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B-2016-2588 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2588 10883 SWEET OAK ST CUPERTINO,CA 95014(326 51034) A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC MEMPHIS,IN 38120 OWNER'S NAME: STUPECKY MILDRED C TRUSTEE DATE ISSUED:08/25/2016 OWNER'S PHONE:408-732-2987 PHONE NO:(408)286-8931 LENSED CONTRACTOR'S ARATI N BUILDING PERMIT INFO: License Class C20 Lic.#742039 Contractor R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC X BLDG —ELECT _PLUMB Date 10/31/2017 X MECH X RESIDENTIAL=COMMERCIAL 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 JOB DESCRIPTION: license is in full force and effect. REPLACE FURNACE;REPLACE A/C UNIT(SAME LOCATIONS) I hereby affirm under penalty of perjury one of the following two declarations: 1. 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. G)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 Sq.Ft Floor Area: Valuation:$10056.00 permit is issued. APPLICANT CERTIFICATION 1 certify that l have read this application and state that the above APN Number: Occupancy Type: information is correct.I agree to comply with all city and county ordinances 326 51034 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 PERMIT EXPIRES IF WORK IS NOT STARTED City of Cupertino against liabilities,judgments,costs,and expenses which WITHIN 180 DAYS OF PERMIT ISSUANCE OR may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point 180 DAYS FROM L XD" ION. source regulations per q upertino Municipal Code,Section 9.18. ,r Issued by: Signature = Date 08/25/2016 Date:08/25/2016 OWNER-B DER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed:If a roof is following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1. I,as owner of the property,or my employees with wages as their sole inspection. compensation,will do the work,and the structure is not intended or offered for sale(Sec.7044,Business&Professions Code) Signature of Applicant: 2. I,as owner of the property,am exclusively contracting with licensed Date:08/25/2016 contractors to construct the project(Sec.7044,Business&Professions Code). 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the 2. I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will Section 3700 of the Labor Code,for the performance of the work for which this 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 3. 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 will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code,Sear" s 25 05,25533,and 25534. 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 Owner or authorized agent:' (f be deemed revoked. Date:08/25/2016 APPLICANT CERTIFICATION CO STRIJ -<JIENDMM.A�Nt-v I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance correct.I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued(Sec.3097,Civ C.) relating to building construction,and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments,costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands ARCHITECT'S DECLARATION and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records. Code,Section 9.18. Licensed GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE CUPERTINO, CA 95014-3255: Ct3P1'RT[NO (408)777-3228 FAX(408)777-3333 buildingC(1cupertinoorg M I C Zvt6' 89 [:1 PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS fy ( tom APN3 .�/ I .� y OWNER NAME/A�j,�/�j/%_/ llvpe l+//� PHONE q � 473Z. 297 E-MAIL \ STREET ADDRESS/,/// , 3 Jm e4� aoe (�L C TY,STATE�P(�U (^J� �� ) � FAX CONTACT NAME /y / /J PHONE /J/1 ! rq.O�l O GE-MAIL. STREET ADDRESS C ( C CITY,STATE,,ZIP FAX ❑ 0W1,ER ❑ OVAT'ER-BUILDER ❑ OWNTERAGENT ❑ CONTRACTOR ❑CONITRACTORAGENT ❑ ARCH= ❑ENGINEER ❑ DEbTLOPER ❑ TENANT CONTRACTOR NAME �1;A_( T�� {l® LICENSE NUMBER`7/`7�` �j LICENSE TYPE / v BUS.LIC- (f � 0 COMPANY hLfiME A-AS L 1 E-MAIL l `?G V / [ FAX L STREET ADDRESS / CIT TE dJ P C �1��Z PHO vE//�8( 2 0 rjG� ARCHITECT/ENGINEER NAME ` l• LICENSE NUMBER ( BUS.LIC 4 (J COMPANY NAME. E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE: OF ❑ SFD Or Duplex ❑ Multi-Family PROJECT N NXILDLANTI) I PROJECT N STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ NO DESCRIPTION OF WORK '/ e 4/c . F- rki a" TOTAL VALUATION: "r v By my signature below,I certify to each of the following: I ani 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. ave 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 cons on. authorize representatives of Cupertino to enter the above-identified property for inspection proposes. SignatareofApplicant/Agent: _ Date: SUPPLEME L INFORMATION REQUIRED NN �y01 EFt THE tOLTTT „ EJ.PF2ESS ,. x " ,ST_ANDARD xs t U,' z g..:� ❑ LARGE A1fEPA47scApp_201J.doc revised 03116/11 CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E Alterations to Space Conditioning Systems(formerly CF-1R-ALT-HVAC) (Page l of 3) Project Name: Mildred Stupecky Date Prepared: 2016.08-12 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 CF111-ALT-02 document for each dwelling unit. 01 Project Name Mildred Stupecky 02 Date Prepared 2016-08-12 03 Project Location 10883 Sweet Oak Street 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name Mildred Stupecky 07 Zip Code 95014 08 Dwelling Unit Conditioned 1500 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� 06 07', Q& 09 10 1s the SC Installing a SC System SC System CFA served system a=-- n2#rigeraitt Installing iewSC Ir*stalting