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15090123CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10864 DRYDEN AVE CONTRACTOR: AAA FURNACE & AIR PERMIT NO: 15090123 CONDITIONING OWNER'S NAME: GREENMAN PENELOPE A TRUSTEE 1712 STONE AVE DATE ISSUED: 09/18/2015 OWNER'S PHONE: 4082530269 SAN JOSE, CA 95125 PHONE NO: (408)293-4717 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ •a 1 Lic.# License Class Z �7 REPLACE (E) FURNACE, SAME LOCATION A A �N� C.� Z 0( Contractor ff Date I hereby affirm that I am licensed under the provisions of Chap er 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. Sq. Ft Floor Area: Valuation: $34� 8 I hereby affirm under penalty of perjury one of the following two declarations: APN Number: 35615019.00 Occupancy Type: t. 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 erformance 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 PERMIT EXPIRES IF WORK IS NOT STARTED permit is issued. WITHIN 180 DAYS OF PERMIT ISSUANCE OR APPLICANT CERTIFICATION 180 D YS FROM LAST CALLED INSPEC ION. 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 Issued by: Date: l upon the above mentioned property for inspection purposes. (We) agree to save 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 ermit. Additionally, the applicant understands and will comply with RE-ROOFS: all no mt sourc e l the Cupertino Municipal Code, ection 9.18. All roofs shall be inspected prior to any roofing material being installed. If a roof is p,r installed without first obtaining an inspection, I agree to remove all new materials for e,� Signature Date i c �� inspection. Signature of Applicant: Date: ❑ OWNER-BUILDER DECLARATION ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1 hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: t. I, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIALS DISCLOSURE compensation, will do the work, and the structure is not intended or offered for I have read the hazardous materials requirements under Chapter 6.95 of the sale (Sec.7044, Business & Professions Code) California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain 2. I, as owner of the property, am exclusively contracting with licensed contractors to compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & construct the project (Sec.7044, Business & Professions Code). Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air I hereby affirm under penalty of perjury one of the following three declarations: contaminants as defined by the Bay Area Air Quality Management District I will t. I have and will maintain a Certificate of Consent to self-insure for Worker's maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Compensation, as provided for by Section 3700 of the Labor Code, for theTbyl�l &Safety Code, Sections 25505, 25533, and 25534. performance of the work for which this permit is issued. ,t r' g t: 2. I have and will maintain Worker's Compensation Insurance, as provided fo Date:Section 3700of the Labor Code, for the performance of the work for whichpermit is issued.CONSTRUCTION LENDING AGENCY 3 I certify that in the performance of the work for which this permit is issued,sa not employ any person in any manner so as to become subject to the Worker's I hereby affirm that there is a construction lending agency for the performance of work's Compensation laws of California. If, after making this certificate of exemption, I for which this permit is issued (Sec. 3097, Civ C.) become subject to the Worker's Compensation provisions of the Labor Code, I Lender's Name must forthwith comply with such provisions or this permit shall be deemed Lender's Address revoked. ARCHITECT'S DECLARATION APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I understand my plans shall be used as public records. correct. I agree to comply with all city and county ordinances and state laws relating Licensed Professional 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date CUPERTINO GENERAL PERMIT APPLICATION 1501012 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.org ❑ BIN MECHANICAL ❑ELECTRICAL ❑ MISCELLANEOUS MEP MISIC PLUM PROJECT ADDRESS ` I? , ' n APN # I 3� ///�A� 01q OWNER NAME '/� ,rp�n� PHONE I� O ��•�� i) / E-MAIL STREET ADDRESS CITY, STATE, ZIP ` FAX CONTACT NAME '` C ,/ ^ PHONE /�Ily�•1�� 2 I E-MAIL STREET ADDRESS A� � ( CITY, STATE, ZIP nJ p r q�25 FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT 'CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME r` / �.