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B-2016-1192CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2016-1192 21613 TERRACE DR CUPERTINO, CA 95014-4792 (356 20 018) (ATKINSON CLIMATROLLERS INC) SAN JOSE, CA 95112 OWNER'S NAME: MULLANE ROGER D ET AL DATE ISSUED: 01/14/2016 OWNER'S PHONE: PHONE NO: LICENSED CONTRACTOam&//R'S DECLARATION[�,� BUILDING PERMIT INFO: I/ ""v License Class Lic L, ✓ Contractor (ATKIN 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: 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 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: $4120.00 this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above Number: Occupancy Type: information is correct. I agree to comply with all city and county 356 20 018 3 56 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 WORD 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, Se744? Issued b 1 1 �� 6 : �� 1 Signature Date Date: OWNER -BUILDER DECLARATION RE -ROOFS: 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 3. 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 taertinfMunicipaI Code, Chapter 9.12 and Worker's Compensation laws of California. If, after making this certificate of the Health & Safety C5505, 2 33, a d 25534. exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such or this permit shall �(6 provisions Owner or authorized age be deemed revoked. Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING EN Y I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agenc 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 J GENERAL PERMIT APPLICATION COMI'diLINITY DEVELOPIdiENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 9501A 3255 CUPERT[NO. ('08) 777-3228 - FAX (408) 777-3333 • build ina(a cuoerino.org ❑PLUh13LTG ❑l'ECH.a2'ZC.kL ❑ELECTRICAL. ❑ARSCELL4NEOUS pRorycrADDPEss !/ �1 l l� '2fi�Ptw TRw' nn r OWTrRT�AiJ Gt[.rKwt W/G I'140A. 06 L(qb t)-51 td E1✓t1Z STREETA.DDRESStf�r+V�`ti 4ove ` I IIY, C�QiG I FAX G5ort CONTACT NA>JE -rrwe �wq ® E ?fe 71 STREET A..DDPMS CITY, STATE, Z3 I -.:Ax ❑ omnia ❑ ❑ 0\+TNMAC.ENT ❑ C CTOR 0'` R1,CTORAG=:T ❑ ARC BCT ❑ BNOWE R ❑ D-=vrLO?_t ❑ E �� CONTILACTORNAI\M ob-ctyjs� 196'wo I LICEC-TE) I ttbL C' FN `L( COIJ3kTY Np METL �i'\�� I E V (e I G G ( jkgea. l %l -0 `Y ` STREETAD1DRZE SS -� 1 ��`- CITT?TE,Zi 6p, 6tst t I q g• `LAK • - A-RCETEMENGINEERNAN=- LICENSE NUMBER BUS. LIC COIJ,PANYNA1VE E-?J:A T I FAY, STREETIADDRESS I CITY, STATE, Zip I pHONES USE or ❑ SFD or DUPLEX ❑ MULTI-rAhr I.Y PROJECT LN RrI DLRSD ❑ Y� ??.OT -CT IN ❑ Y zS IS i 3LDG AT ❑ ` =5 Blip Nri: ❑COhD, C_T URBAYLKice.'-ACE AP.E4 ❑ TO FLOOD ZOMS ❑ >;o NO DESCRIPTION OF FrORK (_ w � � 1, SA t LWA �CUY` TOTALS 4J-UkT?ON: I9 o I R C�IR V � By my signa«L-e below, I certify to each of the followi=g: I am the prope<`ty ovmcr or au`u} orized agent to act on the prop . ty owner's behalf. I have read tl us - application and the L-aforn ation I have pro 'de is co. ect. I have read the Description of"Wo--k and verify itis accurate. I 2sree to comply vy-ith all applicable local ordinances and state laws-el_atLng to build Q ons, ction. I author, -7e representatives of Cupertino to enter the abov -idea : fed prropel ty for i-ispection purposes. Sim-,-tureofAllWicantl."-_gent: Date: C t PLEl`�ENTAI ! tORvIATION REQliLpED 5U't'�-'_IT s al'za .bw:':=-:f :i'p�.`'. � _ � 2_v � i _-=>_: • :l?.> '.: '_ _:. i RKt. ... Y . NO, ,; TERM i".' - 51 IN sk �M> d2JOR .,cz 1vj'EPM,7sc,Dp_2011. doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 21613 Terrace Dr FEE ID DATE: 01114/2016 REVIEWED BY: PAUL APN: 356 20 018 BP#: *VALUATION: 1$4,120 *PERMIT TYPE: Mechanical Permit 1MFR=<100 PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: # PENTAMATION FURN/AC PERMIT TYPE: WORK Replace furnace - Same Location SCOPE F APPLIANCE / EQUIP TYPE FEE ID gail t.' is N QTY UNITS BP FEES Furnace, Forced -Air J 1MFR=<100 7F 1 # $143 permil Fee: Insf.).1"ec F PME Unit Fee: $143.00 PME Permit Fee: $48.00 Administrative Fee: 1ADMIAT $45.00 Work Without Permit? 0 Yes (j) No $0.00 TOTALS: Travel Documentation Fee: I TRA VD OC 143.00 $ Strong Motion Fee: IBSEISMICR NOTE: 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 Dreliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff711113 Mech. Plan Check hrs $0.00 Fo-.—o I gail t.' is N 1""'Clo. Phoa — Mech. Permit Fee: IMPERMIT Other Mech. Insp. hrs 1 $48.00 7F PME Plan Check: $0.00 NOTE: 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 Dreliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff711113 FEE E QTY/FEE MISC ITEMS Plan Check PME Plan Check: $0.00 permil Fee: Insf.).1"ec F PME Unit Fee: $143.00 PME Permit Fee: $48.00 Administrative Fee: 1ADMIAT $45.00 Work Without Permit? 