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15090003E CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22432 BALUSTROL CT CONTRACTOR: HUSSEY BROS INC PERMIT NO: 15090003 OWNER'S NAME: DALE & EARL COLLINGS 903 GEORGE ST DATE ISSUED: 09/01/2015 OWNER'S PHONE: 4083738806 SANTA CLARA, CA 95054 PHONE NO: (408)733-6360 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL Q C2-0Lic. ��j/46 "/ INSTALL (N) 3 TON A/C UNIT IN NEW LOCATION, IN SAME LOCATION License Class #� REPLACE (E) FURNACE WITH (1) AND Contractor Date ! /.r REPLACE DUCTING I hereby affirm that I a lice ed under the provisions of Chapter 9 (commencing with Section 00) 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: $17000 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: 35603017.00 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 CALLEDINSPE TON. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the q y ` granting of this permit. Additionally, the applicant understands and will comply Issued by: T Iw1">✓ Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. �f 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. 1 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 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Q f 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 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 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 regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CUPERTINO GENERAL PERMIT APPLICATION 1,TqWO3 COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building ftupertino.orq ❑PLUbIBING (EXECAANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDP-ESS f •` "R 4 V S if O I C IPN ; ' / 0./ D �� OWN'ERNAME /r 01 c I (� �t° yIyt( �D I/ PHOIvE(60 ��' ��%G E•]✓eIL STREET ADDRESS LU L iV5 �fvf C CITY,STATE,C t,,-rA 1+0 q -oi y I F.AX TT CONTACT NAME PHONE E-MAIL STREETADDRESS CITY, STATE, ZIP FAX ❑ MNER ❑ OWNTER-BUILDER ❑ OWNER AGENT ❑ CO/.TRACTOR ❑ CONTRACTORAGII.T ❑ ARCHITECT ❑ FvGi\= ❑ DEVELOPER ❑ TENANT CONTRACTORNA.M pus c` b roS LICENSE RG5 LICEI`' o Se G C BUS. LICI COMPANY NAME J Q V 2 4v SS e 7 E-MAIL FAX STREET ADDRESS CITsTAw Z PHONE 733 --06o ARCHITECT/ENGINTEER N.A1,1E LICENSE NUMBER BUS. LIC n COMPANY NAME F. -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ MULTI-FAbOLY PROJECT LN wII.DLAND ❑ YES PROJECT IN ❑ YES BLIIIDLNG: ❑ COMMERCLAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ ATO ( IS THE BLDG AN ❑ YF.s EICHLER HOME? [] NO DESCRIPTION OF WORK /�eylac� v rw�Ct �o, ouv A7 -u -ZkJ II 14eW Alt L*J1A;4 T -r 3 �0 •. — TOTAL VALUATION: /1 (J b� U RE C j: �D ' By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the ptopeity oWller's a alf. 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 build' o construction. I authorize representatives of Cupertino to enter the above -i e' ' (edpoperty for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENT&_D4FORMATIONREQUIRED 01-FJc u�\Lr LA 7r_ A,fEFA7iscApp_2011.doc remised 06121/11 CITY OF CUPERTINO 1 1 ''Y/fil FFF F.IRTIMATOR — BUILDING DIVISION IA'ADDRESS: 22432 BALUSTROL CT. Phuuh. 11Iun C`heci, DATE: 09/01/2015 REVIEWED BY: PAUL BP FEES APN: 356 03 017 BP#: 1BREMAIR -VALUATION: 1$17,000 PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex p Furnace, Forced -Air 1MFR=<100 PENTAMATION FURN/AC USE: # $143 PERMIT TYPE: WORK Install N 3 ton A/C unit in new location Replace E furnace with N in same location and replace SCOPE I ducting i'011SO-UCti0f7 KIX. APPLIANCE / EQUIP TYPE FEE ID Phuuh. 11Iun C`heci, QT1' UNITS BP FEES riec. Permit Fee: A/C Units (<=10K cfm) 1BREMAIR Other E16c. Inst-. 1 # $72 Furnace, Forced -Air 1MFR=<100 suppl. Irish Fee 1 # $143 PME Unit Fee: $215.00 PME Permit Fee: $48.00 i'011SO-UCti0f7 KIX. Administrative Fee: IADMIN $45.00 Work Without Permit? Yes Q 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, tire, Santtaryy'ewer u/strict, acnoot n 916— f".. __ h—d — tho nra/isninnnf infarm"finn availahlo and are only an estimate. Contact the Deet for addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) Meeh. Plan Check Fo.0 hrs $0.00 Phuuh. 