B-2017-0011CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0011
20090 LA RODA CT CUPERTINO, CA 950144410 (369 34 033)
ATKINSON
CLIMATROLLERS INC
SAN JOSE, CA 95112
OWNER'S NAME: CRAMB DALE S AND BILLIE R TRUSTEE
DATE ISSUED: 01/04/2017
OWNER'S PHONE: 408-892-4880
PHONE NO: (408) 294-6290
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C-20 Lic. #258540
Contractor ATKINSON CLIMATROLLERS INC Date 12/31/2018
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 DUCT WORK
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 ofthe work for which this permit is issued.
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
permit is issued.
Sq. Ft Floor Area:
Valuation: $5500.00
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
369 34 033
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.
Additionally, the applicant understands and will comply with all non -point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 1/4/2017
Issued by: Abby Aygnde
OWNER -B lII D R DECLR TION
Date: 01/04/2017
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 (Scc.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 1/4/2017
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
s. I certify that in the performance of the work for which this permit is issued, I
Health & Safety Code, Section 25532(a) should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the
material. Additionally, should I use equipment or devices which emit hazardous
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:e, ` w,
222L
APPLICANT CERTIFICATION
Date: 1/4/2017
1 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 and state laws
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
relating to building construction, and hereby authorize representatives of this city
of work's for which this permit is issued (Sec. 3097, Civ C.)
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
and will comply with all non -point source regulations per the Cupertino Municipal
ARCHITECT'S DECLARATION
Code, Section 9.18.
1 understand my plans shall be used as public records.
Licensed
Signature Date 1/4/2017
Professional
AV 1f. � 0
a+'o4 - 00
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildintLna.cupertino.org
PLUMBING VfMECHANICAL ❑ELECTRICAL ❑MISCELLA
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENTlf CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME &{ _ e
LICENSE NUMBER ''% � ® LICENSE TYPPE
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PHONE
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BUS. LIC
COMPANY NAME
E-MAIL
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STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ZSFDorDUPLEX ❑ MULTI -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
TOTAL VALUATION:$ 0, � �f
RECEIVED BY-. -
By my signature bellow, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's be alf. 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/Agcnt:/ Date:
SUPPLEMENTAL INFORMATION REQUIRED
0MCE e ov
0 0, VER THE-C_QUNTRR
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MEPMiscApp_2011.doc revised 06/21/11
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC)
Project Name:
2016- 0442 Billie Cramb I Date Prepared:
CFIR-ALT 02-E
(Page 1 of 4)
2017-01-03
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
2016- 0442 Billie Cramb
02
Date Prepared
2017-01-03
03
Project Location
20090 La Roda Ct
04
Building Type
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
2016- 0442 Billie Cramb
SC System
SC System
CFA served
system a
Dwelling Unit Conditioned
Installing new SC
07
Zip Code
95014
08
Floor Area (ft)
2622
by this SC
ducted
containing
system
Number of Space
entirely new
09
Climate Zone';;
Name
10
Conditioning (SC) Systems in
1
component?
components?
feet of ducts?
duct system?
this Dwelling Unit:
Alteration Type
B. Space Conditioning (SC) System Information -_
01
02
03
9 04
05
`. .., 06 '
Oi
08
09
10
Is the SC,
lristalling•a
SC System
SC System
CFA served
system a
refrigerant
Installing new SC
Installing
Installing
Installing
Identification or
Location or Area
by this SC
ducted
containing
system
more than 40
entirely new
entirely new
Name
Served
System (ft2l
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
Entirely new or
complete
Replace Ductwork
Whole House
2622
Yes
No
No
Yes
Yes
No
replacement duct
system with or
without equipment
changeout
Registration Number: 217-A020000743A-000-000-0000000-0000
Registration Date/Time: 2017-01-03 12:01:56
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-01-03 12:02:10
Schema Version: rev 10/16
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)
This section does not apply to this project.
E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)1Diia and 150.2(b)1E, F)
01
02
03;.
