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B-2016-2947CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2947 19479 ROSEMARIE PL APT 4 CUPERTINO, CA 95014-3452 (375 01 007) 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 SERVICES OF CALIFORNIA INCX 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 4 - 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. 2. /A have and will maintain Worker's Compensation Insurance, as provided for by Sq. Ft Floor Area: Valuation: $12685.00 Section 3700 of the Labor Code, for the performance of the work for which this 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 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 LAST CALLED INSPECTION. source regulations per the Cupertino Municipal Code, Section 9.18. r Issued by: Signaturel� Date 10/19/2016 Date: 1 9/ 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. 1, 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. 1, as owner of the property, am exclusively contracting with licensed Date: 10/19/2016 contractors to construct the project (See.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. 1 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 s. 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 air contaminants as defined by the Bay Area Air Quality Management District I shall not employ any person in any manner so as to become subject to the 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, Sections 25505, 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 shallYci, Owner or authorized agent: be deemed revoked. Date: 10/19/2016 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) CUI�I�RT;NOmisc �. 206 r 2R /-)- El PLUMBING DIMECHANICAL LECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS //' % E�,y,, �� 'r 1L? � Z{� i 114. � APN # 3 t OWNER NAME �} PHONE j I% ' E-MAIL �aV/7�fe� / STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME l PHONE j , E-MAIL STREET ADDRESS jj >j/ jJ� CTI'Y STATE, IP f j 1(2;1 h Y.�I�Uli }'C G15t ilSG (./ � ('/I (l f FAX ❑ OWNER ❑ OWNER -BUILDER' ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME<rlfi' i> LICaF� p TvFGBUS. LIC # 7b31�E tr COMPANY NAME E-MAIL FAX STREETADDRESS r /��t ! C9 /) J CITY, STATE, ZIP 471 1 T/I f f PHONEO rj ARCi tITECVEA'GINEE(RJ N E � 11 rrt7 �j j� ( LICENSE NUMBER t (f V ( BUS. LIC # 4 F"7.C,s✓JFf7'A5 d`�F.�N97,C COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ sFD.,DUPLEX.. ❑. muLTI-FAMH.Y PROJECT IN WILDLAND. ❑ YES PROJECT N ❑ YES IS THE BLDG AN ❑ YES BUILDING: E] COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO EICHLER HOME? ❑ NO DESCRIPTION OF WORK TOTAL VALUATIO 2 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 ner 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-iidentified property for inspection purposes. Signature of Applicant/Agent: yj LMG Date: 1 ! SUPPLEMENTAL INFORMATION REQUIRED o�FrcF 17sE o vI ., , MEPMiscApp 2011.doc revised 06121,111 CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 1 of 4 ) Project Name: 19479 Rosemarie place Date Prepared: 2016-10-14 A. General Information CF111-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 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name 19479 Rosemarie place 07 Zip Code 95014 08 Dwelling Unit Conditioned 1500 3 _. k _w Floor Area (ft2) SCS stern y SCS stem y CFA served '"��' �� system a�-J � refrigerant Number of space conditioning I sta'I ing 09 Climate Zone 4 10 (SC) systems in this dwelling 4 ducted containing system more than 40 unit. entirely new �, B. Space Conditioning (SC) System Information x >.kx i' �- 01 02 03 04; '- D5 06 7 $ 09 10 * ... Is the SC , ... u stalling a 3 _. k _w SCS stern y SCS stem y CFA served '"��' �� system a�-J � refrigerant #� y nstalling ievix S I sta'I ing Ins alli ngp installing 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 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 Srhema Version- O.SSSSDD HERS Provider: CalCERTS Report Generated: 2016-10-14 10:57:52 CERTIFICATE OF COMPLIANCE CF1R-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 ISO. 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 AC co ponets t ktt,`.. j applicable applicable �.. All new I ` ne iel This field or This field or System 3 Central gas heating AFUE s �0 den C�altcoolm SEER 14 Stback section is not section is not furnace components `; 4�: "AC p. eotrt her is ��,.:,_.•,..° s,� applicable pp applicable pp Central All new ' j s ."'' >Centra`Itspltt All pe i? - This field or This field or System 4 gas heating AFUE 80 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.. 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 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 CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Date/Time: 2016-10-14 10:57:27 Report Version: 2013 Rev 1.008 Schema Versinn: 0.555SDD HERS Provider: CaICERTS Report Generated: 2016-10-14 10:57:52 CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E Alterations to Space Conditioning Systems (formerly CF -1R -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 Srhema Versinn: O.SSSSDD HERS Provider: CalCERTS Report Generated: 2016-10-14 10:57:52 VA "4� _z,� a. d '*� 0u , a- v '�..s ,�y cl ai 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 Srhema Versinn: O.SSSSDD HERS Provider: CalCERTS Report Generated: 2016-10-14 10:57:52 CERTIFICATE OF COMPLIANCE CFIR-ALT-02-E Alterations to Space Conditioning Systems (formerly CF -IR -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 �,�7L �iy�f�LfGf�P/7�'l�U�GfGQ� 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 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 Code of R_guiatibns. } 4 t _.,. 4. The building design features or system design features ic,pntified onithis Certificatei�f Com iliance are rrtp intent kit"the ir�iormationh\ rovided on athe�ap ica(je"compliance documents, worksheets, calculations, plans and specifications submitted to the ettfrcemeni agency folpprvwih this buiing permit appiicatioi k. shall enforcement for 5. I will ensure that a registered copy of this Certificate"p( CTppliance (elmae ariail,ble wn(tl1l� bi)irfg p3Xmit�. issu: for 11 and4tnae avallablLche agency all applicable inspections. I understand that a registered copy of th ", cate of Compl,tancea(s�requjred to ba„included y{ith the ocumentation the b04414er pr,-qvides to t(�e bujld ng owner at occupancy. x Responsible Designer Name: t€ nare: R a /— b L Responsible De�igrler Sidtu Hawkins, Stephanie 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: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Schema Ver -inn: 0.S.5SSDD Report Generated: 2016-10-14 10:57:52