B-2016-1793 •
CITY OF CUPERTINO BUILDING PERMIT I
i
F=DING ADDRESS:�:� ::]oTOR: PERMIT NO:B-2016-1793 PORTAL AVE CUPERTINO,CA 95014-2313(316 30 030) LLERS INCCA 95112
OWNER'S NAME: SRIPATHY PRAKASH AND PRAKASH VIJAYALAKSHMI DATE ISSUED:04/19/2016
OWNER'S PHONE: PHONE NO:(408)294-6290 h
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRACTOR Lic.#22-544 X BLDG _ELECT —PLUMB
Contractor ATKINSON CLIMATROLLERS INC Date 12/31/2016, X MECI3 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 JOB DESCRIPTION:
license is in full force and effect.
REPLACE(E)FURNACE SAME LOCATION AND ADD(N)A/C AT
I hereby affirm under penalty of perjury one of the following two declarations: THE SIDE OF HOUSE
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.
C�2. 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:$10810.00
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 316 30 030
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 expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulawonp p1q the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Date Issued by:Abby Ayende OVAA kC LN&
G
eignatureA�p Date:04/19/2016
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
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 i pp
contractors to construct the project(Sec.7044,Business&Professions Code).
Date:
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 by California Health&Safety Code,Sections 25505,25533,and 25534. I will
Section 3700 of the Labor Code,for the performance of the work for which this maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
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.Are Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the C er.' o Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Co e, ec' ns Municipal
and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall �
be deemed revoked. l Owner or auth sized agent
APPLICANT CERTIFICATION Date:
tK([� E7 CONSTRUCTION LENDA
ING GENCY
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 understands ARCHITECT'S DECLARATION
and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records.
Code,Section 9.18.
Licensed
Signature Date Professional
GENERAL PERMIT APPLICATION MEP
its COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333•building(a)cupertino.org
cl�I�RTIIr�O � � ® l
MISC
[-]PLUMBING CHANICAL ELECTRICAL []MISCELLANEOUS
PROJECT ADDRESS L 0k5-i � APN#
OWNER NAME ✓ (. '19(l. �'�`e(i/^7v� v PHONE �j19�j �/,i7���f0 E-MAIL
STREET ADDRESS CITY, STATE,Z /�C hl(/ FAX
lvv �y� LOT
c JV ( �(
CONTACT NAME PHONE I.O V E MAIL&ve
/// W t
STREET ADDRESS e / �j( CITY,STATE, \Ke 571/f, �f �<J ?
[I OWNER ❑ OWNER-BUILDER ElOWNERAGENT CONTRACTOR ❑CONTRACTOR AGENT El ARCHITECT El ENGINEER ❑'(DDEVELOPERt�°'C❑TENANT
CONTRACTOR NAMELIC(, LICENSE NUMBER LICENSE BUS. fry . ® ;A'
COMPANY NAME C d r Vv e 'b(" EMAIL F ti L L(V`'
STREET ADDRESS / I {t 1, CITY,STATE,ZIP + GJl d 2 PHO1�E/ G yt7� V
_ L(, 1
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF XSFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES. IS THE BLDG AN ❑❑OS
BUILDING: "Ci-COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME?
DESCRIPTION OF WORK --S-Awe
ORK -- -''W
WWW.
TOTAL VALUATION: t��l9 RlitiYEIHY t at
d. t
By my signature belo'W certify to a h of e following: 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 h pro ided 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 rel in o uil n construction. I authorize representatives of Cupertino to enter the abCo �id,ntified property for inspection purposes.
Signature of Applicant/Age Date: f l
SUPPLEMENTAL INFORMATION REQUIREDtIS
' tom
� �E
ar
3 F-k P
v az
r
MEPMiscApp 201I.doc revised 06121111
- OFFICE
i
4- 1 1
-i - ZiL�
p6 'A
1
9 o I I I
p p p j� ;. d.Ty ✓ 5
e
. '
/
- 3
H
3 � 1
l F
8 � 3
9 d
3 F
°- -IUN!TY DEVELOPMENT DEPARTMENT"
BUILDING DIVISION - CUPERTINO
APPROVED
s of plans and specifications MUST be kept atter
� �T PLANS K o s<< ;luring construction.Itis unlawful to make any
c hanges or alterations on same, or to deVlate
'.xprefrom, without approval from the Buildinj Official.
DATE— ne Stamping of this plan and specifications SHALL NOT
PLANNI DE T ::e held to permit or to be an approval of the violation
CUPERTINO �' �t any rovisions of any City Ordinance or StateLaw:
BY f ',�--- -------
DA i E
PERMIT##, x
fi Y 4a
- r..
I C 1WR-ALT-02-E
611
CERTIFICATE OF COMPLIANCE
(Pale 1 of 3)
Alterations to Space Conditioning Systems(formerly CF-1R-ALT-HVAC)
2015-0670 Prakash Sripathy Date Prepared: 2016-04-08
Project Name: -
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,
Prepared-
use one CF1R-ALT-02 document for each dwelling unit.
