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B-2016-2868CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2868 892 CANDLEWOOD DR CUPERTINO, CA 95014-4653 (369 19 024) ATKINSON CLIMATROLLERS INC SAN JOSE, CA 95112 OWNER'S NAME: DOLERA RICHARD RAND SHARON H TRUSTEE DATE ISSUED: 10/06/2016 OWNER'S PHONE: 408-725-4303 PHONE NO: (408) 294-6290 LICENSED ONT TOR' RATION BUILDING PERMIT INFO; License Class 5 Lic. #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 Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: REPLACE FURNACE & DUCT (SAME LOCATION) I hereby affirm under penalty of perjury one of the following two declarations: is 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. 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 Sq. Ft Floor Area: Valuation: $13132.00 permit is issued. APPLICANT CERTIFICATION 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 36919 024 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 the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. � — Signature 4 G�/r✓11G✓ Date 10-6-2016 Issued by: Kim Dunbar OWNER -BUILDER DECLARATION Date: 10/06/2016 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 1. 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 of Applicant: contractors to construct the project (Scc.7044, Business & Professions Cade). Date: 10-6-2016 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 2. 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 3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(x) should I store or handle hazardous 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 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 & Safety Code, Sections 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. � owner or authorized agent: Gi! X11 it APPLICANT CERTIFICATION Date: 10-6-2016 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY 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 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 DECLARATION and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S I understand my plans shall be used as public records. Code, Section 9.18. Licensed Signature Date 10-6-2016 professional GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildin cu ertino.or MECHANICAL MEP MISC PROJECT ADDRESS (% 7 APN # %_ q — p . — u e4 V L•' OWNERNAME �. �.f}'��. (�\ nC)p E MAIL .:.'- . , f 9' ! .' PHONE . ` ! �(� E -MAIL STREET ADDRESS ARCHITECT/ENGINEERNAME CITY, STATE, ZIP ' CONTACT NAME .. FAX STREET ADDRESS PHONE Je,! [� PJ O E-MAIL STREET ADDRESS p f I IS. THE BLDG AN ❑. YES EICHLER HOME? ❑ NO CITY, STATE, ZIP 56`T )} �n A 15 j) J.k CA FAX ElowNER 1:1 OWNER -BUILDER ❑ OWNER AGENT 'CONTRACTOR`--., ❑ CONTRACTOR AGENT ❑ ARCHITECT 0 ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME t LICENSE ER "' _- LICENSE TYPE BUS. LIC # V_ y K) I COMPANY N. " E MAIL .:.'- . , f 9' ! .' F 1 . t'' —F T STREET ADDRESSB , , - f� CITY, S ,: ZIP PHONEgC) ^1 t.p, ARCHITECT/ENGINEERNAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE. OF 'WSFD or DUPLEX ❑ MOLTI-FAMILY BUILDING: , ❑ COMMERCIAL PROJECT IN WILDLAND ❑ YES URBAN INTERFACE AREA ❑ NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO IS. THE BLDG AN ❑. YES EICHLER HOME? ❑ NO DESCRIPTION OF WORK (_� _ I n a _ TOTAL VALUATION: !� RECEVEDB 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 building coonsocti�opn. I authorize re resentatives of Cupertino to enter the above -identified operty for inspection purposes. ZL Signature of Applicant/Agent: ''� `L try Date: REQUIRED MEPMiscApp_201 1. doc revised 06121111 CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 1 of 3 Project Name: 2016- 0215 Richard Dloera Date Prepared: 2016-10-04 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 MR -ALT -02 document for each dwelling unit. 01 Project Name 2016- 0215 Richard Dloera 02 Date Prepared 2016-10-04 03 Project Location 892 Candlewood Drive 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name 2016- 0215 Richard Dloera 07 Zip Code 95014 OB Dwelling Unit Conditioned 1201 nstalliri nevV Sir nsta l sg ns alhing Installing Floor Area (ft2) Identification or Location or Area by this SC ducted containing Number of space conditioning more than 40 09 Climate Zone 4 10 (SC) systems in this dwelling 1 system? component? components? feet of ducts? unit. SC system? B. Space Conditioning (SC) System Information 01 02 0304X05 06n 07,J' 08 09 10 JY Isthe S Installing a SC System SC System CFA served ystem a refnge��t nstalliri nevV Sir nsta l sg ns alhing Installing Identification or Location or Area by this SC ducted containing system more than 40 u entirely new 'entirely new Name Served System (ft2) system? component? components? feet of ducts? duct system? SC system? Alteration Type Furnace and Duct replacement whole house 1201 Yes No Yes -T Yes No No Altered space 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-A0372966A-000000000-0000 Registration Date/Time: 2096-10-04 14:59:08 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-10-04 14:59:14 Schema Version: 0.555SDD CERTIFICATE OF COMPLIANCE