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15120080CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20720 GARDEN MANOR CT CONTRACTOR: ATLAS-TRILLO HVAC PERMIT NO: 15120080 OWNER'S NAME: LAI TERRY K AND LAI-CHEANG PEG 1965 KYLE PARK CT DATE ISSUED: 12/08/2015 OWNER'S PHONE: 4082530862 SAN JOSE, CA 95125 PHONE NO: (408)286-8931 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL E] License Classi! Lic. #, REPLACE FURNACE AT SAME LOCATION pp l' � o Contractor art- m`1, Date I hereby affirm that I am licensed under the provisions of Ch4 ter 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: $2400 performance of the work for which this permit is issued. nd 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: 36230071.00 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 FROM LAST CALLED 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 Issued by:OAAboi4Date: IJ r granting of this permit. Additionally, the applicant understands and will comply "?4 with all no - nt source regulations per the Cupertino Municipal Code, Section RE-ROOFS: 9.18. C Signature ,— 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 (See.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (See.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. 1 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 b Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance wp�t upertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code ectio 505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized 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 PERMIT i APPLICATIONMEP 1W COMMUNITY DEVELOPMi�ENT DEPARTMENT • BUILDING DIVISION 10300 T ORRE AVENUE • CUPERTINO, CA 05014-3255 (408) 177-3228 • FAX (408) 777-3333 • buildina(a cuoeriino.org m 1 ±rUPERT[l�©� � �� Ca DDD ❑PLUl;,BLNG 41YIECKANICAL ❑ELECMCAL ❑h/iSCELLANiEOUS PROJECT.ADDRESS V .. I .APNr J j 07VIFRNAME i /� 1 I PHONE- �0�6 LEAV-14jL STREET A-DDP.ESS I CITY, STATn,ZIP V w q56 CONTACT NhMEC I PHO:I� (�(;� -Z �6^ f , T'r 5�E-iyLALf STRE7'T ADDRESS I CITY, STATE, ZIP -Ax , ❑ OVNM ❑ OV NZ-R-BUIIDER ❑ OWN -ER AGMNTT 6�--�CTOR ❑ CO'-."IP.ACTOR AGENT ❑ .SRC_LITECT ❑ B GL'\:: R ❑ D-=�+ELOpHR ❑ i= e �T CONTRACTORKAJ,CE aC r LICr1:SEN 'R I LIC-- E ` I BUS. LIC- COMPANY NAIL �\ J /i LV / I I - -A41,(n ;r ` n ^ FA STREETADDRESS I CITY, STATE A RCHITBCT,ENGIN = NATE L LICENSE ATUMDER I BUS. LIC r COMPANY NAM ' — E-IJlAII I RA STREET.ADDRESS CITY, STATE, ZIP I PiiOlhi USE OF or DU?= ❑ 2,rMTI-FA ,1JLY PROj=CT LN w1IDLAND ❑ Y: -:s PROT=CT IN ❑ ti rS is i? = BLDG AN ❑ � =S B u IDNIG: ❑ C01,,2,, ,CIAI, I URBAY INTrRP?.CE )-P.E.A ❑ T'0 FLOOD ZOh3 ❑ NO I EIC11MER HOMM? ❑ NO DESCRIPTIONTT OF wORK f C C TOTAL VALUATION,: `� V . V By my signature below, I cerify o e owing: I am the propertyowner or authorized agent to act on the prop --'-'Ly Owner's behalf(?ave read this application and the infor_nation I provid is rrect. I have read the Description of Work aad verify it is accurate. I agree to comply;; all applicable local ordiumces and state laws relat: -a o bu ]ding onstm `ion. '- entatives of Cupertino to enter the abo = iden d ro i- ,fir �nspec ion purposes. J� Signature ofA plicant/.Agent: ate: SL-PP_El,rENI AL LNT1='OR UIR.ED - OFFIGE'LSE01\Ll W, �.; � Oti'ER'TiiF COti''�TER E 11 RIO n � r' _ �N -Alj'EP-Mffsc,4vp_ 011.doc remised 06121111 CITY OF CUPERTINO FEE ESTIMATOR -BUILDING DIVISION ia,ADDRESS: 20720 Gardeb Minor Ct DATE: 12/08/2015 REVIEWED BY: Phuong APN: 362 30 071 BP#: *VALUATION: 1$2,400 'PERMIT TYPE: Mechanical Permit Furnace, Forced -Air PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: .1 PENTAMATION FURN/AC PERMIT TYPE: WORK Replace furnace at same location 1,i'7 mit .Fe : SCOPE APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES Furnace, Forced -Air 1MFR=<l00 .1 # $143 Eli Mech. Plan Check 10.0 1 hrs $0.00 llhvtrj:. !'aan Ch - k 1'tr;. 1'10N C;:ter;7 Mech. Permit Fee: IMPERMIT 1'fuinh. 1'e•t•,�tit l e° : ("Iec. I'e�t?trat Peep: Other Mech. Insp. 0.0 hrs $48.00 CJr,'xc;° .