� LICENSE NUMBER • Ljo43 TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESSAV I n J # ( CITY, STATE, ZIP (� �,� `J I / I r� (A J `J u PHONE (0),2 AR CHITECT/F.NGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ MULTI-FAMII-Y PROJECT Al 7 DLAND ❑ YES PROJECT BUILDING: ElCOMMERCIAL URBAN INTERFACE AREA [3 NO FLOOD IN ❑ YES ZONE ❑ NO IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO DESCRIPTION OF WORK x 000 9.7 TOTAL VALUATION: 39 C5 RECEIVED BY - � By my signature below, 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 t buildi construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of ApplicandAgent: �` Date: UPPLEMENTAL INFORMATION REQUIRED - oFFcE USE ONLY OVER-THE-COUNTER FWD� E' ` ❑ EXPRESS U. w V ❑ STAI�'DARD :. a .. ❑ LARGE r .MAJOR MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION imADDRESS: 10864 Dryden Avenue DATE: 09/18/2015 REVIEWED BY: PAUL UNITS APN: 35615 019 BP#: *VALUATION: 1$3,458 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: p # PENTAMATION PERMIT TYPE: FURN/A WORK Re lace E furnace Same Location SCOPE Suppl. Insp F'ee APPLIANCE / EQUIP TYPE FEE ID Phimb. Plan Check QTY UNITS BP FEES Elec. Permit fee: Furnace, Forced -Air 1MFR=<100 Other Elee. Insp.Li 1 # $143 Permit Fee.: Suppl. Insp F'ee PME Unit Fee: $143.00 PME Permit Fee: $48.00 r "'olsfrztcliott Ztrx: Administrative Fee: ]ADMIN $45.00 Work Without Permit? 0 Yes (j) No $0.00 TOTALS: Travel Documentation Fee: ITRA VDOC $143.00 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 preliminary information available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-053 E ' 7/1/13) Meeh. Plan Check F6.61hrs $0.00 Phimb. Plan Check Plec. I'lan Cheek Mech. Permit Fee: IMPERMIT Plumb. Permit fee: Elec. Permit fee: Other Mech. Insp. 0.0 hrs $48.00 Insp, Other Elee. Insp.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 fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-053 E ' 7/1/13) FEE QTY/FEE MISC ITEMS I'lun Cluck I'ee: PME Plan Check: $0.00 Permit Fee.: Suppl. Insp F'ee PME Unit Fee: $143.00 PME Permit Fee: $48.00 r "'olsfrztcliott Ztrx: Administrative Fee: ]ADMIN $45.00 Work Without Permit? 0 Yes (j) No $0.00 dvemeed Planning Fees: Travel Documentation Fee: ITRA VDOC $48.00' Strong, Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $285.50 $0.00 TOTAL FEE: I $285.50 Revised: 07/02/2015 STATE OF CALIFORNIA ALTERATIONS - HVAC n CEC-CF1 R -ALT -03-E Revised 06/14 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE CF1R-ALT-03-E Alterations - HVAC CZ 1, 3 to 7 and 16 (formerly CF -IR -ALT -HVAC) (Page 1 of 1) Site Address: p — I I � aVW ` ��iVl�� Y�ll� Enforcement Agency: Date Prepared: Permit#: Equipment TYPe Equipment Efcienty New: Ducting, Plenums, Lineset Required R -value Conditioned Floor Area (sq ft) Thermostat ❑Packaged System ❑Evaporator Coil AFUE COP ❑ R-6 (CZ 1,3-7) Ducts Served b�y,�ystem Setback ❑ Split System ❑ Condensin& Unit SEER HSPF ❑ R-8' ll 16) Ducts ❑ R-6 (all CZ's) Plenums ivy sq ft present, must urnace ❑ Lineset EER ❑ R-5 or R7.5 Lineset3I be installed) HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this form is allowed to be filled out by hand. For final inspection all forms are to be registered (no hand filled forms allowed) and a copy left on site. 1. HVAC Changeout/Repair Required Compliance Documents to be left on site for Final: 'Can include new ducting All Equipment, CF1R-ALT-02-E Condenser Unit, Evaporator Coil, CF2R: MECH-01, MECH-20-HERS CEVED Air Handler/Furnace EI CF3R: MECH-20-HERS L Installer Requirement: Duct leakage (:L15% or, < 10% to outside, or seal all accessible leaks) Exempted from duct leakage testing if: 1. fl, 15 ❑ 1. Duct system registered with HERS provider as previously sealed, or ❑ 2. There is less than 40 linear feet of duct in unconditioned space, or ❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building ❑ 2. New HVAC System Required Compliance Documents to be left on site for Final: All new equipment and All New Ducts' CF1R-ALT-02-E CF2R-MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS CF3R-MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS'' Installer Requirement: Duct leakage < 6%, Fan Efficacy (.58W/CFM), Air Flow >_ 350 CFM/ton (or Standards Table 150.0-C / D alternative) ❑ 3. All New Ducts with Replacement Required Compliance Documents to be left on site for