14080199 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19837 BEEKMAN PL CONTRACTOR:ONE HOUR HEATING PERMIT NO: 14080199
AND AIR
OWNER'S NAME: GOPINEEDI VIJAYA K AND USHASREE 1400 PETALUMA HILL RD DATE ISSUED:08/19/2014
OWNER'S PHONE: 4089960121 SANTA ROSA,CA 95404 PHONE NO:(707)545-1800
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
� Qp REMOVE AND REPLACE A/C&COIL IN SAME LOC
License Class("(O C 20 Li,.# 7// d ( [ 1(�
Contractor Date 8 'f
I hereb a that I am licensed under the provisions of Chapter 9
(com cing 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
Jrformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$5325
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:31630129 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 WITfIIN 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 DAYS M LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Issued /
costs,and expenses which may accrue against said City in consequence of the Id b C Date:
granting of this permit. Additionally,the applicant understands and will comply 3'
with all non-point sou egulations per the Cupertino Municipal Code,Section
9 18.
S f' RE-ROOFS:
Signature Date ( ILI 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
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 505,25533,and 25534. Q q
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:v C
permit is issued. 1-01
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
PAL PcMfT APPLICATION
COMMUNITY DEVELOPMENT DEPART NEN l • BUILDING DIVISIGFCOMMUNITY r ��
10300 I ORRE AVENUE• CUPEER I If\O, CA 85014-?•Goo `�UU
(408) 777-3223• FIX;!0B)7777-3333
c •buildin�C�cu�e�ino.ora w G
tJr'����i I�0 1
LPLLIr nG ❑h rA_1,iC.4L ❑� �=I CAT 71 I'm NEOUs
i O!? pass/ 63 / p /. r !{ 3" 2
Ovhr 4 ,f�L 1�6V�/l�ti� � I i0� 6(2,
geeKrviah p /. c��`T^-�h 69 g56111
I :`1
+- o
CON ACT)i 4I,T P On� I -111-41-7
c�Y—�ADDR�5 C11 i,STATE, Z_ P`X
O'v ❑ OV, :•3L-_J L� Ov,T
COt✓ne\yhitJ� � �fh/ =±J�❑� LCTORAChT El 1.c_=ZCT 10�cm<I r
1:3CO, LICENSE US.L)C
.6 Uc Z - i T
I Fkx
KMNE
/rob Ma((/lNt vL C l! ✓� I U A Irqoq 7 67 - Ull
��Ciui l GihrwZ2 A1✓� I L)Cn'�E).'LT�� R BUS.Uc
STS f AMPMS I CI1Y,STATB,M I r"iOh'r
USE U ❑_—o.DUPT=: 1� JLTI•F�.,rLY I P30�tCf IIi WILDLAINM ❑ YES I PP 07.-r-T JNI ❑Yss I )Si_BLDG fN ❑ 1 S
B,U=, IP. Ll CO.OUEPCL4L 'UT.3p2\1IT-M-R.FACSAA?akA ❑ NO NAFOODZONE �j❑NO z:G•ru 3oMJ5�?/�� ❑ ?�0
D CRIPTiO)i OFSi'0 K /1.
rep//aC.eme,7 !r/ sq v`e- A)l..t�l(Qel
1 /
TO �T VALUATION:
� .:
By^y cion=-be)Dia,I C'i i'�7'LO�_^.iJ DT 77.±'779 IO�ID\i^-�: I uu li;-�r0�._iy Oli'!Cr Or=LutilOi:�.'d_.c�e]L LO i:CL Ori L-:C�.r0j7Ci i}''Oii•TiEr S��;';81 I'i�VC iCHd LP'S
_upilC2aon u�d the in�D:-atiDa I h�F�ar04id��' CO-wL I h2i'_7_=d LiiC�CSCr:�L100 Oi\h OCl G J j F I.;':`t 1S SCCI Er 1 G=BC IO Commly vnitl]21.1 Z-oD iCablt;OC2l
o:dmances and state laws relating to build =cors. coon. 1representatives of Cupe :no Lo eater the above-
propp:DpU.y=or spectioa perpDses.
SUP _�� r_roR1,,kTIeN REQu -D � .
REEM
gpl MO�-
_
• MORE—
IN -- �
1 1 !'scfia� 201_1.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
W- TYPE:
DDRESS: 19837 beekman pl DATE: 08/19/2014 REVIEWED BY: mendez
PN: BP#: *VALUATION: $5,325
Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Duplex PENTAMATION FURN/AC
USE: p PERMIT TYPE:
WORK remove and replace a/c & coil in same loc
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
A/C Units (<=10K cfm) 1BREMAIR 1 # $72
TOTALS: $72.00
x
Mech.Plan Check0.0 hrs $0.00 1'i7117t . Pion(taf�.ck '`'t'.
