B-2016-1409 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1409
22424 MCCLELLAN RD CUPERTINO,CA 95014-2753(356 04 023) (ATKINSON
CLIMATROLLERS INC)
SAN JOSE,CA 95112
OWNER'S NAME: WIDMAN JEFFREY P TRUSTEE&ET AL DATE ISSUED:02/22/2016
OWNER'S PHONE:6509482831 PHONE NO:4082946290
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C20 Lic.#258540
Contractor(ATKINSON CLIMATROLLERS INC,)Date 2/22/2016 X BLDG _ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing. X MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
I hereby affirm under penalty of perjury one of the following two declarations: REPLACE FORCED AIR FURNACE,SAME LOCATION
1. 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
Iperformance of the work for which this permit is issued.
h 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
this permit is issued. Sq.Ft Floor Area: Valuation:$3247.00
APPLICANT CERTIFICATION
certi that I have read this application and state that the above
information is correct.I agree to comply with all city and county APN Number: Occupancy Type:
ordinances and state laws relating to building construction,and hereby 356 04 023
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-poirsoLfce reqUations per the Cupertino Municipal ISO DAYS FROM LAST CALLED INSPECTION.
Code,Section 9.18.
r Issued by:PAUL O'SULLIVAN /
Signature Date 2/22/2016 Date:2/22/2016
kL�
OWNTER-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:2/22/2016
contractors to construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
r. 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 Qualit Management District I
will maintain compliance with the Cupertin unicip Code,Chapter 9.12 and
Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code,Sectio 5505, 533,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:
Date:2/22/2016
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 2/22/2016
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255,
(408)777-3228•FAX(408)777-3333•buildingQcuportino.ora M I
3-:VPER;TIFi{3
❑PLUMBING g1hIECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
22 2�C K, ( // /) ,p\
PROJECTADDRESS � �, APN,. ,
OWNER NAME l� ^ r\°v p 7PHoNE�6,
c% 36
E-MAIL
STREET ADDRESS ` i� V. 1(< Q 1 CITY, STATE,ZIP W ` I/ � /�� FAX
CONTACT NAME L n PHONE q06
! Z L � v" E-MAIL
STREET ADDRESS L, G x I° \1 MY,STATE,ZIP
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ACONTRACTOR 13 CONTRACTOR AGENT ID ARCHITECT J❑1 ENGINEER ❑ DEVELOPER U❑l TENANT(
CONTRACTOR NAME (' LICENSE NUMBER '1 J ( LICENSE TYPE n�/� BUS.LIC n �J/Fg (� o
COMPANY NAME ( c� E-MAIL ` - (/(/ FAX
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r 'A
STREET ADDRESS I d CI Y,STATE,ZI � 3% 'CA
g(�//�7 PHONE /yye, `M
ARCF=CT/ENGINEER N LAME LICENSE NUMBER l� (�J G( L BUS.LIC' (/v b
COMPANYNAME E-MAIL FAX
STREET ADDRES�S,,� CITY,STATE,ZIP PHONE
USE OF 5FD Or Duplex ❑ Multi-Family PROJECT IN WILDLANDPROJECT IN
STRUCTURE:. 'C] Commercial URBAN II9IERFACE AREA [IYeS ClNO FLOOD ZONE ❑ Yes 11 NO
DESCRIPTION OF WORK
TOTAL VALUATION- ' t90 CELVED.E
By my signature below,I certify to each of the f I Wing: am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provide correc 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 buil tructi orize representatives of Cupertino to enter the above identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED
��� EIVL'R THE.�OQIF!VTTIR:-'-�-
IN
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MEPMiscApp 2011.doc revised 03/16/11
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CITY OF CUPERTINO
FEEESTIMATOR-BUILDING DIVISION
ADDRESS: 22424 MC CLELLAN RD DATE: 02/22/2016 REVIEWED BY: PAUL
APN: 356 04 023 BP#: "VALUATION: 1$3,247
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION FURN/AC
USE: PERMIT TYPE:
WORK REPLACE FORCED AIR 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 Fo.o hrs $0.00
Mech.Permit Fee: IMPERMIT
Other Mech.Insp. 0.0 hrs
NOTE:This estimate sloes not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These ees are based on the prelinddna information available and are only an estimate. Contact the De t or addn'Z info.
