B-2016-1408 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1408 {
19261 PHIL LN CUPERTINO,CA 95014-3528(375 40 050) (ATKINSON
CLIMATROLLERS INC)
SAN JOSE,CA 95112
OWNER'S NAME: WHITED JEFFREY C AND THUY NGUYEN DATE ISSUED:02/22/2016 i
OWNER'S PHONE:408-865-1202 PHONE NO:408-294-6290
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-20 Lie.#258540 X BLDG _ELECT _PLUMB
Contractor(ATKINSON CLIMATROLLERS INC)Date
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 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.
z 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:$3885.00
APPLICANT CERTIFICATION
certify 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 375 40 050
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 n n poi source regulations per the Cupertino Municipal 180 DAYS FROM LAST CALLED INSPECTION.
Code,Section
2 2� t Issued by:ABBY AYENDE
:Signature Date Date: ZI2 hc
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(See.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
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. material. Additionally,should I use equipment o
a. t certify that in the performance of the work for which this permit is issued,I r devices which emit hazardous
shall not employ any person in any manner so as to become subject to the air contaminants as defined by t#IBIare QualityManagement District I
will maintain compliance with tMunicipal Code,Chapter 9.12 and
Worker's Compensation laws of California, If,after making this certificate of the Health&Safei s 25505,25533,and 25534.
exemption,I become subject to the Worker's Compensation provisions of the i
Labor Code,I must forthwith comply with such provisions or this permit shall,.Owner or authorized ag@n. 2 `
be deemed revoked. Date:
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
GENERAL PERMIT APPLICATION ME E P
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
UP>E r TING (408)777-3228• FAX(408)777-3333•building(&cupertino.org misc
PLUMBING S4WCHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
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PROJECT ADDRESS I l��( G� APN 4
l ` <
4o C610
OWNERNAME 0Vv 4 li PHONE to Q!_(r• G W�j EMAIL
STREET ADDRESS c CITY,STATE,ZIP V�I / /}� (�r� /// FAX
CONTACT NAME PHONE E MAI 0Jr@ 1/ leak
STREET ADDRESS f �n / A)- CITY,STATE,ZIP43 ,W �A`^//�J FAX
OWNER. El OWNER-BUILDER `❑3 OWNERAGENT ❑ CONTRACTOR El CONTRACTOR AGENT ❑ ARCHITECT (/❑/ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME\f�v`_ LICENSE NUMBER MAO
LICENSE TYPE /1!/f) BUS.LIC#
COMPANY NAME U � L ` ,q� Jam. &MAB /► �� I C FAX ZG, VZ'L
Cj 6✓K l;J I/�.pn.., F�
STREET ADDRESS / /�c ` CITY,STATE,ZIP ! p PHONE Z
ARCHITECTIENGINEER NAME( L LICENSE NUNMER X17 Y ( BUS.LIC k ` Ur U
COMPANYNAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN
sTRucTURs: ❑ Commercial URBAN INTERFACE AREA ❑ Yes EI .No FLOOD ZONE C1Yes ElNo
DESCRIPTION OF WORK
T'
TOTAL VALUATION: SM S- ig D
CESYEI7=B Ga
By my signature below,I certify to eac of followi g: I 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 ov' ed is co ect: I have read the Description of Work and verify it is accurate. I agre to comply with all applicable local
ordinances and state laws relating to b Idi g cons tru ti �L I authorize representatives of Cupertino to enter the abo a-idenri cj�pro erty for inspection purposes.
Signature ofApplicant/Age Date:�� L
SUPPLEMENTAL INFORMATION REQUIRED `r
� 43LTCE iISQ1Y7a .-_
BONN
5.1
MEPMiscApp 2011.doc revised 03116111
_ CITY OF CUPERTINO Nub �Iqcg
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 19261 PHIL LANE DATE: 02/22/2016 REVIEWED BY: ABBY
APN: 375 40 050 BP#: B-2016-1408 *VALUATION: 1$3,885
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition / Repair
PRIMARY PENTAMATION
SFD or Duplex FURNlAC
USE: PERMIT TYPE:
WORK
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced-Air 1MFR=<100 1 # $143
TOTALS: _ $143.00 .; ,
]Meeh.Plan Check 0:0 hrs $0.00 �Phvnb,,Plan t.iec•
Mech.Permit Fee: IMPERMIT ;' #r<'3.P �;,4.Pee:
LrMech.lnsp. 0.0 hrs $48:00 ,, s ;'Ff€ Ir v� Li,..
