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15100116I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 21086 RED FIR CT I CONTRACTOR: ATLAS-TRILLO HVAC I PERMIT NO: 15100116 1 OWNER'S NAME: MOINZADEH NASSER AND MARYAM 1 1965 KYLE PARK CT I DATE ISSUED: 10/14/2015 1 R'S PHONE: 4082552343 YJ LICENSED CONTRACTOR'S DECLARATION License Class C.12DLic. # Contractor Alfo S l Y1 ` ID Date / 7 /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: 1. 1 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 performance of the work for which this permit is issued. 2. 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 is issued. APPLICANT CERTIFICATION I certify that 1 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, costs, and expenses which may accrue against said City in consequence of the granting this Additionally, the applicant understands and will comply with all non -p ' source re ul r the Cupertino Municipal (C�o ,f Sectio j9.18. Signatu Date ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 1. 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 performance of the work for which this permit is issued. 2. 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 is issued. 3. 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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, 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 SAN JOSE, CA 95125 I PHONE NO: (408)286-8931 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ REMOVE AND REPLACE (E) FURNACE, SAME LOCATION Sq. Ft Floor Area: I Valuation: $1800 APN Number: 35905051.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSP T N. Issued by: Date: RE -ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Hget fety Code, Sections 25505, 25533, and 25534. O agent: Date: c� CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professiona CUPERTINO GENERAL PERMIT APPLICATION 1�;JCO) 16 COMMUNITY DEVELOPMi�ENT DEPARTMENT • BUILDING DIVISION 10300 T ORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - buildin0(CDCUDeriino.org ❑ PLu\/,3 G EJ1CN�CNEOliSA❑A- PRO:CT.ADDPESS � d� ci.. .4PN ;'� , 1 � o � I 0WWEER NAME Mo A P' ��Na ' '.✓ik �Z PA9-;Iaq tiI � �� 1 STREET L DDRE° 14g �-~[O/� � I CI Y, STATE, ZIP 0f FAX L j1 tt .J ! CONTACT NAME I PHOXE STREET ADDRESS ( CITY, STATE, ZIP I FAX ❑ O'V,71,ER 01;WER AGENT -7R -ACTOR ❑ COMP. CTOR AG�T ❑ ARC -17.7 -ECT ❑ ENGLNMER ❑ ❑ CO-N1TRACTOR NP 1+,r'� I LICENSE T1T\7'7- � 2-7 BUS. LIC COMMANY NA?J,E � � � � � I E N AIL � •� ^ �"1� �� q ' �FV 1/� STREET ADDRESS CITY, STATE, ZI F12CETECTrNGLN'EER NAME LICENSE NUMBER I BUS. LIC n COIJ,PA.NY NAME I E-MAIL I FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF Lt SFD LTL X ❑ MULTI-FAhGZY I PROIrCT LN WIT DLAND ❑ YES PRO7-CT IN ❑ YES IS TF.E BLDG AN ❑ -,,Es BUMMIG:OIJ1TIi7tCIAL URBA-N L=ACE A_1PEA ❑ NO I FLOOD ZONE ❑ NO I EICHUMHOME? ❑ NO DESCP.ffTION OF'+R'ORK r TOTAL VALUATION: By my signature belowjcertify to ea 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 hav vi d is correct. I have read the Description of Work and verify it is accurate. I agree to comply Nvith all applicable Iocal ordinances and state laws relating t 7d' co traction. e representatives of Cupertino to enter the above--iden flied prop for inspection purposes. SigmatureofApplicant/Agent: Date: V SU-PPLE? IEN T AL L FFORMATIO y _ OFFICE LSE.D:>\Ll ' r� 9� ' 0�'£R TiiF�O0i3'�TER3 "� z ,p •s i,.:❑xi. L.'1C.L�.1w7�T io: i�`2"k,.ay2� �ne ,�,: K � � �" ��i;C�."l ls'`kr �L'Sa�T}'I+•��3y'iSk��d t�.' ' .A�.EPA iscApp_2011.doc revised 06121/11 CITY OF CUPERTINO 15100 116 FEE ESTIMATOR -BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 21086 Red Fir Ct.DATE: 10/14/2015 REVIEWED BY: PAUL MEN APN: 359 05 051 FBP#- '*VALUATION: 1$1,800 TPERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: # PENTAMATION FURN/AC PERMIT TYPE: WORK Remove and Replace E Furnace Same Location SCOPE :Styppl. Insp Fee APPLIANCE / EQUIP TYPE FEE ID Pion (."heck QTY UNITS BP FEES (;lee. Permit hee- Furnace, Forced -Air 1MFR=<100 Other Elec. Insp. 1 # $143 Perinit Fee: :Styppl. Insp Fee PME Unit Fee: $143.00 PME Permit Fee: $48.00 Construction Tta: F Administrative Fee: ]ADMIN $45.00 Work Without Permit? Yes (F) 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 onlv an estimate. Contact the Devt for addn 7 info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) Mech. Plan Check 1 0.0 hrs $0.00 Pion (."heck laec% Plan Check Mech. Permit Fee: IMPERMIT Plumb. Perm8 (;lee. Permit hee- Other Mech. Insp. 0.0 hrs $48.00 (m7er Plum1) Inch. Other Elec. Insp. PME Plan Check: Elec.Insp. FC 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 onlv an estimate. Contact the Devt for addn 7 info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: RSuI1l�l..l'(:' FeE PME Plan Check: $0.00 Perinit Fee: :Styppl. Insp Fee PME Unit Fee: $143.00 PME Permit Fee: $48.00 Construction Tta: F Administrative Fee: ]ADMIN $45.00 Work Without Permit? Yes (F) No $0.00 Idwinced Planning; Pees: Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item 771 Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $285.501 $0.00 TOTAL FEE: $285.50 Revised: 10/01/2015 CERTIFICATE OF COMPLIANCE Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) Project Name: WANG I Date Prepared: CHR -ALT -02-E ( Page 1 of 3 ) 2015-10-14 A. General Information MR -ALT -02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented, use one MR -ALT -02 document for each dwelling unit. 01 Project Name WANG 02 Date Prepared 2015-10-14 03 Project Location 21086 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name WANG 07 Zip Code 95014 08 Dwelling Unit Conditioned 2000 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 Altered space System 1 Location 1 2000 Yes Yes 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. Registration Number: 215-A6357866A-000000000-0000 OCT 14 2015 BY Registration Date/Time: 2015-10-14 13:33:35 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-10-14 13:33:14 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 All new Central split No cooling This field or This field or Less than or System 1 furnace heating AFUE 0.78 AC component section is not section is not Setback equal to 40 R-6 components 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-A6357866A-000000000-0000 Registration Date/Time: 2015-10-14 13:33:35 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-10-14 13:33:14 CERTIFICATE OF COMPLIANCE CHR -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: LG1Z�l2 Trillo, Austin Company: Signature Date: TITAN SYSTEMS INC 2015-10-14 13:33:35 Address: CEA/ HERS Certification Identification (if applicable): 1965 KYLE PARK COURT SUITE B City/State/Zip: Phone: SAN JOSE CA 95125 408-286-8931 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: CXVGGI/ni Trillo, Austin Company: Date Signed: TITAN SYSTEMS INC 2015-10-14 13:33:35 Address: License: 1965 KYLE PARK COURT SUITE B 977238 City/State/Zip: Phone: SAN JOSE CA 95125 408-286-8931 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-A6357866A-000000000-0000 Registration Date/Time: 2015-10-14 13:33,35 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-10-14 13:33:14