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B-2016-2110
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-21 10 10543 CEDAR TREE CT CUPERTINO,CA 95014-2003(316 34 021�1 ATKINSON CLIMATROLLERS INC SAN JOSE,CA 95112 OWNER'S NAME: HORN ELISABETH E AND ROBERT D DATE ISSUED:06/10/2016 OWNER'S PHONE:408-874-5877 PHONE NO:(408)294-6290 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lic.#258540 Contractor ATKINSON CLIMATROLLERS INC Date12131!? 10 X BLDG —ELECT —PLUMB _ I hereby affirm that I am licensed under the provisions of Chapte 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 DUCT WORK 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:$7093.00 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 34 021 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 regulations per e C pertino Municipal Code,Section 9;18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 6/10/2016 Issued by:AbbyAyertde 1 Date:06/10/2016 KJlilA 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 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. I,as owner of the property,am exclusively contracting with licensed Signature ofApplicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:6/10/2016 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 ,i. 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 Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&SafetyCode, a ns 2§05,25533,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:6/1012016 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 6/10/2016 Professional GENERAL PERIVI'IT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION MEP 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333•buildingCcDcupertino.org I CUPERTINO SC X2®1(p - 2i () ❑PLUMBING, ❑MECHANIC AL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS O , 1.) APN# Z1(p ZL4 ()r' OWNER NAME � � ( , PHONE �.`A/� � C �J E-MAIL STREET ADDRESS &V111111CITY, STATE,,!P ' �`��(i c FAX CONTACT NAME / �I'� PHONE R r0 (ALW 0211. (/E-MAIL S STREET ADDRESS U Int CITY,STATE, ZIr. ,�' � FAX/,� 21 , ll!]A 7 ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT --GONT�ACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME F`... (n� LICENSE NUMBER �[Y'(P 5_40 LICENSE TYPE. BUS.LIC# COMPANY NAME V ( f E-MAIL J(,J FAX STREET ADDRESS t CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY 7PROJTECT WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL ERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK TOTAL VALUATION: rz gyp. _,F fLBIUBDYU � By my signature below,I certify to each of the Poll wing: I am the property owner or authorized agent to act on the property o ner's b half. I have read this application and the information I h4ave Ided is orrect. I have read the Description of Work and verify it is accurate. I afire to comply with all applicable local ordinances and state laws relating to b- ng con ruction. I authorize representatives of Cupertino to enter the abo e-dentif/d property for inspection purposes. Signature of Applicant/Agent: Date: 0 L& SUPPLEMENTAL7 INFORMATION REQUIRED • , t Fvs � � a l $.'SC MA T(!R ti MEPMiscApp_2011.doc revised 06/21/11 CERTIFICATE OF COMPLIANCE CF111-ALT 02-E Alterations to Space Conditioning Systems(formerly CF-1R-ALT-HVAC) (Page 1 of 3) Project Name: 2015-0817 Estelle Gackiere Date Prepared: 2016-06-08 A.General Information CF1R-ALT-02 is applicable to multiple space conditioning systems contained within a single dwelling unit.When multiple dwelling units must be documented, use one CF1R-ALT-02 document for each dwelling unit. 01 Project Name 2015-0817 Estelle Gackiere 02 Date Prepared 2016-06-08 03 Project Location 10543 Cedar Tree Ct 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name 2015-0817 Estelle Gackiere 07 Zip Code 95014 08 Dwelling Unit Conditioned 2371 Floor Area(ft2) *' Number of space conditioning 09 Climate Zone 4 10 (SC)systems in this dwelling 1 unit. B.Space Conditioning(SC)System Information Via ' 01 02 03 04 5 � 06 x� _ U7 Q$ 09 10 Is the SC Installing a 6�T � W '7 7.1 , SC System SC System CFA served y;5ystem ax refrigerant InstalhngiewS Instalg 1` Instalhitg ,Installing . . ,a 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 Entirely new or complete Replace Ducts Whole House 2371 Yes No No Yes Yes No replacement duct system with or without equipment changeout 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-A0211362A-000000000-0000 Registration Date/Time: 2016-06-08 11:04:17 HERS Provider:CalCERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-06-08 11:04:33 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) This section does not apply to this project. E. Entirely New or Complete Replacement Duct System,with or without Equipment Changeout(Sections 150.2(b)1Diia and 150.2(b)1E, F) 01 02 03 04 05 06 07 08 09 10 11 Heating Cooling System Heating Minimum Cooling Minimum Required Identification or Heating Altered Heating Efficiency Efficiency Cooling Altered Cooling Efficiency Efficiency Thermostat New Duct Name System Type Component Type Value System Type Component Type Value Type R-Value This field or This field or This field or N0 heating This field or Central gas section is No cooling section is section is SetbackTher Replace Ducts component section is not Central split AC R-6 furnace not component altered not not mostat altiered applicable applicable applicable applicable Required Documentation: CF2Ran -MCH-01-E-Space Conditioning Systems Ducts d Fans '9 -Duct insulation requirement for new plenums R6 3as k ' CF2R-MCH-20-H&CF3R-MCH-20-H Duct Leakage V 4rificati0n regwred ' f -Leakage rate coin liance:_<6%. Ukk, CF211-MCH-22_&_CF3R-MCH_22_Fan Efficacy Venficatibii CF2R-MCH-23&CF3R-MCH-23 System Air Flow Rate Verification " , � w -Compliance:Fan Efficacy<_0.58 W/cfm and Sy"stem Airflow>_350 cfm/ton. ' sof' ?