B-2016-1237CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1237
10366 TONITA WAY CUPERTINO, CA 95014-2932 (359 15 047)
(RANDO AAA HVAC
INC)
SAN JOSE, CA 95125
OWNER'S NAME: NIULFORD ELIZABETH B TRUSTEE
DATE ISSUED: 01/21/2016
OWNER'S PHONE:
PHONE NO:
LICENSED CONTRACTOR'S DEECQL,ARATION
BUILDING PERMIT INFO:
License Class Lic..#� v v
Contractor ( RANDO AAA HVAC INC) Date 2 ( �
X BLDG _ ELECT _PLUMB
P
X MECH X RESIDENTIAL _COMMERCIAL
I hereby affirm that I am licensed under the prov sions f 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
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: $4590.00
this permit is issued.
1 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 15 047
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, Sec 8.
F
Issued by: 1
ignature Date 2(
Date: (�21
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
installed without first obtaining an inspection, I agree to remove all new materials for
following two reasons:
t. 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
Health & Safety Code, Section 25532(a) should I store or handle hazardous
this permit is issued.
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 Cupertino Municipal Code, Chapter 9.12 and
Worker's Compensation laws of California. If, after making this certificate of
the Health &o Sections and 25534.
exemption, I become subject to the Worker's Compensation provisions of the
7,25533,
Labor Code, I must forthwith comply with such provisions or this permit shall
Owner aut orized agent,
be deemed revoked.
Dam t
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
I hereb affir 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
ARCHITECT'S DECLARATION
consequence of the granting of this permit. Additionally, the applicant
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
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildin cupertino.orq
I-1 UI I IIvrRI Wl CHANICAL [:]ELECTRICAL
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❑ MISCELLANEOUS
PROJECT ADDRESS .I �% jn'��
APN #
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E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME 2Ab
LICENSE NUMBER % �Q��
LICENSE TYPE
BUS. LIC # �A
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AR.CHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF 7FtSFD or DUPLEX ❑ MULTI-rAMILY
PROJECT IN WILALAND ❑ YES
PROJECT IN
❑ YES
[ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? �NO
BUILDING: El COMMERCIAL
URBAN INTERFACE AREA NO
FLOOD ZONE
DESCRIPTION OF WORK
x� o
TOTAL VALUATION:
$ {
RECEIVED BYA22
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the
property owner's b lf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to build' b constru n. I authorize representatives of Cupertino to enter the above -id e tified property for inspection purposes.
01
Date:
/4S7
Signature of Applicant/Agent:
PLEMENT INFORMATION REQUIRED
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MEPMiscApp_2011.doc revised 06/21/11
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 1 of 3 )
Project Name: LIZ MULFORD I Date Prepared: 2015-11-18
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 MR -ALT --02 document for each dwelling unit.
01
Project Name
LIZ MULFORD
02
Date Prepared
2015-11-18
03
Project Location
10366 TONITA WAY
04
Building Type
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
LIZ MULFORD
07
Zip Code
95014
08
Dwelling Unit Conditioned
2172
lnstallmg new SC
Installing
;Installing
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 Information
01
02
03
04 '
=` 05 ,
06
07 '°,
08
09
10
-As the SC-
Installing a
SC System
SC System
CFA served
-;system as-
refrigerant
lnstallmg 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
TRANE
WHOLE HOUSE
2172
Yes
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: 215-A6398733A-000000000-0000
Registration Date/Time:
2015-11-18 13:55:36
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-11-18 13:55:43
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)
O1
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
No cooling
This field or
This field or
Less than or
TRANE
Central gas
Gas furnace
AFUE
0.78
No cooling
component
section is not
section is not
Setback
equal to 40
R-6
furnace
AHU
altered
applicable
applicable
feet
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: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 & CF3R-MCH-23 Air Flow z 300 CFM/ton required.when MCH -25 is required.
Exceptions:
-Dud systems registered with HERS provider as previously sealed are exempt from MCH -20 Duct Leakage Testing requirements.-
equirements _-Heating-only systems and Air Handler/Furnace changes do not require verification of Air Flow MCH, -,23; -or Refrigerant Charge MECH 25 ,
-Heating-only
-Existing dud systems constructed, insulated or sealed with asbestos;are exempt from M6H=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.
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-A6398733A-000000000-0000 Registration Date/Time: 2015-11-18 13:55:36 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-11-18 13:55:43
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CKR-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
Company:
Signature Date:
RANDO AAA HVAC INC
2015-11-18 13:55:36
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 applicable compliance documents, worksheets,
calculations, plans and specifications submitted to the enforcement` agency forapproval with this building permit application.
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 Signature: -
Rando, Eric
Company:
Date Signed:
RANDO AAA HVAC INC
2015-11-18 13:55:36
Address:
License:
1712 STONE AVENUE
768871
City/State/Zip:
Phone:
SAN JOSE CA 95125
408-293-4717
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-A6398733A-000000000-0000 Registration Date/Time: 2015-11-18 13:55:36 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-11-18 13:55:43
Schema Version: 0.5555DD