15120153CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10973 NORTHSKY SQ
CONTRACTOR: VALLEY HEATING & PERMIT NO: 15120153
COOLING
OWNER'S NAME: HSIA CHRISTINE Y TRUSTEE & ET AL
1171 N 4TH ST DATE ISSUED: 12/16/2015
OWNER'S PHONE: 4089428530
SAN JOSE, CA 95112 PHONE NO: (408)294-6290
} LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E]
,v c/
REPLACE (E) FURNACE, SAME LOCATION & ADD (N) A/C
License Class!� �- Li J/
UNIT IN REAR YARD
y]
ContractorZ_��'r� Dat600
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: $7820
performance of the work for which this permit is issued.
jq,e and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 31640044.00
Occupancy Type:
ct, n 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
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 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 M LAST C INSPECTIO
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence o to
Issu
granting of this permit. Additionally, the applicant understands and will comply
with all non -points urce regulations per the Cupertino Municipal Code, Section
9.18.
/e r
RE -ROOFS:
Signa ur , _De
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(x) 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, Sections 5505, 25533 and 25534. ;
Section 3700 of the Labor Code, for the performance of the work for which this
�7
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
ARCHITECT'S DECLARATION
indemnify and ]seep 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
MIM �h
4
- Al
REM
CUP ERTIN 0
GENERAL PERM i APPLICATION
CC)MMUNITY DEVELOPVENT DEPARTMENT - BUILDING DIVISION
10300 T ORRE AVENUE o CUPER T INO, CA 5501A-3255
(408) 777-3228 - FAX (408) 777-3333 • buildinOO)CUoerino.orct/
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By icy signature below, I ce: i_
to each of the follov.,ing: I am the propeI—LY owner or au'uorized Q a e. ELY OWDer's behalf. I have read this
application and ue zforma ion
I have provided is co* ect. I have read the Desciiption of Work and vent' �is accurate. I agree to comply with all applicable local
ord—inances and state laws relatir
g to build�hiction. zu hor ze representatives of Cupertino to enter the zbove-;den.' prop -2.4y fo . ection purposes.
Signature of A.oplicant/Agent: Date:
SU-PPLEl\fiENTALT LNT'ORvlATION REQUIRED
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A1FP_A1isa4pp_2011.doc remised 06121/11
CITY OF CUPERTINO
_.� , FF,F F,STIMATOR — BUILDING DIVISION
ADDRESS: 10973 NORTHSKY SQ
i.a"IAPN:
DATE: 12/16/2015
REVIEWED BY: MELISSA
316 40 044
BP#:
'VALUATION: 1$7,820
*PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
SFD or Duplex
PENTAMATION
FURN/A
USE:
$0.00
PERMIT TYPE:
WORK
REPLACE E FURNACE SAME LOCATION & ADD N A/C UNIT IN REAR YARD
SCOPE
APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES
A/C Units (<=10K cfm) 1sREMAIR 1 # $72
Furnace, Forced -Air 1MFR=<100 1 # $143
TOTALS: $215.00
VOTE: 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 only an estimate. Contact the Dept_/or aaan't info.
FEE ITEMS (Fee Resolution 11-053 Ef.. 7/.1/13
FEE
QTY/FEE
MISC ITEMS
/' kin Check 1 -fee:
Sf jyV. N..F<1111'
PME-Plan Check:
$0.00
permit Ifec.
PME Unit Fee:
$215.00
PME Permit Fee:
$48.00
(""Of1:Si1°uefion .l£ix:
Administrative Fee: 1ADMIN
$45.00
Work Without Permit? 0 Yes •) No
$0.00
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: IBSEISMICR
$1.02
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS:
$358.02
$0.00. TOTAL FEE:'
$358.02
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: 2015- 0422 Jim Hsia Date Prepared: 2015-12-09
A. General Information
CF111-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- 0422 Jim Hsia
02
Date Prepared
2015-12-09
03
Project Location
10973 Northsky Square
04
Building Type
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
2015- 0422 Jim Hsia
07
Zip Code
95014
08
Dwelling Unit Conditioned
Floor Area (ft2)
1300
Number of space conditioning
09
Climate Zone
4
10
(SC) systems in this dwelling
1
unit.
