15120074EIA
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21752 COLUMBUS AVE
CONTRACTOR: AAA FURNACE & AIR
PERMIT NO: 15120074
CONDITIONING
OWNER'S NAME: PERKINS WILLIAM F JR AND ALICE
1712 STONE AVE
DATE ISSUED: 12/08/2015
OWNER'S PHONE: 4082535481
SAN JOSE, CA 95125
PHONE NO: (408)293-4717
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL E]
��(
REPLACE (E) FURNACE, SAME LOCATION & ADD (N) A/C
7
License Class � Lic. # CSS (� 9 ( r
UNIT IN REAR YARD AREA
d
ContractoP�c Dat ., v t
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: $4110
performance of the work for which this permit is issued.
I lira- � 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: 35618042.00
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 1'80 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 D 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
-
Issue Date:
granting of this permit. Additionally, the applicant understands and will comp
_
with all non -poi t sou a regu ' ns per the Cupertino Municipal Code, Section
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
9.18. ;
�C
Signatu Date oC 0 ��
installed without first obtaining an inspection, I agree to remove alp 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 stricture 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
constrict 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 compliancewith the Cu ertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sectio is 2 505, ; and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agenDate:
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
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
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
CUPERTINO
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 - buildingQc1�.cupertino.org i �: 00
Isc
n r-1.. T F-11, IT01 UT T A KMnT IQ
1J VLUMt5iNLT IJ 1virl.rltiIN11—tUl u
�J
io
..... ...
APN #
PROJECT ADDRESS ( I C Li ve n v e
I �G,� m i l l m
OWNERNAME �I I I P�I`i �(
PHONE AV -11
�(rj��C�+
101
E-MAIL
STREET ADDRESS
•/ I U 1' I V
CITY, STATE, ZIP peyt 'n 1I r
t/ I L
=FAX
CONTACT NAME
PHONE
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑COMtRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAMEn
Jim /'\
LICENSE NUMBER
LICENSE TYPE
BUS. LIC # Ca
�✓
COMPANY NAME
L
E-MAIL
►, .GII ^ cel
FAX ,
STREET ADDRESS Aip/1
CITY, STATE, ZIP r/�
JUI
PHONE
�(j
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY PROJECT IN WILDLAND ❑ YES
PROJECT IN
❑ YES
IS THE BLDG AN ❑ YES
❑ NO
NO
BUILDING: ❑ COMMERCIAL URBAN INTERFACE AREA E] NO
FLOOD ZONE
❑ NO
EICHLER HOME7
DESCRIPTION OF WORK
ho f_�fflnm_ ndvawf
t-
EIYED
TOTALVALUATION: I I
z$ e
? t
By my signature below, I certify to each of the following: I am the property owner or authorized a e act on the owner's be alf. it4velead this
application and the information I have provided is correct. I have read the Description of Work an verify it is ac5a
nae. I agree t -o ply, all applicable local
ordinances and state laws relating to b ding nstruc ' I authorize representatives of Cupertino to enter the above- identi
erty for inspection purposes.
S
Signature of Applicant/Agent: Date:
UPPLEMENTA INFO ATIONREQUIRED
y_,,O.FFICEUSEONLY�;' ,
mrAl
e OYER THE COUNTER
E" EXPRESS
S
K
❑� MAJOR„ ,t. N a...,� ,,q.
MEPMiscApp_201I.doc revised 06/21/11
CITY OF CUPERTINO
FIFIR ]FRTTMATOR — RTTII,DING DIVISION
imADDRESS: 21752 COLUMBUS AVE
DATE: 12108/2015
REVIEWED BY: MELISSA
APN: 35618 042
BP#:
*VALUATION: F$7,110
*PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
PENTAMATION FURN/AC
I
USE:
$0.00
PERMIT TYPE:
WORK
REPLACE (E) FURNACE, SAME LOCATION & ADD (N) A/C UNIT IN REAR YARD AREA
SupI.V,
SCOPE
APPLIANCE EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced -Air 1MFR=<100 1 # $143
A/C Units (<=1 OK cfm) 1 BREMAIR 1 # $72
TOTALS: $215.00
F
Mech. Plan Check 1 0.0 1 hrs $0.00 I'lan Check c. I'lon Check
Mech. Permit Fee: IMPERMIT Pluill'b, IN.'mn't I.-I'lec, per"I.n't Pee:
_
Other Mech. Insp. 0.0 hrs L $48.00 Other.11"(wb
Akuh. Phtrnb, hisp. e: /r'sp. I"20:
NOTE: This estimate does not include fees due to other Departments (i.e..Planning, Public Worms, 14tre, 3aniiaryooewer vistrictacnuut
El ;"fnrmi7finxi myl7ilahla and aro nnhy an Pstimate- Cnntact the Dent for addh 'I info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711113)
FEE
QTY/FEE7_
MISC ITEMS
Plan. ("heek.17ee:
&1q2pL PC.Fe-e,
PME Plan Check:
$0.00
SupI.V,
PME Unit Fee:
$215.00
PW Permit Fee:
$48.00
(" onsiruction
Administrative Fee: 1ADMIN
$45.00
Work Without Permit? 0 Yes (D No
$0.00
Travel Documentation Fee: I TR,4 VDOC
$48.00
Strong Motion Fee: IBSEISMICR
$0.92
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
i."� SU AL
SUBTOTALS:,;
1 $357.921
$0.00 :TOTALFEE
$357.921
Revised: 10/01/2015
CERTIFICATE OF COMPLIANCE
CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 1 of 3 )
Project Name:
BILL PERKINS I Date Prepared:
2015-12-07
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
BILL PERKINS
02
Date Prepared
2015-12-07
03
Project Location
21752 COLUMBUS AVENUE
04
Building Type
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
BILL PERKINS
07
Zip Code
95014
08
Dwelling Unit Conditioned
1888
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
TRANE
WHOLE HOUSE
1888
Yes
Yes
Yes
No
No
No
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-A6446585A-000000000-0000
Registration Date/Time:
2015-12-07 13:43:12
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-12-07 13:43:03
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
Central split
Outdoor
This field or
This field or
TRANE
furnace
AHU
AFUE
0.78
AC
condensing
SEER
13
Setback
section is not
section is not
unit
applicable
applicable
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 510% 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 vers ication"of Air Flow MCH -23 or�Refrigerant Charge MECH-25:
_
-Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH-20buct Leakage Testing requirements.
E. Entirely New or Complete Replacement Duct -System, with or without, Equipment Change -out (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-A6446585A-000000000-0000 Registration Date/Time: 2015-12-07 13:43:12 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-12-07 13:43:03
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:
Rando, Eric
C
Company:
Signature Date:
RANDO AAA HVAC INC
2015-12-07 13:43:12
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.`a"pplicable'compliance documents, worksheets,
calculations, plans and specifications submitted to the enforcement agency for approvalw'ith this building permit application. `Yl
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 Signat"ure: r
Rando, Eric
Company:
Date Signed:
RANDO AAA HVAC INC
2015-12-07 13:43:12
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 no way implies Registration Providerresponsibility for the accuracy of the information.
Registration Number: 215-A6446585A-000000000-0000 Registration Date/Time: 2015-12-07 13:43:12 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-12-07 13:43:03
Schema Version: 0.555SDD
Cb( U"4bks A.,�-
2015