15080189ON
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10362 JUDY AVE
CONTRACTOR: CONVECTEK
PERMIT NO: 15080189
OWNER'S NAME: BABY MARY E TRUSTEE
955 BENECIA AVE
DATE ISSUED: 08/27/2015
OWNER'S PHONE: 4086459451
SUNNYVALE, CA 94085
PHONE NO: (408) 687-5754
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL
REPLACE WALL FURNACE WITH (N) FORCED AIR
License Class Lic. #/, V
FURNACE
Contractor Date_
�% �Ci��
IN ATTIC, INSTALL (N) DUCTWORK IN HOUSE, INSTALL
y /`�
A/C UNIT IN (N) LOCATION
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: $10500
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
APN Number: 37510006.00
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 D SF LAST CALLED INSPECTI N.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
r
costs, and expenses which may ac a against said City in consequence of the
Issued b - r �
y: Date:
granting of this permit. Additio lly, the applicant understands and will comply
with all non -point source re ions per the Cupertino Municipal Code, Section
9.18.
RE -ROOFS:
Signature Date S—
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.
❑ OWNEIBILDEJ 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 tore or handle hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should I use equipment 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 A uality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cuperti oe, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sectio , and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent Date: g
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 L G 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 150001M,
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildino(cDcuoertino.org
®PLUI SING MECHANICAL ELECTRICAL ❑ hESCELLAINEOUS
PROJECT ADDRESS 16 t J e e APN
OWNERNAhS /In� J PHONE MAIL
STREET ADDRESS /D \ CITY, STATE, Z1P/i , r� ffl n �6 . a - AX
(J (/ 1 `l (.f�
CONTACT NAME PHONE E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ Oti'nfR ❑ owe-ER-sT-=ER ❑ OV✓NERAGF T reVCOh7P-kcTOR ❑ CO\TRACTORAGENT ❑ ARCHITECT ❑ ENGA ER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAPM �� r Ci /� /\ LICENSE NTJhIBER QC^ y� LICF�y'S� E
j / ((1j r
BUS. LIC 4716 5'q
COMPANY I�T.A vM
E-MAIL
FAX
STREET ADDRESS �C G P ' G /]U C'
C �/
/nCITY, STATE, ZIP V4 /e /I
PHONE 50 `
ARCH.NUECT/EGINEER NAME LICENSE NUMBER '7QC��
BUS. LIC #
COMPAA'Y NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF SFD or DUPLEX ❑ MULTI-FAbcLy PROJECT IN 1 ADL kN7D ❑ YES PROJECT AI ❑ YES
B=LNG: ❑ COIJ.MERCLAL URBAN LNTERFACE AREA ❑ NO FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
I EICHLER HOMO ❑ NO
DESCRIPTION OF WORK n
fa a eP 4C
TOTAL VALUATION //1 �Q � � D E1
Li
17
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the pr perry 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 uilding construction. I authorize represe tives of Cupertino to enter the above-id'tified_pro Gty�r rlspection purposes.
Simature of applioant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED
°IJCE USEo vLi ;
FX11RLSS '
MEPA47sc-4pp_2011.doc remised 06/21/11
CITY OF CUPERTINO i�06D101
ti FEE ESTIMATOR — BUILDING DIVISION l
APPLIANCE / EQUIP TYPE
ADDRESS: 10362 Judy Avenue
DATE: 08/27/2015
REVIEWED BY: PAUL
UNITS
APN: 37510 006
BP#:
"VALUATION: $10,500
°PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
#
PENTAMATION FURN/A
PERMIT TYPE.
