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14120035CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21607 VILLA MARIA CT CONTRACTOR: YEH YUSUNG W AND PERMIT NO: 14120035 CHI OWNER'S NAME: YEH YUSUNG W AND CHI 21607 VILLA MARIA CT DATE ISSUED: 12/08/2014 OWNER'S PHONE: 4085061296 CUPERTINO, CA 95014 PHONE NO: JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] ❑ LICENSED CONTRACTOR'S DECLARATION REMODEL (E) KITCHEN (165 S.F.) & 5 (E) BATHROOMS License Class Lic. # (373 S.F.), NO STRUCTURAL CHANGES 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: $35000 I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 35623064 00 Occupancy Type: 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 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 L INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgm costs, and expenses which may accrue against said City in consequence of the Issu Z �� 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. 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 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 25 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 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 reg ations per the Cupertino Municipal Code, Section Licensed Professional 9 18. Date -�� Signature4A- CUPERTINO F-1 ATC\T/ l nMC MT PERMIT APPLICATION CONSTRUCTION �v COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(aD_cupertino.crg FI Ar-1T1TTTnm F-1 Ai TPP ATTOM / TT M RF.VTRTON / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS ;i 1607 V1 LLA ARIA C.T. _ Zf � - 0(, ( y APN # 3 5L OWNER NAME I VVI ' PHONE c6 - -o6-iz ILJ E-MAIL cK STREET ADDRESS Q 16 01 I II 1 HARt /� CT, �/ Ii �,/� If FAX CITY, STATE,�ZIP /A.)OV CA WI IMT *Y CONTACT NAME �� I v�I"� PHONE Q -,," � E-MAIL -5e�q" G �' 6" ` �I ��//t n, q may. STREET ADDRESS I !O� VILLA❑ CTTY,STATEE, ZIP IV�O �i�! + FAX OWNER ❑ OWNER -BUILDER OWNERYAGG{ENT[,'/'❑' CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME ALEHAIR , `J o / N LICENSE NUMBER 8 J, 6 / o 4I (,"7' v 't LICENSE TYPE BUS. LIC # /'T qn COMPANY NAME _DAM H„M ((. 0A( E-MAIL FAX STREET ADDRESS P O . IBoX �Q V"v CITY, STATE, ZIP r�, I IA AOIJ CAIS 9 J N u”' �1 l�T `J �y 7 /� PHONE %� ,�h r� 2- -7D2 L ✓ ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC�#{JV COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ` �`{{ /� p DESCRIPTION OF WORK RE40 IL �� Kt I :q_1W ' 6,5, y (a,D 4/z I ((1 I koOM5 (3 54 ) j\ (� J Fill �aJa Vr� 1 VL► LIKE- RR KC EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA: DETACH []ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY []YES BEING ADDED? []NO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES ` '. �;;]'' " ' 4 TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO By my signature below, I certify to each of the following: I am the property owner or aut t to ac e property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description o ork it is accurate. I agree to comply with all applicable local ordinances and state laws relating to bu ldyig struction. I uthorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENT ORMAT ON RE IREDri" p>La v crr TirE r . > "xouinv�sLIP _ New SFD or Multifamily dwellings: Apply for demolition permit for building(s). Demolition is required to issuance of building�� L�* � R , HFT�COII.'EER�K'�j ©t ;BUILpING PLAN REVIEW � a v.' , existing permit prior a permit for new building.L�� ss� aN REVIEW rLANNINc P,,,_- r Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ti 0 sn�Rn ❑ PUBLIcwoRlcs _ form if any Hazardous Materials are being used as part ofthis project.0�< ❑ 'FIREJ)EPT _ Copy of Planning Approval Letter or Meeting with Planning prior to. �z+j't �( ©''SANITARY SEWER DISTRICT submittal of Building Permit application. A3AJOR`" 4 r'EN� a «'�M q IRbNMENTAL HEALTIi x B1dgApp_2011.doc revised 06121/11 CITY OF CUPERTINO FFF. FCTIMATOR — RITILDING DIVISION im,ADDRESS: 21607 VILLA MARIA CT DATE: 12/08/2014 REVIEWED BY: MELISSA APN: 356 23 064 BP#: `VALUATION: 1$35,000 *PERMIT TYPE: Building Permit = s.f. $645.00 PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex p Suppl. PC Fee: (j) Reg. ® OT PENTAMATION 1 R3SFDREM USE: $0.00 PERMIT TYPE: WORK REMODEL E KITCHEN 165 S.F. & 5 (EBATHROOMS 373 S.F. Remodel, Bath (<=300 sf) 1 IREMRESBAT Permit Fee: SCOPE Suppl. Insp. Feer Reg. 0 OT0,0 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, tire, Nanitary Sewer District, acnooi n.1-1- ,.s,. 