� k -Alternative Compliance:CF2R-MCH-28&CF3R-MCH-28 Return Duct Design Verification is an alternative to MCH-22 and MCH-23 verification. C17213-25-11&CF3R-MCH-25-H Refrigerant Charge Verification required when refrigerant containing components are installed or altered(applicable in CZ 2,8-15). Exceptions: Heating-only systems are exempt from the 0.58 W/cfm and 350 cfm/ton requirements. Note: An"entirely new or replacement duct system"means at least 75 percent of the duct system is new duct material,and up to 25 percent may consist of reused parts from the dwelling unit's existing duct system(e.g., registers,grilles,boots,air handler,coil,plenums,duct material)if the reused parts are accessible and can be sealed to prevent leakage 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-A0211362A-000000000-0000 Registration Date/Time: 2016-06-08 11:04:17 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-06-08 11:04:33' Schema Version:0.555SDD CERTIFICATE OF COMPLIANCE CFIR-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: Faulkner,Cindy (?�y O �UX�i�/jLPJL Company: Signature Date: ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING&ELECTRICAL 2016-06-08 11:04:17 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 statem4i w; 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 ProfessionsCode to accgpplesponsibilityfor the building design or system design identified on this Certificate of Compliance(responsible designer). 3. That the energy features and performance specifications matetlafs co' ponents and anufactured devices for the building design o�system design identified on this Certificate of Compliance conform to the requirements of Title 24,Part 1 and Part.6of the California Code of latjons. �'h �� r' 4. The building design features or system design features d,ratified o his Certificatebf r5mpl ance are conss�stet w.'h the ijiforma on,provided omoth a Mica to o npliance documents,worksheets, calculations,plans and specifications su6.mitted to the a rcemenE�gency for provwth,this building perntlt application,. s , 5. 1 will ensure that a registered copy of this�Certifica of C"i3 e,pliance s alj lae risade-a�1 ail le wiih he bCtlld grpt�imitf s)%issued for the b Id g,and ad ava I bleztq,the�,�nforcement agency for all applicable ins ections.I understand thaia register_`ecLcopy ofshi5 ificate-of-coEnpjiance�ls,requKredsoeriincluded with thegdpcumentation the brier prpyides tootle-bullw(I,ng-owner-at-occupancy. P g "K Responilile Desig erSlgnaYire. �a Responsible Desi ner Name: Faulkner,Cindy4/f2P/t� Company: Date Signed: ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING&ELECTRICAL 2016-06-08 11:04:17 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-A0211362A-000000000-0000 Registration Date/Time: 2016-06-08 11:04:17 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-06-08 11:04:33 Schema Version:0.555SDD (hF- 4- CERTIFICATE OF VERIFICATION CF3R-MCH-20-H Duct Leakage Diagnostic Test (Paged of 3 l Project Name: 2015--0813-Estelle Gackiere Enforcement Agency: City of Permit Number: B-2016-2110 Cupertino ,/ Dwelling Address: 10543 Cedar ree Ct City: Cupertino Zip Code: _ 95014 A.System lnformatio 01 Space Conditioning System Identification or Name Replace Ducts. 02 Space Conditioning System Location or Area Served Whole House 03 Building Type from CF71R Single family Verified Low Leakage Ducts in Conditioned Space _No,credit is not taken 04 _,__ �, (VLLDCS)Credit from CF1R? __._ __ 05 Verified Low LeakageAir Handling Unit Credit from No,credit is not taken CF1R? 06 Duct Systett�Gompliance Category Alteration ka C MCH-20d-Complete Iteplacemt or A red Q ctyem a _ B. Duct Leakage Diagnostic Test ' 01 Condenser Nominal Cooling Capacity(ton) 0 02 Heating Capacity(kBtu/h) 72 03 Conditioned Floor Area served by this HVAC system(ft2) 2371 04 Duct Leakage Test Condition Test final 05 Duct Leakage Test Method Total leakage 06 Leakage Factor 0.15 07 Air Handling Unit Airflow(AHUAirflow)Determination Heating system method Method 08 Measured AHUAirflow This field or section is not applicable 09 Calculated Target Allowable Duct Leakage Rate(cfm) 234 10 Actual duct leakage rate from leakage test measurement 186 (cfm) 11 Compliance Statement: System passes leakage test Registration Number:216-A0211362A-M2000002A-M20A Registration Date/Time: 2016-09-0215:07:54 HERS Provider:Ca10ERTS CA Building Energy Efficiency Standards