NOTE.This estimate does not includefees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta _These ees are based on the relimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053.f. 7/11'13 FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.00
e "wil t° j:
?xfi Isp1,.>. ILI
PME Unit Fee: $143.00
PME Permit Fee: $48.00
Administrative Fee: ]ADMIN $45.00
Work Without Permit? 0 Yes ) No $0.00
Travel Documentation Fee: iTRAVDOC $48.00
Strom Motion Fee: 1BSEISMICR $0.51 Select an Administrative Item
Bldg=Stds Commission Feer IBCBSC $1.00'
81
rBTOTAi $285.51 $0.00 TOTAL FEE: $285.51
Revised: 01/01/2016
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems(formerly CF-IR-ALT HVAC) (Page 1 of 3)
Project Name: 2015-0557 Jeff Whited Date Prepared: 2016-02-12
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 CHR-ALT-02 document for each dwelling unit.
01 Project Name 2015-0557 Jeff Whited 02 Date Prepared 2016-02-12
03 Project Location 19261 Phil Lane 04 Building Type Single family
05 CA City Cupertino 06 Dwelling Unit Name 2015-0557 Jeff Whited
07 Zip Code 95014 08 Dwelling Unit Conditioned 1000
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
,
01 02 03 04' x$05 06 07 09 10
f
041, Is the SC 'Installing a
SC System SC System CFA served System a" r frige t �Installin, iew SG I'staihng 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
Furnace whole house 1000 Yes No Yes No No No Altered space
replacement conditioning system
C. Extension of Existing Duct System,Greater Than 40 Feet(Section 150.2(b)1Diib)
This section does not apply to this project.
Registration Number:216-A0057317A-000000000-0000 Registration Date/Time: 2016-02-12 12:00:28 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-02-12 12:00:51
Schema Version:0.555SDD
$b
CERTIFICATE OF COMPLIANCE CF111-ALT-024
r
Alterations to Space Conditioning Systems(formerly CF-IR-ALT HVAC) (Page 2 of 3)
t
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
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<_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:
-Heating-only ytssetlstered with HERS provider as ems and Air Handler/Furnacechanlgesldo not 2qui require exempt
i ati i of A ZF01owcMCh 23tr
e r Refr ge 2nt Cha e MhLH 25� a
Y y,
Existing duct systems constructed,insulated or sealed with asbestosare 'from MCN 20DuCt.LCgeTest requi mer ts.
E. Entirely New or Complete Replacement Duch tem,with or without quipment Gh ngeout(.Sections 150 2(b-), Dna 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-A0057317A-000000000-0000 Registration Date/Time: 2016-02 12 12:00:28 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-02-12 12:00:51
Schema Version:0.555SDD
r�
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. J , -•QQ
Documentation Author Name: Documentation Author Signature:
Faulkner,Cindy
Company: Signature Date:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING&ELECTRICAL 2016-02-12 12:00:28
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. I 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
Al
requirements of Title 24,Part land Part 6 of the California Code of RiUlations q
4. The building design features or system design features id ntified on this Certifica of Compliance are c�ysteni,suith the informa rovided or therapplicable compliance documents,worksheets,
calculations,plans and specifications submitted to the eiOrcement;agency far a v 'with,this building permit applicatio y \y;
5. I will ensure that a registered copy of this Certificated„Ctaifipliance sf+ailbeimade a;ail le wi J 1lte 401 Id'rtzg permit(jp issu „forthe ildtng,and jlad avarfdbletatbe enforcement agency for all applicable
inspections.I understand that a registered copy of thi - ' icate of Compl�ianced regL1 red to be ncluded with the documentation the,bdilfler provides t4 tb building owner at occupancy.
E
Responsible Designer Name: ' Respon `bie Designer Signature: V` �
Faulkner,Cindy
Company: Date Signed:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING&ELECTRICAL 2016-02-12 12:00:28
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-A0057317A-000000000-0000 Registration Date/Time: 2016-02-12 12:00:28 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated`.2016-02-12 12:00:51
Schema Version:0.555SDD