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B-2016-1963 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1963 21597 ROSARIO AVE CUPERTINO,CA 95014-4756(356 19 032) ATKINSON CLIMATROLLERS INC SAN JOSE,CA 95112 OWNER'S NAME: PEREZ RICHARD LAND CHERYL B TRUSTEE DATE ISSUED:05/17/2016 OWNER'S PHONE:408-446-4180 PHONE NO:(408)294-6290 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lic.#258540 X BLDG ELECT PLUMB Contractor ATKINSON CLIMATROLLERS INC Date 12/31/2016 — — — 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&A/C UNITS,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. 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:$9415.00 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 356 19 032 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 ican nderstands and will comply with all non-point source regulatio er t e Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAS SPECTION. Signature Date 05/17/2016 Issued by: Date:05/17/2016 _ OWNER-BUILDER DECLARATION I hereby affirm that I ant 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) z. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:05/17/2016 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 tite Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. 1 will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 3. I 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 °ho unicipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code, a ons 2 505,25533,and 25534. Labor Code,I trust forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date:05/17/2016 1 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. 1 understand my plans shall be used as public records. Licensed Signature Date 05/17/2016 Professional GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333• building a(�cupertino.org I S cupETfN1 , ❑/JPLUMBIING n Z�SECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS -/ rC�� ]�% �'l A-Otr� c- APN# n�/� t (� I OWNERNAME19— `(9' (CIy_(/� V PHONE t(� //'�J/ L%/cr/� E-MAIL STREET ADDRESS 2(� oS� h ; CITY,C�LtE,ZIP qS�/[f FAX CONTACT NAMEt_L��l, V PHONE- n/!((�P f 0 E-MAIL Tbm �CrF'� STREET ADDRESS kt, t rflL Q 1 L ( CITY,STATE, ZIP Z f! �} ElOWNER ❑ OWN(ER-(BUILDER ❑ OWNERAGENNT_1 CONTRACTOR ❑CONTRACTORAGENTV ❑(/ARCHITECT (/❑CE�NGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME S LICENSE NUMBER 9CT LICENSE TYPE ;l BUS.LIC# COMPANY NAMEA�I ��tB E-MAIL / / FAX STREET ADDRESS CITY,STATE,ZIP PHONE co ARCHITECTIENGINEER NAME 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 AREEAAJ ❑ NO FLOOD ZONE ❑NO EICHLER HOME? DESCRIPTION OF WORK far- _. TOTAL VALUATION: 0 V RE D By my signature below,I c to each o 0 1 wing: I am the property owner or authorized agent to act a pr er's b e read this application and the information I have pro Id is orrect. I have read the Description of Work and verify it is curate. a •e m Ith all applicable local ordinances and state laws relating to build' g o I authorize representatives of Cupertino to enter the (f - gtifie erty for inspection purposes. Signature of Applicant/Agent: Date: O I/6 SUPPLEMENTAL INFORMATION REQUIRED ozc vs ONLY ❑ OVER-THE-COUNTER f Q..EXPRESSJ `-;,❑j'STANDARD U„ Z CI;'LARGE ❑. MAJOR MEPMiscApp_2011.doc revised 06/21/11 CERTIFICATE OF COMPLIANCE CFiR-ALT 02-E Alterations to Space Conditioning Systems(formerly CF-IR-ALT-HVAC) (Page 1 of 3) Project Name: 2015-0745 Sherry Perez Date Prepared: 2016-05-12 A.General Information MR-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 2015-0745 Sherry Perez 02 Date Prepared 2016-05-12 03 Project Location 21597 Rosarino Ave 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name 2015-0745 Sherry Perez Dwelling Unit Conditioned 07 Zip Code 95014 08 2300 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 U6 aV 07 08 09 10 Is the SC Installing a r' � SC System SC System CFA served system a refngeraitt lnstallmg~new SC t Insta`thng 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&AC Whole House 2300 Yes Yes 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. Registration Number:216-A0178330A-000000000-0000 Registration Date/Time: 2016-05-12 14:33:15 HERS Provider:CalCERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-05-12 14:33:30 Schema Version:0.555SDD ,z CERTIFICATE OF COMPLIANCE CF111-ALT-02-E Alterations to Space Conditioning Systems(formerly CF-1R-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 All new All new This field or This field or Furnace& nCentral gas heating AFUE 0.8 Central split cooling SEER 14 Setback section is not section is not Replacement t furnace components AC components 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&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&CF313-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>_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 Testing requirements -Heating-only systems and Air Handler/Furnace changes do not require venficatiflr of Air Flow MCH 23 or RefrigeranfCharge MECH=25 _ t Existing duct systems constructed,insulated or sealed with asbestos are exempYfrom MCH-2QDucYLeakage Testing,requirements. , E. Entirely New or Complete Replacement Duct System,with or without Equipment Changeout(Sections 150 2(b)1DIla 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-A0178330A-000000000-0000 Registration Date/Time: 2016-05-12 14:33:15 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-05-12 14:33:30 Schema Version:0.555SDD 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. Documentation Author Name: Documentation Author Signature: (?