14080260 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10168 RIDGEWAY DR CONTRACTOR:ONE HOUR HEATING PERMIT NO: 14080260
AND AIR
OWNER'S NAME: SHISHIR CHAVAN 1400 PETALUMA HILL RD DATE ISSUED:08/27/2014
OWNER'S PHONE: 4087996623 SANTA ROSA,CA 95404 PHONE NO:(707)545-1800
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL ❑
REPLACE(E)A/C&COIL(SAME LOCATION)
License Class(() C9-r,) Lic.# -7q6 l'[-(
Contractor Date 8 Z7-
I hereby a m 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
Jperformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$8000
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:34241010 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 SUANCE 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 DA ED INSPEC ION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Z
granting of this permit. Additionally,the applicant understands and will comp s a
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18.
Cj.�7- RE-ROOFS:
Signature Date . 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.
ElOWNER-BUILDERDECLARATION
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&Safety Code,Sections 05,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:
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
T� GENERAL PERMIT APPLICATION aRm A E P
DEVELOPMENT DEPARTMENT- BUILDING DIVISION
COMMUNITY O
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(406) 777-3228•Fr.X(403)7-17-3333.buildino -cuo=m�no.ora m I S C
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USE OF ❑SFD o,DUPLEX ❑ MULTI-FALMY I PROTECT LK WU.DLAND ❑ YES I PROSECT NTT ❑"as I IS=---BLDG AAT ❑ YES
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DCRIPTION OP WORK I /Q
TOTAL V f T UATION
By ny si;na«re below,I ce,:iay to each of the follo�t4n� I am u`le propery o,.aer or authorized went�Y ct en opo y ora ler s behalf. I hate rea -
application and the infola ation I have provided is correct I have read the Description of S�'ork and ve iy it is zcct-ate. I z�*ee to comply v i h zll zpplicable local \
Or dinanats and State laws relating to b tel: ^UCiiOn. I allthOriZt repreSenieia'eS Of Cupertino to enteI the abOPe-lderitiaed DiOD`/• 'IOi inspection pL'rpOSeS.
Si�laolre of."-_pplicant/A ee^.t: Date: 7• /
PLEVENTAL 217kOR.1 A TION RE USD —�
Q .e .OFFZGE�SFii)RZY � "
h/EPl:�isc pp_2�1 Ldoc revised 06/21111
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10168 RIDGEWAY DR DATE: 08/27/2014 REVIEWED BY: MELISSA
APN: 342 41 010 BP#: *VALUATION: 1$8,000
PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION FURN/AC
USE: p PERMIT TYPE:
WORK REPLACE E A/C & COIL SAME LOCATION
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
A/C Units (<=1 OK cfm) 1BREMAIR 1 # $72
TOTALS: $72.00
y �
Mech.Plan Check 0.0 hrs $0.00 C hvr ,,%>
Mech.Permit Fee: IMPERMIT '
LtherMech.Insp. "00hrs $48.00 O}A r f'h jr ,,r> Li
{
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 prelimina information available and are onl an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution.1.1-O53.F,ff. 7/1/13) FEE QTY/FEE MISC ITEMS
;;.{ �.-'heck ,
PME Plan Check: $0.00
PME Unit Fee: $72.00
PME Permit Fee: $48.00
Administrative Fee: 1ADMIN $45.00
Work Without Permit? 0 Yes 0 No $0.00
Travel Documentation Fee: ITRA VDOC $48.00 i
Strong Motion Fee: IBSEISMICR $1.04 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
$215.04 $0.00 TC?TAL FEE: $215.04
Revised: 07/10/2014
STATE OF CALIFORNIA
ALTERATIONS - HVAC
CEC-CFIR-ALT-03-E Revised 06/14 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CFIR-ALT-03-E
Alterations-HVAC CZ 1,3 to 7 and 16(formerly CF-IR-ALT-HVAC) (Page 1 of 1)
Site Address: Enforcement Agency: Dae'Prepared: Permit#:
o/ �/� P 0r- •27•i �u�oti6o
Equipment Type Equipment Efficiency New:Ducting,Plenums,Lineset Conditioned Thermostat
Required R-value Floor Area(sq ft)
❑Packaged System Evaporator Coil AFUECOP ❑R-6 (CZ 1,3-7)Ducts Served by system Setback
sq ft
❑R-8' (CZ 16)Ducts �� (if not already
plit System Condensing Unit SEER HSPF ❑R-6(all CZ's)Plenumspresent must
Furnace ❑Lineset EER ❑R-5 or R7.5 Lineset3 be installed)
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this
form is allowed to be filled out by hand. For final inspection all forms are to be registered(no hand filled forms allowed)and a copy left on site.