11Iun C`heci, Elec. Flan Check Mech. Permit Fee: 1MPERMIT P1umh. Permit Fee: riec. Permit Fee: Other Mech. Insp. 0.0 hrs $48.00 Other Plumh hasp.E171- Other E16c. Inst-. Plumb. hrsp. Fee: Elec. Insp. Fee. NOTE: This estimate does not include fees due to other Departments (i. e. Planning, Public works, tire, Santtaryy'ewer u/strict, acnoot n 916— f".. __ h—d — tho nra/isninnnf infarm"finn availahlo and are only an estimate. Contact the Deet for addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: ,SuFpl. PC Fee PME Plan Check: $0.00 Permit Fee: suppl. Irish Fee PME Unit Fee: $215.00 PME Permit Fee: $48.00 i'011SO-UCti0f7 KIX. Administrative Fee: IADMIN $45.00 Work Without Permit? Yes Q No $0.00 ldvaneed Planning Fees: Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICR $2.21 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $359.21 $0.00 TOTAL FEE -T $359.21 Revised: 07/02/2015 OFFICE COPY f -e l -r p 1V? i r: CUPERTINO Building Department I SEP 0 1 2015 REVIEWEDOR CODE COMPLIANCE Review d By: Tf+*4� COMMUNITY D VELOPMENT DEPARTMENT BUILDING DIVISION - CUPERTINO APPROVED &T e s plans a d specifications MUST be kept at the iWging co struction. It is unlawful to make any changes or alterations on same, or to deviate therefrom, witheL t approval from the Building Official. The Stamping of t, is plan and specifications SHALL NOT be held toper i or to be an approval of the violation o an visio � f any Qi Or inance or State Law. BY DAT MIT LAVV PER VIN l � DA)t �� C t ►Njs D"y 3 fick I C�- C (' p ," , CA Cl -614 Flo ? 3-73-- erFrvc ko&V dist 6 %A 014 jve-0 is -Amp I IS v 6 -Fr IfC1np f4� /it, pe.'W r4It D 33'� c--q'.—� / PL., 13•;' PIATP NS CHECKED BY DATA HAW l q�ANtIINGbEPT .� CUPERTINO RECEIVED SEP 01 2015 BY CERTIFICATE OF COMPLIANCE ? epin 1) f A IW9 CX3 - CF1R-ALT-02-E Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 1 of 3 ) I Project Name: 22432 Balustrol I Date Prepared: 2015-08-31 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 22432 Balustrol 02 Date Prepared 2015-08-31 03 Project Location 22432 Balustrol Cr. 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name 22432 Balustrol 07 Zip Code 95014 08 Dwelling Unit Conditioned 1800 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 System 1 Location 1 1800 Yes Yes Yes Yes No No Altered space conditioning system C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)1Diib) This section does not apply to this project. ccp {1 1 2015 Registration Number: 215-A6309755A-000000000-0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Date/Time: 2015-08-31 17:15:46 Report Version: 2014-03-31 Schema Version: 0.555SDD - BYE-. HERS Provider: CaICERTS Report Generated: 2015-08-31 17:15:42 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)lE 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 System 1 Central gas All new heating AFUE 0.96 Central split All new cooling SEER 14.5 Setback Greater than R-6 furnace AC 40 feet components components Required Documentation: CF2R-MCH-01-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:5 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 require verification of Air Flow MCH -23, or Refrigerant Charge MECH-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)1Diia and 150.2(b)lE, 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-A6309755A-000000000-0000 Registration Date/Time: 2015-08-31 17:15:46 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-08-31 17:15:42 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: Documentation Author Signature: Hussey, Steve Company: Signature Date: HUSSEY BROS INC 2015-08-31 17:15:46 Address: CEA/ HERS Certification Identification (if applicable): 903 GEORGE ST City/State/Zip: Phone: SANTA CLARA CA 95054 (408) 733-6360 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 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: 1 S�P/4� Hussey, Steve Company: Date Signed: HUSSEY BROS INC 2015-08-31 17:15:46 Address: License: 903 GEORGE ST 675669 City/State/Zip: Phone: SANTA CLARA CA 95054 (408) 733-6360 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-A6309755A-000000000-0000 Registration Date/Time: 2015-08-31 17:15:46 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-08-31 17:15:42 Schema Version: 0.555SDD