04
05
06
07
08
09
10
11
Heating
Cooling
System
Heating
Minimum
Cooling
Minimum
Required
Identification or
Heating
Altered Heating
Efficiency
Efficiency
Cooling
Altered Cooling
Efficiency
Efficiency
Thermostat
New Duct
Name
System Type;':
Component', '
Type, .,..,
::: •Value
System Type
Component
Type _
Value
Type
R -Value
No heating
chis Held°.or
This fief! or
n - x
This field or
This field or
Replace Ductwork
Central gas
furnace
component ,
sectloh is
a
sect)on is i� t
Central split AC
:} �p coo%ng
altered
s Ctlt}{y Is,
,
not
section is
not
SetbackTher
mostat
R-6
altered
ncitompt5nent
applicable,,.:.,
appllcr�ble
°
applicable'
,,
applicable
Reauired Documentation: h
CF2R-MCH-01-E - Space Conditioning Systems
- Duct insulation requirement`for the new portions of supply -air and return -air ducts or plenums: R6 (CZ 1-10, 12 and 13) and R8 (CZ 11 and 14-16)
CF2R and CF3R-MCH-20-H Duct Leakage Test required
- Leakage rate compliance: <= 5%.
CF211 and CF3R-MCH-22 Fan Efficacy
CF211 and CF3R-MCH-23 Airflow Rate
Compliance:Fan Efficacy <= 0.58 W per cfm and System Airflow >= 350 cfm per ton.
Alternative Compliance: CF2R and CF3R-MCH-28 Return Duct Design verification is an alternative to MCH -22 and MCH -23 verification.
CF211 and CF3R-MCH-25-H Refrigerant Charge verification required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15).
Exceptions:
Heating -only systems are exempt from the 0.58 W per cfm and 350 cfm per ton requirements.
Note: An "entirely new or replacement duct system" means at least 75% of the duct system is new duct material, and up to 25% may consist of reused parts from the dwelling
unit's existing duct system (e.g.,
registers,
grilles, boots, air handler, coil, plenums, duct material) if the reused parts are accessible and can be sealed to prevent leakage
Registration Number: 217-A020000743A-000-000-0000000-0000
Registration Date/Time
2017-01-03 12:01:56
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-01-03 12:02:10
Schema Version: rev 10/16
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 3 of 4)
F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)1C)
This section does not apply to this project.
Registration Number: 217-A020000743A-000-000-0000000-0000
Registration Date/Time: 2017-01-03 12:01:56
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-01-03 12:02:10
Schema Version: rev 10/16
CERTIFICATE OF COMPLIANCE CFIR-ALT 0]4)
Alterations to Space Conditioning Systems (formerly CF -IR -ALT HVAC) (Page 4 of
Documentation Author's Declaration Statement
1.1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature: (?�% dy L/(GCfi/%LPJL
Faulkner; Cindy
Cl
Company:
Signature Date:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL
2017-01-03 12:01:56
Address:
CEA/ HERS Certification Identification (if applicable):
1171 NORTH 4TH STREET
City/State/Zip:
Phone:
SAN JOSE CA 95112408-294-6290
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 i ot.tbe; Business`'and, Professions Code to;acceptresponsibility 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'6a, of the California Code ofR� ulations
4. The building design features or system design features identified on this Certih&teof 6rnbliance are VonsistentwltVthe informal bn provided on othe'rap0')ica41e'compliance documents, worksheets,
calculations, plans and specifications submitted to the e'pforcementagency for approval W6 this builtfing perml`t application.
5. 1 will ensure that a registered copy of this Certificate of (l,mpliance shall lae Made a+aiiable%With the 4ullding permits}Jssded for -the buil¢€ng, and, made avajlable to,thd.enforcement agency for all applicable
inspections. I understand that a registered copy of this:CF fitificate of Compliance a required to be included.with the.docurreptatiort the builder provides to -The building owner at occupancy.
n
Responsible Designer Name:Responsible
Designer Signature.
Faulkner, Cindy
Company!
