B-2016-2944CITY.OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
19479 ROSEMARIE PL APT 2 CUPERTINO, CA 95014-3452 01
CONTRACTOR:
PERMIT NO: B-2016-2944
(375 007)
A R S AMERICAN
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 SERVICE OF CALIFORNIA INCX
BLDG PLUMB
;Date 10/31 /2017
_ELECT _
X MECH X RESIDENTLAL _ 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.
UNIT 2 - REPLACE FURNACE & A/C UNIT, SAME LOCATIONS
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.
YV./ 2,r1 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
I certify that I have readthis application and state that the above
APN Number:
Occupancy Type:
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
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
180 DAYS FROM LAST CALLED INSPECTION.
regulations per the Cupertino Municipal Code, Section 9.18.
i - LAA ,
Signature Pn lJ�✓£. Date 10/19/2016
Issued by: MELI MES
Date: 10/19/2016
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
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 ofApplicant:
z. I, as owner of the property, am exclusively contracting with licensed
Date: 10/1.9/2016
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
Worker's Compensation laws of California. If, after making this certificatewill
of
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:-"/--
gent
Date:
Date: 10119/2016 `
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
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 E P
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 FAX (408) 777-3333 building(a�cupertino.org
M Its k;
MECHANICAL
❑ PLUMBING ❑ ELECTRICAL
❑ MISCELLAN/E�OUS
PROJECT ADDRESS E f f f I P y 7 Z j_APN # 3 � c)/ V 0
OWNERNAME �tfn�pp f PHONE p / ( 1 /P
E-MAIL
STREET ADDRESS jql CITY, STATE, ZIP P_A
Z vfI 5�V�F
CONTACT NAME "err jf
t Cl W y PHONE (r r E _MAII
STREET ADDRESS ✓ s / CTSTATE, ,zI(P
��r'1 :1C/S� C/l_! UI3 FAX
❑ OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑. DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER /, �1 LICENSE TYPE BUS. LIC 4
COMPANY NAME -
E-MAIL FAX
STREET ADDRESS c' CITY, STATE, ZIP
Z . 4PHONrE 1 I (/V f u.
AR ITEC If7 GGINEER NAME e LICENSE NUMBER BUS. LIC 4
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY, STATE, ZIP PHONE
USE OF ❑ SFD or DUPLEX ❑ MULTI-FAMMY PROTECT IN WILDLAND ❑ YES PROJECT IN ❑ YES IS THE BLDG AN ❑ YES
BUILDING: ❑ COMMERCIAL URBAN INTTERFACE AREA ❑ NO FLOOD ZONE. ❑. NO EICHLER HOME? ❑. NO
DESCRIPTION OF WORK
ct (/"` ,ry AAA F V V,
TOTAL VALUATIO S RECEI
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the p Iner 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: -AN P VC, ` 16 Date:
.. L _ , ?"�p 4
SUPPLEMENTAL INTFORMA'TION .REQUIRED Mir
MEPMiscApp_2OJI.doc revised 06121,111
CERTIFICATE OF COMPLIANCE
CFIR-ALT-0
Alterations to Space ConditioningSystems (formerly CF -1R -ALT -HVAC) (Page 1 of 4 )
Project Name: 19479 Rosemarie place Date'Prepared: 2016-10-14
A. General Information
MR -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
19479 Rosemarie place
02
Date Prepared
2016-10-14
03
Project Location
19479 Rosemarie place
04
Building Type
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
19479 Rosemarie place
07
Zip Code
95014
08
Dwelling Unit Conditioned
Floor Area (ft2)
1500
Number of space conditioning
SC System
09
Climate Zone
4
10
(SC) systems in this dwelling
4
Ins+tallih
Installing
Identification or
unit.
