B-2016-2942CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
19479 ROSEMARIE PL APT 1 CUPERTINO, CA 95014-3452 (375 01 007)
CONTRACTOR:
A R S AMERICAN
PERMIT NO: B-2016-2942
RESIDENTIAL
SERVICES OF
CALIFORNIA INC
MEMPHIS, TN 38120
OWNER'S NAME: COHEN DAVID N ET AL
DATE ISSUED: 10/19/2016
OWNER'S PHONE: 650-766-9160
PHONE NO: (408) 286-8931
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C20, C36 Lic. #742039
Contractor A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC
X BLDG —ELECT _PLUMB
X_ MECH X RESIDENTIAL _ COMMERCIAL
Date 10/31/2017
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
JOB DESCRIPTION:
license is in full force and effect.
UNIT 1 - REPLACE FURNACE & A/C UNIT, SAME LOCATIONS
I hereby affirm under penalty of perjury one of the following two declarations:
i. 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.
1::�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: $12685.00
permit is issued.
APPLICANT CERTIFICATION
APN Number:
Occupancy Type:
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
375 01 007
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
may accrue against said City in consequence of the granting of this permit.
WITHIN 180 DAYS OF PERMI R
SUANC
Additionally, the applicant understands and will comply with all non -point
180 DAYS FROM LAST C D I CTION.
source regulations per the Cupertino Municipal Code, Section 9.18.
Y
Signature/2' Clnq
Issued by: MELISSA N
Date 10/19/2016
Date: 10/19/2016
OWNER -BUILDER 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: 10/19/2016
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(x) 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
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 suchprovisions or this permit shall
Owner or authorized agent.
be deemed revoked.
Date: 10/19/2016 v
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
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
MEPGENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(a�cupertino.orgCUPERTINO MISIC
/,?- U/e - 2� 2
❑PLUMBINGa /MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS ^�
PROJECT ADDRESS APN # 3 5 V 0 l
OWNER NAME PHONE ��3 til 6 J t �V E-MAIL
STREET ADDRESS t CITY, STATE, ZIP FAX
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CONTACT NAME �/� ` R PHONE r r E-MAIL
STREET AAD/DRESS 1 /� V V (j/�� CIT STATE, /ZIp 1! /' 1 &15-11f
OWNER
j
Z6 /L, �/I k (I rC�-C -� a/ e C/�� "! i 11I FF
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OWNER ❑ OWNER-BUMDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME j� 1 LLI_CENSE NUMBER 7 z� n T rrF� c� Twp/ / /� /�
� J f 1h et -6,+ ` `C L""&"I✓! Y�//i < f i GS E. ""Y0360
US. LIC # Y0 3 C� l.�
COMPANY NAME EMAIL FAX
STREETADDRESS ` /)Jy /V� CITM 'T� -A!?f7� r (/� ! j PHONE
AR �j7E TECVENGINEERN
P� W A I �
//
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LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP -
PHONE
USE OF ❑ SFD or DUPLEX
BUILDING: ❑.COMMERCIAL
❑ MULTI -FAMILY
PROJECT IN WILDLAND El YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑YES
FLOOD ZONE ❑ NO
15 THE BLDG AN El YES
EICHLERHOME? ❑ NO
DESCRIPTION OF WORK / . —
C / /f &j, iA FUS
TOTAL VALUATIO>kW l RETE%
By my signature below, I certify to each of the following. I'am the property owner or authorized agent to act on the p er 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 construction. I authorize representatives of Cupertino to enter the above -identified property
/for inspection purposes.
Signature of Applicant/Agent: r �i't%� Date:
SUPPLEMENTAL INFORMATION REQUIRED '"' OPFICE USE.ONLY>' r
MEPMiscApp 2011.doc revised 06121111
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC)
Project Name:
19479 Rosemarie place I Date Prepared:
CF113-ALT-02-E
(Page 1 of 4 )
2016-10-14
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
19479 Rosemarie place
02
Date. Prepared
2016-10-14
03
Project Location
19479 Rosemarie place
04
BuildingType yP
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
19479 Rosemarie place
07
Zip Code
95014
08
Dwelling Unit Conditioned
1500
i+ lg ,
II new SC
1 Installin ,
g
,Ins)allmg
fi
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
4
system?
component?
components?
feet of ducts?
unit.
SC system?
