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14110068 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 945 NOVEMBER DR CONTRACTOR:VALLEY HEATING& PERMIT NO: 14110068 COOLING OWNER'S JOB DESCRIPTION:RESIDENTIAL COMMERCIAL 0 �( REMOVE AND REPLACE FURNACE AND ADD A/C WITH License Class C3 Lie.# 04� �/ A NEW / f DUCTS. Contractor � 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:$16520 Pave and will maintain Worker's Compensation Insurance,as provided for by ection 3700 of the Labor Code,for the performance of the work for which this APN Number:36213042.00 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 rect.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 by: granting of this permit. Additionally,the applicant understands and will comply �i Date: with all non-point sourc gulations per the Cupertino Municipal Code,Section 918 ROOFS: Date--/l( All roofs shall be inspected prior to anyny 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 Cuytffi�o Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections ,25533,a 34. 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 /y// 0060 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255L2 MISC (408)777-3228•FAX(408)777-3333•build ingCa�cupertino.ora CllPEFtT1NQ ❑/PL�U///MBING MECHANICAL F-1 ELECTRICAL []MISCELLANEOUS PROJECT ADDRESS 1((5./ O�/gyp „_/ �_ APN#�/ D OWNER NAME. �� / STREET ADDRESS �c /� CITY, ATE,ZIP ,I flet( FAX CONTACT NAMEf PHONE V G Z A X/ Zqa E-MAIL STREET ADDRESS ��"G� �/ CITY,STATE,ZIP ` / �f/� FAX El OWNER ❑ OWNER-BUILDER 11 OWNER AGENT '/ ONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME I 4 � �a� LIC ENSENUMBER �Z LICENSE TYPE C)� BUS.LIC# COMPANY NAME t E-MAIL `(� FAX STREET ADDRESS r j I ' CITY,STATE,ZIP �lyl �J PHONE y6 Of � C210 ARCHITECT/ENGEJEER NAME / LICENSE NUMBER )` (' BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: COMMERCIAL URBAN INTERFACE AREA NO FLOOD ZONE NO EICHLER HOME? �NO DESCRIPTION OF WORK / L 974 'All - 1t Ctg11�Gs � .�-�rn.S TOTAL VALUATION: RECEIVED BYi q By my signature below, certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have pro d is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to bui in c0 truction. I a ze representatives of Cupertino to enter the above-identified property for i pection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY W <, OVER-THE-COUNTER o p_ El EXPRESS V. STANDARD U D LARGE MAJOR MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 945 November dr DATE: 11/12/2014 REVIEWED BY: sean APN: BP#: *VALUATION: 1$16,520 PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: FURN/A WORK REMOVE AND REPLACE FURNACE AND ADD A/C WITH NEW DUCTS. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $143 A/C Units (<=1 OK cfm) 1BREMAIR 1 # $72 TOTALS: $215.00 .m p. wam .x Mech.Plan Check0.0 hrs $0.00 1,11110. 111(in Check ]s ee.P%ae>.Check Mech.Permit Fee: IMPERMIT T1umb.Permit Fee: 1acc. PerFrei;Fee Other Mech.Insp. 0.0 L! J01wi.48.0Numb Insp. El t3rher I,lee.Insp. face. laip. FCC' 11hanb. hap. Fce: 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 prelinmdina information available and are only an estimate. Contact the De t or addn7 in o. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1113) FEE QTY/FEE MISC ITEMS Plant Check S!'q))pl. PC I e PME Plan Check: $0.00 PME Unit Fee: $215.00 PME Permit Fee: $48.00 t.'onstrttclion 7"ax: F] Administrative Fee: ]ADMIN $45.00 Work Without Permit? ®Yes 0 No $0.00 :<Idti'asaeecil P/arming Fees: Travel Documentation Fee: ITRA VDOC $48.00 A Strom Motion.Fee: IBSEISMICR $2.15 Select an Administrative Item Bldg;Stds Commission Fee: IBCBSC $1.00 a: $359.15 $0.00 TOTAL FEE: $359.15 Revised: 10/01/2014 vt c' CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E Alterations to Space Conditioning Systems(formerly CF-1R-ALT-HVAC) (Page 1 of 3) Project Name: Martin Norby-2014-0300 Date Prepared: 2014-11-11 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 02 Date Prepared 2014-11-11 03 Project Location 945 November Drive 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name Martin Norby-2014-0300 07 Zip Code 95014 08 Dwelling Unit Conditioned 1800 Floor Area(ft2) Number of space conditioning 09 Climate Zone 4 10 (SC)systems in this dwelling 1 unit. B.Space Conditioning(SC)Systems formationI/M 01 02 03. tl4 ti (!? 