15070212CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20745 SCOFIELD DR
CONTRACTOR: VALLEY HEATING &
PERMIT NO: 15070212
COOLING
OWNER'S NAME: HONIG RODNEY M AND LUCILLE A
1171 N 4TH ST
DATE ISSUED: 07/29/2015
OWNER'S PHONE: 4082577429
SAN JOSE, CA 95112
PHONE NO: (408)294-6290
LICENSED CONTRACTO 'S DECLARATION
a
S
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL [:]
REPLACE (E) FURNACE WITH (N) FURNACE (AFUE 96%,
License Class �/ LLiic,. # J
BTU 110K) AND REPLACE (E) A/C WITH (N) A/C (SEER
/
�/ 2
14,4 TONS)
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
Sq. Ft Floor Area:
Valuation: $12220
performance of the work for which this permit is issued.
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: 35912001.00
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 D SAF T 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 D + OM ED 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
granting of this permit. Additionally, the applicant understands and will comply
ate:
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
p
Signature_ Z, Date 2 �/
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.
❑ 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 1
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 2 O5, 25533,.and25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner Date:
permit is issued.
permit
or authorized agent:
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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
CUPERTINO
GENERAL PERMIT APPLICATION rEiQ�oa(a
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildino(a cupertino.org
7PLUlyMING F�l,=AmcAL nFT.RCTRTrAT. I—IA/ITSCFTT WPM -,Q
PROJECT ADDRESS S(s 0 4t I D/- APN #
OV✓NERNAMETI On i� 1P"O'4E
Vol i! l ) 5i7 7 VE-MAIL
STREETADDRESS b7 CC I P(
CITY, STATE, ZIP �t{y�b Lj �� / (/ I FAX
CONTACT NAME<4x Le PHONE (%0 { (/ / [ EMAIL
STREET ADDRESS
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CITY, STATE, ZIP ` C
I FAX
❑ OWIM ❑ OWNER -BUILDER ❑ OWNIM AGENT ACON''MkCTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGATEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR KUM t I
I�
a n 1 LICENSE NU7 SER f LICENSE TYPE %� O
r o1
BUS. LIC n
COMPANY NAME
E-MAIL 1 eVe (a ( r
1
FAX
STREET ADDRESS
i A/% S
CITY, STATE ZIP S-1 ��V� /��Q/-�
1
PHONE
ARCMTECT/FNGINEER NAME LICENSE NUMBER
BUS. LIC
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHOATE
USE OF ❑ SFD . DUPLEX ❑ MULTI-FAmg_y I . PROJECT IN WILDLAND ❑ YES PROJECT IN ❑ YES
B1711MG: ❑ COMMERCIAL URBAN INTERFACE AREA ❑ FLOOD ZONE ❑ No/
Is THE BLDG AN ❑ YES
EICI=HOME?? ❑ 0
jNO'
DESCRIPTION OF WORK 'rU rn 4 C ! vl ' �A/ 67 S f m%v I O ! %
TOTAL VALUATION:
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the roperty owner's behalf. I have read this
application and the information I have provided 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 bu, g construction Jautho i presentatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: 2 `� Date: � I f i l
SUPPLEMENTAL I TORMATION REQUIRED
t, I- ,rr ,•�rn�I ,'
OVER-,! -�
r..
A7EPATiscApp_2011.doc revised 0 612 1/11
CITY OF CUPERTINO
FEE ESTIMATOR- BUIDING DIVISION 1 50too.
APPLIANCE / EQUIP TYPE
ADDRESS: 20745 SCOFIELD DR
'iamb. Plan Check
DATE: 07/29/2015
REVIEWED BY: PAUL
BP FEES
APN: 359 12 001
BP#:
1MFR=<100
"VALUATION: 1$12,220
*PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
A/C Units (<=1 OK cfm)
PENTAMATION FURN/AC
PERMIT TYPE:
WORK
Replace E Furnace with N Furnace
AFUE 96% BTU 110K and Replace E A/C with N A/C
SCOPE
(SEER 14, 4 tons)
PME Unit Fee:
APPLIANCE / EQUIP TYPE
FEE ID
'iamb. Plan Check
QTY
UNITS
BP FEES
L. lec. Permit Fce:
Furnace, Forced -Air
1MFR=<100
' )thor 1-_7ec. lisp. Li I
1
#
$143
A/C Units (<=1 OK cfm)
1BREMAIR
Suppl. Insp bee
1
#
$72
PME Unit Fee:
$215.00
PME Permit Fee:
$48.00
Constructiot; /W.