F{
B. Space Conditioning (SC)System Information `
N"I
� Y
F,
01
02
03
06
07
08
09
10
'; Is the SCS'
Installing a
.
SCS stem
Y
SCS stem
Y
CFA served
',-',,,system a,
,my �
.g l
refn Brant
i+ lg ,
II new SC
1 Installin ,
g
,Ins)allmg
fi
Installing
Identification or
Location or Area
by this SC
ducted
containing
'snstalls
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
System 2
Location 2
1500
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
System 3
Location 3
1500
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
System 4
Location 4
1500
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
Registration Number: 216-A0385473A-000000000-0000
Registration Date/Time: 2016-10-14 10:57:27
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-10-14 10:57:52
Srhema VerSinn: O.SSSSDD
CERTIFICATE OF COMPLIANCE CFIR-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 2 of 4 )
C. Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b)1Diib)
This section does not apply to this project.
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
All new
All new
This field or
This field or
System 1
Central gas
heating
AFUE
80
Centrals lit
p
cooling
SEER
14
Setback
section is not
section is not
furnace
components
AC
components
applicable
applicable
All new
All new
This field or
This field or
System 2
Central gas
heating
AFUE
80
Centrals lit
p
cooling
SEER
14
Setback
section is not
section is not
furnace
components
AC
yn °.
components
�'�'
applicable
applicable
All new
"{
'All new
i:r
This field or
This field or
System 3
Central gas
heating
AFUE
80
Centfal,split'�'
I cooling,
SEER
14
setback
section isnot
section is not
furnace
C
coript3nents
„�
�., a"
x...
applicable
pA
applicable
pp
components
All new
r
Centraltsplit .-'�`
All new
k
z
This field or
This field or
System 4
Central gas
heating
AFUE
80
cooll ing
SEER
14
Setback
.section is not
section is : not
furnace
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 & 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%, 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 & 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.
-Heating-only systems and Air Handier/Furnace changes do not require verification of AirFlow MCH -23, or Refrigerant Charge MECH-25.
-Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH -20 Duct Leakage Testing requirements.
Registration Number: 216-A0385473A-000000000-0000 Registration Date/Time: 2016-10-14 10:57:27 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-10-14 10:57:52
Schema Versinn: i1..55ssrm
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 3 of 4 )
E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)1Diia 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-A0385473A-000000000-0000 Registration Date/Time:. 2016-10-14 10:57:27 HERS Provider: CaiCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-10-14 10:57:52
Srhema Vprtinn: 0:55SSF)D
x5
Registration Number: 216-A0385473A-000000000-0000 Registration Date/Time:. 2016-10-14 10:57:27 HERS Provider: CaiCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-10-14 10:57:52
Srhema Vprtinn: 0:55SSF)D
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 4 of 4
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
Hawkins, Stephanie
�7��r�yilL�G�Lf.I/7�1'I�U�GIGO�'
Company:
Signature Date:
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC
2016-10-14 10:57:27
Address:
CEA/ HERS Certification Identification (if applicable):
965 RIDGE LAKE BLVD STE 201
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 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 manufactured devices for the building design system design identified on this Certificate Compliance to the
or of conform
requirements of Title 24, Part 1 and Part 6 of the California Code of Regulations p
4. The building design features or system design features identified on�this Certificate of Compliance are consistent with the iriformation.provided on other applicable compliance documents, worksheets,
calculations, plans and specifications submitted to the e6forcement5agency for approval with this building permit apPhcation. `
2 hi
5. 1 will ensure that a registered copy of this Certificate of.Compliance shall;be,made�ayailable with0e bililding permits) issued for0, IJUkcli6g, andimacle avail.'able to the;enforcement agency for all applicable
inspections. I understand that a registered copy of this'C riificate of Compl ance,is,,required to be included with the,documentation the butt er provides tq the building owner at occupancy.
'�
Responsible Designer Name: � .�. i `_ -.��
Hawkins, Stephanie
Responsible Designer signature: k'
�:lILGP/77�G�
Company:
Date Signed:
A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC
2016-10-14 10:57:27
Address:
License:
965 RIDGE LAKE BLVD STE 201
742039
City/State/Zip:
Phone:
MEMPHIS TN 38120
40$-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-A0385473A-000000000-0000 Registration Date/Time: 2016-10-14 10:57:27 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-10-14 10:57:52
Sr.hPma VPrtinn: 0-S SSDD