B-2016-1239CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1239
11103 WILKINSON AVE CUPERTINO, CA 95014-4734 (356 17 038)
(RANDO AAA HVAC
INC)
SAN JOSE, CA 95125
OWNER'S NAME: CHUANG JIIN-HAUR AND PEI-WEN WANG TRUSTEE
DATE ISSUED: 01/21/2016
OWNER'S PHONE:
PHONE NO:
LICENSED CONTRACTOR'S DEfCLLARATION
BUILDING PERMIT INFO:
License Class Lic. #- r &, V q2 % 2
X BLDG
Contractor O CINC)Date (C
_ELECT _PLUMB
I
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 and ducts.
I hereby affirm under penalty of perjury one of the following two declarations:
r. 1 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.
SI 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: $13400.00
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
ordinances and state laws relating to building construction, and hereby
356
356 17 038
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.
Cod 18.
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2( C�
Issued by:,-1�5 `r V�
Signat reDate
Date: /l
OWNER-BUILDER DECLARATION
RF-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. 1, 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:
i. 1, 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
z. 1 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 Cupertino Municipal Code, Chapter 9.12 and
Worker's Compensation laws of California. If, after making this certificate of
the Health &�S a Code, ections 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
Owner or out or!zed agent:'
be deemed revoked.
Date:
APPLICANT CERTIFICATION
rr__
( ��oCONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is
fi that there is a construction lending agency for the performance
I heref�2
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 PEWIT APPLICATION
COMMIUNITY DEVELOPMjENT DEPARTMENT • BUILDING DIVISION
10300TORRE AVENUE • CUPERTINO, CA 55014,-3255
(408) 777-3228 - FAX (4-08) 777-3333 • buildlnO(E OUDerino.org
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application and he iaforn�` • .wave _ vided is rr c I ave read the Description of V1ork and vent itis accurate. I agree to comp 1 1 l
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crdlmances and st_te'- ,'s relating to bll'�I•� ng c I. I anuot e represen fives of Cope ino to enter the above- de�tified _opo} y for Lspection purposes.
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CERTIFICATE OF COMPLIANCE
CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 1 of 3)
Project Name:
KARTHIK GOJPALAKARISHNAN I Date Prepared:
2016-01-14
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
KARTHIK GOJPALAKARISHNAN
02
Date Prepared
2016-01-14
03
Project Location
11103 WILKINSON AVENUE
04
Building Type
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
KARTHIK GOJPALAKARISHNAN
07
Zip Code
95014
08
Dwelling Unit Conditioned
2840
Installing
Installing
Installing
Floor Area (ft2)
Location or Area
by this SC
ducted
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
B. Space Conditioning (SC) System Information
01
02
03
04.;.
OS
06
07 -',
08
09
10
Is the SC
Installing a
SC System
SC System
CFA served
`,.system a. --
refrigerant '
-.Installing-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
Entirely new or
complete
replacement duct
TRANE
WHOLE HOUSE
2840
Yes
No
Yes
Yes
Yes
No
system with or
without equipment
changeout
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-A0021276A-000000000-0000 Registration Date/Time: 2016-01-14 12:40:35 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2016-01-14 12:40:55
Schema Version: 0.555SDD
--,f
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)
This section does not apply to this project.
E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)1Diia and 150.2(b)1E, F)
01
02
03
04
05
06
07
08
09
10
11
Heating
Cooling
System
Heating
Minimum
Cooling
Minimum
Required
Identification or
Heating
Altered Heating
Efficiency
Efficiency
Cooling
Altered Cooling
Efficiency
Efficiency
Thermostat
New Duct
Name
System Type
Component
Type
Value
System Type
Component
Type
Value
Type
R -Value
This field or
This field or
Central gas
Gas furnace
No cooling
section is
section is
SetbackTher
TRANE
furnace
AHU
AFUE
0.78
No cooling
component altered
not
not
mostat
R-6
applicable
applicable
Required Documentation:
CF211-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 Verification required.
-Leakage rate compliance: <_ 6%.
CF2R-MCH-22 & CF3R-MCH-22 Fan Efficacy Verification
CF2R-MCH-23 & CF3R-MCH-23 System Air Flow Rate Verification
-Compliance: Fan Efficacy <_ 0.58 W/cfm and System Airflow >_ 350 cfm/ton.
- Alternative Compliance: CF2R-MCH-28 & CF3R-MCH-28 Return Duct Design Verification is an alternative to MCH -22 and MCH -23 verification.
CF2R-25-H & CF3R-MCH-25-H Refrigerant Charge Verification required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15).
Exceptions:
Heating -only systems are exempt from the 0.58 W/cfm and 350 cfm/ton requirements.
Note:
An "entirely new or replacement duct system" means at least 75 percent of the duct system is new duct material, and up to 25 percent may consist of reused
parts from the dwelling unit's existing duct system (e.g.,
registers, grilles, boots, air handler, coil, plenums, duct material) if the reused parts are accessible and can be sealed to prevent leakage
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-A0021276A-000000000-0000
Registration Date/Time
2016-01-14 12:40:35
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2016-01-14 12:40:55
Schema Version: 0.5555DD
v
CERTIFICATE OF COMPLIANCE CF1R-ALT02-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
2016-01-14 12:40:35
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 Certif cate'of Compliance are'consistent with the information provided on otherapplicable compliance documents, worksheets,
calculations, plans and specifications submitted to the enforcement agency for approval 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 isrequired 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
2016-01-14 12:40:35
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 no way implies Registration Providerresponsibility for the accuracy of the information.
Registration Number: 216-A0021276A-000000000-0000 Registration Date/Time: 2016-01-14 12:40:35 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2016-01-14 12:40:55
Schema Version: 0.555SDD