by this SC
Y
B. Space Conditioning (SC) System Information" y�
j
01
OZ
03
04
05
06
07
f 08
09
10
' ;Is the SC''
Installing a
SC System
SC System
CFA served
systema
refrigerant
-Installing-new SC
Installing �,
Ins+tallih
Installing
Identification or
Location or Area
by this SC
ducted
containing
system
more than 405
entirely new
entirely new
Name
Served
System (ft2)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
Altered space
System 1
Location 1
1500
Yes
Yes
Yes
No
No
No
conditioning system
Altered space
System 2
Location 2
1500
Yes
Yes
Yes
No
No
No
conditioning system
Altered space
System 3
Location 3
1500
Yes
Yes
Yes
No
No
No
conditioning system
Altered space
System 4
Location 4
1500
Yes
Yes
Yes
No
No
No
conditioning system
Registration Number: 216-A0385473A-000000000-0000
CA Building Energy Efficiency Standards - 2013 Residential Compliance
Registration Date/Time: 2016-10-14 10:57:27
Report Version: 2013 Rev 1.008
Schama VPrsinn: 0.555SDD
HERS Provider: CaICERTS
Report Generated: 2016-10-14 10:57:52
CERTIFICATE OF COMPLIANCE CFIR-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 2 of 4 )
C. Extension of Existing Duct System, Greater Than 40 Feet (Sect1on150.2(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
Central split
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
Central split
cooling
SEER
14
Setback
section is not
section is not
furnace
components
pC s.
componentsx
applicable
applicable
All new
,
This field or
This field or
System 3
Central gas
heating
AFUE
80
Central split
�x
`cooking°,
SEER
14 =
S6tback
section is not
section is not
furnace
components
w
`
LAC
cdtnponents
"��
applicable
applicable
All new
�"
All new
`+'
This field or
This field or
System 4
Central gas
heating
AFUE
80
GentrahspI t_
cooling
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.
CM -MCH -25-11 & 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 Handler/Furnace changes do not require verification of Air flow 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: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-10-14 10:57:52
Sr.hama VPrainn: O.SSSSOD
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
CA Building Energy Efficiency Standards - 2013 Residential Compliance
Registration Date/Time: 2016-10-14 10:57:27
Report Version: 2013 Rev 1.008
SrhPma Vprsinn: 0..5.55SOD
HERS Provider: CaICERTS
Report Generated: 2016-10-14 10:57:52
RT�}
V
I,
-4''-
e
Registration Number: 216-A0385473A-000000000-0000
CA Building Energy Efficiency Standards - 2013 Residential Compliance
Registration Date/Time: 2016-10-14 10:57:27
Report Version: 2013 Rev 1.008
SrhPma Vprsinn: 0..5.55SOD
HERS Provider: CaICERTS
Report Generated: 2016-10-14 10:57:52
CERTIFICATE OF COMPLIANCE CFIR-ALT D2 -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:
Hawkins, Stephanie
Documentation Author Signature: GILGGt%7�'l�W�(iiG�
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 or system design identified on this Certificate of Compliance conform to the
requirements of Title 24, Part 1 and Part 6 of the California Codeof Regulatfbns. t;;
4. The building design features or system design features identified on this Certificate of Compjiance arezconslstent with the info rmationprovided on ptherapplicable'conpliance documents, worksheets,
ia'
calculations, plans and specifications submitted to the etiforcement agency for approval with this building perrplt ation. � 10 `
S. I will ensure that a registered co � *`
g copy of this Certificate of,Cofnpliance shalhbe made available Niththe building permit(s). issued forithe building, and;made avai)ablb''to the`bnforcement agency for all applicable
inspections. I understand that a registered copy of
ft Ce'rtificate of Compliance jsrrequired to be included with the documentation the builder provides to1be building owner at occupancy.
�r
Responsible Designer Name: £ -
= �-
Responsible Aesigrier Signature,
Hawkins, Stephanie
/t�LGP/i�GSGQ�
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
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-A0385473A-000000000-0000 Registration Date/Time: 2016-10-14 10:57:27 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-10-14 10:57:52
Srhpma VPrsinn: f1_5:9:SSDI)
�4m