B-2016-2569IN
l CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-2569
10053 LONG OAK Ll
I CUPERTINO, CA 95014-5613 (342 32 05 1)
ATKINSON
CLIMATROLLERSINC
SAN JOSE, CA 95112
OWNER'S NAME: IHALNIKARRAJESHVASANT
AND PRADNYARAJESH
DATE ISSUED: 08/23/2016
OWNERS PHONE: HONE:
08-307-8317
PHONE NO: (408) 294-6290
LICENSED CONTRACIOR'S
DECLARATION
BUILDING PERMIT INFO:
License Class B, C-
_QLic. #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
ivision 3 of the Business & Professions Code and that my
license is in full force
and effect.
JOB DESCRIPTION:
REPLACE (E) FURNACE; SAME LOCATION; ADD (l) A/C BETWEEN
I hereby affirm under
penalty of perjury one of the following two declarations:
DWELLING & GARAGE
1. I have andv
till maintain a certificate of consent to self -insure for Worker's
1 Compensati
cm, 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 370of
the Labor Code, for the performance of the work for which this
permit is i_ed.
Sq. Ft Floor Area:
Valuation: $7920.00
certify that I have reed
APPLICANT CERTIFICATION
this application and state that the above
APN Number:
Occupancy,Type:
information is; correct
4 I agree to comply with all city and county ordinances
and state laws relating
to building construction, and hereby authorize
342 32 051
representatives of thlu
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 slain
Additionally, the applant
this permit.
City in consequence of the granting all
understands and will comply with all non -point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations p
r the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature W t�
Date 08/23/2016
Issued by: ELISS
OWNER -BUILDER
IECLARATION
Date: 08/23/2016
I hereby affirm that I
in 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 ins d. If a roof is
1. I, as owner
f the property, or my employees with wages as their sole
installed without first obtaining an inspection, I agree to remove all new m als for
compensation,
will do the work, and the structure is not intended or offered for
inspection.
sale (Sec.70
4, Business &Professions Code)
z. I, as owner (if
the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to
construct the project (Sec.7044, Business & Professions Code).
Date: 08/23/2016
I hereby affirm under
penalty of perjury one of the following three declarations:
1. I have and
ill maintain a Certificate of Consent to self -insure for Worker's
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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 A
11 maintain Worker's Compensation Insurance, as provided for by
I have read the hazardous materials requirements under Chapter 6.95 of the
Section 370
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 iss
ied.
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 em
loy any person in any manner so as to become subject to the
material. Additionally, should I use equipment or devices which emit hazardous
Worker's Cc
mpensation laws of California. If, after making this certificate of
air contaminants as defined by the Bay Area Air Quality Management District I
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 & Safety Code, Sections 25505, 25533, and 25534.
Labor Code,
deemed revoked.
I must forthwith comply with such provisions or this permit shall
`/be
Owner or authorized agent -/
APPLICANT CERTIFICATION
Date: 08/23/2016
I certify that I have re
d this application and state that the above information is
CONSTRUCTION LENDINGAGENCY
correct. I agree to co
ply 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 co
struction, and hereby authorize representatives of this city
of work's for which this permit is issued (Sec. 3097, Civ. C.)
to enter upon the abolI
a mentioned property for inspection purposes. (We) agree
Lender's Name
to save indemnify and
keep harmless the City of Cupertino against liabilities,
judgments, costs, anc
expenses which may accrue against said City in
Lender's Address
consequence:of the g
ranting of this permit. Additionally, the applicant understands.
and will comply with
II non -point source regulations per the CupertinoMunicipal
ARCHITECT'S DECLARATION
Code, Section 9.18.
1 understand my plans shall be used as public records.
Signature
Date 08/23/2016
Licensed
Professional
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
cuprmk.I (408) 777-3228 • FAX (408) 777-3333 • building-cupertino.orq
�3-2c misc
t1rZ5-
PLUMBING -EqMECHANICAL U5ZLECTRICAL MISCELLANEOUS
PROJECT ADDRESS L u XW APN # 'L r Z s
,J
OWNER NAME` PHON lIY I E-MAIL
FAX
CONTACT NAME l PHONE 4 J�j�-?� E-MAIL
STREET ADDRESS / �) -71 /� J (_ /�� CITY, STATE; ZIP 56k V".
❑ OWNER ❑ OWNER -BUILDER 0 OWNER AGENT 'I�1 CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT `f ❑(,ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME o\`� �� LSC SIS ER LICENSE T E BUS. LIC # f
-
c l� P, . rA
� CY1 V(ai\1Y��1��i of o ��� 3 '6`i!A FAX
"
LICENSE NUMBER
BUS. LIC #'
F-4
i
COMPANY NAME
i
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or
BUILDING: 0 COMMERCIAL
UPLEX ❑ MULTI -FAMILY
PROJECT IN WILDLAND ❑ YES
URBAN INTERFACE AREA ❑. NO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑. YES
EICHLER HOME? ❑ NO F
DESCRIPTION OF WORK
\jWKE
R00 `Q.- Goinnimm'Mc-n
SUPPLEMENTAL INFORMATION REQUIRED
MEPMiscApp 2011.doc revised 06121111
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 1 of 3' )
Project Name: 2016-0081 Rajesh Phalnikar FDate Prepared: 2016-08-05
A. General Information
CFIR-ALT-02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented,
use one CHR -ALT -02 document for each dwelling unit.
