15010011CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20560 RODRIGUES AVE I CONTRACTOR: R&B HEATING AND A/C PERMIT NO: 15010011
OWNER'S NAME:
V LICENSED CONTRACTOR'S DEE+CLARATION
License Class C<� _Z"' Lic. #
Contractor 43 p %Its
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
ITof the work for which this permit is issued.
%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
permit is issued.
APPLICANT CERTIFICATION
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this per it. Additionally, the applicant understands and will comply
with all non -poi ource regulations per the Cupertino Municipal Code, Section
9 18. S
Signature Date
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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
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
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9 18.
Signature.
Date
SAN JOSE, CA 95128 1 PHONE NO: (408) 977-1401
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E]
INSTALL NEW FURNACE IN ATTIC ABOVE CLOSET AREA
NEXT TO HALLWAY
Sq. Ft Floor Area: I Valuation: $5100
APN Number: 35917017 00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS + ALLED INSPECTION.
te: ✓� /�
CYC RE -ROOFS:
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.
Signature of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with theC ertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Section 505, 255 d 25534.
Owner or authorized agent:
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C )
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CUPERTINO
GENERAL PERMIT APPLICATION o� 1 M E P
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION O
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (�^ 6
1
(408) 777-3228 • FAX (408) 777-3333 • building0cupertino.org misc
LPLUMBING CHANICAL LJELECTRICAL LJMISCELLANEE/OUS
PROJECT ADDRESS d 5 6 0 J v� APN # 3s-9
� V - / ..L
OWNER
`gyp (/ Q ► J / CITY, STATE, ZIP �Q FAX
CONTACT NAME ( YID C ! Kr �/ PHONE !!, ` E-MAIL
STREET ADDRESS CITY, STATE, ZIP 7� / _ FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT„ .CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSEy
ER LICENSE TYPE BUS. LIC #
L
COMPANY NAME E-MAIL FAX
STREET ADDRESS �j AOS ram CITY, STATE, ZIP PHONE p
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC #
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY, STATE, ZIP PHONE
USE OF VSFD or DUPLEX ❑ MULTI -FAMILY PROJECT IN WI.DLAND ❑ YES PROJECT IN ❑ YES IS THE BLDG AN ❑ YES
BUILDING: .b COMMERCIAL J URBAN INTERFACE AREA El NO FLOOD ZONE ❑ NO EICHLER HOME? ❑ NO
7'(
DESCRIPTION OF WORK I !'
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MEPMiscApp 2011.doc revised 06/21/11
CITY OF CUPERTINO
LIVU T, C'TTM A 9x`"12 — RT TTT .nTNC: nIVIRI0N
ADDRESS: 20560 RODRIGUES AVE
FEE ID
DATE: 01/05/2015
REVIEWED BY: MELISSA
APN: 35917 017
BP#:
*VALUATION: 1$5,100
*PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD Or DU 12X
p
#
$143
PENTAMATION FURN/AC
PERMIT TYPE: A
USE:
:5'zr/pl> InsJ.")1'
WORK
INSTALL NEW FURNACE IN ATTIC ABOVE CLOSET AREA NEXT TO HALLWAY
PME Unit Fee:
$143.00
SCOPE
$48.00
T77=
APPLIANCE / EQUIP TYPE
FEE ID
------ -
QTY/FF
QTY
UNITS
BP FEES
Furnace, Forced -Air
IMFR=<100
1
#
$143
Perini! F'ee:
:5'zr/pl> InsJ.")1'
PME Unit Fee:
$143.00
PME Permit Fee:
$48.00
T77=
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? ® Yes (E) No
$0.00
TOTALS:
i
Travel Documentation Fee: ITRAVDOC
$143.00
Strong ]Motion Fee: IBSEISMICR
Mech. Plan Check 10.0 1 hrs $0.00 Ptrarrrb. 111an Check
Mech. Permit Fee: 1MPERMIT m,.1). f'eTmit Fee:
Other Mech. Insp. 10.0 1 hrs I $48.001 Other Plumb Trap
�11aria. aaq�). Fee: Plaid), hzsp. Fee:
fsiet. l',"ran C.'=z ck
cit/'L'!' /_/C . h?sp.
hiec. Ifs lee:
NOTE: This estimate does not include fees due to other ueparrmenrs (Le. rtannfnx, ruuuc rr orna, marc, uuraasury ,
,a ,. � —A, .. rn"tnrt tho Dont fnr addn'l info.