Date Signed:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL
2017-01-03 12:01:56
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: 217-A020000743A-000-000-0000000-0000
Registration Date/Time:
2017-01-03 12:01:56
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-01-03 12:02:10
Schema Version: rev 10/16
CERTIFICATE OF VERIFICATION
CF3R-MCH-20-H
Duct Leakage Diagnostic Test
Replace Ductwork
i
Project Name: 2016- 0442-BAi Cramb
Enforcement Agency:
Cupertino
City of
Permit Num er: B-201770011
Dwelling Address: 20090 La Roda Ct
Cit
Cupertino
Zip Code: 95014
i
A. System Information
{
01
Space Conditioning System Identification or Name
Replace Ductwork
i
02
Space Conditioning System Location or Area Served
Whole House j
03
Building Type from CF -1R
Single family
04
Verified Low Leakage Ducts in Conditioned Space (VLLDCS)
,
No, credit is not_ ,taken v
05
Credit from CF1R?
Total leakage
05
Verified Low Leakage Air Handling Unit (VLLAHU) Credit
No, .credit is not taken
07
from CF1R?
Heating system method
06
Duct System Compliance Category
Alteration using smoke test
MCH -20e - Sealing All Accessible Leaks using Smoke Test
B. Duct Leakage Diagnostic Test j
01
Condenser Nominal Cooling Capacity (ton)
0
02
Heating Capacity (kBtu/h)
87
03
Conditioned Floor Area served by this HVAC system (ft2)
2622
04
Duct Leakage Test Conditions
Test final
05
Duct Leakage Test Method
Total leakage
06--
Leakage Factor
0.15
07
Air Handling Unit Airflow (AHUAirflow) Determination
Method
Heating system method
08
Measured AHUAirflow
This field or section is not applicable
09
Calculated Target Allowable Duct Leakage Rate (cfm)
283
10
Actual Duct Leakage Rate from Leakage Test
Measurement (cfm)
387
Registration Number:
217-A020000743A-000-001-M20001A-M20A
CA Building Energy Efficiency Standards
2016 Residential Compliance
i
Registration Date/Time: 2017-01-18 16:45:46 HERS Provider: CaICERTS
Report Version: 2016.1.005 Report Generated: 2017-01-18 16:45:42
Schema Version: rev 03/16
CERTIFICATE OF VERIFICATION
CF3R-MCH-20-H
Duct Leakage Diagnostic Test (Page 2 of 3) 9
I
B. Duct Leakage Diagnostic Test
01
System was tested in its normal operation condition. No temporary taping allowed.
j
System passes using smoke test of an altered HVAC system in 'an existing building. No
Outside air (OA) duct connections to the central forced air duct system shall not be sealed/taped off during duct leakage
testing. OA ducts used for Central Fan Integrated (CFI) Indoor Air Quality ventilation systems, or Central Fan Ventilation
Cooling.Systems, that utilize dampers that open only when OA is required and automatically close when OA is not required,
may configure the OA damper to the closed position during duct leakage testing.
03
visible smoke exits the accessible portions of the duct system) Smoke is only emanating
04
Building cavities were not usedfas plenums or platform returns h lieu of ducts.
from air -handling unit (AHU) cabinet and non !accessible portions of the duct system. Note
11
Compliance Statement:
- Accessible is defined as having access thereto, but which first may require removal or
07
i
If the system complies using the Smoke Test method, the smoke test was conducted in accordance with the requirements
of Reference Residential Appendix RA3.1.4.3.6. Systems that comply using smoke test shall not be included in sample
groups for HERS verification compliance.
opening of access panels, doors, or moving similar obstructions. If access to the ducts
Verification Status::
Pass - all applicable requirements are met
requires an object to be demolished or deconstructed then sealing of those ducts is not
Correction Notes:
required j
i
12
Notes:
C. Additional Requirements for Compliance
01
System was tested in its normal operation condition. No temporary taping allowed.
02
Outside air (OA) duct connections to the central forced air duct system shall not be sealed/taped off during duct leakage
testing. OA ducts used for Central Fan Integrated (CFI) Indoor Air Quality ventilation systems, or Central Fan Ventilation
Cooling.Systems, that utilize dampers that open only when OA is required and automatically close when OA is not required,
may configure the OA damper to the closed position during duct leakage testing.
