B-2016-1193CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1193
10486 S STELLING RD CUPERTINO, CA 95014-4275 (3 59 13 126)
(ATKINSON
CLIMATROLLERS INC)
SAN JOSE, CA 95112
OWNER'S NAME: JOSIII SHIRISH AAND VINITA S TRUSTEE
DATE ISSUED: 01/14/2016
OWNER'S PHONE:
PHONE NO:
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class Lic. # Cq_io 2'5 S 57 k(
Contractor (ATKINSON CLIMATROLLERS INC) Date
X BLDG _ELECT _PLUMB
X MECH X RESIDENTIAL _ COMMERCIAL
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.
JOB DESCRIPTION:
Replace furnace - Same Location
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.
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
Sq. Ft Floor Area:
Valuation: $7185.00
this permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
APN Number:
Occupancy Type:
information is correct. I agree to comply with all city and county
359 13 126
359
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
PERMIT EXPIRES IF WORK IS NOT STARTED
expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally, the applicant understands and will
comply with all non -point source regulations per the Cupertino Municipal
180 DAYS FROM LAST CALLED INSPECTION.
Code, Sectio . 8.
6
Issued
Signature Date
Date:
OWNER -BUILDER DECLARATION
RF.ROO
I hereby affirm that I am exempt from the Contractor's License Law for one of the
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
1. I, as owner of the property, or my employees with wages as their sole
inspection.
compensation, will do the work, and the structure is not intended or offered
for sale (Sec.7044, Business & Professions Code)
Signature of Applicant:
2. I, as owner of the property, am exclusively contracting with licensed
Date:
contractors to construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I hereby affirm under penalty of perjury one of the following three declarations:
1. 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
HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued.
I have read the hazardous materials requirements under Chapter 6.95 of the
2. I have and will maintain Worker's Compensation Insurance, as provided for
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
by Section 3700 of the Labor Code, for the performance of the work for which
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
this permit is issued.
Health & Safety Code, Section 25532(a) should I store or handle hazardous
s. I certify that in the performance of the work for which this permit is issued, I
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
shall not employ any person in any manner so as to become subject to the
will maintain compliance with the Cuper 'no Municipal Code, Chapter 9.12 and
Worker's Compensation laws of California. If, after making this certificate of
the health & Safety Code, Seefolft 2550f, 25533, and 25534.
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
Owner or authorized agent:
be deemed revoked.
Date:
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is
I hereby affirm that there is a construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
Lender's Name
to enter upon the above mentioned property for inspection purposes. (We) agree
to save indemnify and keep harmless the City of Cupertino against liabilities,
Lender's Address
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant
ARCHITECT'S DECLARATION
understands and will comply with all non -point source regulations per the
I understand my plans shall be used as public records.
Cupertino Municipal Code, Section 9.18.
Licensed
Professional
Signature Date
CUPERTIN0
GENERAL PERMIT APPLICATION?)—)016,11,q3
CONiPJiUNITY DEVELOPIdiEN T DEPARTMENT - BUILDING DIVISION
10300 T ORRE AVENUE • CUPERTINO, CA 9501L 3255
(408) 777-3228 • FAX (408) 777-3333 • buddinO(a)CUDerino.org
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I ars the prope<-iy owner or au'uorized agent to act on the pr perty Owner's behalf. I bave read rl s
applicatiou anil e info. -rayon I have _ o 'ded ' co r-ct.
I ;;ave read the Desc:ip +en of "Work and veru itis accurate. I agree to compl_y;;:ith all applicable local
ord»ances and smote la;; s relit g to b tioa.
I au or_e represen atives of Cuue; no to enter the above ±den ' ed property for inspection purposes.
Siyatureof.Applican/Agent:
Date: tK
SLJ'1 P_T _?,� F i^I Tt ORvIATIOI� T REQUIRED -
OFFSCBLSE'O?;Ll .
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ArF1?A/isc.4_vp_2011. doe revised 06/21/11
CITY OF CUPERTINO b �Ib - I H3
FEE ESTIMATOR -BUILDING DIVISION
ADDRESS: 10486 S. Stelling Rd
Ff/E��yEq/ I7TEfyMS (Fee Resolution 11-053 E{�. 7/U13,)
DATE: 01/14/2016
REVIEWED BY: PAUL
APN: 359 13 126
BP#:
*VALUATION: 1$7,185
*PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
PME Plan Check:
PENTAMATION FURN/A
PERMIT TYPE:
WORK
Re lace furnace - Same Location
SCOPE
APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced -Air 1MFR=<100 1 # $143
TOTALS: $143.00
Mech. Plan Check 10.0 1 hrs $0.00
Mech. Permit Fee: I MPERMIT Fllu i ?I i 1 !)ej 1 ,`[ ljl'0��..
