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15080200sp CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19868 PRICE AVE CONTRACTOR: VALLEY HEATING & PERMIT NO: 15080200 COOLING OWNER'S NAME: GREGORY BUCHANAN 1171 N 4TH ST DATE ISSUED: 08/27/2015 OWNER'S PHONE: 4082530611 SAN JOSE, CA 95112 PHONE NO: (408)294-6290 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑ a n REMOVE AND REPLACE FURNACE AND AIR License Class l� Lic. # �`�0 CONDITIONING. Contractor /7 Date 9 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: $8420 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: 36904031.00 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 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 G Issued Date: "� % granting of this permit. Additionally, the applicant understands and will comply by: /��%1/ / �G� G with all non -point source regulations per the Cupertino Municipal Code, Section RE -ROOFS: 9.18. Signature �v Date Z 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 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) 1, 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 2pfn 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this �( V 2%11i permit is issued. Owner or authorized agent: Date: 1 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 CENEERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building aftuoertino.oro jM 15 ❑PLUMBING ZNIECHANICAL ❑ELECTRICAL 7b0CELLA2\1E0US PROJECT ADDRESS V nK` n %� , /� APN R% ACP— Tn OWNER NAME r U �� W1 I PHONE 611/ EMAIL STREET ADDRESS MO I;u-Ak I CITY,STATE,ZIP �J ( l FAX ` O �CONTACT NAME }r� PHONE E-MAIL STREETSTREET ADDRESS CITY, STATE, ZIP FAX ❑ OaR.'m ❑ Ow im-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ COI.TRACTOR AGENT ❑ ARCHITECT ❑ ENGD,EM ❑ DEVELOPER ❑ TENAN T CONTRACTOR NAME _ ;�� / D� LICENSE NUMBER �� /�\ LICENSE TYPE( pu leo / 1' 6 1. n BUS. LIC\L1 COMPANY NAJvM EMAIL /,i' J -(A II FAX STREET ADDRESS t I S CITY, STATE, ZIP �%' ( PYa A RCHITECT/ENGINEER NAME LICENSE NUMBER . BUS. LIC R COMPANY NAME E-MkIL I FAY. - — STREET ADDRESS CITY, STATE, ZIP PHOATE USE OF SFD or DUPLEX ❑ MULTI -FAMILY PROJECT LN WILDLAND ❑ YES PROJECT IN ❑ YES BUILDLNG: COMMERCLAL I URBAN INTERFACE AREA No FLOOD ZONE NO IS THE BLDG AN TS EICHLER HOME? :0 DESCRIPTION OF WORK TOTAL VALUATION: \ E V. By my signature belov7, I 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 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 buildin struction. I orize representatives of Cupertino to enter the aboN-idenrifiedro er fqr� pect.on purposes. Si�li atureofAppcanVAgent: Date: !S]Zl ` 1 SUPPLEMENTAL INFORMATION REQUIRED MEPA1isc.4pp_2011.doc remised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 19868 Price Ave DATE: 08/27/2015 7R7EVIEWED BY: Sean UNITS APN: BP#: *VALUATION: $8,420 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: # PENTAMATION FURN/AC PERMIT TYPE. WORK Remove and replace furnace and air conditioning. SCOPE 4q)pl. In Sp Fee APPLIANCE / EQUIP TYPE FEE ID Phunb. Plan C:Y ecfc QTY UNITS BP FEES ermit Fee: A/C Units (<=10K cfm) 1 aREMAIR Other Elec. /rasp.Li 1 # $72 Furnace, Forced -Air 1MFR=<100 4q)pl. In Sp Fee 1 # $143 PME Unit Fee: $215.00 PME Permit Fee: $48.00 Construclion Tax: Administrative Fee: IADMIN $45.00 Work Without Permit? Yes (D No $0.00 TOTALS: Travel Documentation Fee: ITRAVDOC $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 oreliminary information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution I1-053 a.' 711113) Mech. Plan Check 0.0 1 hrs $0.00 Phunb. Plan C:Y ecfc },1ec. flan ChpFlec Mech. Permit Fee: I MPERMIT Plumb. Permit f'ee: ermit Fee: Other Mech. Insp.0.0 hrs $48.00 Other Plumb hzsp.Li ]-- Other Elec. /rasp.Li 111'mh. Inv) FCC Fee. 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 oreliminary information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution I1-053 a.' 711113) FEE QTY/FEE MISC ITEMS ;''Jan (::heck 14'ee ' `Ifppl. PC bee PME Plan Check: $0.00 Permit Fee: 4q)pl. In Sp Fee PME Unit Fee: $215.00 PME Permit Fee: $48.00 Construclion Tax: Administrative Fee: IADMIN $45.00 Work Without Permit? Yes (D No $0.00 ItIvanced .Planning Fees: Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICR $1.09 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $358.09 $0.00 TOTAL FEE: $358.09 Revised: 07/02/2015 I OFFIC; (,)RECEIVED 5YR\ AUG 2 7 2015 BY i%! i -1 y p Rr, F- 1. C V ! E ' 7 DEPARTMENT BUILDING D1\ji3K);A - cUPERTINO AP7r',iRZ`,,'7- D Th;,, set of plans and sper-j;c,-,iorjs MUST be kept at the dj -iril-q construction. It is unlawful to make any c_jrne, or to deviate 0,, alterations on without approval from the Building Official. Thostam. go--l-thiplanand specifications SHALL NOT stamping p I to ,161,d to parmit or to b,,,:- an approval of the violation of any provisions of any City Ordinance or State Law. BY 15 DATE —cG -,?.2 - PERMIT NO. CERTIFICATE OF COMPLIANCE Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) Project Name: 2015- 0142 Greg Buchanan I Date Prepared: CF1R-ALT-02-E (Page 1 of 3 ) 2015-08-21 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 2015- 0142 Greg Buchanan 02 Date Prepared 2015-08-21 03 Project Location 19868 Price Avenue 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name 2015- 0142 Greg Buchanan 07 Zip Code 95014 08 Dwelling Unit Conditioned 1300 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 1300 Yes Yes Yes No No No Altered space replacement conditioning system C. Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b)iDiib) This section does not apply to this project. OFFICE -0 Conxi nllate iris: 2015-08-21 09:53:43 Registration Number: 215-A6299274A 000000000 000 g /T CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Schema Version: 0.555SDD AUG 2 7 2015 BY HERS Provider: CaICERTS Report Generated: 2015-08-21 09:51:38 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)IE 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 or ASC furnace heating AFUE 0.8 AC cooling SEER 14 Setback section is not section is not replacement components components applicable applicable Reauired Documentation: MR -MCH -OS -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, or when more than 40 ft of duct length is replaced. -Leakage rate compliance: 5 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 2 300 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. N -Heating-only systems and Air Handler/Furnace changes do not require verification of Air Flow MCH -23 or Refrigerant Charge MKH-25. -Existing duct systems constructed, insulated or sealed with asbestos 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)lDiia 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) This section does not apply to this project. Registration Number: 215-A6299274A-000000000-0000 Registration Date/Time: 2015-08-21 09:53:43 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-08-21 09:51:38 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: ewC �p Faulkner, Cindy O Company: Signature Date: ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL 2015-08-21 09:53:43 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 for approval with this building permit application. 5. 1 will ensure that a registered copy of this Certificate of Compliance shgll.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: Faulkner, Cindy �,,' wt: umwC , Company: Date Signed: ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL 2015-08-21 09:53:43 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-A6299274A-000000000-0000 Registration Date/Time: 2015-08-21 0$:53:43 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-08-21 09:51:38 ` Schema Version: 0.555SDD