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B-2016-1964 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1964 10936 LINDA VISTA DR CUPERTINO,CA 95014-4771(356 14 043) ATKINSON CLIMATROLLERS INC SAN JOSE,CA 95112 OWNER'S NAME: FERNANDEZ RODNEY AND PURBA DATE ISSUED:05/17/2016 OWNER'S PHONE:408-725-1876 PHONE NO:(408)294-6290 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lic.#255-542 X BLDG —ELECT —PLUMB Contractor ATKINSON CLIMATROLLERS INC Date 12/31/2016 — MECH X RESIDENTIAL—COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9(commencing X— 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 I hereby affirm under penalty of perjury one of the following two declarations: t. 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:$4169.00 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 ordinances APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 356 14 043 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 applica understands and will comply with all non-point source regulations p e C ,ertino Municipal Code,Section 9.18. 180 DAYS F + PECTION. Signature Date 05/17/2016 Issued by:MELISSA 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 t. 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. 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 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 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 s. 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 Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the C rtin Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code, ctio s 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date:05/17/2016 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 I understand my plans shall be used as public records. Code,Section 9.18. Licensed Signature Date 05/17/2016 Professional GENERAL PERMIT APPLICATION MEP L01 COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333• building cDcupertino.orcl misc CUPlERTINO � � � r Q ❑PLUMBING LWCHANICAL [-]ELECTRICAL ❑MISCELLA INE, OU(St0 v ' PROJECT ADDRESSl� � I A ', lio, I?_ APN# //r� �� _ / d If OWNER NAME PHONE � E-MAIL STREET ADDRESS f y CITY, STATE,ZIP FAX CONTACT NAME ��'" PHONE,z Jam! CV'/9 ��Q® E-MAILr✓� C�, ,n G'l�`�" , �(- �� �f11 j `'�t/�G°(1�( ( (_Jf (iC�l.�' cifl/1it• STREET ADDRESS p p }I I 1 ' CITY,STATE, ZIP /?,� C� /r� FAX /lj/6 ❑OWNER ❑ OWNER`-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMEya r LICENSE NUMBER Z*N v LICENSE TYPr BUS.LIC# COMPANY NAME V l A E-MAIL FAX STREET ADDRESS n_ I\S CITY,STATE,ZIP PHONE ARCHITECTIENGINEER NAME G� LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF FD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES 1S THE BLDG AN [3 YES BUILDING: COMMERCIAL URBAN INTERFACE AREA E] NO FLOOD ZONE ❑NO EICHLER HOME? 1pbo DESCRIPTION OF WORK C/-- /J, TOTAL VALUATION: By my signature below, certify to each of the fo owi g: I am the property owner or authorized agent to act on the p owner's behalf. I have read this application and the information I have provide i cor ect. I have read the Description of Work and verify it is accurate. I agree to omp with all applicable local ordinances and state laws relating to buil ' o stru tion. I authorize representatives of Cupertino to enter the above-identified ope for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED omm use onv. w : ';❑ ovt tz TxE cc►urrrER G^_ aET;, LARGE a ❑ MA.1UR MEPMiscApp_2011.doc revised 06121/11 CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E Alterations to Space Conditioning Systems(formerly CF-iR-ALT HVAC) (Page 1 of 3') Project Name: 2015-0714 Rodney Fernandez Date Prepared: 2016-04-25 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 CF1R-ALT-02 document for each dwelling unit. 01 Project Name 2015-0714 Rodney Fernandez 02 Date Prepared 2016-04-25 03 Project Location 10936 Linda Vista Drive 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name 2015-0714 Rodney Fernandez 07 Zip Code 95014 08 Dwelling Unit Conditioned 2119 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 ` .s i . ry e 01 02 03 04 Vis° 05 ; 06' s; 07 F 08 09 10 s �rls the SC' Installing a x 9..- � -- SC System SC System CFA served systema refrigeraht nstalhn&iie SC � Install ng Installing, Installing Identification or Location or Area by this SC ducted containing system more than 40 entirely new 1%entirely new Name Served System(ft2) system? component? components? feet of ducts? duct system? SC system? Alteration Type Furnace whole house 2119 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-A0152324A-000000000-0000 Registration Date/Time: 2016-04-25 13:45:32 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-04-25 13:45:21 Schema Version:0.555SDD CERTIFICATE OF COMPLIANCE CF1R-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 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: C1`211-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::5 15%,or 510%leakage to outs de"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, 300 CFM/ton requiredmhen MCH-25 is required. Exceptions: -Duct systems registered with HERS