Mech.Permit Fee: IMPERMIT
Other Mech.Insp. 0.0 hrs $48.00 F>dwp hi2d nb InstLi 01he!,1 i1,'c h?sp'
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 prelimiina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ef. 711113) FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.00
PME Unit Fee: $72.00
PME Permit Fee: $48.00
Administrative Fee: ]ADMIN $45.00
Work Without Permit? ® Yes 0 No $0.00
Travel Documentation Fee: ITRAVDOC $48.00 i
Strom;Motion Fee: IBSEISMICR $0.69 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
x � ' r SV�B�TOTAIS $214.69 $0.00 TOTAL FEE: $214.69
Revised: 07/10/2014
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems(formerly CF-IR-ALT HVAC) (Page 1 of 4)
Project Name: 19837 BEEKMAN PL Date Prepared: 2014-08-19
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: 19837 BEEKMAN PL 02 Date Prepared: 2014-08-19
03 Project Location: 19837 BEEKMAN PL 04 Building Type: Single family
05 CA City: Cupertino 06 Dwelling Unit Name: 19837 BEEKMAN PL
07 Zip Code: 95014 08 Dwelling Unit Conditioned 1500
Floor Area(ft2):
Number of space conditioning
09 Climate Zone: 4 10 (SC)systems being altered in 1
this dwelling unit.:
a k`
B.Space Conditioning(SC)System Information F
.. .,; b.
01 02 03 X14.., ', 0S ` 6 07 8 09 10
�,,. 3, Y y
A -Moe
° I�5hetire
_._,
components? duct system
(packaged unit,or accessible Are all of the
condensing unit, Installing for sealing, system's
Is thealtered Altering or or more than 40 and is more components
d-r 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
System 1 HOUSE 1500 Yes Yes Yes No N4 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-A0077676A-000000000-0000 Registration Date/Time: 2014-Q8-19 07:39:09 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2914-08-19 07:38:34
y
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
No heating This field or This field or All new This field or This field or
AC
System 1 Central gas component section is not section is not Central split cooling SEER 13 Setback section is not section is not
furnace altered applicable applicable components applicable applicable
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 510%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 MGH 25 is required ,
Exceptions: tgy
-Duct systems registered with HERS provider as ipusly sealed are exemp. R MCH-20 Duct Leakage Testing requirements
-Heating-only systems and Air Handler/Furnac anges do not Require Yer ica1,S)Vbf Air Flow M0 x'�'�r Refrigeran#Charge M 25
Existing duct systems constructed,insulated or� ed with.as. e�toS arae �3 etYii m MCH,-20� Leakage Tetfhge i�hremen i
1
v .
'fir :. ':.v ° j
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-A0077676A-000000000-0000 Registration Date/Time: 2014-08-19 07:39:09 HERS Provider:CalCERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2014-08-19 07:38:34
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.
e"',�3
" 5 _ fly
Registration Number:214-A0077676A-000000000-0000 Registration pate/Time: 2014-08-19 07:39:09 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2014-08-19 07:38:34
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. r- -
Documentation Author Name: Documentation Author Signature: (?��%r CLGLf�i
Wilson,Candace
Company: Signature Date:
The Energuy CA LLC 2014-08-19 07:39:09
Address: CEA/HERS Certification Identification(if applicable):
1215 K St., 17th Floor
City/State/Zip: Phone:
Sacramento CA 95814 1-877-600-0123
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 acccep responsibility fpr the build' gydesign or syster design i entified on this Certificate of Compliance(responsible designer).
3. That the energy features and performance specifications,materials cofilponents,and manufactured d ices dr the bu tiding designibr system design identified on this Certificate of Compliance conform to the
requirements of Title 24,Part 1 and 6 of the 61'forn od lof Relations.P. 4
4. The building design features or syst design features idehttfi d tin i Certificate o dance ar ori tent with he informatded� n other applicable compliance documents,worksheets,
calculations,plans and specificatio bmitted tofie 3fo`c eht icy for aper- `ith t is rngrmit appt�on t
5. I will ensure that a registered copy of „is CerViic ` fm�ranee s l q r��de a r �t ildmg germit(s}issued foFthe bu)I.r�g n_rrt fde available to the enforcement agency for all applicable
inspections.I understand that a registered cop th s Ceficate t� pliane is req red to a inc uded with the dacuinentation the;builder provides to the building owner at occupancy.
Responsible Designer Name: Responsible Designer Signature:
Wilson,Candace G; l GCCZGPi
Company: Date Signed:
The Energuy CA LLC 2014-08-19 07:39:09
Address: License:
1215 K St.,17th Floor
City/State/Zip: Phone:
Sacramento CA 95814 1-877-600-0123
Digitally signed by CaICERTS. 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-A0077676A-000000000-0000 Registration Date/Time: 2014-08-19 07:39:09 HERS Provider:CalCERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2014-08-19 07:38:34