installing 'Installing k,: 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 1500 Yes Yes Yes No No No Altered space 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-A0302028A-000000000-0000 Registration Date/Time: 2016-08-1217:47:10 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-08-12 17:47:40 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 Space Conditioning System(Sections 150.2(b)IE 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 All new All new Less than or System 1 Central gas heating AFUE 78 Central split cooling SEER 14 Setback equal to 40 R-6 furnace components AC components feet Required Documentation: CF2R-MCH-01-E-Space Conditioning Systems Ducts and Fan's -Duct insulation requirement for new plenums:R6. CF2R-MCH-20-H&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 1551,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). CF2RCF3R-MCH-23&MR-MCH-23 Air Flow x-.300 CFM/ton required when MCH.-25 is required. Exceptions: -Duct systems registered with HERS provider as previously sealed are exempt from,KCH-20 Duct Leakage Testing re�nrements , -Heating-only systems and Air Handler/Furnace changes do not require veriflcattpi'of A rir Flow MCF 23{i r-Refiig,4rpnt Charge M£H 25r. -Existing duct systems constructed,insulated or sealed with asbestos;;are exemptfrom MCH 2QDu teakage Testing requirgmar4ts. E.Entirely New or Complete Replacement Duct tem,with or without Equipment Chanpeout(Sections._3.SQ.2(b)1Duaandr150.2(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-A0302028A-000000000-0000 Registration Date/Time: 2016-08-12 17:47:10 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-08-12 17:47:40 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: /L��LG�P/TT (/�GlLGl' Hawkins,Stephanie Company: Signature Date: A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC 2016-08-12 17:47:10 Address: CEA/HERS Certification Identification(if applicable): 965 RIDGE LAKE BLVD STE 201 742039 City/State/Zip: Phone: MEMPHIS TN 38120 408-286-8931 X123 Responsible Person's Declaration statement I certify the following under penalty of perjury,under thelaws 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 ofthe 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,materlats,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 1 and Part 6 of the California Code of 846; cations 4. The building design features or system design features identified onthis Certifiigal f Compliance are consistent with the if7,farmaffion provided on oth17"z ap}iiicable compliance documents,worksheets, calculations,plans and specifications submitted to the anforcemenAgency fora$16val witttthis building permjt applicatid6 �;.. 1�. B, -� fl agency PP 5. I will ensure that a registered copy of this Certificat,of Compliance sh33tbe matle'-a'uailabie wish the buikli p`E',fmrt s issu,�tl forthe.htiildl andma, availabla,#o- enforcement a en for all applicable inspections.I understand that a registered copy of this Ce`rifficate of Compliance)}{equired to 4e,ncluded ty,Rh the documei}tation,theblder provides to,the building owner at occupancy. - e _:. �._ Responsible Designer Name: + 1 �v Responsible Designer Sgpature. ` 6•-`- Hawkins,Stephanie1!(I�GlLd Company: Date Signed: A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC 2016-08-12 17:47:10 Address: License: 965 RIDGE LAKE BLVD STE 201 742039 City/State/Zip: Phone: MEMPHIS TN 38120 408-286-8931 X123 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-A0302028A-000000000-0000 Registration Date/Time: 2016-08-12 17:47:10 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-08-12 17:47:40 Schema Version:0.5555DD Aug 17 16 01 Barbara Beebe 408.245.64SI P.2 cy:ESh GBS ENOAKS PARK VILLAS ASSOCIATION 10M Nmot C%k StMt a tnperdW COMWAU 95014, "EL-TCAMN EQR_; A� i __ 27V/- E-mil , ri ar p R � phows or broclum if applicable] t e 1hen do you expectt to` � Applicadon is for a single modification only, Any odw chuge will mqW=anadw application- 21 ppy °apt.1 Submission of OW farm alone does not fidO a requirertwnts for approval. rm Architecturalk application remains pending. If 3 dmges to plaw am required by ft wanuum, r ewditions may be placed On completion Of vwork 1 A pernfit fiotnthe City of Ca r addition to Committea approval. Any WditKgW work needed to acb1m conformance vdth approved p!ans,specifications ' requftmWts is the responsibik Dike appficanL If audh additiorial work .at perfonned witidn a poxiod of tim specified b= e Cominittee,itwill be ompletedby the Association ap-Acg6 U1'wM'iP*" I=*sub 'submk your omplMd applimon by nmil or hand deliver to the Ardiiteduml Comwiq=at Rzcdv�ed Date Pen-&t NO. 8sLENOAKS FARK VILLAS I ATLON PERMIT kpPlicautC[ Name Z- NaMmofmodification x Arclutecunal Con=uechave revmvzd your aphewou re ved on PR NO' a of mo&ficafion vdH now ad ever aft ranain at your mqxwc or tha ofaWrof property.tws You or a future owner=y not a1mr ft modificafion t prior approval oftbe ArduuxUW CbmuWttw. You must subnit . City of Cupertino. You must sub 'submk a copy oftha;dmvhug w approved by'the City ofCupp pian ofthe modificadon you must wUfy the ArchitectuW Cmmifto so it may' pest for its final rove Adchtiwa/mpwsmtLqbepau*dtoT=tchodoWsuuctum WoWtrh= :arty- m 1245 AiwvS1k1dWbod Moss#197' KcHyMbore 1240 Acry4hield,Oyster#26 %pproved by Committee Date cif n r t dit appy �°f �. a Fuml b Approval—Archnectural CommitteeMoard Daft_