01
Project Name
2016- 0081 Rajesh Phalnikar
02
Date Prepared
2016-08-05
03
Project Location
10053 Long Oak Lane
04
Building Type
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
2016- 0081 Rajesh Phalhikar
07
Zip Code
95014
08
Dwelling Unit Conditioned
1341
stahtgnstalhttg_
installing
Floor Area (ft2)
Location or Area
by this SC
ducted a
containing
system
Number of space conditioning
entirely new
09
Climate Zone
4
10
(SC) systems in this dwelling
1
component?
components?
feet of ducts?
duct system?
unit.
Alteration Type
B. Space Conditioning (SC) System Information,°
i. ,,::.
01
02
03
04
05
Fid � t:" ..
06 ' '
0i z
0
09
10
ti"<v
Is the SC "'"
ins allmg a 1177777,7777
�"7 44
a
f-7
ftF
SC System
SC System
CFA served
ystem a 3
r#ngeattitnstalhrgiev
SSC
stahtgnstalhttg_
installing
Identification or
Location or Area
by this SC
ducted a
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
replacement add
whole house
1341
Yes
Yes
Yes
No
No
No
Altered space
A/C
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section1S0.2(b)1Diib)
This section does not apply to this project.
Registration Number: 216-A0293186A-000000000=0000 Registration Date/Time: 2016-08-05 12:59:27 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-08-05 12:58:40
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 $pace Conditioning System (Sections 150.2(b)IE a I nd F)
01
02
03
04
05
06
07
08
09
10
11
12
Heating
Cooling
System
Heating
Altered
Heating
Minimum
Altered
Cooling
Minimum
Required
New or
Identification
System
Heating
Efficiency
Efficiency
Cooling
Cooling
Efficiency
Efficiency
Thermostat
Replaced
New Duct
or Name
Type
Components
Type
Value
System Type
Components
Type
Value
Type
Duct Length
R -Value
Furnace
replacement
Central gas
furnace
All new
heating
AFUE
80
Central split
All new
cooling
SEER
14
Setback
This field or
section is not
This field or
section is not
add A/C
components
AC
components
applicable
applicable
Required Documentation:
CF2R-MCH-01-E - Space Conditioning Systems Ducts and Fans
-Duct insulation requirement for new plenums: R6.
CF2R-MCH-20-H & CF313-MCH-20-1-1 — Duct Leakage testing I required when heating or cooling components are installed in ducted systems, or when more than 40 ft of duct length is replaced.
-Leakage rate compliance: 15 15%, or <_ 10% leakage to outside, or seal all accessible leaks.
CF2R-MCH-25-H & CF3R-MCH-25-H Refrigerant Charge Verification required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15).
I
MRCF311-MCH-23 & CF3R-MCH-23 Air Flow;� 300 CFM/ton re qqlred When MCH 25 is required.
Exceptions:
-Duct systems registered with HERS provider as previously sealed are exempt from, ',R ment4,
".7,20 Duct Leakage_TW'ng rem.
-Heating-only systems and Air Handler/Furnace changes do no qlteVerificatj 6 " ir' F�1$ M C '23 rige "nt a,
f
-Ex m
Existing duct systems constructed, insulated or sealed with a bes from q
to re exe MC U Leakage Test
Or
'4'eoi
4: 4 24,
E. Entirely New or Complete Replacerhent Duct 4 em with or Tthoyqqqipm
ent Changegut (Sectio ,,n�1S0.2[,b),4,.Dil nd,150.2(b)IE, F)
*
224
This section does not apply to this project.
J. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)1C)
This section does not apply to this project.
Registration Number: 216-A0293186A-000000000-0000 Registration Date/Time: 2016-08-05 12:59:27
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007
Schema Version: 0.555SDD
HERS Provider: CaICERTS
Report Generated: 2016-08-05 12:58:40
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. I certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature: 6�Q
A
Faulkner, Cindy
�
Company:
Signature Date:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL
2016-08-05 12:59:27
Address:
CEA/ HERS Certification Identification (if applicable):
1171 NORTH 4TH STREET
City/State/Zip:
Phones
SAN JOSE CA 95112
408-294-6290
Responsible Person's Declaration statement,
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. I 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).
ices for t e building esign or system design identified on this Certificate of Compliance conform to the
requirements of Title 24, Part 1 and Part 6 of the Callforhia Code of " ' a ons. " "� " �n "`
3. That the energy features and performance specifications, materials, co m onents, and ••, anufactured dE.,
r
4. The building design features or system design features identified o y his Certifica f £mptiance stste with the i ormatiit.: royided on oth ,o ca " pliance documents, worksheets,
calculations, plans and specifications submitted to the ei2forcemen r ency fotalri ovai;w` this bwli�ng per P ,Jicati
5. I will ensure that a registered copy of:tli Cerfific f Cts": pliance s IO3 ria e yaila ale e ki Tiding p `mit issued for• (ry ild`iti'g, and ad avallablg the nforcement agency for all applicable
inspections. i understand that a registered copy of thi icate of Cq pl'ance is req ' d to b-, ncluded ith the documeri ation,Yhe b[�ilder proXldes to the buij ing owner at occupancy.
e: e ;,.