FEE ITEMS O ee Resolution 11-053 Ef. 7/11113,1 FEE QTY/FEE MISC ITEMS
issl r; ..r:t`f-'e
PME Plan Check: $0.00
Pernn'. F
PME Unit Fee: $143..00
PME Permit Fee: $48.00
Administrative Fee: IADMIN $45.00
Work Without Permit? 0 Yes (D No $0.00'
Travel Documentation Fee: ITRAVDOC $48.00
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrati It
Bldg Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS $285.50 $0.00 TOTALFE $285.50
Revised: 01/01/2016
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems(formerly CF-1R-ALT-HVAC) (Page 1 of 3)
Project Name: 2015-0581 Vivian Widman Date Prepared: 2016-02-19
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 CF111-ALT-02 document for each dwelling unit.
01 Project Name 2015-0581 Vivian Widman 02 Date Prepared 2016-02-19
03 Project Location 102042 Alpine Drive Unit 2 04 Building Type Single family
05 CA City Cupertino 06 Dwelling Unit Name 2015-0581 Vivian Widman
07 Zip Code 95014 08 Dwelling Unit Conditioned 1400
Floor Area(ft2)
Number of space conditioning
09 Climate Zone 4 10 (SC)systems in this dwelling 1
unit.
B.Space Conditioning(SC)System Information
, to
x.
01 02 43 %h06 09 10
��..
?- Is the SC Installing a
SC System SC System CFA served tystem a, � refrigeatnstalhrgtte 5i~ Irfsta�hrg nsfalhng' Installing
„°, Cl<, 1
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
Furnace Whole house 1400 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.
1
Registration Number:216-A0066711A-000000000-0000 Registration Date/Time: 2016-02-19 11:25:12 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-02-19 11:25:34
Schema Version:0.555SDD
fa:
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)
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 No cooling This field or This field or This field or This field or
replacement furnace heating AFUE 0.8 No cooling component section is not section is not Setback section is not section is not
components altered applicable applicable applicable applicable
Reauired Documentation:
CF2R-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 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&CF3R-MCH-23 Air Flaw'a 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 T, ng requ.rement.
-Heating-only systems and Air Handler/Furnace changes do not require verificat' 6f Air Flow MC, z3,or ei ngetant Charge M
Existing duct systems constructed,insulated or sealed with,asbesto are exem from MCH 2�Du�Leakage Te
-Existing
E. Entirely New or Complete Replacement Duct S` em,with or w!tho, Equipment hangeout Se tions 0 2(b)JDi1a 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-A0066711A-000000000-0000 Registration Date/Time: 2016-02-19 11:25:12 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-02-19 11:25:34
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
Company: Signature Date:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,000LING&ELECTRICAL 2016-02-19 11:25:12
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 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,'co o ents and manufactured dev ces for the bwidm 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 a ions. <
4. The building design features or system design features identified of: his Certifiateflf Ctrm(.iance areoniste ith the inform rovided on�therrap}icable compliance documents,worksheets,
calculations,plans and specifications submitted to the forcemen 'gency fo vat, is bwlcting per t application. , j'
W. W:
5. I will ensure that a registered copy of this Gertifica�- pliance s tl.ben ailable wttte building p,,,mit('s)',issul forth tftt�l g,and; a available) inforcement agency for all applicable
inspections.I understand that a registered copy of this e,ificate of Compliance is;regyiled to be,included with th dpcumentation the b ilder protides togthe b il.ing owner at occupancy.
Responsible Designer Name: .> Responsible De igri'er Signature: t - nN
Faulkner,Cindy
Company: Date Signed:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING&ELECTRICAL 2016-02-19 11:25:12
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 noway implies Registration Provider responsibility for the accuracy of the information.
Registration Number:216-AO066711A-000000000-0000 Registration Date/Time: 2016-02-19 11:25:12 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-02-19 11:25:34
Schema Version:0.555SDD