1 Ti... ., f'.,., ., A--4 — ib., nvnilnhia and ora nnhy an Pvtimaty_ rantart the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 ff. 7/1/13) 1'iart C,�ha<t`k I'1'tw1h. Plum Cht"c"l MISC ITEMS Fee: Plan Check Fee: $0.00 = s.f. $645.00 Remodel, Kitchen (<=300 sf) IREMRESY-IT rptsj Ll Suppl. PC Fee: (j) Reg. ® OT phtmb. hup. FCC NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, tire, Nanitary Sewer District, acnooi n.1-1- ,.s,. 1 Ti... ., f'.,., ., A--4 — ib., nvnilnhia and ora nnhy an Pvtimaty_ rantart the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 ff. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = s.f. $645.00 Remodel, Kitchen (<=300 sf) IREMRESY-IT Suppl. PC Fee: (j) Reg. ® OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 300 s.f. $645.00 Remodel, Bath (<=300 sf) 1 IREMRESBAT Permit Fee: $0.00 Suppl. Insp. Feer Reg. 0 OT0,0 hrs $0.00 L_L3_j s.£ Remodel, Other $431.00 IREMRESOTH PME Unit Fee: $0.00 PME Permit Fee: $0.00 (,(,1tsI1 n hon Lid. 4c ;n1'1?rttr(j!i u e"': 0 G Work Without Permit? ® Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure I E) A i`r.za,{3ti 1)t?Crr;raet2t{;tticlrr Fees: Strong Motion Fee: IBSEISMICR $4.55 Select an Administrative Item Bldg; Stds Commission Fee: IBCBSC $2.00 IS 1B�QhS NeRw $6.55 $1,721.00 1 .n TOTAL FEE;. $1,727.55 Revised: 10/01/2014 CUPERTINO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408} 777-3228 • FAX (408) 777-3333 • buildingQcupertino.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESSZ / APN Olt B # / j l r V OWNER NAME, O NER ADDRES \ ` L > DESCRIPTION OF WORK: 6 C7¢ ti We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and passible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Bu der" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. 14— 2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. C_ 3. 1 understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license nu bers on permits and contracts. 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the totTl value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. C6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and fed ral government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. r17. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family eire idential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. Jf 8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for inancial or personal injuries sustained by any subsequent owner(s) that result from any latent construction ts in the workmanship or materials. OwneYBuildeYForm 2010.doc revised 04/14/10 '.I understand I may obtain more information regarding my obligations as an "employer" from the Internal Itnhe nue Service, the United States Small Business Administration, the California Department of Benefit Payments, California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors. 10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am he party legally and financially responsible for proposed construction activity at the site address listed above. 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by II applicable laws and requirements that govern Owner -Builders as well as employers. C� 12.1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the in f mation I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If yo contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: --------------------------------------------------------------------------------------------------------------------------------------------- (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwnerBuilderForm 2010.doc revised 04/14/10 tqu.me : Y A f (NI Yal - r 216ol VILLA