IN 1.HVAC Changeout/Repair Required Compliance Documents to be left on site for Final:
Can include new ducting
All Equipment, CFIR-ALT-02-E
Condenser Unit,Evaporator Coil, CF2R:MECH-01,MECH-20-HERS
Air Handler/Furnace CF3R:MECH-20-HERS
Installer Requirement:Duct leakage(S.15%or,<10%to outside,or seal all accessible leaks)
Exempted from duct leakage testing if:
111.Duct system registered with HERS provider as previously sealed,or❑2.There is less than 40 linear feet of duct in unconditioned
space,or ❑3.Existing duct systems are constructed,insulated or sealed with asbestos(list manufacture date of building
112.New HVAC System Required Compliance Documents to be left on site for Final:
All new equipment and All New DuctsZ CFIR-ALT-02-E
CF2R-MECH-01,MECH-20-HERS,MECH-22-HERS,MECH-(23 or 24)-HERS
CF3R-MECH-20-HERS,MECH-22-HERS,MECH-(23 or 24)-HERS2
Installer Requirement:Duct leakage<6%,Fan Efficacy(.58W/CFM),Air Flow>_350 CFM/ton(or Standards Table 150.0-C/D alternative)
❑3.All New Ducts with Replacement Required Compliance Documents to be left on site for Final:
Includes replacing.or installing All New CF111-ALT-02-E
DuctsZ and one or more of the following: CF2R-MECH-01,MECH-20-HERS,MECH-(23 or 24)-HERS
Condenser Unit,Evaporator Coil,Furnace CF3R-MECH-20-HERS,MECH-(23 or 24)-HERS
Installer Requirement:Duct leakage<6%,Air Flow>_350 CFM/ton(or Standards Table 150.0-C/D alternative)
❑Exempted from duct leakage testing I existing duct systems are constructed,insulated or sealed with asbestos.
❑4.New Ducting over 40 feet Required Compliance Documents to be left on site for Final:
Adding or replacing ducts in unconditioned CFIR-ALT-02-E
space but less than All New DuctsZ CF2R:MECH-20-HERS
CF3R:MECH-20-HERS
Installer Required to:Duct leakage(:L15%or,<10%to outside,or seal all accessible leaks)
❑ Exempted from duct leakage testing I existing duct systems are constructed,insulated or sealed with asbestos.
'All new ducting R-8 required when more than 40 ft installed and R-6 when less than 40 ft installed. This includes in walls,between floors etc.
Z A New Duct system is when the duct system is constructed of at least 75 percent new duct material,and up to 25 percent may consist of reused
parts from the dwelling unit's existing duct system(e.g.,registers,grilles,boots,air handler,plenums,duct material.
a R-5(1"thick insulation)for linesets 1"and less. R-7.5(1.5"thick insulation)for linesets over 1 inch. Most mfg will require Suction line Diameter
with insulation as the following 1.5-2T-2%",2.5-3T-2%",3.5 to 4T-2%",5T-4%"
Contractor(Documentation Author's/Responsible Designer'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 California Business and Professions Code to accept responsibility for the information on this document.
3. 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(CCR).
4. 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 CCR.
5. 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.