01 Project Name
2015-0670 Prakash Sripathy 02 Date Prepared 2016-04-08
03 Project Location 10451 N Portal Ave.
04 Building Type Single family
05 CA City Cupertino 06 Dwelling Unit Name 2015-0670 Prakash Sripathy
08 Dwelling Unit Conditioned 1800
07 Zip Code 95014 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
X06 -
08 09
03 04 10
07'
01 02 a
Is the SC Install ng as
'installing
SC System SC System CFA served stem a rfrigerat nstalhng new SC Irista)lirgInllmg, g
Identification or Location or Area by this SC ducted containing system more than 40 entirely new entirely new
Name Served System(ft2) system7 component? components? feet of ducts? duct system? SC system? Alteration Type
Furnace Altered space
Yes Yes
Yes No. No No conditioning system
replacement add whole house 1800
A/C
C.Extension of Existing Duct System,Greater Than 40 Feet(Section 150.2(b)1Diib)
This section does not apply to this project.
Re istration Date/Time: 2016-04-08 15:13:15 HERS Provider:CalCERTS
Registration Number:216-A0132533A-000000000-0000 g
CA'Building'Energy Efficiency Standards
Report Version:2013 Rev 1.007 Report Generated:2016-04-08 15:13:31
2013 Residential Compliance Schema Version:0.555SDD
# o.
f� w
CF1R-ALT-02=E
CERTIFICATE OF COMPLIANCE
(,Page 2 of 3
Alterations to Space Conditioning Systems(formerly CF-IR-ALT HVAC)
D.Altered Space Conditioning System(Sections 150.2(b)1E and F)
04 05 06 07 08 09 10 1
01 02 03 1 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
Value System Type Components Type Value Type Duct Length R-Value
or Name Type Components Type
All new All new This field or This field or
Furnace Central gas Central split cooling SEER 14 Setback section is not section is not
replacement heating AFUE 0.8 AC furnace components applicable applicable
add A/C components
Required Documentation:
CF2R-MCH-01-E-Space Conditioning Systems Ducts and Fans
-Duct insulation requirement for new plenums:R6.
required when heating or cooling components are installed in ducted systems,or when more than 40 ft of duct length is replaced.
CF2R-MCH-20-H&CF3R-MCH-20-H-Duct Leakage testing
-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 Airflow Zt300 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 verificatid of Air FI MCH 23,rif R'efng nt Chae MhI
-Existing duct systems constructed,insulated or seated with asbestos�are exem fZ from MCH�O Duct,Leakage Testi g r,quer mens• u
tem,wi h or without EquipSections,t
E. Entirely New or Complete Replacement Duct l moment Chjangeut Q 2O Dua and 1501(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.
g
Re istration Date/Time: 2016-04-08 15:13:15 HERS Provider:CaICERTS
Registration Number:216-A0132533A-000000000-0000
Report Version:2013 Rev 1.007 Report Generated:2016-04-08 15:13:31
CA Building Energy Efficiency Standards-2013 Residential Compliance p
Schema Version:0.555SDD
£FIR-ALT 02-E
CERTIFICATE OF COMPLIANCE
(Page 3 of 3)
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: Documentation Author Signature:
Faulkner,Cindy -
Signature Date:
Company:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING&ELECTRICAL 2016-04-08 15:13:15
CEA/HERS Certification Identification(if applicable):
Address:
1171 NORTH 4TH STREET
Phone:
City/State/Zip: 408-294-6290
SAN JOSE CA 95112
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 14the Business and Professions Code to.acceptresponsibility 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 deves fore building esign 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 f i9ulations p., ciSfn
4. The building design features or system design features identified or,this Certifi,66&of Compliance are�st§isteCt#wit the i orma n rovided on others ca pliance documents,worksheets,
if g Y i
calculations,plans and specifications submitted,to the orcemen„a enc fo a rovat-wt Ci this bull ing permit a ip)icati ` ad � itehforcement agent for all applicable
5. i will ensure that a registered copy of this Certificat�af'ss pliance sfi ;tre in�atte vailable wi j1;t buJldihlg p rmit(sl!issued for,th%b ildtl�g,and ma a avajlabl Y pp
inspections.I understand that a registered copy of thi 'G'"�icate of Compliances req fired to b�e;nciuded vy,Qth the dpcumentation the builder provides to the bua ding owner at occupancy.
1. :' Responsible Desigrfer An .
Responsible Designer Name:
Faulkner,Cindy
Date Signed:
Company:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING&ELECTRICAL 2016-04-08 15:13:15
_ License:
Address: 258540
1171 NORTH 4TH STREET
Phone:
City/State/Zip: 408-294-6290
SAN JOSE CA 95112
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.
g
Re istration Date/Time: 2016-04-0815:13:15 HERS Provider:CaICERTS
Registration Number:216-A0132533A-000000000-0000
Report Version:2013 Rev 1.007 Report Generated:2016-04-08 15:13:31
CA Building Energy Efficiency Standards 2013 Residential Compliance Schema Version:0.555SDD