MAKtA Ur. 0AP6kTr&)t), CA q5,01-14 Ail zo 13 CA 61t G& KI Tde, COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION - CUPERTINO APPROVED This set of plans and specifications MUST be kept at the job site during construction, it is unla,%fui to make any changes or alterations on same, or to deviate therefrom, without approval from the Building Official. The Stamping of this plan and specifications SHALL NOT be held to permit or to be an �roval of the violation of ami nce or State Law. PERMIT # / ZaU3 COORC we - 3)ACT-- t -IIA M (C -tot, PALL RAM ILIOA) 6N54W 10 I sAIJ M,401J X& C�-oB-Z-7 1'7 L� 10 .C-UP€RTINO Building Deparhent L' 0 0 2014 D FOR CODE COMPLIANCE wed By: K�-/_ fic�e�. RECEIVED DEC 0 on 2014 BY CA41 Yc- H '216-01 VILLA MAR(A CT. WET Wo, CA qV( (09 -� 6- (2,96) s4e, ort Fr, o1c:r-- Af I zo 13 CA 63I � CO&4 " �ow�stG� � Pa ��� Cel CO m m OST O C) —DA(I--- HAM (L—JoIN) TA(Y- RAM ILTW Ok MtalQtJ -]A)( P 0. RO,-c, 6D R SAA.), 1,W7ti eA qSp IM0145+CA47 7 7 Rq6ce CM plq4i c"UP s I 101<1 Building oepE, rtMent � FEVIEi E ED OR CODE COMPLIANCE Reviewect QGyll e= 'OM t CSI YGH A,w : 2107 VLLA HA2IA Cor CuPF%fZ.T1fV0j Cil 4' vlly- (406 —40�— 128� ) Sco)u, U& -Fw Lf,& All Zo(3 CA ielt G0d4 Arr% CO�IKAQO K -PAQ�- Wtl l(-7oiJ DA(�- k0fIL70A) C0A)SV .64CT'c, P,D.8a 0,miz-(/ CA%sys ( -a'�Z -'7 7'70 I CUPERTINO Building Department R CSE COMPLIANCE 3Y Name Nduo-- Qi6o"1 OLLA WIA CA-. CKCF,kn,00., CA q�I4- CA-0-g-SV6- tile") Lt45 f&%- LiKrt CA 181 co&.o 1) BAAYDDM m 1 4-/ Cbt)YmJ,w .7 DkE HAM( L —toij IN cs - H Am I L -totJ COA)5xvajaJ T�c, PC), Ric f SAiJqAR-(/A) c , A ?so4L6 C4 0� -'0 * 2 -77 Z) T U8 CN) ReOooe aH pkfhi� J2) f IKtcfffiER Building Der REVIEWED FOR C()f)E CoMp, Reviewed By; 00 ) tO 1< xtsuo� t 0641 yt-(A ` Qt601 VILLA M41ZIA CT. CqQZr/A) 0, CA 1,519 Ail '200 CA Sit 4ta,,V� BA" (Z) a Co oml:D-c- &h) wcciok - DA(F-. HSM crotJ �LE tfAAJI(,(OkST&CN?A) 2A(,. LQJ+2- - 7 1172- s-. 01) ) lace a(( 14t 00 oze s /M rz 3 H OaR 1 1 3 how F-/ R uvAl\-, B*vo-A(Z) CUPERTINO Building Depatnent REVIEWED FOR CGDE COMPLIANCE Reviewed By. �6w, UA t UP Y'5H -A4",, Q 16o`7' ALA ivA(?!A C -r. cuP�Rvlvo, cA T�vf4� C4.09-6-06s12TO SGGr: Li4 fw Al( 2013 CA t3W ad, -lo 4 �rtrl�l I3Gv�`No"^ C3� sHowFr� �p DD _6 I�c� all . l��►d� C WRAGIOR : �DAC�- NAAJIL 7oir b4Lr- NAM1e ToA) C-'1QSrXodiO4j74 PT,9�x 3�6 S4�J (#op - e* 7- - 7f 17L> Ute,ti'lj BA4Q7m (3) m CUPERTINO 3uilding OPPartmenk y � D FOR CODE COMPLIANCE 'wed By: CUPERTINO Address SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 tzinR1 777_377.. FOX rdr)M 777_3333 , hi d1Hinn(n)ri mcrtinn nm 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 8314 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: fit 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. 1 have read and agree to comply with the terms and conditions of this statement Owner (or Owner Agent's) Name: � n - CL ✓ 6 1 ,'" � V'Le'*­ 1 Q. � � �. alt`}' Si nature......................................................................................................... Date: ................... Contr ct(orr Name: �......... Si nature ....... .. .... .................................... ......Lic.# ....v.!....... Date: �.. Smoke and CO form.doc revised 03/18/14 CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 1 of 4 Project Name: BRYAN MILLER Date Prepared: 2014-10-3C 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 CHR -ALT -02 document for each dwelling unit. 01 Project Name BRYAN MILLER 02 Date Prepared 2014-10-30 03 Project Location 21702 COLUMBUS AVENUE 04 Building Type Single family CIS CA City Cupertino 06 Dwelling Unit Name BRYAN MILLER 07 Zip Code 95014 08 Dwelling Unit Conditioned 2119 tt`I'ks`theSC "'-, �Instalinga Floor Area (ft2) SC System SC System CFA served Number of space conditioning refrigerant 09 Climate Zone 4 30 (SC) systems in this dwelling 1 Location or Area by this SC ducted containing unit. more than 40 B. Space Conditioning (SC) Systemf@$imatlon O1 02 006 `. 