT Residential Alterations Page 2 of 5 Project Name:Chin Li Climate Zone#A 1#of Stories Mass and Furring Strips Construction(footnotes) 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 JA4. 2. This is the U-Factor based on the thickness of the assembly in inches. 3. The R-value of the insulation to be added on the interior or exterior of the assembly. 4. 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 Appendix JA 4. 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 Sur ace Details in Column J FENESTRATION PROPOSED AREAS [I Replacing window alone—Replacement windows shall meet the U-Factor and SHGC Value requirements of Component Package D in Table 151-C. The Total Fenestration and West facing Area requirements are not applicable. E]Adding 50ft2 or less ofwindow area—Newly installed windows shall meet the U-Factor and SHGC Value requirements of Component Package D in Table 151-C. Adding more than 50ft2 ofwindow 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 Allowed Area 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 or Skylight) South,West) (ft') U-factor2.3 SHG C2.3.4 Values 1. Fenestration area is the area of total glazed product(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. 5.1 a licable at this stage enter "NERC" or NERC Certi red windows or are CEC "Default"valuesfound in Table 116-A or B. ALTERED FENESTRATION ALLOW ED AREAS (Complete if more than 50ft of fenestration is added) A B C D E F G CFA of Allowed Existing Allowed Entire %of Fenestration Area Fenestration Area Proposed Areae' Dwelling CFA2.3 Area Removed' Area Added' (A x B) (E-D)+C Total Fenestration > Area2•(ft2) 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 if any in column D. 6. Enter the Fenestration area that is being added as part of the alteration. RegisiratioltIte istraliort Date,/rhxe ��- 2008 Residential Compliance Forms March 2010 Prescriptive Certificate of Compliance: Residential CF-IR-ALT Residential Alterations (Page 3 of 5 Project Name: Climate Zone# #of Stories Chin Li 4 1 ROOFING PRODUCTS (COOL ROOFS)§151(J)12 When the area of exterior roof surface to be replaced exceeds more than 50% of the existing roof area,or more than 1,000f ,whichever is less,the new roofing area must meet the roofing product"Cool Roof"requirements of§I52(b)IHi, 152(b)IHii,or 152(b)IHiii. Check applicable alternative or exception below if the roof alteration is exempt from the roofing product "Cool Roof'requirements.Note:If any one of the alternatives or exception below is checked,the Aged Solar Reflectance and Thermal Emittance requirements for roofing products in §1 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 I through 9 and 16 with a Steep-Sloped Roofs(pitch greater than 2:12)and product unit weight less than 51b/ft2. Alternatives to§152(b)1Hi and §152(b)Hii,Steep-slope roof(pitch >2:12) Insulation with a thermal resistance of at least 0.85 hr-ft2•°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(010;or In climate zones 10, 12 and 13,with 1 ft2 of free ventilation area of attic ventilation for every 150 ft2 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(f)2;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)1Hiii,Low-slope roof(pitch:52:12) Q Building has no ducts in the attic. Other Exceptions []Roofing area covered by building integrated;photovoltaic panels and solar thermal panels are exempt from the below Cool Roof criteria. Roof constructions that have thermal mass over the roof membrane with at least 25 lb/ft2 is exempt from the below Cool Roof criteria. Note:If no CRRC-1 label is available,this compliance method cannot be used,use the Performance Approach to show compliance,otherwise, Check the applicable box below if Exem t from the Roofing Products"Cool RoofRequirement: Roof Slope Product Weight Product Aged Solar Thermal CRRC Product ID Number < 2:12 >2:12 < 51b/ft2 > 51b/ft' Type 2 Reflectance"4 Emittance SRI [] [] [] Er I V-111 rU U [] [] [] [] [] [] [] 1. The CRRC Product ID Number can be obtained from the Cool Roof Rating Council's Rated Product Directory at www coo lroofs.orglyroductsisearch.php 2.Indicate the type of product is being used for the roof top,i.e.single-ply roof,asphalt roof,metal roof,etc. If the 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(Pmaial—0.2)to obtain a calculated aged value. Where pis the Initial Solar Reflectance. 4.Check box if the Aged Reflectance is a calculated value using the equation above. 5.Calculate the SRI value by using the SRI-Worksheet at hup:.;www.ener¢y.ca.uov.7itle24,and enter the resulting value in the SRI Column above and attach atopy of the SRI-Worksheet to the CF-IR. o 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____________ RegistratidnA'unher._ _ � l�.e istraal.DirteIrime: '; � v 2t 2008 Residential Compliance Forms March 2010 Prescriptive Certificate of Compliance: Residential CF-IR-ALT Residential Alterations (Page 4 of 5 Project Name:Chin ' hIn Li Climate Zone#A 1#of Stories HVAC SYSTEMS -HEATING Minimum Duct or Piping Configuration Heating Equipment Efficiency Distribution Insulation Thermostat (Central,Split, Type and Capacity''2,3 (AFUE or HSPF) Type and Location R-Value Type Space,Package or H dronic) CENTRAL/70K 80% DUCTS / ATTIC R-6 SETBACK 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§151(6)3 exception. 