14080198CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10430 PRUNE TREE LN CONTRACTOR: AAA FURNACE & AIR PERMIT NO: 14080198
CONDITIONING
OWNER'S NAME: MINDER RICHARD D AND VALERIE L 1712 STONE AVE DATE ISSUED: 08/19/2014
OWNER'S PHONE: 4082063700 SAN JOSE, CA 95125 PHONE NO: (408)293-4717
,tel LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
n� REMOVE AND REPLACE (E) FURNACE AND A/C COIL
License Class Lic.# -7� ��'"
Contractor 1' J rN�i c Date
I hereby affirm that I am licensed under the provisions of Chapter 9
(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: $8885
I 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 APN Number: 31633120 00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter 180 DAYS FRQM�IjAST CALLED INSPECTION.
upon the above mentioned property for inspection purposes. (We) agree to save CCS\
indemnify and keep harmless the City of Cupertino against liabilities, judgments, C,/ /'+O`
costs, and expenses which may accrue against said City in consequence of the Issued by: Date: !.
granting of this permit. Additionally, the applicant understands and will comply
with on -p source regul ions per the Cupertino Municipal Code, Section
9
Q / RE -ROOFS:
Signature Date V l All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
❑ OWNER -BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I, 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,
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain complia� Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Sa Code, Sections 505, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent. Dater
permit is issued.
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
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
upon the above mentioned property for inspection purposes. (We) agree to save ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional
9 18.
Signature Date
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 - building(5-cuoertino.org
1-1 11 11 nnTn_ I:W' AT. rAT r— Tr=V('-I'R1c'_AL F I ZSCELLANEOUS
MEP
MISC
PROJECT ADDRESS # r f n � 3 � Z�
10430 � J vi -c/ TMO � � ; 1AP`
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STREETADDRESS�
(V C Z•IP I FAX
CONTACT NAPHONE E-MAIL
ME
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ O'MM-BUILDER ❑ 0'%W RAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCtTITECT ❑ ENGn,-=. ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME A LICENSEMMBER-i�{ti(�It E �E
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BUS. LIC
COMPANY NAME
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ARCHlTECUENGINEER NAME LICENSE NUMBER
I BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CRY, STATE, ZIP
PHONE
USE OFFD or DUPLEX ❑ MULTI -FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑ YES
ZONE ,2\/�rv�
BUILDING: ❑ CoboaRCLAL URBAN ITTERFACE AREA ��0
LS TIM BLDG AN ❑ YES
EICHI.FR HOI.gY �B-ICO
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DESCRIPTION OF WORK kt 1 , " kff— 1 � G QM "� - ' `
ws
TOTAL VALUATION: D
By my signature below, I certify to eac a 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 I have rovid is correct. ave r�ttheescriptionofWork and verify it is accurate. I agree to comply with all applicable local
ordinances and state law's relating tob ilding onstruction. uth esentatives of Cupertino to enter the above -i - entif e property for inspection purposes.
S i °nature of Applicant/Agent: Date:
SUPPLE INFORMATION REQUIRED.
,x'.nuFc
AfEPA1isa4pp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10430 prune tree In DATE: 08/19/2014 REVIEWED BY: mendez
APN: BP#: *VALUATION: J$8,885
xPERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY PENTAMATION FURN/AC
USE: SFD or Duplex PERMIT TYPE: A
WORK remove and replace existing furnace a/c and coil
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
U'. — �
QTY/FEE
QTY
UNITS
BP FEES
A/C Units (<=10K cfm)
1BREMAIR
1
#
$72
Furnace, Forced -Air
1MFR=<100
1
#
$139
Permit Fee:
$48.00
lPME
Administrative Fee: 1ADMIN
$45.00
Work Without Permit? 0 Yes (F) No
$0.00
TOTALS:
$48.00
Strom Motion Fee: IBSEISMICR
$1.16
$211.00
131da Stds Commission Fee: 1BCBSC
711M ,
Mech. Plan Check 0.0 1 hrs $0.00 f hunb- Plan Cthfr �7:i"
Mech. PermitFee: 1MPERMIT Plumb. Tcrrns7 Pee. e, F'x`�``'
Other Mech.Insp. 1 0.0 1 hrs$48.00 odie�PlulnbIns,n- Offle7'_�'�
•f=Ler �,as'�2 1�r': �
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
!',,. f—f th. Pont fnr nddn °l info.
District, etc.). These fees are based on the preummary
Resolution 11-053 Eff. 7/1/13)
FEE ITEMrrS
an urmu tuft uvuccuuco
FEE
U'. — �
QTY/FEE
_.. ---_..--- __ _ _
MISC ITEMS
.(Fee
PME Plan Check:
$0.00
PME Unit Fee:
$211.00
Permit Fee:
$48.00
lPME
Administrative Fee: 1ADMIN
$45.00
Work Without Permit? 0 Yes (F) No
$0.00
Travel Documentation Fee: ITRA VDOC
$48.00
Strom Motion Fee: IBSEISMICR
$1.16
Select an Administrative Item
131da Stds Commission Fee: 1BCBSC
$1.00
I[3TLS
MUM MWIMS
$354.16
$0.001 TOTAL FEE: $354.16
lIAA A
r\GVIJGIl. VII ivlcv I�
a
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 1 of 4 )
Project Name: Rick Minder Date Prepared: 2014-08-12
A. General Information
CF1R-ALT 02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be
documented, use one CF1R-ALT-02 document for each dwelling unit.:
01
Project Name:
Rick Minder
02
Date Prepared:
2014-08-12
03
Project Location:
10430 Prune Tree Lane
04
Building Type:
Single family
05
CA City:
Cupertino
06
Dwelling Unit Name:
Rick Minder
07
Zip Code:
95014
013
Dwelling Unit Conditioned
1534
accessible
Are all of the
Floor Area (ft2):
condensing unit,
Installing
Number of space conditioning
system's
09
Climate Zone:
3
10
(SC) systems being altered in
1
or
more than 40
and is more
components
this dwelling unit.:
B. Space Conditioning (SC) System information = .
01 02 03 04 45 06
07 .. y dab 09 10
I�istallg-
anew�`
e�
`IsthentirE
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: 214-A0073470A-000000000-0000 Registration Date/Time: 2014-08-12 14:45:20 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2014-08-12 14:45:49
components?
