B-2016-2598I' CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
10211 VICEROY CT APT 3 CUPERTINO, CA 95014-0932 (326 15 036)
OWNER'S NAME: BETTENCOURT FILBERT AND JENNIFER TRUSTEE
OWNER'S PHONE: 408-249-4133
LICENSED CONTRACTOR'S DECLARATION
License Class C20 Lic. #768871
Contractor RANDO AAA HVAC INC Date 09/30/2017
I hereby' affirm that I am licensed under the provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
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
•ij'�_ _ Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
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
and state laws relating to building construction, and hereby authorize
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
may accrue against s id City in consequence of the granting of this permit.
Additionally, the app ant understands and will comply with all non -point
source regulati ns r the Cupprtino
Municipal Code, Section 9.18.
Signature Date 08/26/2016
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. 1, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
CONTRACTOR: PERMIT NO: B-2016-2598
RANDO AAA HVAC
INC
SAN JOSE, CA 95125
ISSUED: 08/26/2016
NO: (408) 293-4717
BUILDING PERMIT INFO:
BLDG —ELECT _ PLUMB
MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
FURNACE (SAME LOCATION) UNIT 3
Sq. Ft Floor Area: I Valuation: $3980.00
APN Number: Occupancy Type:
326 15 036
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by S
Date: 08/26/2016
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials 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: 08/26/2016
I hereby affirm under penalty of perjury one of the following three 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.
2. 1 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.
3. I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the
Worker's Compensation laws of California. If, after making this certificate of
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
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 and state laws
relating to building construction, and hereby authorize 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 may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
Signature Date 08/26/2016
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the CoWtino unic' Code, Chapter 9.12 and
the Health & SafeAqe 11 ctions 5533, and 25534..
Owner or authorized agen
Date: 08/26/2016
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Address
ARCHITECT'S DECLARATION
understand my plans shall be used as public records.
Licensed
Professional
CUPERTINO
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION
10300 TORRE AVENUE • CUPERT'INO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 building(afcupertino.org
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT R (CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER 11 DEVELOPER ❑ TENANT
CONTRACTOR NAME �/� ,/1 /� x
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LICENSE NUMBER I
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ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LICn
COMPANY NAME
E-MAIL
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STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑SFD or Duplex/":rulti-Family
STRUCTURE: ❑ Commercial
PROJECT IN WILDLAND
URBAN INTERFACE AREA ElYes ❑ NO
PROJECT IN
FLOOD ZONE ❑ Yes ❑ No
DESCRIPTION OF WORK �Q I /+
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---------------
TOTAL VALUATION:
RECEIVED BY
By my signature below, I certify to each of the following: 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 correct. 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 buil • g construction. I authadze representatives of Cupertino to enter the aboye_iden ed property for inspection purposes.
Signature of ApplicanUAgent:Date: fV1I2Z 1Y�
SUPPLEMENTAL INFORM
N REQUIRED
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04
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC)
Project Name:
PHIL BETTENCOURT I Date Prepared:
CF1R-ALT 02-E
(Page 1 of 3 )
2016-08-22
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
PHIL BETTENCOURT
02
Date Prepared
2016-08-22
03
Project Location
10211 VICEROY COURT APT 3
04
Building Type
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
PHIL BETTENCOURT
07
Zip Code
95014
08
Dwelling Unit Conditioned
900
Floor Area (ft2)
SC System
St System
CFA served
system ay
refngera t
Number of space conditioning
Installing °,
09
Climate Zone
4
10
(SC) systems in this dwelling
1
xducted '
containing
system
more than 40
unit.
rentirely new
B. Space Conditioning (SC) System Information
y. f y
f„
01
02
03
04 r,:
':'' 05
fl
09
10
r,
�..
k .�
f
S
C
is the SC'
Installing a
SC System
St System
CFA served
system ay
refngera t
Installing new SC
Installing °,
lnstalImg
Installing.
Identification or
Location or Area
by this SC
xducted '
containing
system
more than 40
entirely new
rentirely new
Name
Served
System (ft2)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
Altered space
BRYANT
'I
WHOLE HOUSE Iconditioning
900
Yes,
No
Yes
No
No
No
system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b) 1Dii b)
This section does not apply to this project.
Registration Number: 216-A0312716A-000000000-0000
Registration Date/Time: 2016-08-22 12:10:50
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-08-22 12:10:50
Schema Version: 0.555SDD
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
No cooling
This field or
This field or
This field or
This field or
BRYANT
Central gas
Gas furnace
AFUE
78
No cooling
component
section is not
section is not
Setback
section is not
section is not
furnace
AHU
altered
applicable
applicable
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 & 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: <_ 15%, or <_ 10% leakage to outside, or seal all accessible leaks.
CF2R-MCH-25-H & CF311-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 , �r
-Heating-only systems and Air Handler/Furnace changes do not require verificatio '&Air Flow MCH 23; `or Re{rigerant Change MF,CH-2S� `
Existing duct systems constructed, insulated or sealed with asbestos are exempfrom MCH'' -70 Duct LekageTestln requieemen#3,
7777777 777 44
E. Entire) New or Complete Replacement Duct S stem, with r without,E i ment khan eo,ut Sectlons�150 2 b 1
Entirely p p y � qq p g ( �F O Dua 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-A0312716A-000000000-0000
Registration Date/Time: 2016-08-22 12:10:50
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-08-22 12:10:50
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: E;4�
Rando, Eric
44
Company:
Signature Date:
RANDO AAA HVAC INC
2016-08-22 12:10:50
Address:
CEA/ HERS Certification Identification (if applicable):
1712 STONE AVENUE
N/A
City/State/Zip
Phone:
SAN JOSE CA 95125
408-293-4717
Responsible Person's Declaration statement
1 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 ipanufactured devices for the buildingdesignor system design identified on this Certificate ofCompliance conform to the "
requirements of Title 24, Part 1 and Part b of the California Code of Regulations. �
4. The building design features or system design features identified on„this Certificate of Compliance are consistent witif'the niformatnon,provided orrotherapplicabie compliance"documents, worksheets,
calculations, plans and specifications submitted to the a forcement.agenc fora royal with this building per"' a lication.
p p Y �, fp g p pp
n,s,
�; . r�,.
5. I will ensure that a registered copy of this Certificafzof,Co' pliance shad be ttiadeavail ble�Wrt(j the bay),cjing permit{s ;,issue`d for th, buildrng and„mad`,` ava%�ableto they :nforcement agency for all applicable ;
inspections. I understand that a registered copyofthisC tt�ficate of Comphancejs required to be;ncluded kith theKdocumentation the budder prpvid'es to, the building owner at.occupancy.
�,. ,,_ w.
Responsible Designer Name:
Responsible DeSigrfer Signature.
Rando, Eric��
Company:
Date Signed:
RANDO AAA HVAC]NC ., _
2016-08-22 12:10:50
Address: _
License:
1712 STONE AVENUE
768871
City/State/Zip:
Phone:
SAN JOSE CA 95125 J
408-293-4717
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-A'0312716A-000000000-0000 Registration Date/Time: 2016-08-22 12:10:50 HERS Provider: CaIC€RTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-08-22 12:10:50
Schema Version: 0.555SDD