15110156I],
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1131 ELMSFORD DR
CONTRACTOR: VALLEY HEATING &
PERMIT NO: 15110156
COOLING
OWNER'S NAME: HUANG VICTOR K L AND SHIRLEY L TRUS
1171 N 4TH ST
DATE ISSUED: 11/20/2015
OWNER'S PHONE: 4087770241
SAN JOSE, CA 95112
PHONE NO: (408)294-6290
LICENSED CONTRACTOR'S DECLARATION
or_t
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E]
��
9
REPLACE 2 FURNACES - UPSTAIRS AND DOWNSTAIRS
License Clasjs Lic. #
lt
Ci
Contractor V 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:
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: $4619
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: 36208013.00
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 DS FROM LAST CALLED INSP
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
f
I
Issued by: ""`''�' Date: r
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
RE -ROOFS:
9.18.
t l
1 �r
Sig#a ure 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. 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 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, Section 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
I %2 c7j r
Owner or K orized 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
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 PEPM1T APPLICATION t5HOl5(o,
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 T ORRE AVENUE • CUPERTINO, CA 55014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildino(a.cuoerino.org
❑ PLUl/,317NCT ❑ MECH_a l`IC.AL ❑ ELECTRIC?? ❑ AIISCELLAKiEOUS
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LICENSE NUArBER
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LTSE or ❑ SFD ., DU•PLr : ❑ mui:rI-i!amy . PROizCT
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DESCRIPTIO]\' OF WORK
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TOTAL VALUATION: ��
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By my signatcre below, I certify to each of the following: Iain the propety owner or authorized agent to act on the propery owner's behalf. I have read this
application and the information I have provided is correct. I have
read the Desciption of'Work and verify itis accurate. I agree to comply with all applicable local
ordinances and state laws relating to b inz construct' I authorize representatives of Cupertino to enter the above-identi ied for inspection purposes.
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Sismatere ofA.pplicanJAgent: 19A�_
/property
Date:
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SUPP_E_ ZEA 1 AI. _ rFOR _ATIOI� REQUL.ED
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hrEP.Aa, sCApp_2011.doc revised 06/21/11
CITY OF CUPERTINO 15 110)!%
W.RN70 FEE ESTIMATOR — BUILDING DIVISION
Mech. Plan Check 0.0 1 hrs $0.00 1'lum-b. 111a t Chee': 1` °ec. Plan Cfac c
Mech. Permit Fee: IMPERMIT I'luni z. 1'ermit I r e: Eiec. Pe:rta:-it Fee::
Other Mech. Insp. 0.0 1 hrs $48.00 Odl er.."hwnb Ir„sp. CJs'rc. t:i c. tnso.
ril wh, Irr=1. 1 i f-: Ph?inb. Jiwv, Fees: Elec. Insp. [!e":
NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.. These ees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
ADDRESS: 1131 Elmsford Dr
DATE: 11/20/2015
REVIEWED BY: PAUL
MISC ITEMS
APN: 362 08 013
BP#:
*VALUATION: 1$4,619
*PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION FURN/AC
I PERMIT TYPE:
WORK
Re lace 2 furnaces - Upstairs and Downstairs
SCOPE
Mech. Plan Check 0.0 1 hrs $0.00 1'lum-b. 111a t Chee': 1` °ec. Plan Cfac c
Mech. Permit Fee: IMPERMIT I'luni z. 1'ermit I r e: Eiec. Pe:rta:-it Fee::
Other Mech. Insp. 0.0 1 hrs $48.00 Odl er.."hwnb Ir„sp. CJs'rc. t:i c. tnso.
ril wh, Irr=1. 1 i f-: Ph?inb. Jiwv, Fees: Elec. Insp. [!e":
NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.. These ees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check
�S'z ppL N.". Ff' e
PME Plan Check:
$0.00
Permit 17ee.
SUP/}Z. Ins") .1" C'.C'.
PME Unit Fee:
$286.00
PME Permit Fee:
$48.00
C "Onsiruc:lion :i 1x:
Administrative Fee: 1ADMIN
$45.00
Work Without Permit? 0 Yes (E) No
$0.00
Ads anc°r,>ci./ hmn.in ,,1 ees:
Travel Documentation Fee: ITRAVDOC
$48.00
Strom Motion Fee: IBSEISMICR
$0.60
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS
$428.60 $0.001,TOTAL FEE $428.60
Revised:
CERTIFICATE OF COMPLIANCE CF111-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 1 of 3 )
Project Name: 2015- 0342 Victor Huang Date Prepared: 2015-11-19
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 MR -ALT -02 document for each dwelling unit.