duct system
(packaged unit, or
accessible
Are all of the
condensing unit,
Installing
for sealing,
system's
is the altered
Altering or
or
more than 40
and is more
components
or installed
installing a
cooling/heating
linear feet of
than 75% of
and ducts new
SC System
SC System
CFA served
system a
refrigerant
coil, or
new or
the duct
or replaced?
Identification or
Location or Area
by this SC
ducted
containing
air -handling unit,
replacement
system new
(entirely new
Name
Served
System (ft2)
system?
component?
etc)
ducts?
or replaced?
system)
Alteration Type
Trane/Bryant
whole house
1534
Yes
Yes
Yes
No
No
No
Altered space
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: 214-A0073470A-000000000-0000 Registration Date/Time: 2014-08-12 14:45:20 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2014-08-12 14:45:49
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 2 of 4 )
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
Trane/Bryant
Central gas
Gas furnace
AFUE
0.78
Central split
Outdoor
condensing
SEER
13
Setback
Less than or
equal to 40
R-6
furnace
AHU
AC
unit
feet
Required Documentation:
CF2R-MCH-01-E - Space Conditioning Systems Ducts and Fans
-Duct insulation requirement for new plenums: R6.
CF2R-MCH-20-H & CF3R-MCH-20-H — Duct Leakage testing required when heating or cooling components are installed in ducted systems, or when more than 40 ft of duct length is replaced.
-Leakage rate compliance: <_ 15%, or <_ 10% leakage to outside, or seal all accessible leaks.
CF2R-MCH-25-H & CF3R-MCH-25-H Refrigerant Charge Verification required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15).
CF2RCF3R-MCH-23 & CF3R-MCH-23 Air Flow >_ 300 CFM/ton required when MCH 25 is required
Exceptions:
-Duct systems registered with HERS provider as previously sealed are exempt from MCH -20 Duct leakage Testmg�r�equirements.
-Heating-only systems and Air Hand ler/Fu rnace,chdnges do not require verification of Air Flow MCFE=23, or Refng E ant Charge MECH-25.
-Existing dud systems constructed, insulated orsealed with asbestos are exempt from MCH 20 Duct Leakage Te mg requirements':
E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)1Diia and 150.2(b)1E, F)
This section does not apply to this project.
Registration Number: 214-AO07347OA-000000000-0000
Registration Date/Time: 2014-08-12 14:45:20
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2014-08-12 14:45:49
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 3 of 4 )
F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)1C)
This section does not apply to this project.
Registration Number: 214-A0073470A-000000000-0000
Registration Date/Time: 2014-08-12 14:45:20
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2014-08-12 14:45:49
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT HVAC) (Page 4 of 4 )
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature: r/C
Rando, Eric
t
Company:
Signature Date:
RANDO AAA HVAC INC
2014-08-12 14:45:20
Address:
CEA/ HERS Certification Identification (if applicable):
1712 STONE AVENUE
n/a
City/State/Zip:
Phone:
SAN JOSE CA 95125
(408) 293-4717
Responsible Person's Declaration statement
I certify the following under penalty of perjury, under the laws of the State of California:
1. The information provided on this Certificate of Compliance is true and correct.
2. 1 am eligible under Division 3 of the Business and Professions Code to accept:responsibility forthe building design or system design identified on this Certificate of Compliance (responsible designer).
3. That the energy features and performance specifications, materials,' cogir bnents,and m ufaciured deuices;for the build(ng design"br system design identified on this Certificate of Compliance conform to the
requirements of Title 24, Part 1 and Rett 6'of the Calrforni Cod"f Regulations
tbe information rovided on other applicable compliance documents, worksheets,
4. The building design features or system design features identifier) on this Certificate of $,, are td`nsistent withp
calculations, plans and specifications submittedto the enforcement agency for appy oval with this building permit application_ "
5. I will ensure that a registered copy of�this Gertfficaii? o4 Cbmplianceshal be�m de a 112ble,with;the building;permitj&,},issued forthe. bihfldipg;'anfl mgde�ayailable to the enforcement agency for all applicable
inspections. I understand that a registered copy of this Certificate of Compliance is required to be included with the documentation the,builder provides two the building owner at occupancy.
Responsible Designer Name:
Responsible Designer Signature:
Rando, Eric
Company:
Date Signed:
RANDO AAA HVAC INC
2014-08-12 14:45:20
Address:
License:
1712 STONE AVENUE
768871
City/State/Zip:
Phone:
SAN JOSE CA 95125
(408) 293-4717
Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document, and in no way implies Registration Provider responsibility for the accuracy of the
information.
Registration Number: 214-AO07347OA-000000000-0000 Registration Date/Time: 2014-08-12 14:45:20 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2014-08-12 14:45:49