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
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IS. THE BLDG AN ❑. YES
EICHLER HOME? ❑ NO
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ElowNER 1:1 OWNER -BUILDER ❑ OWNER AGENT
'CONTRACTOR`--., ❑ CONTRACTOR AGENT
❑ ARCHITECT 0 ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME t LICENSE ER "' _- LICENSE TYPE BUS. LIC #
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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.
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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