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14110055 CITY OF CUPERTINO BUILDING PERMIT BUILDING SAN JOSE,CA 95110 PHONE NO:(408)279-0722 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL F] C1 ^� REMOVE AND REPLACE FORCED AIR UNIT IN UNIT#2. License Class '2 T tLie. # Contractor /li/X/_SL— Date 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$2150 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:37501009 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 FROM 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 Issued b �9:; � �� Date: granting of this permit. Additionally,the applicant understands and will comply rte, with all non-point source regulations per the Cupertino Municipal Code,Section 9 18. // r!l' (� 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) 1,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 25505,25533, nd 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: 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 411106 -6 I GENEMPAL PE,RMiT A%.PPLICA[IO COMMUNITY DEVELOPMENT DEPART MEN i• BUILDING DI MSION' ID300 TORR_AVENUE• CUPER 1 INO, CA 95014-3235 (408) 777-3228• Ery(408)7777-33323.5uiloinaf�cuo=�ino.ora �U i�'_�TI 1`I 0 m I s G CPLLi�--TG - 1, CELL.��-O0S 112 F CONTACT NjUIr 5- l 70 ( CaT,s,-A- �'" ZJ! c" Z l!/1` 0'v" �] C�;!1=: _rZ ❑ Gv, '?4C T mv7u TOi ❑CO7 ?�Cv?SQ�1 ❑ c?C_:�CT ❑ C+ ❑ D:1_ O?? ❑ ai�T'r f �7 / / T CG?�i:�!.CSO1�.rik.1Js LC�'.SHJiubT?�2✓�`7 I �!C��SBT1?l.- L7C r CO7!flxh�'7v1C? '�/� ✓ I �i✓47 lVwI S1ticTA�D?FSS f� '' ✓I I Cl�Y,STA_ _ �r®fG�G 1 [ f�Cii:ECT/�Ci��?1�L1(�/ I LiC:'?�SEhl3l�.r.-r.R t./,/ 13tiS.LiCr Coll 2i?NTY AWIS- ST?�aT ADDRESS I CITY,STAir,Z? I r"si0 USE OF ❑_�o D JPI VmL-'I-?:,'=Y ?80�:Q DzTY-IL L A-I M ❑ 1 B� FROMM iN, Y- 7Si_BIZC3 M, ❑ Y S BL=,TC: ❑jCo-mv :CiL I IMBENI:N-1 C Pak 7:0 I nmD.Loy: 7 0 DESCPIPTiO"Os h C)-Rx _ �^ P- r B V my SignaT:T 0 btIO-W,I Cef:j!t0 aaCn OI tn9%DLlowi t_g' 1 u'a a iO�BIi}T OSi•T!�i OP°Lu]Oi1�.•'�2�Ce1i i0 SCi Oil i'�rr0}7C ''OSiitP-i•5 �:i2i I�icPB lead iyh.15 ---- }+ of h •i? ayt- a} 1 .T and Vel��itis G:c.'•.�'a'!. 1 FE7t'.:O comply��r L. all_LS]licable local _ua�lCEiiOil u7�i..0 3.'0:';u10;1I 2S' Ino"e0--n'tr i=1.'Fbov- IGCr/`t�:re 0, iDi L_• :1 � C — et ( V SLPLBArNTi rT vrO1,LA i i0N .QUDZEN- elg- 1 —, M • 1��?A�'s�E��_2D1_7.docr_vsed06/sl/L7 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 19480 Richwood Ct#2 DATE: 11/10/2014 REVIEWED BY: Sean APN: I BP#: *VALUATION: 1$2,150 *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 forced air unit. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $143 TOTALS: $143.00 § Mech.Plan Check 0.0 hrs $0.00 Phwlh. Phin C'hcc.A 11W".P/W?�' c Mech.Permit Fee: IMPERMIT Plumb. Permit Fther Mech.Insp. 0.0 hrs $48.00 Other Piumh Irrs`n <�_'{!�'1' lllw ' hisp. 1"'e: 1-1C(_hl if t'l c: NOTE: This estimate does not include fees due to other Departments(he.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc . These fiTs are based on the prelimina information available and are only an estimate. Contact the Dept-for addn'1 info. FEE ITEMS (Fee Resolution 11-053 E f 7/1/13) FEE QTY/FEE MISC ITEMS P(_'t``'f tPME Plan Check: $0.00 PME Unit Fee: $143.00 PME Permit Fee: $48.00 T7-= Administrative Fee: (ADMIN $45.00 Work Without Permit? ® Yes 0 No $0.00 Travel Documentation Fee: 1TRAVDOC $48.00 Strom Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 , " r� L : $285.50 $0.00 TOTAL FEE: $285.50 M. Revised: 10/01/2014 CERTIFICATE OF COMPLIANCE CF111-ALT 02-E Alterations to Space Conditioning Systems(formerly CF-IR-ALT-HVAC) (Page 1 of 4) Project Name: 19480 Richwood#2 Date Prepared: 2014-11-05 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 19480 Richwood#2 02 Date Prepared 2014-11-05 03 Project Location 19480 Richwood Ctt#2' 04 Building type Single family 05 CA City Cupertino 06 Dwelling knit Name 19480 Richwood#2 07 Zip Code 95014 08 Dwelling Unit Conditioned 1000 Floor Area(ft2) Number of space conditioning 09 Climate Zone 4 10 (SQ systems in this dwelling 1 unit. S.Space Conditioning(SC)System Information 01 02 0a04f x `^ 07 08 09 10 5�, x t "ui r3�'.r,.V, fs the SC I»sial Itt .a SC System SC System CFA served system a refrigerant Installing new SC Installing Installing Installing Identification or Location or Area by 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 System 1 Location 1 1000 Yes No Yes No No No Altered space conditioning system C.Extension of Existing Duct System,Greater Than 40 Feet(Section1S0.2(b)1DIib) This section