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15060156 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1568 S STELLING RD CONTRACTOR:DG HEATING&AIR PERMIT NO: 15060156 CONDITIONING OWNER'S NAME: NELSON ATSUKO T TRUSTEE&ET AL 2288 CHERRY AVE DATE ISSUED:06/24/2015 OWNER'S PHONE: 4086218710 SAN JOSE,CA 95125 PHONE NO:(408)978-1411 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL �•; -� 2 f�� ADD(N)A/C UNIT TO REAR OF SFD License Class Lic.# �(� r7 , 1 _ Contractor 0&W�h/1M&*-n/� 4LODate a T -Y 5 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 0ecerformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$4195 ave and will maintain Worker's Compensation Insurance,as provided for by tion 3700 of the Labor Code,for the performance of the work for which this APN Number:36624050.00 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 FRO LED 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 2 granting of this rmit. Additionally,the applicant understands and will c ssu Da with all non-p source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Si atu Date U! All roofs shall spected 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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 u equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by a ay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with a upertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Se '0 2550 ,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or an orize gent: Date (A 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 convect.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 GENERAL PERMIT APPLICATION E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 950143255 CUPERTINO (408)777-3228 - FAX(408)777-3333• building(a)cupertino.org /q_o� o1s6 M I S C ❑PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS (0A p APNR 6� �7 // 6 wrs PHO I E-MAIL STREETADDRESS CITY, STATE,ZIP FAX �,STc�—L ► N36t2 I CONTACT NAME ) E-MAIL 1- sv - p� I' Com l —S-71 STREET ADD S _ 1 N! CITY STATE,ZIP I FAX S. C� D. ❑ oNRwER ❑ owNER-BUILDER ❑ CANTER AMrr J;!73ZPN"TRACTOR ❑CONTAACTORAGENT ❑.ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT C CTORN A\� ��C�� I�t � LICENSEpi IMBA LICENSE�'PE BUS.LIC# COMPANY NAME I� I�+V E-MAIL�-( (AM A 1p—@�� FAX c+�_Tj"c— aiyw IL 4M73/ Ha cl �w� r.s c ZCISAT7A �a PHONE> ARCHITECT/ENGINEER NAjME LICENSE NUMBER BUS.LIC n COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD w DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑ YES IS THE BLDG AN ❑ S BU=1','0: ❑COMMERCIAL URBAN II.=,ACE AREA ❑ NO FLOOD ZONE ❑ NO EICHLER HOME^ ❑ NO DESCRIPTION OF WORK ' 1 - J A-=< POO CSN LX= 0-F TOTAL VALUATION: CEIVE By my signature below,I certify to each of following: I am the property o r or rued a. s ehalf. I have read this application and the information I have pro d 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 buil z-construchon. I authorize representa'ves of Cupertino to enter the above-identified property fg uspection purposes. Signature ofApplicanUA pt- C Date: to c> 4/ "( SUPPLEMENTAL LNIFORMATION REQUIRED OFFICE USE O_NL� LE-CO U1 1 E a LSI I:ESS 1 J. LARGE -J MAJOR hffPATisc4pp_2011.d6c revised 06/21/11 1K-z T-i Oso i;� c) KV L�I V 15�s�- S. STac(kc fL C v Pt-2-T1A-0 CA 9�301L-) N G 1 \ Y COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION-CUPERTINO ed /APPROVED This set of plans and specifications MUST be kept at the -� job site during construction. It Is unlawful to make any qr�Tl N 0 v charges or alterations on same,or to deviate C therefrom,without approval from the Building Official. Suil ingepartment �f ( The stamping of this pla tions SHALL NOT �l be h^!d to p r r to he provai of the violation JUN 2 � 015 0.-- , a r State Law. RE IEWED FOR COD COMPLIANCE CQ&Z Reviewed By: PERMIT N 0. O/ 0 G C , �c PLOT p n�8 CHECKED BY ✓U IQ C � N2� � �U0 '. -- ?DSS DATE 2 0 �Y iL PLANNING DEPT CUPERTINO CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E Alterations to Space Conditioning Systems(formerly CF-IR-ALT-HVAC) (Page 1 of 3) Project Name: KERI&ATSUKO NELSON Date Prepared: 2015-06-19 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 CF1R-ALT-02 document for each dwelling unit. 01 Project Name KERI &ATSUKO NELSON 02 Date Prepared 2015-06-19 03 Project Location 1568 S.STELLING ROAD 04 Building Type Single family 05 CA City 06 Dwelling Unit Name KERI&ATSUKO NELSON 07 Zip Code 95014 08 Dwelling Unit Conditioned 1852 Floor Area(ft2) Number of space conditioning 09 Climate Zone 4 10 (SC)systems in this dwelling 1 unit. 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 FA served system a refrigerant Installing new SC Installing Installing Installing Identification or, Location or 'ea ducted containing system more than 40 entirely new entirely new Name Sery S system? component? components? feet of ducts? duct system? SC system? Alteration Type Altered space System 1 Yes Yes Yes No No No conditioning system I PAN pa 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:315-A1008353A-000000000-0000 Registration Date/Time:2015-06-19 14:17:00 HERS Provider:USERA CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2015-06-19 14:17:51 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 No heating All new Less than or AC System 1 Central gas component AFUE 78 Central split cooling SEER 13 Setback equal to 40 R-6 furnace altered components feet 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—Dud 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 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-2S. -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)lE, F) This section does not apply to this project. r 16xw F. Entirely New or Complete Replacement Space Co i ltmniU e ociation Iigrq This section does not apply to this project. Registration Number:315-A1008353A-000000000-0000 Registration Date/Time:2015-06-19 14:17:00 HERS Provider:USERA CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2015-06-19 14:17:51 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. Tina Mercado Company: Signature Date: DG Heating and Air Conditioning, Inc. 2015-06-19 Address: CEA/HERS Certification Identification(if applicable): 1040 Commercial Street Ste. 104 928315 City/State/Zip: Phone: San Jose CA 95112 408-599-4212 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 enswe that a registered Cgpy oft rtificate 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 inspectior�.J11inderstand t 3 reg py ofthis Certificate of Compliance,is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Designer( e: Responsible Designer Signature: i Tina Mercado Company: Date Signed: DG Heating and AW MMOC.Abor 2015-06-19 Address: License: 1040 Commercial Street Ste. 104 U.S. Energy Ra ft&VAASSoclation City/State/Zip: Phone: San Jose CA 95112 408-599-4212 This digital signature is provided in order to secure the content of this registered document,and in no way implies Registration Prooder responsibility for T#A UAL on" the accuracy of the information," Registration Number:315-A1008353A-000000000-0000 Registration Date/Time:2015-06-19 14:17:00 HERS Provider:USERA CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2014-03-31 Report Generated:2015-06-19 14:17:51 Schema Version:0.555SDD