01
Project Name
2015- 0342 Victor Huang
02
Date Prepared
2015-11-19
03
Project Location
1131 Elmsford Drive
04
Building Type
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
2015- 0342 Victor Huang
07
Zip Code
95014
08
Dwelling Unit Conditioned
2200
refrigerant
=#nstallirfg new -SC
Installir g E
"installing
Floor Area (ft2)
Identification or
Location or Area
by this SC
ducted "
Number of space conditioning
system
09
Climate Zone
4
10
(SC) systems in this dwelling
2
System (ft2)
system?
component?
components?
unit.
duct system?
C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)1Diib) 1 ET""'
This section does not apply to this project. N O V 2 0 2015
Registration Number: 215-A6400607A-000000000-0000 Registration Date/Time: 2015-11-19 15:22:01
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006
Schema Version: 0.555SDD
HERS Provider: CalCERTS
Report Generated: 2015-11-19 15:22:08
B. Space Conditioning (SC) System Information
01
02
03
04
FO6
07
08
y
09
10
FIs the SC"
Installing a
SC System
SC System
CFA served
system a
refrigerant
=#nstallirfg new -SC
Installir g E
"installing
H Installing
Identification or
Location or Area
by this SC
ducted "
containing
system
w:.
more than 40`
entirely new
.
` entirely new
Name
Served
System (ft2)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
Furnace
upstairs
1000
Yes
No
Yes
No
No
No
Altered space
replacement
conditioning system
Furnace
downstairs
1200
Yes
No
Yes
No
No
No
Altered space
replacement
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)1Diib) 1 ET""'
This section does not apply to this project. N O V 2 0 2015
Registration Number: 215-A6400607A-000000000-0000 Registration Date/Time: 2015-11-19 15:22:01
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006
Schema Version: 0.555SDD
HERS Provider: CalCERTS
Report Generated: 2015-11-19 15:22:08
CERTIFICATE OF COMPLIANCE CF111-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
TypeDuct
Length
R -Value
All new
No cooling
This field or
This field or
This field or
This field or
Furnace
Central gas
heating
AFUE
0.8
Central split
component
section is not
section is not
Setback
section is not
section is not
replacement
furnace
components
AC
altered
applicable
applicable
applicable
applicable
All new
No cooling
This field or
This field or
This field or
This field or
Furnace
Central gas
heating
"AFUE
0.8
Central split
_AC
component
section is not
section is not
Setback
section is not
section is not
replacement
furnace
components
altered
applicable
applicable
applicable
applicable
Required Documentation:
CF2R-MCH-01-E - Space Conditioning Systems Ducts and Fans
-Duct insulation requirement for new plenums: 136:
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: 515%, or 510% leakage to outside, or seal all accessible leaks.
CF2R-MCH-25-H & CF3R-MCH-25-H Refrigerant Charge Verification required wheri"r 4rrigerant 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 l
-
Exceptions:
-Duct systems registered with HERS provider as previously sealed are exempt frotti.MCH 20 Dutt Leakage Testing requirements
='
' w
-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 areexempt from MCHr20 Duct>Leakage.Testmg requirements r
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-A6400607A-000000000-0000
Registration Date/Time
2015-11-19 15:22:01
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-11-19 15:22:08
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -IR -ALT HVAC)
CF1R-ALT 02-E
(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:
/ �j
Documentation Author Signature: %�W6U
Faulkner, Cindy
(�C Q
Company:
Signature Date:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL
2015-11-19 15:22:01
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 o6", his Certificate of Compliance are consistent with -the information provided on othe't,'appitcat3le'conpliance documents, worksheets,
calculations, plans and specifications submitted to the enforcement agency for,approvalwrth this building permit application. °.
5. I will ensure that a registered copy of this Certificate of Compliance shall be made available vifththe tiuilding permits} issued forthe;.biiildttig, and,tnad2 avatlabfeLto 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: },x??
Responsible Designer Signature.
Faulkner, Cindy
Company:
Date Signed:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL
2015-11-19 15:22:01
Address:
License:
1171 NORTH 4TH STREET
258540
City/State/Zip:
Phone:
SAN JOSE CA 95112
408-294-6290
Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered document and in no way implies Registration Provider responsibility for the accuracy of the information.
Registration Number: 215-A6400607A-000000000-0000 Registration Date/Time: 2015-11-19 15:22:01 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-11-19 15:22:08
Schema Version: O.SSSSDD