B-2016-1940 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1940
22330 HOMESTEAD RD CUPERTINO,CA 95014-0137(326 59 999) ON-TIME AIR
CONDITIONING&
HEATING INC
PLEASANTON,CA
94588
OWNER'S NAME: VIVIAN WANG DATE ISSUED:05/13/2016
OWNER'S PHONE:408-355-3658 PHONE NO:(925)444-4444
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-20 Lic.#817040 X BLDG _ELECT _PLUMB
Contractor ON-TIME AIR CONDITIONING&HEATING INC Date 09/30/2017
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:
(R)HEAT PUMP-ROOF;(R)AIR HANDLER IN CLOSET-UNIT 307
I hereby affirm under penalty of perjury one of the following two declarations:
t. 1 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:$10755.00
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 326 59 999
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 nsequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant unde ands and will comply with all non-point
source regulations per theCu j rtino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 5/13/2016 Issued by:Abby Ayende
Date:05/13/2016
OWNER-BUILDER DECLA TI N
I hereby affirm that I am exec t 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)
z. 1,as owner of the property,am exclusively contracting with licensed Signature ofApplicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:5/13/2016
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
r. 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
z. 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
a. 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 Cupertin unicipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sectio 5505,25533,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:5/13/2016
1 certify that I have read this application and state that the above information is CONSTRUCTION ING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construe on ding agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issue (S .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 5/13/2016
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 MISC
CUPERTINO (408)777-3228• FAX(408)777-$333•building aaW cupertino.org 7 ,�
I✓" 111 Iq/If-)
❑PLUMBING EAMECHANICAL [:]ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS ?, 3
API
_U #
OWNER NAME q� �tJj � B�Y W 1 �P,HONE�/� .�,/ d_ /� E-MAIL
STREET ADDRESS I_�J S20� TY, ST(�TE,ZI /`Y/J�', rI FAX
�/� ;� 1.
CONTACT NAME qN,E E- AIL
I f. �.(�� Z I L(
STREET ADDRESS `vE,ZIC,Gntl `�I
If
El OWNER ElOWNER-BUILDER ` El OWNER AGENT 1x CONTRACTOR 1:1 CONTRACTOR AGENT ❑ ARCHITECT�j V❑ENGINEER ❑/DEVELOPER ❑ TENANT
COT 3 iCM n � LICENSE NUMBE ,jO LICENSE TYPE BUS.LIC# J Q 2
COMPANYNAME Gs E-MAIL (- FAX U J
STREET ADDRESSi� CI STAT ZIP CA sw
ARCHITECT/ENGINEER NAME LICENSE NUMtBER (� 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 Keac k C-,� \9 S --kS _ (� LAt
D l
TOTAL VALUATION:
RECEIVED BY: ��/4� -
By my signature below,I certify to each of the follow' 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 provided is co ct. 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 building c tion. I authorize representatives of Cupertino to enter the above-identifi prop for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENT FORMATION REQUIRED ;` OFFICE'USE ONLY
W
OVER-THE-COUNTER
F" E EXPRESS,
x
� U
x v � STANDARD. .
zUz
a ::0 'LARGE
cL
E)"MAJOR "
MEPMiscApp_2011.doc revised 06/21/11
Woodspring
Homeowners Ass-olciatib n
5/12/2016
File Reference# A44083-SR1
Vivian Wang
22330 Homestead Road Unit 307
Cupertino, CA 95014
RE: Architectural Approval -A/C
Dear Vivian Wang,
The Association has received your request to install an air conditioning unit at your home.
Please be advised,the installation of the A/C unit was approved at the May 10,2016 Board of Directors meeting
with the following conditions:
1.The unit must be installed per the specifications submitted on your request.Any changes must be submitted to
Management and approved by the Board of Directors at a Board meeting prior to proceeding.
2.The work must be performed by the licensed and insured contractor submitted in your application.
3.The installation must take place in the same location as the current unit.
4.There may be no penetration of the roofing membrane.
5.The A/C unit must be marked with your unit number.
6.The Association retains the right to inspect the installation of the A/C unit upon completion, and if any changes
are required,you will be notified.
7.The homeowner assumes sole responsibility for obtaining all applicable City of Cupertino permits and
inspections.
8.All construction debris must be disposed of offsite. Hauling charges will be billed back to the homeowner if
debris is left at the community.
9.The homeowner is responsible to remove and reinstall the A/C unit at their cost if any building maintenance is
required,Le. roof maintenance, etc.
