B-2016-1835 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1835
20235 NORTHGLEN SQ CUPERTINO,CA 95014-0517(316 39 007) ATKINSON
CLIMATROLLERS INC
SAN JOSE,CA 95112
OWNER'S NAME: CHEN DEBORAH AND WONG DANIEL DATE ISSUED:04/26/2016
OWNER'S PHONE:408-368-6025 PHONE NO:(408)294-6290
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class CC=20 Lic.#258540
Contractor ATKINSON CLIMATROLLERS INC Date 12/31/2016 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:
REPLACE FURNACE-SAME LOCATION,ADD NA/C.
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
pIerformance of the work for which this permit is issued.
2 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:$9248.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
information is correct.I agree to comply with all city and county ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 316 39 007
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 WORD 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 pl• ant nderstands and will comply with all non-point
source regulatio r th Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
o ture Date 4/26/2016 Issued by:Abb A e'er
Date:04/26/2016
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:4/26/2016
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
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
s. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cu r'no Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code, c'ons 5505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. 0 ner or authorized agent:
APPLICANT CERTIFICATION Date:4/26/2016
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9 18 I understand my plans shall be used as public records.
Signature Date 4/26/2016 Licensed
Professional
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
MISC
C�PEff��t,16+iC7 (408)777-3228 • FAX(408)777-3333 • buildingCcDcupertinggM
❑PLUMBING ❑MECHANICAL ❑ELECTRICAL [:]MISCELLANEOUS
PROJECT ADDRESSA®�rJ� J09
,J peA) S APN# •2I� -'7/;�0!'i'"'1._
OWNER NAME PHONE G/�/ �/ E-MAIL
STREET ADDRESS nr / CITY, STATE,ZIP 6A
?21�e FAX
CONTACT NAME /Ia PHONE p/� ry��wo E-MAIL &A
STREET ADDRESS vv Q�a CITY,STATE, Z[ •�V c J A� C (er FAX
❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT J[❑(/ARCHITECT ❑ENGINEER ❑`Z DEVELOPER ❑ TENANT
CONTRACTOR NAME Q e LICENSE NUMBER ? -500 7CENSETYPEegg BUS.LIC#
COMPANY NAME �d3r t E-MAIL FAX
STREET ADDRESS n^__ /d / CITY,STATE,ZIP PHONE
ARCHITECT/ENGINEER NAME 9 ('�y/f LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑ YES IS THE BLDG AN ❑ YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑ NO
DESCRIPTION OF WORK e
TOTAL VALUATION: 2�A} (�(� RECEIVED By:
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 half. I have read this
application and the information I have prov' ed 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 bu' g e truction. I authorize representatives of Cupertino to enter the above-i P
entif d property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED torcE usE oNLy
❑ OVER-THE-COUNTER
❑ EXPRESS
_', ❑ STANDARD
❑ 240
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DEPARTMENT
BUILDING DIVISION:- C'UP�RTINQ ' ! ; ' . i
APPR� D i
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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: 2015-0691 Kevin Tam Date Prepared: 2016-04-22
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 MR-ALT-02 document for each dwelling unit.
01 Project Name 2015-0691 Kevin Tam 02 Date Prepared 2016-04-22
03 Project Location 10141 Stern Ave 04 Building Type Single family
05 CA City Cupertino 06 Dwelling Unit Name 2015-0691 Kevin Tam
07 Zip Code 95014 08 Dwelling Unit Conditioned 2800
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:' 05' 06 07"," E 08 09 10
Is the SC' Installing a
SC System SC System CFA served` system a, refrigerant Installing new S,C 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
Add A/C whole house 2800 Yes Yes Yes No No No Altered space
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-AO14963OA-000000000-0000 Registration Date/Time: 2016-04-22 10:03:12 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-04-22 10:03:48
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)
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
Central gas
No heating This field or This field or Central split All new This field or This field or
Add A/C furnace component section is not section is not AC cooling SEER 14 Setback section is not section is not
altered applicable applicable components applicable applicable
Required Documentation:
CF2R-MCH-01-E-Space Conditioning Systems Ducts and Fans
-Duct insulation requirement for new plenums:R6.
CF213-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:<-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&CFBR-MCH-23 Air Flow>_300'CFM/ton required when MCH-25 is required.. .
Exceptions:
-Duct systems registered with HERS provider as previously sealed are exempt from MCHr20 Duct Leakage Testing regwrements
F
-Heating-only systems and Air Handler/Furnace changes do not require verification of Air Flow MCH 23,qr Refrigerant Charge MCH 2S5
-Existing duct systems constructed,insulated or sealed with asbestos are exemp,,from MCH=20 Du&.Leakage Testing requirements
N
E.Entirely New or Complete Replacement Duct System,with or without Equipment Changeout(Sections 150.2(b)1Dua 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-A0149630A-000000000-0000 Registration Date/Time: 2016-04-22 10:03:12 HERS Provider:CalCERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-04-22 10:03:48
Schema Version:0.555SDD
r r
CERTIFICATE OF COMPLIANCE CF111-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. _ Q�
Documentation Author Name: Documentation Author Signature: /��%�,�, �CGGGCf�
Faulkner,Cindy l 6
Company: Signature Date:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING&ELECTRICAL 2016-04-22 10:03:12
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,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. """ ""
Tg
4. The building design features or system design features identified on this Certificate of Compliance are consistent with^the information;provided on oth& Oplicable'compliance documents,worksheets,
calculations,plans and specifications submitted to the eriforcement,agency Torapprov8cwith this building permit application.
