14110056 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10541 MADERA DR CONTRACTOR:VALLEY HEATING& PERMIT NO: 14110056
COOLING
OWNER'S NAME:
SAN JOSE,CA 95112 PHONE NO:(408)294-6290
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL F]
�/ REMOVE AND REPLACE DUCTS(10 SUPPLIES).
License Class �O Lic.# ��� ( C7
Contractor Date tI O� z
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
an
e fi
ce of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$4930
0ave 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:32635027 00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
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 FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 10,
costs,and expenses which may accrue against said City in consequence of the Issued by: Date: "IQ—!�
granting of this permit. Additionally,the applicant understands and will comply
with all non-point so regulations per the Cupertino Municipal Code,Section
9 18,
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.
❑ 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 Cu ertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 15,255335534.
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 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
G'ENEPALPcE--,RMTAPP GAI IYIAO-�6 . MEP
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revised 061-71171
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10541 MADERA AVE DATE: 11/10/2014 REVIEWED BY: SEAN
APN: BP#: *VALUATION: $4,930
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY PENTAMATION 1 RMAP7
USE: SFD or Duplex PERMIT TYPE:
WORK REMOVE AND REPLACE DUCTS 10 SUPPLIES).
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Ventilation System 1BREMVENS 0 # $0
TOTALS: $0.00
Mech.Plan Check 0.0 hrs $0.00 llhwrh. /Tarr Chercl; 1.7<r Pt<r l,rc1
Meeh.Permit Fee: IMPERMIT 1'G4mh. Permit Fee"
Other Mech.Insp. T 1.0 hrs $48.00 Other Plumb 7rtslr. t�tfrer�Y'161(. fy=s1�.
El
Mech.Insp.Fee: 1MECHINSP $143.00 /'itzrrth. IIID. Bele: L;iec' Psisp, /"'c:
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 Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ef.. 7/1/13) FEE QTY/FEE MISC ITEMS
Plan "'hecA
PME Plan Check: $0.00
f
PME Unit Fee: $0.00
PME Permit Fee: $191.00
('onwrticti{art Tux:
Administrative Fee: ]ADMIN $45.00
Work Without Permit? ® Yes (F) No $0.00
ffCil'€:171C'c`t,+ P/urm'ing 11't'.e :
Travel Documentation Fee: ITR,4VDOC $48.00 i
Strong Motion Fee: IBSEISMICR $0.64 Select an Administrative Item
Bldy,Stds Commission Fee: IBCBSC '$1.00
_.
$285.641 $0.00 TO`)�AL FEE: $285.64
Revised: 10/01/2014
CERTIFICATE OF COMPLIANCE CF1R-ALT=02-E
Alterations to Space Conditioning Systems(formerly CF-1R-ALT-HVAC) (Page 1 of 4)
Project Name: Jack Chu-2014-0270 Date Prepared: 2014-11-03
A.General Information
CFIR-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 Jack Chu-2014-0270 02 Date Prepared 2014-11-03
03 Project Location 10541 Madera Dr. 04 Building Type Single family
05 CA City Cupertino 06 Dwelling Unit Name Jack Chu-2014-0270
Dwelling Unit Conditioned
07 Zip Code 95014 013 1500
Floor Area(ft2)
Number of space conditioning
09 Climate Zone 4 10 (SC)systems in this dwelling 1
unit.
B.Space Conditioning(SC)Syste formation A 01,
01 02
94 Is S I g,a
SC System SC System CFA served syst,,,"a refrigerant Installing new SC Installing Installing Installing
Identification or Location or Area ,,b this SC dUcted containing system more than 40 entirely new entirely new
Name Served System(ft2) system? component? components? feet of ducts? duct system? SC system? Alteration Type
Entirely new or
complete replacement
Downstairs duct Downstairs 1500 Yes No No Yes Yes No duct system with or
replacement without equipment
changeout
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-A0131584A-000000000-0000 Registration Date/Time: 2014-11-03 13:31:32 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2014-11-03 13:31:17
Schema Version:0.551SDD
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)
This section does not apply to this project.