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? Yes 0 No
$0.00
TOTALS:
Travel Documentation Fee: ITRA VDOC
$215.00
Strong Motion Fee: IBSEISMICR
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 preliminar information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E(: 7/1/13)
Mech. Plan Check 0.0 hrs $0.00
'iamb. Plan Check
Elec. Placa Check
Mech. Permit Fee: IMPERMIT
Plamb. Permit Fee.
L. lec. Permit Fce:
Other Mech. Insp. 0.0 hrs $48.00
! ;; vr. Plumb lavLl
' )thor 1-_7ec. lisp. Li I
'. i
Plumb. Insp. F>r
l:lec. Ij"q' / , "
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 preliminar information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E(: 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
T
Suppl. PC.' Fee.T
PME Plan Check:
$0.00
Permit Fee:
Suppl. Insp bee
PME Unit Fee:
$215.00
PME Permit Fee:
$48.00
Constructiot; /W.
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? Yes 0 No
$0.00
.fir VOW.'ed Planning Fees:
Travel Documentation Fee: ITRA VDOC
$48.00
Strong Motion Fee: IBSEISMICR
$1.59
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$358.59
$0.00 TOTAL FEE:
$358.59
Revised: 07/02/2015
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC)
Project Name:
215- 0056 Lucille and Rodney Honig I Date Prepared:
CF1R-ALT-02-E
(Page 1 of 3 )
2015-07-23
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 MR -ALT -02 document for each dwelling unit.
01
Project Name
215- 0056 Lucille and Rodney Honig
02
Date Prepared
2015-07-23
03
Project Location
20745 Scofield Drive
04
Building Type
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
215- 0056 Lucille and Rodney Honig
07
Zip Code
95014
08
Dwelling Unit Conditioned
3000
Installing
Installing
Installing
Floor Area (ft2)
Location or Area
by this SC
ducted
containing
system
Number of space conditioning
entirely new
09
Climate Zone
4
10
(SC) systems in this dwelling
1
component?
components?
feet of ducts?
duct system?
unit.
Alteration Type
B. Space Conditioning (SC) System Information
01
02
03
04
05
06
07
08
09
10
Is the SC
Installing 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
Furnace and A/C
Whole house
3000
Yes
Yes
Yes
No
No
No
Altered space
replacement
conditioningsystem
y
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: 215-A0203784A-000000000-0000
Registration Date/Time: 2015-07-23 13:43:53
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-07-23 13:43:52
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 2 of 3 )
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
Furnace and
Central gas
All new
Central split
All new
This field or
This field o r
A/C
heating
AFUE
0.95
cooling
SEER
14
Setback
section is not
section is not
replacement
furnace
components
AC
components
applicable
applicable
Reauired Documentation:
CF2R-MCH-01-E - Space Conditioning Systems Ducts and Fans
-Duct insulation requirement for new plenums: R6.
CF2R-MCH-20-H & CF311-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: <_ 15%, or <_ 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_ 300 CFM/ton required when MCH -25 is required.
Exceptions:
-Duct systems registered with HERS provider as previously sealed are exempt from 'MCH 20 Duct Leakage Testing requirements.
-Heating-only systems and Air Handler/Furnace changes do not requite verification of Air Flow MCH -23, or Refrigerant Charge MECH-25.
-Existing duct systems constructed, insulated or sealed with asbestosare 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)IE, F)
This section does not apply to this project.
F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)1C)
This section does not apply to this project.
Registration Number: 215-A0203784A-000000000-0000
Registration Date/Time:
2015-07-23 13:43:53
HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance` Report Version: 2014-03-31' Report Generated: 2015-07-23 13:43:52
• Schema Version: 0.555SDD
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:
�j� /�j/��
Documentation Author Signature: (?�%t
Faulkner, Cindy
ndy eCGCl4/rLPh
Company:
Signature Date:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL
2015-07-23 13:43:53
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. 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 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 California Code of Regulations.
4. 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 forapproval with this building permit application.
5. 1 will ensure that a registered copy of this Certificate of Compliance shall be 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 Compliance is required to be included with the documentation the builder provides to the building owner at occupancy.
Responsible Designer Name:
Responsible Designer Signature: r—
9
Faulkner, Cindy
l
Company:
Date Signed:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL
2015-07-23 13:43:53
Address:
License:
1171 NORTH 4TH STREET
258540
City/State/Zip:
Phone:
SAN JOSE CA 95112
(408) 294-6290
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: 215-A0203784A-000000000-0000 Registration Date/Time: 2015-07-23 13:43:53 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-07-23 13:43:52
Schema Version: 0.555SDD