3.Refer to the HERS Verification section on Page 4 of the CF-IR-AL T Form for additional requirements and check applicable boxes. 4. Indicate Type or Location (Ducts,Hydronic 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 Space,Package or H dronic) 1.indicate Cooling Type(A C,Heat pump,Evap.Cooling,etc) 2.Refer to the HERS Verification section on Page 4 of the CF-/R-ALT Form for additional requirements and check applicable boxes. 3.Indicate Type or Location(Ducts,H dronic in Floor,Radiators,etc.) WATER HEATING List water heaters and boilers for both domestic hot water(DHW)heaters and hydronic space heating. Individual dwelling DHW heaters must be gas or propane fired. Hot water pipe insulation from the DHW heater to the kitchen(s)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,Recirculatin )2 System Capacity( al) Thermal Efficiency R-Value3 1.Indicate Type(Storage Gas,Heat Pump,Instantaneous,etc.) 2. 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 o §150('). SPECIAL FEATURES The enforcement agency should pay special attention to the Special Features specified in this checklist below. These items may require written 'esti kation and documentation and special verification. NEW ROOF ASSEMBLY -Radiant Barrier The radiant barrier requirement of§151( 2 does not apply to roof alterations. Slab Edge(Perimeter)Insulation YES LJNO YES:In Climate Zone 16 in Component Packages D,R-7 insulation is required. Heated Slab Insulation D YES _NO YES:Slab edge insulation required for all heated slabs in all Climate Zones. See details in Table 118-A of the standards. Raised Slab insulation UYES NO YES: In Climate Zones 1,2, 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. R gistrator�•Nwm$er � _ � lte i�iral#vn ate�?'i�te:_ � _���__�' ��v. � ��?��1de1 2008 Residential Compliance Forms March 2010 Prescriptive Certificate of Compliance: Residential CF-IR-ALT Residential Alterations Page 5 of 5 Project Name:Chin Li Climate Zone#^ 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 required for 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)1Dii and the newly installed ducts are to be insulated per§151(f)10. Q EXCEPTION: Existing duct systems that are extended,which are constructed,insulated or sealed with asbestos. DYES [FINO 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(b)1Di. []YES ONO 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)l 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. EXCEPTION: Existing ducts stems constructed,insulated or sealed with asbestos. Refrigerant Charge - Split System HERS verification is required for this measure. YES El 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 furnace 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 re uirements of 150(o)do notapply to existing residential homes. Ducted Split Systems -Air Conditioners and Heat Pumps: Airflow HERS verification is requiredfor this measure. YESx®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§I52(b)1Ci to meet the requirements of§151(f)7B. Documentation Author's Declaration Statement • I certify that this Certificate of Compliance documentation is accurate and complete. Name: Signature: Company:Valley Heating and Cooling Date: Address:1271 N 4Th Street If Applicable - CEA or CEPE (Certification#): City/State/Zip:San J o S e,C A 95112 Phone:408-294-6290 Responsible Building Designer's Declaration Statement • t 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:Valley Heating and Cooling Date: Address:1271 N 4Th Street License:258540 City/State/Zip:S a n J o S e,C A 95112 Phone: 408-294-6290 For assistance or questions regarding the Energy Standards,contact the Energy Hotline at: 1-800-772-3300. Reg3strctl)aatbr � �� � texztl .l?ate/ irae: - __, - _99 - 2008 Residential Compliance Forms March 2010 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: :76,10 PERMIT# ��-- OWNER'S NAME: Jus r PHONE# 7 �f- 2 -sSIPI GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: // 7t �, L{ $+ CITY/ZIPCODE: 1-4Pq 5 t/ 2 *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. 1 am not using any subcontractors: � -�— S�z� Signature Date Please check applicable subcontractors and complete the following information: V 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 /c2c)/ 6 `--)a3 GENERAL PERMIT APPLICATION MEP is COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINQ (408)777-3228•FAX(408)777-3333•building(ftupertino.org MIS C [:1 PLUMBING MECHANICAL n❑ELECTRICAL [:]MISCELLANEOUS PROJECT ADDRESS 7Z, V'V5 5r4n e 1� �I? 5 b �/ APN# -//- � OWNER NAME (�n1 PHONE E-MAIL STREET ADDRESS CITY, STATE,ZIP FAX F1,16) Druz 8 sa r c LQ 5�t CONTACT NAME PHONE / z D E-MAIL rt.- d l -d*.- tog-2fµ'6 STREET ADDRESS CITY,STATE,ZIP FAX 1:1OWNER 11OWNER-BUILDER ❑ OWNER AGENT 11CONTRACTOR 1' J_CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# �_ 1 1 2585 d C-ZG l ( COMPANY NAME V / E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE — C q5 z qe5e1-7_qq-62se ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ;59FD 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 i PC TOTAL VALUATION: 30 FO RECEIVED BY: (�Ct))_ By my signature below,I certifytoeach 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 information 1 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. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED 2=USE ONLY CiN vE TRE-COUNTED f © EXPRESS STANDARD U r Z © LARGE a ❑ MAJOR MEPMiscApp_201 1.doc revised 06/21/11