('atrt% li?sz:>. C3.lt 3 L°:t c . tit: t>. F-1 -L-1 f .r z , t 3.., t, 1.122: �c;.rt. lrtsn. ••r:�e�: 1 arra;,.. rr:�t•=. ,t; r:: ;arc. i;.r DOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, Schooi District, etc.). These_ fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/132 FEE QTY/FEE MISC ITEMS l hm (.'/!i'L. k flee: Su/~pL P(:' .F:e e PME Plan Check: $0.00 1,i'7 mit .Fe : PME Unit Fee: $143.00 PME Permit Fee: $48.00 ('.'O 1si7 uclion Ktx Administrative Fee: (ADMIN $45.00 Work Without Permit? C) Yes (F) No $0.00 ,fir./vancet,l Planning)- 'eyees: Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTAL$, $285.50 $0.00 TOTAL FEE: $285.50 Revised: 10/01/2015 CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 1 of 3 ) Project Name: LAI Date Prepared: 2015-12-08 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 LAI 02 Date Prepared 2015-12-08 03 Project Location 20720 GARDEN MANOR 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name LAI 07 Zip Code 95014 08 Dwelling Unit Conditioned 2000 SC System SC System CFA served Floor Area (ft2) refrigerant fnstallirig nevi. SC Installing Installing Installing Number of space conditioning Identification or 09 Climate Zone 4 10 (SC) systems in this dwelling 1 entirely new entirely new Name unit. System (ft2) B. Space Conditioning (SC) System Information 01 02 03 04"';,",`05 06 07 O8( 09 10 =:Is the SC ,.., Installing a SC System SC System CFA served systema <" refrigerant fnstallirig nevi. 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? conponent? components? feet of ducts? duct system? SC system? Alteration Type System 1 Location 1 2000 Yes No Yes No No No Altered space conditioning system C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)1Diib) This section does not apply to this project. Registration Number: 215-A6452462A-000000000-0000 Registration Date/Time: 2015-12-08 11:58:30 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-12-08 11:58:25 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 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. CF213-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:510% leakage to outside, or seal all accessible leaks. MR -MCH -25-11 & 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 MC, z23, or Refrigerant Charge MECH 25 -Existing duct systems constructed, insulated or sealed with asbestos<are exempt:from MCH -20 DugLeakage Testin reciuir#me€ is E. Entirely New or Complete Replacement Dudtkem, with or without.Eau;ipment 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-A6452462A-000000000-0000 Registration Date/Time: 2015-12-08 11:58:30 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-12-08 11:58:25 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: �/GG1(�//G 2G�ClY c Trillo, Austin �J Company: Signature Date: TITAN SYSTEMS INC 2015-12-08 11:58:30 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 land Part 6 of the California Code of Regulat(ons. 4. The building design features or system design features identified orrtthis Certificate -of d6mpfiance are consistent with'the irifoi mation•provided onothei''applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcementagency forapproval with this building permit apphcatign. 5. 1 will ensure that a registered copy of this Certificat"f Compliance sPiaJ!•be.rradeavailable with the building pefmit(s) issued for the°building, and,made avai(abVtb the;enforcement agency for all applicable inspections. I understand that a registered copy of this', ertificate of Compliance]s;required to be,included with the documentation the builder prpv des to the burld.ing owner at occupancy. „...._ Responsible Designer Name: Responsbe Designer S)gnature. M- ��X9 Trillo, AustinG%/moi Company: Date Signed: TITAN SYSTEMS INC 2015-12-08 11:58:30 Address: License: 1965 KYLE PARK COURT SUITE B 977238 City/State/Zip: Phone: SAN JOSE CA 95125 408-286-8931 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-A6452462A-000000000-0000 Registration Date/Time: 2015-12-08 11:58:30 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-12-08 11:58:25