Final: Includes replacing or installing All New CF1R-ALT-02-E Ducts' and one or more of the following: CF2R-MECH-01, MECH-20-HERS, MECH-(23 or 24) -HERS Condenser Unit, Evaporator Coil, Furnace CF3R-MECH-20-HERS, MECH-(23 or 24) -HERS Installer Requirement: Duct leakage < 6%, Air Flow >_ 350 CFM/ton (or Standards Table 150.0-C / D alternative) ❑ Exempted from duct leakage testing I existing duct systems are constructed, insulated or sealed with asbestos. ❑ 4. New Ducting over 40 feet Required Compliance Documents to be left on site for Final: Adding or replacing ducts in unconditioned CF1R-ALT-02-E CF2R: MECH-20-HERS space but less than All New Ducts' CF3R: MECH-20-HERS Installer Required to: Duct leakage (< 15% or, < 10% to outside, or seal all accessible leaks) ❑ Exempted from duct leakage testing I existing duct systems are constructed, insulated or sealed with asbestos. All new ducting R-8 required when more than 40 ft installed and R-6 when less than 40 ft installed. This includes in walls, between floors etc. ' A New Duct system is when the duct system is constructed of at least 75 percent 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, plenums, duct material. a R-5 (1" thick insulation) for linesets 1" and less. R-7.5 (1.5" thick insulation) for linesets over 1 inch. Most mfg will require Suction line Diameter with insulation as the following 1.5-2T-2%", 2.5 -3T -2Y4", 3.5 to 4T-2%", 5T-4%" Contractor (Documentation Author's /Responsible Designer's Declaration Statement) 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 California Business and Professions Code to accept responsibility for the information on this document. 3. That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations (CCR). 4. That the energy futures 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 CCR. 5. 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. Responsible Desi ner Name: 0�d Responsible Designer Signature: � � Date Signed: :1/Ids 15 License: Own n0 Company: Address: City/State/Zip: Phone: For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300 CERTIFICATE OF COMPLIANCE Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) Project Name: PENELOPE GREENMAN I Date Prepared: CF1R-ALT-02-E (Page 1 of 3 ) 2015-09-10 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 PENELOPE GREENMAN 02 Date Prepared 2015-09-10 03 Project Location 10864 DRYDEN AVENUE 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name PENELOPE GREENMAN SC System SC System CFA served system a Dwelling Unit Conditioned Installing new SC 07 Zip Code 95014 08 Floor Area (ft2) 1888 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 Altered space TRANE WHOLE HOUSE 1888 Yes No Yes No No No conditioning system C. Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b)1Diib) This section does not apply to this project.-1� Registration Number: 215-A6321232A-000000000-0000 Registration Date/Time: 2015-09-10 11:43:59 SEP 8 2015 BY HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-09-10 11:44:02 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) 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 Central gas Gas furnace No cooling This field or This field or Less than or TRANE furnace AHU AFUE 0.78 No cooling component section is not section is not Setback equal to 40 R-6 altered applicable applicable 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 — 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 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)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-A6321232A-000000000-0000 Registration Date/Time: 2015-09-10 11:43:59 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-09-10 11:44:02 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: Rando, Eric Company: Signature Date: RANDO AAA HVAC INC 2015-09-10 11:43:59 Address: CEA/ HERS Certification Identification (if applicable): 1712 STONE AVENUE N/A City/State/Zip: Phone: SAN JOSE CA 95125 (408) 293-4717 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: �/L Rando, Eric Company: Date Signed: RANDO AAA HVAC INC 2015-09-10 11:43:59 Address: License: 1712 STONE AVENUE 768871 City/State/Zip: Phone: SAN JOSE CA 95125 (408) 293-4717 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-A6321232A-000000000-0000 Registration Date/Time: 2015-09-10 11:43:59 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-09-10 11:44:02 Schema Version: 0.555SDD