14080203 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21860 ALCAZAR AVE CONTRACTOR:VALLEY HEATING& PERMIT NO:14080203
COOLING
OWNER'S NAME: RAJRUPA GHOSH 1171 N 4TH ST DATE ISSUED:08/19/2014
OWNER'S PHONE: 4085960291 SAN JOSE,CA 95112 PHONE NO:(408)294-6290
_LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
`,0� INSTALL(2)CONDENSER IN REAR OF SFDWL
License Class Lie.# p-�
Contractor V1
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
F ectiomance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$7474
and will maintain Worker's Compensation Insurance,as provided for by
n 3700 of the Labor Code,for the performance of the work for which this APN Number:35714036 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
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAY M LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, /
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply Issued by: j Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18.
(/ RE-ROOFS:
Signature 4171 Date ll ( 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
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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,
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 compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this t
d
Owner or authorize agent: Date: l
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
Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
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
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1+1 %+1w�c.Ep _2011.eoc revised 06121111
CITY OF CUPERTINO
'12 FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 21860 alcazar ave I DATE: 08/19/2014 REVIEWED BY: Mendez
APN: I BP#: "VALUATION: 1$7,474
*PERMIT TYPE: Mechanical Permit I PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Duplex PENTAMATION 1 RMAP1
USE: p I PERMIT TYPE:
WORK install (2) condenser in rear of sfdwl
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Other Appliance/Equip J 1BAPPLOT 2 # $144
TOTALS: $144.00
Mech.Plan Check 0.0 hrs $0.00 ;'Garb Nun Ch--{/. I I
Mech.Permit Fee: IMPERMIT
Other Mech.Insp. 0.0 hrs 1 $48.00 Ot1rc,Pivmit
I'Irt rrf. I.rcp. 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 preliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711113) FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.00
PME Unit Fee: $144.00
PME Permit Fee: $48.00
Administrative Fee: IADMIN $45.00
Work Without Permit? 0 Yes 0 No $0.00
Travel Documentation Fee: ITRAVDOC $48.00 �
Strong Motion Fee: IBSEISMICR $0.97 Select an Administrative Item
Bldp Stds Commission Fee: 1BCBSC $1.00
SU$TOTALS: $286.97 $0.00 TOTAL FEE: I $286.97
Revised: 07/10/2014
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems(formerly CF-1R-ALT HVAC) (Page 1 of 4)
Project Name: Ghosh,Rajrupa I Date Prepared: 2014-08-15
A.General Information
CF111-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: Ghosh,Rajrupa 02 Date Prepared: 2014-08-15
03 Project Location: 21860 Alcazar Avenue 04 Building Type: Single family
05 CA City: Cupertino 06 Dwelling Unit Name: Ghosh,Rajrupa
07 Zip Code: 95014 08 Dwelling Unit Conditioned 3429
Floor Area(ft2):
Number of space conditioning
09 Climate Zone: 3 10 (SC)systems being altered in 2
this dwelling unit.:
B.Space Conditioning(SC)System Information
01 02 03 04 05 06 07 08 09 10
Installing new Is the entire
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
Condenser 1 Half of House 1714 Yes Yes Yes No No No Altered space
conditioning system
Condenser 2 Half of House 1715 Yes Yes Yes No No No Altered space
conditioning system
Registration Number:214-A0076217A-000000000-0000 Registration Date/Time: 2014-08-15 15:20:34 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2014-08-15 15:21:25
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems(formerly CF-1R-ALT HVAC) (Page 2 of 4)
C. Extension of Existing Duct System,Greater Than 40 Feet(Section 150.2(b)1Diib)
This section does not apply to this project.
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
No heating This field or This field or Outdoor This field or This field or
AC
Condenser 1 Central gas component section is not section is not Central split condensing SEER 13 Setback section is not section is not
furnace altered applicable applicable unit applicable applicable
No heating This field or This field or outdoor This field or This field or
Condenser 2 Central gas component section is not section is not Central large condensing SEER 13 Setback section is not section is not
furnace altered applicable applicable packaged AC unit applicable applicable
Reouired Documentation:
CF213-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.
Exceotions:
-Duct systems registered with HERS provider as previously sealed are exempt from MCH-20 Duct Leakage Testing requirements.
-Heating-only systems and Air Handler/Furnace changes do not require verification of Air Flow MCH-23,or Refrigerant Charge MECH-25.
-Existing duct systems constructed,insulated or sealed with asbestos are exempt from MCH-20 Duct Leakage Testing 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-A0076217A-000000000-0000 Registration Date/Time: 2014-08-15 15:20:34 HERS Provider:CalCERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2014-08-15 15:21:25
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems(formerly CF-1R-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-A0076217A-000000000-0000 Registration Date/Time: 2014-08-15 15:20:34 HERS Provider:CalCERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2014-08-15 15:21:25
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems(formerly CF-1R-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:
Faulkner,Cindy
Company: Signature Date:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING&ELECTRICAL 2014-08-15 15:20:34
Address: CEA/HERS Certification Identification(if applicable):
1171 NORTH 4TH STREET
City/State/Zip: Phone:
SAN JOSE CA 95112 (408)294-6290
Responsible Person's Declaration statement
I certify the following under penalty of perjury,under the laws of the State of California:
1. The information provided on this Certificate of Compliance is true and correct.
2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance(responsible designer).
3. That the energy features and performance specifications,materials,components,and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the
requirements of Title 24,Part 1 and Part 6 of the California Code of Regulations.
4. The building design features or system design features identified on this Certificate of compliance are consistent with the information provided on other applicable compliance documents,worksheets,
calculations,plans and specifications submitted to the enforcement agency for approval with this building permit application.
5. 1 will ensure that a registered copy of this Certificate of Compliance shall be 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 registered copy of this Certificate of Compliance is required to be included with the documentation the builder provides to the building owner at occupancy.
Responsible Designer Name: Responsible Designer Signature: (?�%Y // UI
Faulkner,Cindy
Company: Date Signed:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING&ELECTRICAL 2014-08-15 15:20:34
Address: License:
1171 NORTH 4TH STREET 258540
City/State/Zip: Phone:
SAN JOSE CA 95112 (408)294-6290
Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered document,and in noway implies Registration Provider responsibility for the accuracy of the
information.
Registration Number:214-A0076217A-000000000-0000 Registration Date/Time: 2014-08-15 15:20:34 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2014-08-15 15:21:25
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