5. 1 will ensure that a registered copy of this Certificate of Compliance shall,be,rnaac[6available with.Ahe b.bilding permit(s).issued for the�building,and made avatlabie.to_the_enforcement agency for all applicable
inspections.I understand that a registered copy of thisFCertificate of Compliance_isjequired to be.included with the documentation the builder provides tothe building owner at occupancy.
Responsible Designer Name: c Responsible Designer Signature.
Faulkner,CindyGiC�l��2P�i
Company: Date Signed:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING&ELECTRICAL 2016-04-22 10:03:12
Address: License:
1171 NORTH 4TH STREET 258540
City/State/Zip: Phone:
SAN JOSE CA 95112 408-294-6290
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:216-A0149630A-000000000-0000 Registration Date/Time: 2016-04-22 10:03:12 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-04-22 10:03:48
Schema Version:0.555SDD
Sc MQKE I CARBON M 0 N OXI DE ALARM
S
OWNER CERTIFICATE OF COMPLIANCE Cn
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255
(408)777-3228- FAX(408)777-3333- building(a)cupertino.ong
CNA&
-Lm-WOW4,ft-M- It k C: 11 �notde
ln"k-MIT CA�N'NOT BE FINALED AND CaM.WLETED UNTIL TMS CE RTIFICATEi
I WS IR UN S 19 W, ` A ND,N U-
AM=TOM 13TJ jN9D1V1$T0-Nf
PURPOSE
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
inspections are required.
GENERAL INFORMAT109
Existing single-family and multi-family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds
$1000.00,CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that.Smoke Alarms and/or Carbon
Monoxide Alarms be installed in the following locations:
AREA SMOKE ALARM CO-ALA.
Outside of each separate sleeping area in the immediate vicinity of the X X,
bedroom(s)
On every level of a dwelling unit including basements (
Within each sleeping room X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel-buming appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply:In dwelling units with no commercial power supply, alarm(s)may be solely battery operated.
In existing dwelling,units, alarms are permitted to be solely battery operated where repairs or alterations do
not result i.ii,the removal of wall and ceiling finishes or there is no access by means,of attic,basement or crawl.
space.Refer to,CRC Section R314 and CBC Sections 907.2.11.4 and 4201.6.2.An electrical permit is required for
alarms which must be coni-Lected to the building wiring.
As owner of the above-referenced property,I hereby certify that the al-arm(s)referenced above has/have been
installed in—accordance with the m—arnufactuxer's instructions and in,compliance with the California Building
and California Residential"Codes.The alarms have been tested anal are operational, as of the date,signed[
b-ellow-
t have rrrr,,,,ea jand agree,to,compAy wifih the terms and conditions.of this statemenl,
er.
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Smoke nnd-C101fbrntdbc revised,03111811,14
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERT(NO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
I (408)777-3228•FAX(408)777-3333•buitding(W-cupertino.org --
Owner Name 19)4i,�, t Permit No�_1
t
Address �,k/N`�a,,, S.Mm h. aA- Zba
1. Is your real property a registered historical-site?
El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
2rNo Go to Question 2.
2. Does your real property have a licensed plumber certifying that,due to the age or configuration of the property or its
plumbing,installation of water-conserving plumbing fixtures is not technically feasible?
Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
❑ The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
,r-,
jNo Go to Question 3.
3. Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
IJ`No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
No My real property is built and available for use or occupancy after January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and.sign bottom of form.
Kl,/Yes My real property is built and available for use or occupancy on or before January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign
bottom of form..
5. 1Ple�a e check ONE of the following:
M' My property is a single-family residential real property. See Civil Code Section 1101.4.
On and after January 1, 2014,building alterations or improvements shall require all non-compliant plumbing fixtures
to be replaced with water-conserving plumbing fixtures throughout the building.On or before January 1,2017,all non-
compliant plumbing fixtures shall be replaced with water-conserving plumbing fixtures (regardless of whether
property undergoes alterations or improvements).
El My property is a multifamily residential real property. See Civil Code Section 1101.5.
On and after January 1,2014,specified building alterations or improvements shall require non-compliant
_ plumbing fixtures to be replaced with.water-conserving-plumbing.fixtures. - -
On or before January 1,2019,all non-compliant plumbing fixtures shall be replaced with water-
conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or
improvements).
❑ My property is a commercial real property. See Civil Code Section 1101.5.
On and after January 1,2014,specified building alterations or improvements shall require non-compliant
plumbing fixtures to be replaced with water-conserving plumbing fixtures.
On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving
plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvements).
I,as the owner or owner's agent of this property,certify under penalty of perjury that non-compliant plumbing fixtures will be
replaced prior to date specified above with water-conserving plumbing fixtures in accordance with Civil Code Sections 1101,1
through 1101.8,the current California Plumbing Code and California Green Building Standards Code,and manufacturer's
installation requirements,and that the water-conserving plumbing fixtures comply with the requirements as indicated in the
table on the following page.
Owner or Owner Agent's Signature4r ;� 1 Date: ; tif
Upon completing and signing this Certificate,please return it to the Ppilfing Division in order to final your building permit.
�—_A SB4072015.doc revised 08126115