14080200 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11087 FLOWERING PEAR DR CONTRACTOR:ONE HOUR HEATING PERMIT NO: 14080200
AND AIR
OWNER'S NAME: FERNANDES DOMINIC AND SUSHMA 1400 PETALUMA HILL RD DATE ISSUED:08/19/2014
OWNER'S PHONE: 4087846593 SANTA ROSA,CA 95404 PHONE NO:(707)545-1800
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL ❑
�} REMOVE AND REPLACE A/C&COIL IN SAME LOC
License Class( c w Li,.# �K q?
Contractor Date • f
I hereby affi 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:$7926
1 have and will maintain Worker's Compensation Insurance,as provided for by
)L Section 3700 of the Labor Code,for the performance of the work for which this APN Number:32345033 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 DAYS rZLAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, i
costs,and expenses which may accrue against said City in consequence of the Issued b Date.
granting of this permit. Additionally,the applicant understands and will comply y'
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18.
��jj RE-ROOFS:
/
Signature Date Z/ u j` q 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 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&SafetyCode,S ons 2.5 5,25533,and 25534. f
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized a nt: Date: 1 r
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
GIENERt.L PERM11 l r4PPLIGATIONM E P
COMMUNITY DEVELOPMENT DEPART Ixfi=N i - BUILDING DIVISION
10300 i ORRE AVENUE- CUPcRTINO, CA 95014-325S
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CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 11087 flowering DATE: 08/19/2014 REVIEWED BY: mendez
APN: BP#: *VALUATION: 1$7,926
,PERMIT TYPE: 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 (<=1 OK cfm) 1BREMAIR 1 # $72
TOTALS: $72.00
EAON
RN
a_ y. L
Mech.Plan Check T0.0 hrs $0.00 Phlixh. I'kin("hoc'k
Mech.Permit Fee: IMPERMIT 1111rrnh.Permit 1,ee: Eiec. Pe mif
r1her Mech.Insp. 0.0 hrs $48.00 011rer�Plumb Insp. offs'r`�"1=3'.Insp.
E3-L-
i'a. Iszs1. t` c:: I'It±rrzh. Irrz}r. 7 trc< I i`ec- Its of
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . Theseees are based on the relimina information available and are onlyan estimate. Contact the Det or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 7./1/13) FEE QTY/FEE MISC ITEMS
f lun: Che 'k 1',Je:
/PME }Plan Check: $0.00
PME Unit Fee: $72.00
PME Permit Fee: -T-T $48.00
Uon,strvction Tax:
Administrative Fee: IADMIN $45.00
Work Without Permit? 0 Yes (E) No $0.00
Travel Documentation Fee: 1TRAVDOC $48.00
Strong Motion Fee: IBSEISMICR $1.03 Select an Administrative Item
BldgStds Commission Fee: IBCBSC $1.00
„ 3L15.031 $0.00 $2
f
n $2Toai FEE 03
15
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: 11087 FLOWERING PEAR DR I Date Prepared: 2014-08-14
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 CF111-ALT 02 document for each dwelling unit.:
01 Project Name: 11087 FLOWERING PEAR DR 02 Date Prepared: 2014-08-14
03 Project Location: 11087 FLOWERING PEAR DR 04 Building Type: Single family
05 CA City: Cupertino 06 Dwelling Unit Name: 11087 FLOWERING PEAR DR
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.:
B.Space Conditioning(SC)System lffvrmationAIR
...... `
01 02 .. 03 4 `. „ 6, 0 08 = 09 10
"S
: 3 ,
3s ,1�15a �' 3 #Vie`. tine
a e
components? system
(packaged unit,or accessible Are all of the
y Installing for sealing, system's
�� condensing unit, g g,
Is,tWaltered 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
System 1 House 1500 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-A0074894A-000000000-0000 Registration Date/Time: 2014-Q8-14 08:38:39 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2014-08-14 08:39:23
CERTIFICATE OF COMPLIANCE CF111-ALT 02-E
Alterations to Space Conditioning Systems(formerly CF-IR-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
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 AC components applicable applicable
Required Documentation:
CF211-MCH-01-E-Space Conditioning Systems Ducts and Fans
-Duct insulation requirement for new plenums:R6.
CF2R-MCH-20-H&CF311-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:515%,or!<10%leakage to outside,or seal all accessible leaks.
CF2R-MCH-25-H&CF311-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 M H-25 egUi d f
Exceoti!2ns:
Duct Systems registered with HERS provider as previilusly sealed ar em rOH'20 Duct Lea�Cage Testingr�uir e is
Heating-only systems and Air Handler/FurnaceC ranges do not cui Verj ca o f Air Flow MChI 23,or,Refri�atflharge MEGkI 25y3
,� ff
Existing duct systems constructed,insulated ors led with sbestosre exeCnpt ftom MCH=20 Dudt Leakage Tis tng ceq�r�rement -
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-A0074894A-00Q000000-0000 Registration Date/Time: 2014-08-14 08:38:39 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2014-08-14 08:39:23
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.
9 ;
RAI
ft
N333\ E c
Registration Number:214-A0074894A-000000000-0000 Registration Date/Time: 2014-08-14 08:38:39 HERS Provider:CalCERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2014-08-14 08:39:23
• 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:
Wilson,Candace
Company: Signature Date:
The Energuy CA LLC 2014-08-14 08:38:39
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
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 acce ,,tesonslb�ltty forMthe bu�3d g design or system design ident1fed on this Certificate of Compliance(responsible designer)..
3. That the energy features and performance specifications materials compents and manufactured 1 picesf r the building de3ig dor system design identified on this Certificate of Compliance conform to the
requirements of Title 24,Part 1 and Paet1.6 of the California Code of Regulations. "
4. The building design features or systemdesign features�dikified onx iiCertificate of Corripliance aCe consistent with the mformati�ll fowded qn other applicable compliance documents,worksheets,
calculations, tans and specificatiori s5'bmitted toieoli okcettien "' fora '*
P g, Ppro�ia(With this bUildmgpermit application
5. I will ensure that a registered copy of tliS CertifiCf `p�ance s t be r �t�le with the bu�ldmgpermit(sisued fbittg boiling-and
'irlde avajlable to the enforcement agency for all applicable
inspections.I understand that a registered copy oft iN Certificate of Compliant is required to be included with the documentation the builder provides to the b(uil�di�ngy owner at occupancy.
Responsible Designer Name: Responsible Designer Signature:
Wilson,Candace
Company: Date Signed:
The Energuy CA LLC2014-08-14 08:38:39
Address: License:
1215 K St.,17th FIQQr
City/State/Zip: Phone:
Sacramento CA 95814 1-877-600-0123
Digitally signed by Ca10ERTS. 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-A0074894A-000000000-0000 Registration Date/Time: 2014-08-14 08:38:39 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2014-08-14 08:39:23