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15100224CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10121 EMPIRE AVE CONTRACTOR: VALLEY HEATING & PERMIT NO: 15100224 COOLING OWNER'S NAME: WANG JERRY AND DONG DIANA TRUSTEE 1 1171 N 4TH ST DATE ISSUED: 10/28/2015 OWNER'S PHONE: 4087721159 SAN JOSE, CA 95112 1 PHONE NO: (408)294-6290 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ p- REPLACE FURNACE AND A/C AT SAME LOCATION License Class f*i2 U Lic. # Contractor ,&.4, Date 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: 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 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 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 sopuejregulat*o er the Cupertino Municipal Code, Section 9.18. Sienature ✓�A� sG� Date l ��Z D�'✓ ❑ OWNER -BUILDER DECLARATION I 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 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: 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 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 Sq. Ft Floor.krea: I Valuatiow $12659 APN Number: 32624057.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: fol 2 2, 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 Health & Safety Code, Sections 25505, 25533, and 25534. Owner outhorized agent: 4__-- Date: U 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 Professional Rr MEP GENERAL PERIMI i APPLICATION COMMUNITY DEVELOPI\11ENT DEPARTMENT • BUILDING DIVISION '. 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 - build ino(cDcuoertino.org CUPERTI��IO l �CQZ ❑PLUPMINC, �MiECI-LM IC.AL. El ELECTRICAL ❑1�iSCELLA.��OUS PROTr.CT ADDR.FSS I o 1 ?, 1 `� r !�� A4, -C_ � .SPN ONwaRNAJym PHONEqN Z I I E-Mib-IL jig STREET ADDRESS 1 L I Z I i1 I CITY, STATE, ZIPG �� o / Z/ I FAX CONrTACT N4IvIE�0.-�; C'`1e y 1(l I� � I PHONE U J r[ (� 6 T D i E f.4aIL STREETAMDRESS ((7' A/ C � CITY, STAT' ZIP S� ' ' FAX ❑ OMM ❑ O)ARN' R -BUILDER ❑ OWNER AGENT CON-ULACTOR ❑ CO?g7PACTOR AGENT ❑ ARC^IITECT ❑ M;GwEEK DEVELOPER ❑ i _K 4T r CONTRACTORN?.br-P �j II e ! I LICENSEN'IA4M `fir% * LICENSE TYPE / I BUS. LICA COMPANY N.A a I E•MA1L (/ l � e n `r'` 10-yA414% LdA I FAX STREET ADDRESS I1�( ( l 7 S� I CITY, STATE, ZIP �� %G /r/� L f % I PITAJ a Z9/ 42 A.RCHITECT/EX-GLNTEER N.A.S I LICENSE NUMBER BUS. LIC COMPA.TYNAME E-MAIL I FAY, - STREET ADDRESS CITY, STATE, ZIP I PHONE USE OF FD w DUPL.FX ❑ I✓,tiLTI-F.4bG1.Y PROJECT LN MMLAND ❑ YES PROTECT LN ❑ YES BUILD O: ❑ Coho MCLAL I URBAd INTERFACE AREA NO I FLOOD Z017S N-0 IS THE BLDG AN ❑ -y-Zs I EICHLER HObM NO DESMPTION OF WORK -- r rn (,C e �4Ge L) S 0 6 G64 �) 0 n Alc �[ a � l� cZ' n V1/l-t I O C a 'kf D ✓L ` — TOTAL VALUATION: V l #LE�EI D 1 By Iny signature below, I certify to each of the following: I am the property owner or authorized agent to act on erys behalf. I hive read this application and the information I have provided is correct. I have read the Description ofWork and verify it is accurate. I amply with all applicable local ordinances and state laws relating to buil g construction. I authorize representatives of Cupertino to enter the above -id Gerty for inspection purposes. Signatere of Applic.ant/Agent: Date: I d 2 D 11r SUPPLEMENTAL INTFORMATION REQUIRED Oil E CINLl' /u V L, - JC, MFPA,liscAPp_2011.doc remised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 10121 EMPIRE AVE DATE: 10/28/2015 REVIEWED BY: PHUONG UNITS APN: 326-24-057 BP#: *VALUATION: $12,659 'PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition /Repair PRIMARY SFD or Duplex USE: # PENTAMATION FURN/A PERMIT TYPE: WORK REPLACE FURNACE AND A/C AT SAME LOCATION SCOPE rrppl. Insp