Report Version:2013 Rev 1.008 Report Generated:2016-09-02 15:05:58 2013 Residential Compliance Schema Version:2013.1.007 CERTIFICATE OF VERIFICATION CBR-MCH-20-H Duct Leakage Diagnostic Test (Page 2 of 3 B. Duct Leakage Diagnostic Test 12 Notes: C'..Additional Requirements for Compliance 01 System was tested in its normal operation condition. No temporary taping allowed. Outside air(OA)duct connections to the central forced air duct system shall not be sealed/taped off during duct leakage 02 testing. OA ducts used for Central Fan Integrated(CFI) Indoor Air Quality ventilation systems,or Central Fan Ventilation Cooling Systems,that utilize dampers that open only when OA is required and automatically close when OA is not required, may configure the OA damper to the closed position during duct leakage testing. 03 If a complete replacement,all supply and return register boots were sealed to the drywall. 04 Building cavities were,-' idt used as plenums or platform returns in lieu of ducts. 05 If cloth backed tape was used it was covered with Mastic and draw bands. 06 All conn"t'i points between the air.handlerand the supply and return plenums are completely sealed. If the system corr,plies using the Smokelest mel i d,�e moke t t�ias con &cted in a rdance witi t)�r uirei nts 07 of Reference Resider"tial Appi dix RA14.3 6, s�ems tilt compY usi smpke tt shall riat be in Ob maple groups for HE verificatn cc ,pliance r sAr 08 Verification Status x �u .. Bass-all a plicabe reemetx s are mete 09 Correction Notes for this table The responsible persons signature on this compliance document affirms that all applicable requirements in this table have been met unless otherwise noted in the Verification Status and the Corrections Notes in this table. D.Determination of HERS Verification Compliance All applicable sections of this document shall indicate compliance with the specified verification protocol requirements in order for this Certificate of Verification as a whole to be determined to be in compliance. 01 Complies:All specified verification protocol requirements on this document are met. Registration Number:216-A0211362A-M2000002A-M20A Registration Date/Time: 2016-09-02 15:07:54 HERS Provider:CaICERTS CA Building Energy Efficiency Standards Report Version:2013 Rev 1.008 Report Generated:2016-09-02 15:05:58 2013 Residential Compliance Schema Version:2013.1.007 n CERTIFICATE OF VERIFICATION CF3R-MCH-20-H Duct Leakage Diagnostic Test (Page 3 of 3 Documentation Author's Declaration Statement 1. 1 certify that this Certificate of Verification documentation is accurate and complete. Documentation Author Name: Documentation Author Signature; 1 David Garza Ot�Gt;G Q Company: Date Signed: v Elements-E3 2016-09=02 15:07:54 Address: CEA/HERS Certification Identification(if applicable): 1718 Creek Drive City/State/Zip: Phone: San Jose CA 95125 408-634-6690 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 Verification is true and correct. 2. 1 am the certified HERS Rat6r who performed the verification identified and reported on this Certificate of Verification(responsible rater). 3. The installed features,materials,,components,manufactured devices,or system performance diagnosticresultsthat require HERS verification identif o,0©r#hls`Cert ficate ofvecificatiori coniply_with the applicable requirements in Reference Appendices RA2,RA3,and the requirements specified cri;the Certificate of Compliancefoi;t#re building approved by the enforcement agency. 4. The information reported on applicable sectiorss=o the Certific (s)-01 j s'taila t�F2t}si c rtcl sufr"Wby the persons)responsible for the construction or insfallation conforms to the.0 uiremer ecis�ted#!the Ce%ccaate(s)%f Co,pIian a(CF,. approved by eek fffr m ncy. S. I will ensure that a reglSterEd cd of this CeYtificate of Ve catf'Z shall be potted or a aiI bi, with f wilding per iit(s)issu, � ; the building,and madeavailat o t(teenforcerriI age fot ill appl!t a msp t n�I nde 'and�at a egist r copycTftfi s Ce ac f F, i Verification is required to be finr with the c)ocllmentation t ie builder provrc es to t ie build' ing owner at occu�cy ,, A Builder Or Installer Information As shown On The Certificate Ctf Instllation Company Name(Installing Subcontractor,General Contractor,or Builder/Owner): ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING&ELECTRICAL Responsible Builder or Installer Name: CSLB License: Cindy Faulkner 258540 HERS Provider Data Registry Information Sample Group Number(if applicable): Dwelling Test Status in Sample Group(if applicable) Tested HERS Rater Information HERS Rater Company Name: Elements-E3 Responsible Rater Name: Responsible Rater Signature: David Garza oavts N Responsible Rater Certification Number w/this HERS Provider: Date Signed: CC2016094 2016-09-02 15:07:54 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-A0211362A-M2000002A-M20A Registration Date/Time: 2016-09-02 15:07:54 HERS Provider:CaICERTS CA Building Energy Efficiency Standards Report Version:2013 Rev 1.008 Report Generated:2016-09-02 15:05:58 2013 Residential Compliance Schema Version:2013.1.007