Resp) Bible Designer Name: ResponsiblDesign Date Signed: License:
� l- ee Le -2 7• Lf I 7-4 g q
Company: Addre City/State/Zip: Phone:
om hov►- he�fi oaf% IIffrf1U Peb(w"A, H_ia ✓ dSamtoS4 Cry l fa"( 707. S-Lf
For assistance or questions regarding the Energy Standards,contact the Energy Hotline at:1-800-772-3300
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems(formerly CF-IR-ALT HVAC) (Page 1 of 4)
Project Name: 10168 RIDGEWAY DR TDt,Prepared: 2014-08-22
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: 10168 RIDGEWAY OR 02 1 Date Prepared: 2014-08-22
03 Project Location: 10168 RIDGEWAY DR 04 Building Type: Single family
05 CA City: Cupertino 06 Dwelling Unit Name: 10168 RIDGEWAY 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;fi�format�on
zf
01 0203 ! X04 ` OS` ;06 07 08 09 10
r _ InstalU
ng Isthe'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
System 1 HOUSE 1500 Yes Yes Yes No No No Altered space
conditioning system
C.Extension of Existing Duct System,Greater Than 40 Feet(Section150.2(b)1Diib)
This section does not apply to this project.
Registration Number:214-A0081298A-000000000-0000 Registration 0ate/rme: 2014-08-22 07:07:13 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2014-08-22 07:06:54
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems(formerly CF-111-ALT-HVAC) (Page 2 of 4 j
D.Altered Space Conditioning System(Sections 150.2(b)lE 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 1 applicable applicable components applicable applicable
Required Documentation:
CF2R-MCH-01-E-Space Conditioning Systems Ducts and Fans
-Duct insulation requirement for new plenums:R6.
CF211-MCH-20-1-1&CF311-MCH-20-11—Dud 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.
MR-MCH-25-1-1&MR-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 a 300 CF,M/tom�equired when MCH-25 is requires!.
Exceptions:
-Duct systems registered with HERS provider as previously sealed are, m,tfrom MCH-20 Duct Leakage Testing requirements.
-Heating-only systems and Air Handler/Furnace.'- donot requ erfRcefion of Air Flow MCH-23,or.Refrigerant Charge MECH-25.
-Existing duct systems constructed,insulated or=5,ggled with,asbesto5re 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)lE,F)
This section does not apply to this project.
Registration Number:214-A0081298A-000000000-0000 Registration Date/Time: 2014-08-22 07:07:13 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2014-08-22 07:06:54
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-A0081298A-000000000-0000 Registration Date/Time: 2014-08-22 07:07:13 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2014-08-22 07:06:54
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: \Jt/ II
Wilson,Candace Ca 1 i V V
am
Company: Signature Date:
The Energuy CA LLC 2014-08-22 07:07:13
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 accept responsibility for the building design or system design identified on this Certificate of Compliance(responsible designer).
3. That the energy features and performace specif`ations,materials tomponents,�and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the
requirements of Title 24,Part land Pali of the California;Codgaf Regulations.
4. The building design features or systerrll,design features i deiltifled ootfais Certificate oKpmphance are consistent withthe Information provided on other applicable compliance documents,worksheets,
calculations,plans and specif catiogs5�ibmitted_toA',e enfo' ent agency for approval with this building permit application.
S. I will ensure that a re istered co of 4 R CeRlficate of
g copy �Isa Cornpliartice 3ltallbe made availablewiththe'buildingpermit(s)hsued for the building,and made available to the enforcement agency for all applicable
inspections.I understand that a registered copyof 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: \A f i)
Wilson,Candace V V
am
Company: Date Signed:
The Energuy CA LLC 2014-08-22 07:07:13
Address: License:
1215 K St.,17th Floor
City/State/Zip: Phone:
Sacramento CA 95814 1-877-600-0123
Digitally signed by CeICERTS.This digital Signature is provided in order tosecure the content of this registered doc ument,and in noway implies Registration Provider responsibility for the accuracy ofthe
information.
Registration Number:214-A0081298A-000000000-0000 Registration Date/Time: 2014-08-22 07:07:13 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2014-08-22 07:06:54