WORK
Re lace wall furnace with N forced air furnace in Attic Install N ductwork in house Install A/C unit in
SCOPE
(N) location
APPLIANCE / EQUIP TYPE
FEE ID
'un:b. Plan Cheer
QTY
UNITS
BP FEES
Elec. Permit Tee:
A/C Units (<=10K cfm)
1 BREMAIR
Cather Elea hisp Li
1
#
$72
Furnace, Forced -Air
1MFR=<100
1
#
$143
PME Unit Fee:
$215.00
PME Permit Fee:
$48.00
Administrative Fee: IADMIN
$45.00
Work Without Permit? Yes (F) 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 Pees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ek.711113)
Mech. Plan Check 0.0 1 hrs $0.00
'un:b. Plan Cheer
I lec. Plan Check
Mech. Permit Fee: IMPERMIT
Fl,,,, -h, Permit Fee:
Elec. Permit Tee:
Other Mech. Insp. 0.0 hrs $48.00
Ofiier Plumb Insp,
Cather Elea hisp Li
PME Plan Check:
$0.00
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These Pees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ek.711113)
FEE
QTY/FEE
MISC ITEMS
PME Plan Check:
$0.00
PME Unit Fee:
$215.00
PME Permit Fee:
$48.00
Administrative Fee: IADMIN
$45.00
Work Without Permit? Yes (F) No
$0.00
-Ir/vnneed Plrxrrrtlrt .Fees:
Travel Documentation Fee: ITRA VDOC
$48.00
Strong Motion Fee: IBSEISMICR
$1.37
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS:
$358.37
$0.00 TOTAL FEE:
1 $358.37
Revised: 07/02/2015
CERTIFICATE OF COMPLIANCE
CFIR-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 1 of 3 )
Project Name:
Mary I Date Prepared:
2015-07-30
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 CFIR-ALT-02 document for each dwelling unit.
01
Project Name
Mary
02
Date Prepared
2015-07-30
03
Project Location
10362 Judy Avenue
04
Building Type
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
Mary
07
Zip Code
95014
08
Dwelling Unit Conditioned
1323
Installing
Installing
Installing
Floor Area (ft2)
Location or Area
by this SC
ducted
containing
system
Number of space conditioning
entirely new
Eog
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
Entirely new or
System 1
Whole House
1323
Yes
Yes
Yes
Yes
Yes
Yes
complete
replacement space
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b)1Diib)
Registration Number: 215-A0211117A-000000000-0000
This section does not apply to this project.
Registration Date/Time
2015-07-30 14:51:07
HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-07-30 14:51:11
Schema Version: 0.555SDD
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)1Diia 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)iC)
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
Component
Type
Value
System Type
Component
Type
Value
Type
R -Value
Central gas
All new heating
Central split
All new cooling
SetbackTher
System 1
AFUE
0.78
SEER
13
R-6
furnace
components
AC
components
mostat
Required Documentation:
CF2R-MCH-01-E - Space Conditioning Systems Ducts and Fans
-Duct insulation requirement for new plenums: R6.
CF2R & CF3R-MCH-20-H Duct Leakage Verification required.
-Leakage rate compliance: <_ 6%.
CF2R & CFBR-MCH-22 Fan Efficacy Verification
CF2R & CFBR-MCH-23 System Air Flow Rate Verification
-Compliance: Fan Efficacy <0.58 W/cfm and System Airflow>_ 350 cfm/ton.
- Alternative Compliance: CF2R & CF3R-MCN-28 Return Duct Design Verification is an alternative to MCH -22 and MCH -23 verification.
CF2R & 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: 215-A0211117A-000000000-0000
Registration Date/Time
2015-07-30 14:51:07
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-07-30 14:51:11
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -1R -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: ����
Hornung, Karl
/�R' eAzoli v
d
Company:
Signature Date:
CONVECTEK
2015-07-30 14:51:07
Address:
CEA/ HERS Certification Identification (if applicable):
955 BENECIA AVENUE
City/State/Zip:
Phone:
SUNNYVALE CA 94085
(408) 687-5754
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 for approval with this building permit application.
S. I 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: UU
Hornung, Karl
/tR'WAZ910hy
Company:
Date Signed:
CONVECTEK
2015-07-30 14:51:07
Address:
License:
955 BENECIA AVENUE
953068
City/State/Zip:
Phone:
SUNNYVALE CA 94085
(408) 687-5754
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-A0211117A-000000000-0000 Registration Date/Time: 2015-07-30 14:51:07 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-07-30 14:51:11
Schema Version: 0.555SDD
CUPERTINO
Building Department
REVIEWED FOR CODE COMPUP
I
Reviewed By: Tm'aai
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Attached
Shed
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19'
Judy Avenue OFFICE COPY
10362 Judy Avenue
Main House
C
RECEIVED
AUG 2 7 2015
BY
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION - CUPERTINO
APPROVED
This set of r fans and specifications MUST be kept at the
job site du ing construction. It is unlawful to make any
chang s or alterations on same, or to deviate
therefrom, without approval from the Building Official.
The stamp!of this plan and specifications SHALL NOT
be hold to permit or to be an approval of the violation
of ar}ypro isions of any City Ordinance or State Law.
BY _:J
DATE '
PERMIT NO.
PLOT -'CH D BY
DATE _ /y�S —
PLANNING DEPT
CUPERTINO