�% aCfXfy/IL2/t� Faulkner,Cindy Company: Signature Date: ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING&ELECTRICAL 2016-05-12 14:33:15 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.; F 4. The building design features or system design features identified on this Certificate of Cbmpliance are�conststehi with�the information provided on other,applicable compliance documents,worksheets, calculations,plans and specifications submitted to the enforcement agency for appr val`with this building perrrlit application. ie 5. 1 will ensure that a registered copy of this Certificate of Cor6pliance shall be mac(o=available w4ith,1he building;permit(s)_issu l for-the building,and made available tot d"ghforcement agency for all applicable this inspections.I understand that a registered copy of Certificate of Compliance,,s,required to l6e.includith ed.w, the documentation the builder provides to the building owner at occupancy. Responsible Designer Name: Responsible Designer Signature: Faulkner,Cindy c�uGf�f�/f2P/1' Company: Date Signed: ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING&ELECTRICAL 2016-05-12 14:33:15 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-AO17833OA-000000000-0000 Registration Date/Time: 2016-05-12 14:33:15 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-05-12 14:33:30 Schema Version:0.555SDD - 1 i SMOKE / . R BION , 0MIa.M E ALARM OWNER CER FICATTE OF COMPLIANCE COMMU'NIT'Y DEVELOPMENT DEPARTMENT,BUILDING DIVISION 10300 TORRE AVENUE ,CURLRTINO,+CA 95014-3255 COVER "0 (408)777-3228•FAX,'(408)777-3333►+buildingfcupertino.org nC t PtiRpos This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section 8314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access.for . _.. - inspections are require- =----- GENERAL WORMATION, 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 $1000.001 CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke A,larrris and/or Carbon Monoxide Alarms be installed in the following locations: AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the X X bedroom(s), On every level of a dwelling,unit including basemertts X . X Within each sleeping room X i Carbon Monoxide alarms are not required in dwellings which do not contain fuel-bunting appliances and that do not halve an attached ga,rage°. Carbon monoxide alarms combined with smoke alarms s str ain comply with CB°C Section1420.6 and shall be approved by the Office of the State Fire IVlarshal. T':ower-Supply:_1a dw?ltii gig;tm-tits�with na coixttnercial power supply,-alar n(s)--i-nay be solely batteryop�r<ated. —_ In existing dwelhing a-a-ta,alarms are permitted to be solely battery operated where repairs or alterations do ino"t resuk in the removal of wall and ceilinig finishes or there is ino access by means of attic,basement m crawl space.Refer: to CRC Section R314 and CBC Sections 907.2.11.4 and 420°,6.2.An electrical permit is.required for.. 02iun.s which-must be coiulected to the building wiring. As owner of the above-refer eirtced pi operty,I hereby certify that the alarms)referenced above has/have been installed in,accordance with them ailufacture s instructions and in compliance with the California Building and Calif ori�ua Residential Codes". f e alarms have been tested and are operational,as of the date signed below. _ t have,readf ands a dee fo cora l;r with.fie terms and conditions of(firs statement 5r i�trcre . (,..1!L.r . b I ..: .............. ..: ........................ tic:: .. QaEe.;....._.. WATER-CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228 FAX(408)777-3333 buiiding(�cupertino Cvn:r N1Yt .hermit N o. t l(v I sari rA-dd ess tt ' JV_6-aloz 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. No 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. El The licensed plumber's certification has been provided to the Building Division. Skip the rest of the form and sign bottom of form. % No _ -_Go to__Q_.uestion0._�__.._ 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. 0 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. q,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. Please check ONE of the following: 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). ❑' 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 Tanrivafy P-20T9 AlI f6r-c6mplfaAt pluinlimg fixtures shall be replaced wits w'ater- conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvements). ❑ My property is a commercial real properly. 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 Signatulre: Dae_14- d� Upon completing and signing this Certificate,please return it iOthe Building Division in order to final your building permit. SB4072015.doc revised 08126115