Other Mech. Insp.0.0hrs $48.00
hzv. '. 'Fec :
NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, Sc/tool
District, etc.). These ees are based on the preliminar information available and are only an estimate. Contact the De t or addn'l info.
Ff/E��yEq/ I7TEfyMS (Fee Resolution 11-053 E{�. 7/U13,)
FEE
QTY/FEE
MISC ITEMS
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k �i�€.2f [
PME Plan Check:
$0.00
PME Unit Fee:
$143.00
PME Permit Fee:
$48.00
(1`(.' .'':'11°71s1C1h-d1.tL :
Administrative Fee: IADMIN
$45.00
Work Without Permit? 0 Yes No
$0.00
Travel Documentation Fee: ITRA VDOC
$48.00
Strong Motion Fee: IBSEISMICR
$0.93
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
.. . . ......... .. .
SUBTOTALS:,' $285.93 $0.00. TOTAL FEE. $285.93
Revised. 01/01/20
r
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 1 of 3 )
Project Name: 2015- 0441 Vinida Joshi Date Prepared: 2016-01-07
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 CF1R-ALT 02 document for each dwelling unit.
01
Project Name
2015- 0441 Vinida Joshi
02
Date Prepared
2016-01-07
03
Project Location
10486 South Stelling Road
04
Building Type
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
2015- 0441 Vinida Joshi
07
Zip Code
95014
08
Dwelling Unit Conditioned
2400
#nstallirigsneviC 5
Irstapirligr„
Ilnstalhng
installing
Floor Area (ft2)
Identification or
Location or Area
by this SC
ducted
containing
Number of space conditioning
more than 40
09
Climate Zone
4
10
(SC) systems in this dwelling
1
system?
component?
components?
feet of ducts?
unit.
SC system?
B. Space Conditioning (SC) System Informationion 4 b
t ? k
01
02
.03
04
05
"O6
07
OS
09
10
;Is the SC
Installing a
7 7t
SC System
SC System
CFA served,.
'System a
rfngelart
#nstallirigsneviC 5
Irstapirligr„
Ilnstalhng
installing
Identification or
Location or Area
by this SC
ducted
containing
system
more than 40
ent ely new
entirely new
Name
Served
System (ft2)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
Furnace
Whole house
2400
Yes
No
Yes
No
No
No
Altered space
replacement
conditioning system
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: 216-A0014563A-000000000-0000 Registration Date/Time: 2016-01-07 14:37:28 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2016-01-07 14:37:54
Schema Version: 0.555SDD
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
Furnace
Central gas
All new
Central split
No cooling
This field or
This field or
This field or
This field or
replacement
furnace
heating
AFUE
0.98
AC
component
section is not
section is not
Setback
section is not
section is not
components
altered
applicable
applicable
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 & CF311-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 FIow2300 CFM/ton required„whenMCH-25 is required.
Exceptions:
-Duct systems registered with HERS provider as previously sealed are exempt from,MCW20 Duct Leakage Testing requirements
Heating only systems and Air Handler/Furnace changes do not require verification�of Air Flow MCR '23 or Refngeldnf Charge Mi CH 25
-Existing duct systems constructed, insulated or sealed with asbesto are exemptjfrom MCH 2i'# puot 1*age Testing egwretnentS
E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150 2(b)1Diia and 150.2(b)1E, F)
nx°
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: 216-A0014563A-000000000-0000 Registration Date/Time: 2016-01-07 14:37:28 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2016-01-07 14:37:54
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
Cl'LLCGt f�%2P/G
Company:
Signature Date:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL
2016-01-07 14:37:28
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 taws of the State of California:
1. The information provided on this Certificate'of Compliance is true.and correct.
2. lam eligible under Division 3 of.fhe 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 perfo'rniance specifications, mate"rials 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 6iof the California Code of Regulations
4. The building design features or system design features identified op;this Certificate of Compliance areonSisteClt wttftthe mformaon provided orx'nthor apjlicabte compliance documents, worksheets,
calculations, plans and specifications submitted to the enforcement agency for, ,ap'rovaf.qwI this building permit applicatipn. l
5. 1 will ensure that a registered copy of thisCertificatd bf CdMpliance 9ti4.1 `be'mad , auaifai7le with tti bt 0ing;peimit(QJssu� i for'titg,building, and.ana 2 availabi�. o tfie,enforcement agency for all applicable
inspections. I understand that a registered copy of this Certificate of Conpljiance;is requ��ed to bQsincluded with the documentation the,budder provides tq,the building owner at occupancy.
Responsible Designer Name:, K<.
Respons3bie Designer
Faulkner, Cindy
Company:
Date Signed:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL
2016-01-07 14:37:28
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: 216-A0014563A-000000000-0000 Registration Date/Time: 2016-01-07 14:37:28 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2016-01-07 14:37:54
Schema Version: 0.555SDD