10.The homeowner assumes full responsibility for events creating,the improvement, maintaining the improvement
in good condition, and any encroachment this improvement may make on common area improvements.The
homeowner will be responsible for any damage caused due to the installation and will be billed back for repairs
completed by the Association.
11. If noise complaints regarding the unit are received,the installation will require modification to accommodate the
issue.
12. Upon sale of the unit,the seller is responsible to disclose these requirements to the purchaser.
Please retain a copy of this approval with your Association documents.
If you have any questions or concerns regarding this matter, please submit them in writing to Management for
review by the Board of Directors.
Sincerely,
Jackie McGarry
Association Manager
P.O. Box 320819 Los Gatos,CA 95032-0113
408.866.4537 — Fax:408.866.4619
t
RECEIVED DFFOC [E� 0
MAY 1 3 2016
13Y
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems(formerly CF-IR-ALT-HVAC) (Page 1 of 3)
Project Name: VIVIAN WANG Date Prepared: 2016-05-12
A.General Information
CRR-ALT-02 is applicable to multiple space conditioning systems contained within a single dwelling unit.When multiple dwelling units must be documented,
use one CF111-ALT-02 document for each dwelling unit.
01 Project Name VIVIAN WANG 02 Date Prepared 2016-05-12
03 Project Location 22330 HOMESTEAD ROAD#307 04 Building Type Single family
05 CA City Cupertino 06 Dwelling Unit Name VIVIAN WANG
07 Zip Code 95014 08 Dwelling Unit Conditioned 1250
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 ; 'r 06,: 07'," 08 09 10
Is the SC Installing a
SC System SC System CFA served system a,-- ref'rige'rant Installing-new SC 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
System 1 Location 1 1250 Yes Yes Yes No No No Altered space
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-A0178849A-000000000-0000 Registration Datepme: 2016-05-1218:32:21 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-05-12 18:32:38
Schema Version:0.5555DD
A
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)lE and F)
01 02 03 04 0S 06 07 08 09 30 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 Central split All new Less than or
System 1 Electric heating AFUE 0.78HP cooling SEER 13 Setback equal to 40 R-6
components components feet
Required Documentation:
CF2R-MCH-01-E-Space Conditioning Systems Ducts and Fans
-Duct Insulation requirement for new plenums:R6.
MR-MCH-20-1-1&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::5 15%,ors 30%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 2:300 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 verificatidn'of Air Flow MCH-23,,or Refrigerant Charge MECH-25.1 '
-Existing duct systems constructed,insulated or sealed with asbestos are exempt from MCH-20 Duct Leakage Testing requirements.
E.Entirely New or Complete Replacement Duct System,with or without-Equipment Changeout(Sections 150.2(b)11)iia 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-A0178849A-000000000-0000 Registration Date/Time: 2016-05-1218:32:21 HERS Provider:CalCERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-05-12 18:32:38
Schema Version:0.555SDD
CERTIFICATE OF COMPLIANCE CF1R-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.
Documentation Author Name: Documentation Author Signature: O
tew Queen
Queen,Drew
Company: Signature Date:
1 PERMIT E RATERS 2016-05-12 18:32:21
Address: CEA/HERS Certification Identification(if applicable):
31225 La Baya Drive#213
City/State/Zip: Phone:
West Lake Village CA 91362 818-735-7876
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.
4. The building design features or system design features Identified on this Certificate of Compliance are;consistent with the information provided on other,applicable compliance documents,worksheets,
calculations,plans and specifications submitted to the enforcement,agency for approval with this building permit application. '
S. I will ensure that a registered copy of this Certificate of-Compliance shall,be made available with the building,permit(s),Issued for-the building,and made available to the enforcement agency for all applicable
Inspections.I understand that a registered copy of this Certificate of Compliance,is.requ red to be.included with the documentation,the builder provides to the building owner at occupancy.
Responsible Designer Name:, .I - - 1y tr Responsible Designer Signature:'
Queen,Drew
Company: Date Signed:
ON-TIME AIR CONDITIONING&HEATING INC dba SERVICE CHAMPIONS 2016-05-12 18:32:21
Address: License:
7020 COMMERCE DR 817040
City/State/Zip: Phone:
PLEASANTON CA 94588 925-598-1911
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 ofthe information.
Registration Number:216-A0178849A-000000000-0000 Registration Date/Time: 2016-05-12 18:32:21 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-05-12 18:32:38
Schema Version:0.555SDD