provider as previously sealed are exempt from„MCH-20 Dud Leakage Testing requirements -Heating-only systems and Air Handler/Furnace changes do not require"yenficat!6ri"of Air Flow MCH+23;nr Refr"igerant Charge MECH25g Existing duct systems constructed,insulated or sealed with asbestos are exempt-from MCH20[)uCtiLeakage Test!ng;egwrgments ai - 9� E. Entirely New or Complete Replacement Duct System,with or without E ui ment Chan eout Sections 150.2 b 1Dila and 150.2 b lE F) q p g ( ( ) �.d r A_a ?r O r 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-A0152324A-000000000-0000 Registration Date/Time: 2016-04-25 13:45:32 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-04-25 13:45:21 Schema Version:0.555SDD r t 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: Faulkner,Cindy Gxdy pp qa PJA Ph Company: Signature Date: ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING&ELECTRICAL 2016-04-25 13:45:32 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 land Part'6 of the California Code of Regulations. € q 4. The building design features or system design features Identified on this Certificateof Compliance are copsistent with the information provided on other applicable'campliance documents,worksheets, calculations,plans and specifications submitted to the enforcementagency forapproval�wth this building permit application. 5. 1 will ensure that a registered copy of this Certificate of Compliance shall,be:made,avaiiable with the building permits,issued forthe build&and made available to the enforcement agency for all applicable inspections.I understand that a registered copy of this Certificate of Complianceris,required to be„included with the,documentation�he�bulder p oyides to the building owner at occupancy. Responsible Designer Name: Responsible Designer Signature. Faulkner,Cindy �GZIGY� Company: Date Signed: ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING&ELECTRICAL 2016-04-25 13:45:32 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-A0152324A-000000000-0000 Registration Date/Time: 2016-04-25 13:45:32 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-04-25 13:45:21 Schema Version:0.555SDD SMOKE / CAR, BON(MONO DE AL 6 7 b 3cl -1 COMMUNITY DEVELOPMENT'DEPARTMENT BUILDING DIVISION �.i�11��f1tT'•��4► 10300 TORRE AVENUE,CUPERTINO,,CA 95014-3255 (408)777-3228• FAX:(408)777-3333.=bullClinQRCWpertlno.orQ Mno z PURPOSE U-iis 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. GENtRA1..1NWRMATIOl l Existing single-farnily 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 $10100.00,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 SMaK,,E ALARM 'C ALAk Outside of each separate sleeping area in the immediate vicinity of the X X kdr<oom(s)- On every level',,of a dwelling unit including baseritents X Within each sleeping room X Carbon Monoxide alarms are not required in-dwellings which do not contain fu l burning appliances and that do not Have anis attc ahed garage. Carbon monoxide alarms combined with srnolle alarms shall comply with CIBC Secti.an 420.6 and sha,11he approved by the Office of the State Fire Marshal.j Power Supply:In,dwellbag amts with no commercial power supply,,alarrn(s)may be solely battery operated. In exMinig dWeVirtg runts, alarms are permitted to b°e solely battery operated where repairs or alteratiozzs do not result m the removal of wall and ceiling firuslies©r there is no:access by means of attic;basemeztt or cr:avrI space.Refer to:CR-.C- Section R314 and CBC Sections 997.2.11.4 and 420.6.2.An electrical"permit is required for of anus which must be co erected to the buUding wiring. As owner of the above refereiwed property,I Hereby certify, that the alarmn(s)referenced above has/have, been, installed m accordance with the tanufa:ct arrer's instm etions and in cornp}liance with the California Buil'dnig; and California,Residenttial.Codes.The alarm shave been tested and are operational,as of the date signed below. t have read and a.`ree to coin;f s.witri.ffi'e terms:and candltlons of flus:statement' � .� S1 l t ra: 0 r +� 6 l a �i"nature ......... ' L`i�:� Date :. WATER-CONSERVING 'PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCEr -�-t� COMMUNITYDEVELOPMENT DEPARTMENT•BUILDING DIVISION � J r CUPHMNO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (40 777-3228•FAX(408)777-3333•'buildingC�cupertino org_ icerNarn c - .0 �u Permit No.' ,[ A��res�ff 1 �?��� �11�` tft�"� � �U� �.► 1�� "` � J 1 1. Is your real property a registered historical site? 171 Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. 0 K 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. ❑ The licensed plurnbcr's certification has been provided to the Building Division. Skip the rest of the forin and sign bottom of form. No 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. R 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. [i 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 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 age. Owner or Owner Agent's SignafDafe--_l VDal--10 44 Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit. SB4072015.doc revised 08/26115