CKR-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 09 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 and Central gas All new No cooling This field or This field or Duct furnace heating AFUE 96 No cooling component section is not section is not Setback Greater than R-6 replacement components altered applicable applicable 40 feet Renuired Documentation: cr2R-MCH-01-E - Space Conditioning Systems Ducts and Fans -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: :< 15%, or15 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 & 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 fromA " 20 Duct Leakage Test muirem -t -Heating-only systems and Air Handler/Furnace changes do no t require verificatiis f Air .1 CH�'23;-,or'Ref -25, rlg0 Cha e afitC M Existing duct systems constructed, insulated or sealed withasbest9sare exemmfr m u Test[ uir m el Leakage Te 2� E. Entirely New or Complete Replacement D "ttern, with or Without. ,Equipment.Chn ut IS AQ. (Sections iia,and.150.2(b)1E, F) eo I 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-A0372966A-000000000-0000 Registration Date/Time: 2016-10-04 14:59:08 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-10-04 14:59:14 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: /� ow qt� Faulkner, Cindy Company: Signature Date: ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL 2016-10-04 14:59:08 Address: CEA/ HERS Certification Identification (if applicable): 1171 NORTH 4TH STREET City/State/Zip: Phone: SAN JOSE CA 95112 408-294-6290 ResponsiblePerson's Declaration staternt.nt 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 aeceptresponsibility for the building design or system design identified on this Certificate of Compliance (responsible designer). 3. That the energy features and performiance specifications, materials, components, and . anufactured' devices for he buildjpg design system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6,of the Callfornia-Cocle of RegulaCi'ons. 4. The building design features or system design features identified onhis Certi a f om :fiance are otislsteti with the ir�formatiertt, rovided orf othi?C apphcaffle compliance documents, worksheets, calculations, plans and specifications submitted to the prcement�gency for approvalwih this building per niit aplicatiol` .3 '' �h 5. I will ensure that a registered copy ofthis Certifi6b` C�itnpliance shod be rria !ail ile #h blitld, 0 p rmit ,issu�d for buiicl% g, and na p ava ab e nforcement agency for all applicable inspections. I understand that a registered copy of thi rt[ficate of Compancqls requjred to be;,included yj h they h dgcu7ptation;the builder provides to_e bu#ding owner at occupancy. Responsible Designer Name: .Responsible De�grier Signature: re: ` Faulkner, Cindy r4 Company • Date Signed: ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL 2016-10-04 14:59:08 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-A0372966A-000000000-0000 Registration Date/Time: 2016-10-04 14:59:08 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-10-04 14:59:14 Schema Version: 0.555SDD CUPERTINO PURPO SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildina(acunertinn orn This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections are required. k GENERAL INFORMATION Existing single-family and multi -family dwellings shall be provided with Smoke Alarms and Carbon -- Monoxide. alarms._,W1aen the_valuation,of-additions, alterations, or-repairs.to existing. dwelling -units exceeds_ $1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations: AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicirdty of the bedroom(s) _ X X On every level of a dwellin unit including basements X X _ Within each sleeping room X Carboni Monoxide alarms are not required ini dwellings which do not contain fuel -burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal. I Power Supply: In dwelling -units with no corranercial power supply, alarm(s) may be solely, battery operated. In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling filtishes or there is no access by means of attic, basement or crawl space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for alarms which must be connected to the building wiring. As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes. The alarms specified below have been tested and are operational, as of the date signed below. ,�, p, Address: ' -b . i i i GIA 0d�#" Permit No. Specify Number of Alarms: 4 Smoke AIarms: � # Carbon Monoxide Detectors: I have read and agree tdcompiv, with the terms and conditions of this statement Owner (or Owner Agent' )Name: Signature: ............................................................................................................... Date: IU� L) 14�................................................................................................................................. Contractor Name: Signature.................................................................. Lic.# ......................................Date: Smoke cnad COform.doc revised 09'27/16