I/lsdrbcl, CIV.z. 1 nvae aa:u wrc o—w — r. • ..............
FEE ITEMS (Fee Resolution 11-053 E . 7/1/13)
.._ ... ..__-.--- -. ---------
FEE
------ -
QTY/FF
MISC ITEMS
Nun Che cli'
Stipp!, .P(' 1' cc'
PME Plan Check:
$0.00
Perini! F'ee:
:5'zr/pl> InsJ.")1'
PME Unit Fee:
$143.00
PME Permit Fee:
$48.00
T77=
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? ® Yes (E) No
$0.00
i
Travel Documentation Fee: ITRAVDOC
$48.00
Strong ]Motion Fee: IBSEISMICR
$0.66
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
$285.66
$0.00 v TOTAL FEE:
r
$285 66
Revised: 10/01/2014
STATE OF CALIFORNIA
ALTERATIONS - HVAC
0
CEC-CF1R-ALT-03-E Revised 06114 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-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:
Date Prepared:
Permit#:
Equipment Type
Equipment Efficiency
New: Ducting, Plenums, Lineset
Conditioned
Thermostat
bC_
Required R -value
Floor Area (sq ft)
❑ Packaged System
❑ Evaporator Coil
BS�_AFUE
COP
Pt R-6 (CZ 1,3-7) Ducts
Se ry d b system
etback
qg9tplit System
❑Condensing Unit
SEER
El R-81 (CZ 16) Ducts
sq ft
(If not already
HSPF
❑ R-6 (all CZ's) Plenums
present, must
❑ Furnace
❑ Uneset
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.
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 (:<.15% or, < 10% to outside, or seal all accessible leaks)
Exempted from duct leakage testing if:
F%].. 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 ....... I
2. New HVAC System
Required Compliance Documents to be left on site for Final:
All new equipment and All New Ducts'
CF111-ALT-02-E
�! ��, as
F
CF2R-MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS
v'
CF3R-MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS'
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 CF1R-ALT-02-E
Ducts' and one or more of the following: CF2R-MECH-01, MECH-20-HERS, MECH-(23 or 24) -HERS
Condenser Unit, Evaporator Coil, Furnace CF3R-M ECH-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
CF1R-ALT-02-E
space but less than All New Ducts'
CF2R: MECH-20-HERS
CF3R: MECH-20-HERS
Installer Required to: Duct leakage (:5_15% or, < 109,. 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.
' 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.
3 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.
Respo ible Designer Name:
Respo Ie Designer Signature: r
Date Signed:
License:
�2r;ea 1v'c / t• 2-
Company
�U l`�JGC aa�
ddress:
��gu's�-
City/State/Zip: L�
��25� /U�
Phone: /
For assistance or Wuestions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300
- -Yvcu t- UR CODE COMPLIANCE
Reviewed By.
CERTIFICATE OF INSTALLATION
rVD Y1IS • CF2R-MCH-20-H
Duct Leakage Diagnostic Test
(Page 1 of 3 )
Project Name: 20560 rodrigues ave
Enforcement Agency:
Cupertino
City of
Permit Number: 15070023
Dwelling Address: 20560 rodrigues ave
City:
Cupertino
Zip Code: 95014
A. System Information
01
Space Conditioning System Identification or Name
bryant
02
Space Conditioning System Location or Area Served
Location 1
03
Building Type from CF -111
Multi -family
04
Verified Low Leakage Ducts in Conditioned Space
(VLLDCS) Credit from CF1R?
No, credit is not taken
05
Verified Low Leakage Air Handling Unit (VLLAHU) Credit
from CF1R?
No, credit is not taken
06
1 Duct System Compliance Category
New
MCH -20a - Completely New Duct System
B. Duct Leakage Diagnostic Test
01
Condenser Nominal Cooling Capacity (ton)
0
02
Heating Capacity (kBtu/h)
34
03
Conditioned Floor Area served by this HVAC system (ft2)
800
04
Duct Leakage Test Condition
Test final
05
Duct Leakage Test Method
Total leakage
06
Leakage Factor
0.12
07
Air Handling Unit Airflow (AHUAirflow) Determination
Method
Heating system method
08
Measured AHUAirflow
This field or section is not applicable
09
Calculated Target Allowable Duct Leakage (cfm)
89
10
Actual duct leakage rate from leakage test measurement
(cfm)
41
11
Compliance Statement: System passes leakage test
Registration Number: 215-A0185136A-M2000002A-0000 Registration Date/Time: 2015-07-08 07:29:44 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2014-05-08 Report Generated: 2015-07-07 20:08:32
2013 Residential Compliance Schema Version: 0.51SDD
CERTIFICATE OF INSTALLATION CF2R-MCH-20-H
Duct Leakage Diagnostic Test (Page 2 of 3 )
C. Additional Requirements for Compliance
01
System was tested in its normal operation condition. No temporary taping allowed.
Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage
02
testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA ventilation is required to meet
ASHRAE Standard 62.2, and close when OA ventilation is not required, may be configured to the closed position during duct
leakage testing.
03
All supply and return register boots were sealed to the drywall.
04
Building cavities were not used as plenums or platform returns in lieu of ducts.
05
If cloth backed tape was used it was covered with Mastic and draw bands.
06
All connection points between the air handler and the supply and return plenums are completely sealed.
Visual Inspection at Final Construction Stage (applicable if system was tested at rough -in)
After installing the interior finishing wall and verifying that the above rough -in tests was completed, the following procedure must
be performed
07
For all supply and return registers, verify that the spaces between the register boot and the interior finishing wall are
properly sealed.
08
If the house rough -in duct leakage test was conducted without an air handler installed, inspect the connection points
between the air handler and the supply and return plenums to verify that the connection points are properly sealed.
09
Inspect all joints to ensure that no cloth backed rubber adhesive duct tape is used.
The responsible persons signature on this compliance document affirms that all applicable requirements in this table have
been met.
Registration Number: 215-A0185136A-M2000002A-0000 Registration Date/Time: 2015-07-08 07:29:44 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards Report Version: 2014-05-08 Report Generated: 2015-07-07 20:08:32
2013 Residential Compliance Schema Version: 0.51SDD
CERTIFICATE OF INSTALLATION
Duct Leakage Diagnostic Test
CF2R-MCH-20-H
(Page 3 of 3 )
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Installation documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature: ��77
Xm 3azier
Ken Frazier
Company:
Signature Date: 2015-07-07 20:09:28
Golden State Energy Efficiency Services
Address:
CEA/ HERS Certification Identification (if applicable):
1463 Circus Ct.
City/State/Zip:
Phone:
Turlock CA 95380
1209 648 2999
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 Installation is true and correct.
2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design,
construction, or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of
Installation and attest to the declarations in this statement (responsible builder/installer), otherwise I am an authorized representative of the
responsible builder/installer.
3. The constructed or installed features, materials, components or manufactured devices (the installation) identified on this Certificate of Installation
conforms to all applicable codes and regulations, and the installation conforms to the requirements given on the plans and specifications approved by
the enforcement agency.
4. 1 understand that a HERS rater will check the installation to verify compliance, and that if such checking identifies defects; I am required to take
corrective action at my expense. I understand that Energy Commission and HERS Provider representatives will also perform quality assurance checking
of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the
requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS
sample group will be performed at my expense.
5. 1 reviewed a copy of the Certificate of Compliance approved by the enforcement agency that identifies the specific requirements for the scope of
construction or installation identified on this Certificate of Installation, and I have ensured that the requirements that apply to the construction or
installation have been met.
6. 1 will ensure that a registered copy of this Certificate of Installation shall be posted, or made available with the building permit(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
Installation is required to be included with the documentation the builder provides to the building owner at occupancy.
Responsible Builder/Installer Name:
Responsible Builder/Installer Signature:
Ramiro Bejinez
Company Name: (Installing Subcontractor or General Contractor or
Position With Company (Title): IV
Builder/Owner)
Owner
R & B HEATING & AIR CONDITIONING
Address:
CSLB License:
P 0 BOX 270
789287
City/State/Zip:
Phone:
Date Signed:
NEW ALMADEN CA 95042
(408) 977-1401
2015-07-08 07:29:44
Third Party Quality Control Program (TPQCP) Status:
Name of TPQCP (if applicable):
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: 215-A0185136A-M2000002A-0000 Registration Date/Time: 2015-07-08 07:29:44 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2014-05-08 Report Generated: 2015-07-07 20:08:32
2013 Residential Compliance Schema Version: 0.51SDD