E. Entirely New or Complete Replacement Duct System,with or without Equipment Changeout(Sections 150.2(b)1Diia and 150.2(b)1E,F)
01 02 03 04 05 06 07 08 09 10 11
Heating Cooling
System Heating Minimum Cooling Minimum Required
Identification or Heating Altered Heating Efficiency Efficiency Cooling Altered Cooling Efficiency Efficiency Thermostat New Duct
Name System Type Component Type Value System Type Component Type Value Type R-Value
This field or This field or This field or
Downstairs duct Central gas No heating section is This field or No cooling section is section is SetbackTher
component section is not No cooling R-6
replacement furnace not. component altered not not mostat
altered pp a placable applicable applicable
a ticabl
Required Documentation:
CF2R-MCH-01-E-Space Conditioning Systems Bnd Fans y iy2800,
-Duct insulation requirement for new plenums. _
CF2R-MCH-20-H&CF3R-MCH-20-H Duct Leakag fic uireci � �
\ �s
-Leakage rate compliance:<_6%.
CF2R-MCH-22&CF3R-MCH-22 Fan Efficacy Verification
CF2R-MCH-23&CF311-MCH-23 System Air Flow Rate Verification
-Compliance:Fan Efficacy 5 0.58 W/cfm and System Airflow>350 cfm/ton.
-Alternative Compliance:CF2R-MCH-28&CF3R-MCH-28 Return Duct Desi Verification is an alternative to MCH-22 and MCH-23 verification.
CF2R-25-H&CF3R-MCH-25-H Refrigerant Charge Verification required whe refrigerant containing components are installed or altered(applicable in CZ 2,8-15).
Exceptions:
Heating-only systems are exempt from the 0.58 W/cfm and 350 cfm/ton requirements.
Note:
An"entirely new or replacement duct system"means at least 75 percent of the duct system is 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,coil,plenums,duct material)if the reused parts are accessible and can be sealed to prevent leakage
Registration Number:214-A0131584A-000000000-0000 Registration Date/Time: 2014-11-03 13:31:32 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2014-11-03 13:31:17
Schema Version:0.551SDD
• CF1R-ALT-02-E
CERTIFICATE OF COMPLIANCE
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.
�d �
.,
We
ffi
a
,€ f �, >
Registration Number:214-A0131584A-000000000-0000 Registration Date/Time: 2014-11-03 13:31:32 HERS Provider:CalCERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2014-11-03 13:31:17
Schema Version:0.551SDD
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: Gw� C1'GCGGt/'�/I7�/li
Faulkner,Cindy l�
Company: Signature Date:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING&ELECTRICAL 2014-11-03 13:31:31
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. I am eligible under Division 3 of the Busine,, .an rofessions Code to acce r spons)�' •,e build sign or, er d n i tified on this Certificate of Compliance(responsible designer).
3. That the energy features and performai c speci anions,matena�� orients and Waged device a butld�ng deli` system design identified on this Certificate of Compliance conform to the
requirements of Title 24,Part 1 and of the Cairfor Lodt3l ions.
4. The building design features or syste esign featur i fled ori certificate of� I ce a cortOft-ll wit: nformat i vi led on other applicable compliance documents,worksheets,
calculations,plans and specification mitte ent cY for ppr �rv7th is itg�tntit ap on
5. 1 will ensure that a registered copy oftettl ce afsl drt���Yi� y ed fdle fire f�uJ YtF d �il�ble to the enforcement agency for all applicable
i
inspections.I understand that a registefed'copy of Mils Ce �catesfnmplian' i iitC e f etl viith`the d' mentation'the bu Eder provides to the building owner at occupancy.
Responsible Designer Name: ik Responsible Designer Signature: C1'LxGG�wi'/!2�/7� 1
Faulkner,Cindy
F,.
Company: fill Date Signed:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLIIVG&ELECTRICAL 2014-11-03 13:31:32
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 no way implies Registration Provider responsibility for the accuracy of the information.
Registration Number:214-A0131584A-000000000-0000 Registration Date/Time: 2014-11-03 13:31:32 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2014-11-03 13:31:17
Schema Version:0.551SDD