Responsible Designer Name:
Responsible Degig er 516a re: '
Faulkner, Cindy
cf/tZU(�
Company:
Date Signed:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL
2016-08-05 12:59:27
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 noway implies Registration Provider responsibility for the accuracy of the information.
Registration Number: 216-A0293186A-000000000-0000 Registration Date/Time: 2016-08-05 12:59:27 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-08-05 12:58:40
Schema Version: 0.555SDD
COMMUNITY DE\fELCRMtNT DEPARTMENT I #
BU
iLDNG D[ViSiON - Ogg DRTiNO s
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changes e+�, ,.qe a9t 9,$& qjy np�f� r4o9 same,
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I CA, BON ". ONOXYME ALARMS
SMOKE , R N.
0, WN CERTIFICATTE-OF COMPLIANCE
is
COMMUNITY DEVEL'OPK4ENT!DEP-AiRT,,MENT O-BURILDING DIVISION
10300 I'G.RK-'E -A-VENU,,E -GUANERTWO, GA 195044-3255
VIURPOSP,
ThIg 9-fidavilia a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CSC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
inspections are requi-red.
-at vs *Is 6mg.11g4amfly M, d multi -family dwellings shall: be provided with Smoke Alarms and Carbon
Me—m-9 Aamrm, Whew the valuatio-h of additions, alterations, or re-palirs to existing dwellis U'rafs, exigee&,
$10 -WOO, CRC Ste fiort 1k314 and CDC 9-ectio7Ys 507.2,11-5 8nd 420.6 requicre that Smoke Allallmls andM CaTblen.
Mommax-idig Allamm, be installed in the fgllaw lo'cafiota.
m
AUA
S-MOIKKE ARM 'CC) ALAM
X
. girft.
C avbvno, M@m %i d, e, all, am R als- are not required in dw eHl W1 dch do iv d, eonta n fu el-bvmia, g, appill, a) n,, c, ffg md filial
da mollm, e an, aRat-l-ved gat, age. Caubonn"Emidlealmnoc with smoke gamms, Ovall eoFA?J� Wk@hi
C 10 C,' Stcl on) �2 V 6 w t d, sT; v ail I bet approved by t h-, P-, 0 r c, e of t hl, & S'- I a t e Fire M m, s h,,aI
Y(i m, er Smi Pil 'Ily: : hki a W, el I i a[ Ll g, V, 4 t S With M) ca, U" , m I e r C, if all, p v " W, e, � T, s. ; xRpj, y, a 1, a - E. mm ( s-) i, n, ay b P, sfolely b Rkme 7 yj 0 F P I a k, di
In, ex dwell -mdta, allam ts, are permiNed to be gulek baeery@periatedl whimeye iseya&& ei, alk-matimm, dig,
rm w,
space. R&ffexlu CRC Sed an? R3114 mmid CBC Secti6ims, 9091.2314 and 42,Q6.2- Am, e-lecWmlpemYMI lsjequmedt f@11
Ot,rins wlldchl must he e omaected W the buil ding wkimt
Vis, owner of'th, e, ab-, o iv, e - r. e, f ex e i, tc e d p=rop-,ev ty. �, 1, ller,eby e er W y, tl ;at #Ir tel ala mn ( s,),, re'fcrenced abtvv e has,; -e if e,,
in.s.,ti,aftled im aommAmitee, with Ifie- mmarmmhdmier's kakm6m& m;idl in compliance wiA ffie Czdi�oxmailvm
and CalHomA&RIesidlenfial Codes, The- altatrmsllavebeem, testedaind are, operaktimeal, asp olvlie diatesitped,
b el -ow.,
It hkame ve-adlanadi avree. tb) com, olvi witfta th.e. ramm, andinafflUbm:s ofthl,s st8tmev L?
ATC -SR V, F�iALNjic-AF-- I' ,
... - , ";�,
. .................... ....... ...........
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! �6"LPpSJ.
Owner N
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE o CUPERTINO, CA 950143255
(408) 777-3228 • FAX (408) 777-3333 s buildinq@cuper ino.org
9 V, PN A L-A1i --A1elPermit Nod
ka�
®2-56
Address 10 0 5 3 L-0 aJ 61- O A k- L..rJ ci) la -e�2i— I /Vc2 CA 1 �� 1 �
1. Is your real property a registered historical site?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
9 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 plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
CNo 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.
Ej 19/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.
r r 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:
t Nly 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, 20'19, all non-compliant plumbing fixtures shall be replaced with water- conserving
plumbing fixtures. throughout the building (regardlessof 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 1101.81 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 Signature:+! Dafen 1 1- I ! -1
Upon completing and signing this Certificate, please return it to the Building Division in order to final your building permit.
SB407201.5.dbc revised 08126/1'5