09 10 �a r —,, Is tliie S SC System SC System thi SC sductedcontaining y y y refrigerant Installing new SC Installing Installing Installing Identification or Location or Area.., .,�'" system more than 40 entirely new entirely new Name Served System(ft2) system? component? components? feet of ducts? duct system? SC system? Alteration Type Furnace Entirely new or replacement add ac Whole house 1800 Yes Yes Yes Yes Yes Yes complete replacement and duct space conditioning replacement 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-A0136777A-000000000-0000 Registration Date/Time: 2014-11-11 09:42:55 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2014-11-11 09:43:46 Schema Version:0.551SDD t CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E Alterations to Space Conditioning Systems(formerly CF-IR-ALT HVAC) (Page 2 of 3) 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)iDiia and 150.2(b)1E,F) This section does not apply to this project. F.Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)1C) 01 02 03 04 05 06 07 08 09 10 11 Heating Cooling System Heating Minimum Cooling Minimum Required Identification or Heating System Altered Heating Efficiency Efficiency Cooling Altered Cooling Efficiency Efficiency Thermostat New Duct Name Type nt p. Y Sys#'Irr %Com�lo [1t Type Value Type R-Value J 107 Furnace RK- fl. replacement add Central gas AI new h Cet7t plit All newco SetbackTher 14 R-6 ac and duct furnace ampbd A comprtie � mostat replacement Required Documentation: ' CF2R-MCH-01-E-Space Conditioning Systems Ducis and Fans -Duct insulation requirement for new plenums:R6. CF211&CF3R-MCH-20-H Duct Leakage Verification required. -Leakage rate compliance:<_6%. CF211&CF3R-MCH-22 Fan Efficacy Verification CF211&CF3R-MCH-23 System Air Flow Rate Verification -Compliance:Fan Efficacy<_0.58 W/cfm and System Airflow 2 350 cfm/ton. -Alternative Compliance:CF2R&CF3R-MCH-28 Return Duct Design Verification is an alternative to MCH-22 and MCH-23 verification. CF211&CF3R-MCH-25-H Refrigerant Charge Verification required when 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-A0136777A-000000000-0000 Registration Date/Time: 2014-11-11 09:42:55 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2014-11-11 09:43:46 Schema Version:0.5515DD e: CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E Alterations to Space Conditioning Systems(formerly CF-IR-ALT HVAC) (Page 3 of 3) Documentation Author's Declaration Statement 1.1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: (?�% C1'LC(GC/7 /L Faulkner,Cindy Company: Signature Date: ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING&ELECTRICAL 2014-11-11 09:42:55 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 ofGalifornia: 1. The information provided on this Certificate of Compliance is true and correct. 2. 1 am eligible under Division 3 of the Business anti-Professions Code to accept-;yes nsib i for the builsign es gn iderttjfied on this Certificate of Compliance(responsible designer). 3. That the energy features and perform tEcs specifications mater ,(c I ottsnts nd ttufactrired ell, dC ew. d�sigrk orsystem design identified on this Certificate of Compliance conform to the : requirements of Title 24,Part 6 de 1 and of the Californ Coltions. 4 4. The building design features or Sys esign features ic( tttifi Certificate o C11 nce a sl tent with formatioft p pvided on other ap licable compliance documents,worksheets, calculations,plans and specificatio fjmitted t he eCffttrC n ncy for nor with t is b eC }Sap ttn ✓ ; 5. 1 will ensure that a registered copy o i of, tim ce s I / h 11 tied fortis bu)I a[lable to the enforcement agency for all applicable inspections.I understand that a registe'r`s copy`ofthis Certifi f p a, s et'to tie tri dsd w� the itocumentation the builder provides to the building owner at occupancy. Responsible Designer Name: Responsible Designer Signature: �-- Faulkner,Cindy Company: Date Signed: ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING&ELECTRICAL 2014-11-11 09:42:55 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 noway implies Registration Provider responsibility for the accuracy of the information. Registration Number:214-A0136777A-000000000-0000 Registration Date/Time: 2014-11-11 09:42:55 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2014-11-11 09:43:46 Schema Version:0.551SDD