0 Yes (j) No $0.00 i4drw?(Tl Plannilig.1"ec'- Travel Documentation Fee: I TRA VD OC $48.00 Strong Motion Fee: IBSEISMICR $0.54 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS:. $285.54 $0.+ TOTALFEE: 00 $285.54 Revised: _b'1769/ 6 CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E Alterations to Space Conditioning Systems (formerly CF -IR -ALT HVAC) (Page 1 of 3 ) Project Name: 2015- 0503 Roger Mullane Date Prepared: 2016-01-14 A. General Information CFIR-ALT-02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented, use one MR -ALT -02 document for each dwelling unit. 01 Project Name 2015- 0503 Roger Mullane 02 Date Prepared 2016-01-14 03 Project Location 21613 Terrace Drive 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name 2015- 0503 Roger Mullane 07 Zip Code 95014 08 Dwelling Unit Conditioned 1560 Irsta4ing\ Installing Installing Floor Area (ft2) Location or Area by this SC ducted .z containing system Number of space conditioning entirely new 09 Climate Zone 4 10 (SC) systems in this dwelling 1 component? components? feet of ducts? duct system? unit. Alteration Type xv .. B. Space Conditioning (SC) System Information" 01 02 03 04 •i;.s. aw 05 M 06 m; 07 ;,- 0$ 09 10 Is the SC'"`"" Installing a SC System SC System CFA served .system refrigei�arlt �lnstalling neW Sry Irsta4ing\ Installing Installing Identification or Location or Area by this SC ducted .z containing system more than 40M" entirely new entirely new Name Served System (ft2) system? component? components? feet of ducts? duct system? SC system? Alteration Type Furnace whole house 1560 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) This section does not apply to this project. Registration Number: 216-A0021134A-000000000-0000 Registration Date/Time: 2016-01-14 11:41:10 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2016-01-14 11:41:34 Schema Version: 0.555SDD 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 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 0.8 AC component section is not section is not Setback section is not section isnot 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. t 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 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, 5-15). CF2RCF3R-MCH-23 & CF3R-MCH-23 Air Flow i?;300 CFMA6n required�when MCHs25 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 c6rig2s do not require`verificatiori"of Air Flow MCH 3, or Refr gerant Charge MECH 25 -Existing duct systems constructed, insulated or sealed with asbestos -are exemp?sfrom MCH-20pudkLI s age Testing requirements ,... -. E. Entirely New or Complete Replacement Duet'System, with or without EquipmentChangeout (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: 216-A0021134A-000000000-0000 Registration Date/Time: 2016-01-14 11:41:10 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2016-01-14 11:41:34 Schema Version: 0.555SDD CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E Alterations to Space Conditioning Systems (formerly CF -1R -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: (?�%Y Faulkner, Cindy (moi C1'LlG4CIi��i O Company: Signature Date: ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL 2016-01-14 11:41:10 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 acceptr,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 f requirements of Title 24, Part 1 and Part 6,of the California Code of Regulations y ,' " 4. The building design features or system design features identified on,his Certificate of Compliance are consistent with the mformatton provided on othel apphcable`compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement -agency for`approvaiy,, t' .this buildl,ng permit application. 5. 1 will ensure that a registered copy of this Certificatenof Coi'npliance shafl be inatle auaila)ile wath tH budding e i peimit(s),issuforthe,buildi& and;mad� ava�labfe.tt;the,enforcement agency for all applicable inspections. I understand that a registered copy of this Certificate of Compliance,is required to bg ncluded with the,documeptation the builder provides to,,,the building owner at occupancy. Designer Name: ponsDesigner Snature. bleResResponsible Faulkner, Cindy �t(� Company: Date Signed: ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL 2016-01-14 11:41:10 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-A0021134A-000000000-0000 Registration Date/Time: 2016-01-14 11:41:10 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2016-01-14 11:41:34 Schema Version: 0.555SDD