I B. Space Conditioning (SC) System Information
a
01 02 03 0 06 07 :b. 08 09 10
x
SC System
SC System
"CFA served
Identification or
Location or Area
by this SC
Name
Served
System (ft2)
Furnace
replacement add
whole house
1300
A/C
Is the SC Installing a
F�
;Ystem a° refngetant #nstallirtg neW SC Insta)hr g ;linstalhng Installing
R:., ..F ,
ducted containing system more than 40 entirely new entirely new
system? component? components? feet of ducts? duct system? SC system?
Yes I Yes I Yes I No I No I No
C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)iDiib)
This section does not apply to this project.
Alteration Type
Altered space
conditioning system
Registration Number: 215-A6459660A-000000000-0000 Registration Date/Time: 2015-12-09 15:03:51 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-12-09 14:59:43
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
Furnace
Central gas
All new
Central split
All new
This field or
This field or
replacement
heating
AFUE
0.8
cooling
SEER
14
Setback
section is not
section is not
add A/C
furnace
components
AC
components
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 fieguired 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,:6r seal all accessible leaks.
CF2R-MCH-25-H & CF311-MCH-25-11 Refrigerant Charge Verification required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15).
CF2RCF3R-MCH-23 & CF311-MCH-23 Air FIow2 300 CFIYIJton required whenMCH-25 is required.
Exceptions:
-Duct systems registered with HERS provider as previously sealed are exempt from MGH 20 Duct Leakage Testing requirements
Heating -only systems and Air Handler/Furnace changes do not require verification of Air Flow MCHM/or Refrigerant Charge Mi GH 25
-Existing duct systems constructed, insulated or sealed with ashestosiare exempt',from MCH=7(3puC£ 11*age Testin ;r�c}uir merits
M;
E. Entirely New or Complete Replacement Duct System, with or wtithout,Equipment Ch ngeout (Sections 150.2(b)1Dua 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-A6459660A-000000000-0000
Registration Date/Time:
2015-12-09 15:03:51
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-12-09 14:59:43
Schema Version: 0.5SSSDD
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
C1'L�GGC/i�LP/li
Company:
Signature Date:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL
2015-12-09 15:03:51
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, matenals, 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 RegUiations.
4. The building design features or system design features identified on.Yhis Certificate of Compliance are consistent with the mformatton provided ort otherapp#Icable`rompliance documents, worksheets,
calculations, plans and specifications submitted to the enforcement agency forapprbval wrt this building permit application:.
S. I will ensure that a registered copy of this Certificate of Compliance shall:be madg,availa6le with the building permit(Q issued for tha,15, 10ing, and.anade avatlable'to the:enforcement agency for all applicable
inspections. I understand that a registered copy of this Certificate of Compliance•is,require.d to be„included with the,documentation the,Wider provides to,.the building owner at occupancy.
Responsible Designer Name: Y
Responsible Designer Signature. --.
Faulkner, CindyGrClXlv�2P/�
Company:
Date Signed:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL
2015-12-09 15:03:51
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-A6459660A-000000000-0000 Registration Date/Time: 2015-12-09 15:03:51 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-12-09 14:59:43
Schema Version: 0.555SDD
COM[,.-!1,-!Nl-rY DEkiF-.j..0PMENT DEPA!
BUILDING DMISION - CUFER711
,j 8.0.erlf;cations MUS
This set Of Phns 2"e
d,CO!IS--U(,-'Lj0l1. It 1S unlaw
L :--;t'Gl-'S on sc-,me, or
then-D-fronl, %qjt,,,oui appl'OvP,! froln tho 6
--tamping of this plan and
t ol.
perrjj�I
ol E -my pro n rclinanc
PERMIT NO.
CUPERTINO
`3uilding Department
VIEWED FOR CODE COMPLIANCE
Reviewed By:
1
1A
Fu
01 V'SD\
DATE
P ING DEPT
CU ERT NO
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