03
All supply and return register boots were sealed"tathe drywall.
04
Building cavities were not usedfas plenums or platform returns h lieu of ducts.
05
If cloth backed tape was used it was covered with Mastic and draw bands. r
06
All connection points between the air handler and the supply and return plenums are completely sealed.
I
07
i
If the system complies using the Smoke Test method, the smoke test was conducted in accordance with the requirements
of Reference Residential Appendix RA3.1.4.3.6. Systems that comply using smoke test shall not be included in sample
groups for HERS verification compliance.
08
Verification Status::
Pass - all applicable requirements are met
09
Correction Notes:
The responsible person's signature on this compliance document affirms that all applicable requirements in this table have
been met unless otherwise noted in the Verification Status and the Corrections Notes in this table.
D. Determination of HERS Verification Compliance
All applicable sections of this document shall indicate compliance with the specified verification protocol requirements in order
for this Certificate of Verification as a whole to be determined to be in compliance. j
! 01 1 Complies: All specified verification protocol requirements on this document arel met. j
Registration Number:
217-A020000743A-000-001-M 20001A -M 20A
CA Building Energy Efficiency Standards
2016 Residential Compliance
Registration Date/Time: 2017-01-18 16:45:46 HERS Provider: CalCERTS
Report Version: 2016.1.005 Report Generated: 2017-01-18 16:45:42
Schema Version: rev 03/16
i
CERTIFICATE OF VERIFICATION
Duct Leakage Diagnostic Test
CF3R-MCH-20-H
(Page 3 of 3)
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Verification documentation is accurate and
complete.
Documentation Author Name:
Documentation Author
�ignature:
David Garza
9)6w4d
Company:
Date Signed:
Elements - E3
2017-01-18 16:45:46
Address:
CEA/ HERS Certification
Identification (if applicable):
1718 Creek Drive
City/State/Zip:
Phone:
San lose CA 95125
408-634-6690
Resp-onsible Person'sDecla ation=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 Verification is true and correct.
2. 1 am the certified HERS Rater who performed the verification identified and reported on this Certificate of Verification (responsible rater).
3. The installed features, materials, components, manufactured devices, or system performance diagnostic results that require HERS verification
identified on this Certificate of Verification comply with the applicable requirements in Reference Appendices RA2, RA3, and the requirements
specified on the Certificate of Compliance for the building approved by the enforcement agency.
4. The information reported on applicable sections of the Certificates) of ltistallatiort (CF2R) iigjied and submitted by the person(s) responsible for the
construction or installation conforms to therequiremenisspecifigd.on the Certificate(s)of Compliance (CFIR) approved by the enforcement agency.
5. 1 will ensure that a registered copy of this Certificate of Verification thall be posted; or made available with the building permit(s) issued for the
building, and made available to tie enforcementagency for all applicable inspktions. I understand that a -registered copy of this Certifcate,of
Verification is, required to be included with the documentation the builder provides to the building owner at occupancy.
Builder Or Installer Information As Shown On The'Certfficate Of Installation 'l
i
Company Name (Installing Subcontractor, General Contractor, or Builder/Owner):
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL
Responsible Builder or Installer Name:
CSLB License:
j
Cindy Faulkner
258540
I
HERS Provider Data Registry Information
Sample Group Number (if applicable):
Dwelling Test Status in Sample
Group (if applicable)
Tested
--HEIS Rater Information -
HERS Rater Company Name:
Elements - E3
Responsible Rater Name:
Responsible Rater Signature:
9)6WZ�
David Garza
Responsible Rater Certification Number w/ this HERS Provider:
Date Signed:
CC2016094
2017-01-18 16:45:46
I�I
Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered r ocument, and in noway implies
Registration Provider responsibility for the accuracy of the information.
I
Registration Number: Registration Date/Time: 2017-01-18 16:45:46 HERS Provider: CaICERTS
217-A020000743A-000-001- M 20001A -M 20A
CA Building Energy Efficiency Standards Report Version: 2016.1.005 Report Generated: 2017-01-18 16:45:42
2016 Residential Compliance Schema Version: rev 03/16