Fee APPLIANCE / EQUIP TYPE FEE ID Plumb. Plum Checti I I QTY UNITS BP FEES Flee. Permit Fee: A/C Units (<=10K cfm) 1BREMAIR Other Elec. Insp. 1 # $72 Furnace, Forced -Air 1MFR=<100 rrppl. Insp Fee 1 # $143 PME Unit Fee: $215.00 PME Permit Fee: $48.00 Constiwtion Tax: Administrative Fee: IADMIN $45.00 Work Without Permit? o Yes E) 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, Fire, Sanitary Sewer District, School District, etc.. These fees are based on the prelimina information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution 11-053 Ef f 7%1%73) Mech. Plan Check 0 .0 hrs $0.00 Plumb. Plum Checti I I Elee, Plan Check Mech. Permit Fee: 1MPERAVT Plumb. Permit Fee: Flee. Permit Fee: Other Mech. Insp.0.0 hrs $48.00 OrhEr t'i' imb lnsp. Other Elec. Insp. Plumb. Irish Elec. Inst'. 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 prelimina information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution 11-053 Ef f 7%1%73) FEE QTY/FEE MISC ITEMS lan Check Fee: t.tppl. PC Faye PME Plan Check: $0.00 `''mit Fee: rrppl. Insp Fee PME Unit Fee: $215.00 PME Permit Fee: $48.00 Constiwtion Tax: Administrative Fee: IADMIN $45.00 Work Without Permit? o Yes E) No $0.00 0vanced Panning Fees: Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICR $1.65 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $358.65 $0.00 TOTAL FEE: $358.65 Revised: 10/01/2015 CERTIFICATE OF COMPLIANCE Alterations to Space Conditioning Systems (formerly CF -IR -ALT HVAC) Project Name: 2015- 0328 Jerry Wang I Date Prepared: CF111-ALT-02-E (Page 1 of 3 ) 2015-10-27 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 CF111-ALT-02 document for each dwelling unit. 01 Project Name 2015- 0328 Jerry Wang 02 Date Prepared 2015-10-27 03 Project Location 10121 Empire Avenue 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name 2015- 0328 Jerry Wang 07 Zip Code 95014 08 Dwelling Unit Conditioned Floor Area (ft2) 2100 Installing Installing Installing Number of space conditioning Location or Area 09 Climate Zone 4 10 (SC) systems in this dwelling 1 entirely new Name Served unit. system? 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 I 2100 Yes Yes Yes No No No Altered space system replacement I I I Iconditioning 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-A6372652A-000000000-0000 Registration Date/Time 2015-10-27 14:24:30 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-10-27 14:24:34 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)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 Furnace and Central gas All new Central split All new Less than or A/C heating AFUE 0.8 cooling SEER 14 Setback equal to 40 R-6 replacement furnace components AC 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 & MR -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-A6372652A-000000000-0000 Registration Date/Time 2015-10-27 14:24:30 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2013.Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-10-27 14:24:34 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: Faulkner, Cindy CJ'CCGGCIi�%LP�Ii Company: Signature Date: ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL 2015-10-27 14:24:30 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 forapproval'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: Faulkner, Cindy cf/(� Company: Date Signed: ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL 2015-10-27 14:24:30 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-A6372652A-000000000-0000 Registration Date/Time: 2015-10-27 14:24:30 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-10-27 14:24:34 Schema Version: 0.555SDD