04 O5 07 08 09 10 . , . tt`I'ks`theSC "'-, �Instalinga 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 Bryant whole house 2119 Yes No Yes No No No Altered space conditioning system C. Extension of Existing Duct System, Greater Than 40 Feet (Section 15O.2(b)1Diib) This section does not apply to this project. Registration Number: 214-A0129708A-000000000-0000 Registration Date/Time: 2014-10-30 15:03:22 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2014-10-30 15:04:19 Schema Version: 0.5515DD CERTIFICATE OF COMPLIANCE CFIR-ALT-02-E Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 2 of 4 ) D. Altered Space Conditioning System (Sections 150.2(b)lE and F) O1 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 Outdoor Central large No cooling This field or This field or Less than or Bryant furnace condensing AFUE 0.78 packaged AC component section is not section is not Setback equal to 40 R-6 unit altered applicable applicable feet Required Documentation: CF2R-MCH-03-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, orwhen more than 40 ft of duct length is replaced. -Leakage rate compliance: 5 SS%, or15 10% 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 2 300 CFM/ton,, uired when MCH -25 is required.. . Exceptions: - -Duct systems registered with HERS provider as pre kisly sealed are exempt from MCH.20 Duct Leakage Testing requirements. -Heating-only systems and Air Handler/Furnace cha ii do not aequj e�yeriffwtwn of Air Flow MCH -23, or Refrigerant Charge MECH-25. -Existing duct systems constructed, insulated ons aged withfasbestos'are 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-AO12970BA-000000000-0000 Registration Date/Time: 2014-10-30 15:03:22 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2014-10-30 15:04:19 Schema Version: 0.551SDD CERTIFICATE OF COMPLIANCE CFIR-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 15O.2(b)1C) This section does not apply to this project. Registration Number: 214-A012970BA-000000000-0000 Registration Date/Time: 2014-10-30 15:03:22 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2014-10-30 15:04:19 Schema Version: 0.5515DD I 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: Rando, Eric 2014-10-30 15:03:22 Company: Signature Date: RANDO AAA HVAC INC 2014-10-30 15:03:22 Address: CEA/ HERS Certification Identification (if applicable): 1712 STONE AVENUE owner City/State/Zip: Phone: SAN JOSE CA 95125 1(408) 293-4717 Responsible Person's Declaration statement I certify the following under penalty of perjury, under the laws of the State dfCalifornia: 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 performartEespecifcations, materials cortip'onents; and manufactured devices forthe building design or system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part1 and Part 6 -of the California Coc!4 Regulations. 4. The building design features or syst� i°design featurAAes id ntifield dr this.Certificate okoinpliance are consistent with the information provided on other applicable compliance documents, worksheets, calculations, plans and specification bmitted,tottie�e}fi�f�rce�nentajEhcy for approvalwith this bwldingpermit application. 5. 1 will ensure that a registered copy of th�ls Certlfica'te o"CoMliha be shaWbe made ava lable,with the building permits) issued for the building; and made available to the enforcement agency for all applicable inspections. I understand that a registered copy oftliis is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Designer Name: - Responsible Designer Signature: Rando, Eric Company: Date Signed: RANDO AAA HVAC INC 2014-10-30 15:03:22 Address: License: 1712 STONE AVENUE 768871 City/State/Zip: Phone: SAN JOSE CA 95125 (408) 293-4717 Digitally signed by Ca/CERTS. This digital signature is provided in order to secure the content ofthis registered document, and in noway implies Registration Provider responsibility for the accuracy ofthe information. Registration Number: 214-A0129708A-000000000-0000 Registration Date/Time: 2014-10-30 15:03:22 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2014-10-30 15:04:19 Schema Version: 0.551SDD