B-2016-1158CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1158
6370 COTTONWOOD CT CUPERTINO, CA 95014-4620 (369 18 013)
( SUPREMEAIR
SYSTEMS INC)
CAMPBELL, CA 95008
OWNER'S NAME: NUNES BARBARA TRUSTEE
DATE ISSUED: 01/12/2016
OWNER'S PHONE:
PHONE NO:
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class LicdOcic) 740 667
Contractor ( SUPREME AIR SYSTEMS INC -1 Date,/ 1 Az [ � �
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 (E) FURNACE, SAME LOCATION
I hereby affirm under penalty of perjury one of the following two declarations:
i. 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
A VJ by Section 3700 of the Labor Code, for the performance of the work for which
Sq. Ft Floor Area:
Valuation: $3500.00
this permit is issued. -
APPLICANT CERTIFICATION
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
Number:
Occupancy Type:
ordinances and state laws relating to building construction, and hereby
369 18 013
3 69
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 F ED INSPECTION.
Code, Section 9.18.
�
ssu
Signature?, Date
i
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
i. 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:
i. 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
shall not employ any person in any manner so as to become subject to the
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
Worker's Compensation laws of California. If, after making this certificate of
the Health & Safety Code, Sections 25505, 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
be deemed revoked.
Owner or authorized agent,r�
Dat 2// &
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
CUPERTINO
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - buildin9acupertino.orcl
�ING ® MECHAAIjCAI, MX F.T.R TRTrn T I71k,rr01Nar r • — TTM
MEP
MISC
I PROJECT ADDRESS n �) J okftrli p ocl ct I APN # J
.k
OWNER NAME
11J E-MAIL
STREET ADDRESS CITY, STATE, ZIP
rl��(�c.)d o C,�1 Va-hrim FAX
CONTACT NAME y-ff 1 V p
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STREET ADDRESS CITY. STATE, ZIP
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❑ OWNER ❑ OWNER -B ILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME - LI CEN R LICENSE TYPE BUS. LIC #
COMPANY NAME b � E_ L
STREET ADDRESS
q0A� CITY, STATE, ZIP 1,,,, Q�
G l� I CA O 1 �j �i VOC7 PHONE
ARCHITECTIENGINEER NAM
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUP
X ❑ MULTI -FAMILY
PROJECT IN WILDLAND ❑ YES
PROJECT IN ❑ YES
BUILDING: ❑ COMMERC
URBAN INTERFACE AREA NO
FLOOD
IS THE BLDG AN ❑ YES
❑
ZONE ❑ NO
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
r ,
Y d/6vnnr-P'. t7Ann n/AP A l F�
TOTAL VALUATION: i U U REC D BY
By my signature below, I cerify to each of the following: I am the property owner or authorized agent to act on the propertyawn r ave read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. ee to comply with all applicable local
ordinances and state laws relating lding construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
I �
Signature of Applicant/Agen : WAII J Date:
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
F
OVER-THE-COUNTER
EXPRESS
v
x ❑ STANDARD
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❑ MAJOR
MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 6370 COTTONWOOD CT
DATE: 01112/2016
REVIEWED BY: MELISSA
APN: 36918 013
BP#:
*VALUATION: 1$3,500
*PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY FD or Duplex
S
USE:
PENTAMATION FURN/AC
PERMIT TYPE: A
WORK
REPLACE (E) FURNACE, SAME LOCATION
SCOPE
Mech. Plan Check 0.0 1 hrs $0.00 Ph,,,wb,.Mia1,, ('-fleck 1,1*1ec. Plan
Mech. Permit Fee: IAIPERMT perr" p7ec, Per"Wi,
Other Mech. Insp. 0.0 hrs L$48.00
Ir
sP. Insp, Ft.?e"
TOTE: This estimate does not include fees due to other Departments (L 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 for addit'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13FEE
QTY/FEE
MISC ITEMS
Plan ("heck- Fee:
S-upp/I.PC ]-."ee
PME Plan Check:
$0.00
-F-T
PME Unit Fee:
$143.00
PME Pen -nit Fee:
$48.00
(..'Onstyuclion Tu,,,-,,
Administrative Fee: 1,4DAffN
$45.00
Work Without Permit? 0 Yes 0 No
$0.00
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: IBSEISAlffCR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: 1B CBSC
$1.001
$285.50
$0.00 TOTAL FEE:
$285 .50
Revised: 01/01/2016
CERTIFICATE OF COMPLIANCE
CFIR-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 1 of 3 )
Project Name: 6370 COTTONWOOD COURT Date Prepared: 2016-01-12
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 CF113-ALT-02 document for each dwelling unit.