does not apply to this project. Registration Number:214-A0133826A-000000000-0000 Registration Date/Time: 2014-11-05 18:33:12 HERS Provider:CalCERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2014-11-05 18:33:38 Schema Version:0.551SDD CERTIFICATE OF COMPLIANCE CF111-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 Central gas Gas furnace No cooling This field or This field or This field or This field or System 1 furnace AHU AFUE 0.78 No cooling component section is not section is not Setback section is not section is not altered applicable applicable applicable applicable Reouired 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:515%,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 t 300 CFM/ton,required when MCH-25 is required. Exceptions: - -Duct systems registered with HERS provider as prgviousiy sealed are exempt from MCH-20 Duct Leakage Testing requirements s -Heating-only systems and Air Handler/Furnace cF#anges do not require`;verificatlon:of Air Flow MCH-Z3,or Refrigerant Charge MEC"25 Existing duct systems constructed,insulated 0r1�31ed with as st s ire exemptWfom MCH20 Duct leakage Ts[mg retluiremens3 rr `�esYYx 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-A0133826A-000000000-0000 Registration Date/Time: 2014-11-05 18:33:12 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2014-11-05 18:33:38 Schema Version:0.551SDD 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-A0133826A-000000000-0000 Registration Date/Time: 2014-11-05 18:33:12 HERS Provider:CaiCERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2014-11-05 18:33:38 Schema Version:0.551SDD 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: � �� Phelps,Dale Company: Signature Date: A&H HEATING&AIR CONDITIONING SERVICE INC 2014-11-05 18:33:12 Address: CEA/HERS Certification Identification(if applicable): 770 CHESTNUT STREET City/State/Zip: Phone: SAN JOSE CA 95110 (408)279-0722 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 Busihessand,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,cornponentr.and manufactured devices1br 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 systh�Yi_design features identifleil on this Certificate ofCompliance are consistent with,-t n pvfl he.informatrovided on other applicable compliance documents,worksheets, calculations,plans and specification3 submitted to the enforcement agency for approval with this building permit application. S. I will ensure that a registered copy of this Certificate of Compliance shall be matl.e available with the bpildingzpermit(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: �a��e� Phelps,Dale Company: Date Signed: A&H HEATING&AIR CONDITIONING SERVICE INC 2014-11-05 18:33:12 Address: License: 770 CHESTNUT STREET 304472 City/State/Zip: Phone: SAN JOSE CA 95110 (408)279-0722 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-A0133826A-000000000-0000 Registration DateMme: 2014-11-05 18:33:12 HERS Provider:CaICERTS ,CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2014-11-05 18:33:38 Schema Version:0.551SDD CUPERTINO Address SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE r------ r9-i h �" COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE . CUPERTINO, CA 95014-3255 (408) 777-3228 -. FAX (408) 777-3333 • building(abcupertino.org Permit No. PURPOSE This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections are required. GENERAL INFORMATION Existing single-family and multi -family dwellings shall be provided with Smoke Alarms and Carbon Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds $1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations: AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the bedroom(s) X X On every level of a dwelling unit including basements X X Within each sleeping room X Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated. In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for alarms which must be connected to the building wiring. As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes. The alarms have been tested and are operational, as of the date signed below. I have read and agree to comply with the t -ms and conitioxaf this statement Owne (or Owner A nt'sZNa e: Si................................................................. Date. ................... o tractor Name: ' Sinature...................................................................Lic*...................................... Date:................... Smoke and CO form.doc revised 03/18/14