01 Project Name 6370 COTTONWOOD COURT 02 Date Prepared 2016-01-12
03 Project Location 6370 COTTONWOOD COURT 04 Building Type Single family
05 CA City Cupertino 06 Dwelling Unit Name 6370 COTTONWOOD COURT
07 Zip Code 95014 08 Dwelling Unit Conditioned 1500
Floor Area (ft2)
Number of space conditioning
09 Climate tone 4 10 (SC) systems in this dwelling 1
unit.
B. Space Conditioning (SC) System Information
01
02
.03
04
10
Installing a
refrigerant
containing
component?
Installing new SC
system
components?
Is the SC
SC System
SC System
CFA served
system a
Identification or
Location or Area
by this SC
ducted
Name
Served
System (ft2)
system?
System 1
Location 1
1500
Yes
05
06
07
08
09
10
Installing a
refrigerant
containing
component?
Installing new SC
system
components?
Installing
more than 40
feet of ducts?
Installing
entirely new
duct system?
Installing
entirely new
SC system?
Alteration Type
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: 216-A0018832A-000000000-0000 Registration Date/Time: 2016-01-12 10:59:56
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2016-01-12 11:00:21
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE
CFIR-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)IE and F)
01 02 03 04 05 06 07 0809 10 11ff12Heating
Cooling
System Heating Altered Heating Minimum Altered Cooling Minimum Required New orIdentification System Heating
Efficiency Efficiency Cooling Cooling Efficiency Efficiency Thermostat Replaced
or Name Type Components Type Value System
ewDuct
Type Components Type Value Type Duct Length
R -Value
Central gas All new No cooling This field or This field or
System 1 heating AFUE 0 g Central split This field or
This field or
furnace AC component section is not section is not Setback section is not
components
section is not
altered applicable applicable applicable
applicable
Required Documentation:
CF2R-MCH-01-E - Space Conditioning Systems Ducts and Fans
-Duct insulation requirement for new plenums: R6.
CF211-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::5 15%, or 5 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
& MR -MCH -23 Air Flow z 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 MCH -23, or Refrigerant Charge MECH-25.
-Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH -20 Duct Leakage Testing requirements.
E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)1Diia and 150.2(b)1E, F)
This section does not apply to this project.
IF. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)1C)
Registration Number: 216-A0018832A-000000000-0000
This section does not apply to this project.
Registration Date/Time
2016-01-12 10:59:56
HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006
Report Generated: 2016-01-12 11:00:21
Schema Version: 0,555SDD
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -IR -ALT HVAC)
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
Persad, Shanta
Company:
The Energuy CA LLC
Address:
1215 K St., 17th Floor
City/State/Zip:
Sacramento CA 95814
Responsible Person's Declaration statement
Documentation Author Signature:
Signature Date:
2016-01-12 10:59:56
CEA/ HERS Certification Identification (if applicable):
Phone:
187-760-0012 3
CF1R-ALT 02-E
(Page 3 of 3 )
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 applicable compliance documents, worksheets,
calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application.
5. I 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:
Persad, Shanta
Company:
The Energuy CA LLC
Address:
1215 K St., 17th Floor
City/State/Zip:
Sacramento CA 95814
Responsible Designer Signature:
Date Signed:
2016-01-12 10:59:56
License:
Phone:
187-760-0012 3
Digitally signed by Ca/CERTs. 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-A0018832A-000000000-0000 Registration Date/Time: 2016-01-12 10:59:56
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006
Report Generated: 2016-01-12 11:00:21
Schema Version: 0.555SDD