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B-2017-0012CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2017-0012 22250 HOMESTEAD RD CUPERTINO, CA 95014-0115 (326 51 003) ATKINSON CLIMATROLLERS INC SAN JOSE, CA 95112 OWNER'S NAME: CHEN XIAODA AND YAO HUI DATE ISSUED: 01/04/2017 OWNER'S PHONE: 408-306-3918 PHONE NO: (408) 294-6290 LICENSED CONTRACTOR'S DECLARATION Au ATION 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 FURNACE (SAME LOCATION) I hereby affirm under penalty of perjury one of the following two declarations: t. 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 �a - performance of the work for which this permit is issued. 2. 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: $4000.00 APPLICANT CRTIFI ATION 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 APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 326 51 003 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 Cs Date 1/4/2017 Issued by: Abby Ayende - OWNER -BUILDER DECLARATION 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 (Sec.7044, Business ,& Professions Code) z. 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: 1/412017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. 1 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(a) 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: cj✓ - ts'� 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 DECLARATION I understand my plans shall be usseded a as public records. Code, Section 9.18. Licensed Signature Date 1/4/2017 Professional • GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 misc (408) 777-3228 • FAX (408) 777-3333 • building�cugertino.org ❑PLUMBING .Y (MECHANICAL ❑FLF,CTRTCAL nNtlscF.I.I.ANF.0IIc PROJECT ADDRESStr(om'Ves-") , APN# 1bZtp 1S A 003 OWNERNAME CAL A lip PHONE OlT--MAIL ADDRESS j I CTiY, STATE, ZY1 �> FAX CONTACT NAXIE q i " PHONEf pI i1 G- E MAII, _ / JCIA l� „ I Val � C ( STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER BUILDER ❑ OWNERAGENIIT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME / p a LICENSE NUMBER j `bl^ LICENSE TYPE( fSo BUS. LIC # I `-G(' COMPANY NAME I. d �v �. �- ��o �r � E-MAIL, 1 Q _ A ;r � a;1 P % o FAX o vi,, j 557 STREET ADDRESS r 1 - i/V ��� e CITY, STATE "P -) "S' / ((( ��q PHONE (:J f� %f ),� ,% Y� -G ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF FD m DUPLEX ❑ MULTI -FAMILY BUILDING: ❑ COMMERCIAL PROJECT IN WBALAND ❑ YES I URBAN INTERFACE AREA ❑ NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES ❑ NO /EICHLERHOME? + DESCRIPTION OF WORK r� L J lo�+/ o &d 1 TOTAL VALUATION: 0 ®" 0 V RECEIVEDBY: aw 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 b6half 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 uthonze representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: G % /3z 17 SUPPLEMENTAL INFORMATION REQUIRED OMCE USE ,ONLY ,. OVER-THE-COUNTER � A. Q EXPRESS ©s~�`ANntilut ©�,AxtG1� MEPMiscApp_201 1. doe revised 06/21/11 y C�0 '% CERTIFICATE OF COMPLIANCE Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) Project Name: 2016- 0421 Allen Chen] Date Prepared: CFIR-ALT-02-E (Page Icf 3 ) 2016-12-22 A. General Information |�tomu�ip|espacecon�dioninQsystennocontainadvv�hinasingle dxveU|ngun�.VVhenmu�in|edvx�Ungundsmnustbedocumented, CRR-ALT use one CF1R-ALT-O2document for each dwelling unit. 01 Project Name 2016- 0421 Allen Chen — 22250 Homestead Rd 02 Date Prepared 2016-12-22 04 Building Type Single family 03 Project Location Cupertino 06 Dwelling Unit Name 2016- 0421 Allen Chen 05 CA City 95014 4 08 Dwelling Unit Conditioned 1 Floor Area W) 1400 07 Zip Code 10 1 Number of space conditioning (SC) systems in this dwelling 1 — 09 Climate Zone B. Space Conditioning (SC) System Information 01 02 03 0:4 08 1 09 10 SC System Identification or Name SC System Location or Area Served CIA served by this SC System (ft2) Q–s Fst ducteld system? nt Furnace replacement whole house 1400 Yes C.Extension mf Existing Duct System, Greater Than 40 Feet This section does not apply to this project. Registration 2016-12-22 16:49:20 HERS p�wdecCa�EnTS Registration Number: CABuilding Energy Efficiency Standards -2o13Residential Compliance Report Version: zO13Rev 1.no8 Report Generated: zV16-1Z-2Z 16:49:16 Schema Version: O.5sssoo 07 08 1 09 10 71 nt containing system more than 40 entirely entirely new component? components? feet of ducts? duct system? SC system? Alteration Type -T Altered space No Yes No No No 1conditioning system C.Extension mf Existing Duct System, Greater Than 40 Feet This section does not apply to this project. Registration 2016-12-22 16:49:20 HERS p�wdecCa�EnTS Registration Number: CABuilding Energy Efficiency Standards -2o13Residential Compliance Report Version: zO13Rev 1.no8 Report Generated: zV16-1Z-2Z 16:49:16 Schema Version: O.5sssoo 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) O1 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 No cooling This field or This field or This field or This field or Furnace Central gas heating AFUE 80 No cooling component section is not section is not Setback section is not section is not replacement furnace components altered applicable applicable applicable applicable Reauired 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: 515%, or 510% 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 �t 300 CFMJton required when MCH -25 is required. Exceptions: -Duct systems registered with HERS provider as previously sealed are exempt from MCH -20 Duct Leakage.Tesbng requirements._ -Heating-only systems and Air Handler/Furnace changes do not require verification'of Air Flow MCH-23,,`or Refrigerant ChatSe MECH=25. -Existing duct systems constructed, insulated or sealed with asbestos are exempffrom MCH -20 Duct Leakage Testingrequiremehfs. E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)lDiia 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-A0474640A-000000000-0000 Registration Date/Time: 2016-12-22 16:49:20 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-12-22 16:49:16 Schema Version: 0.555SDD CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E Alterations to Space Conditioning Systems (formerly CF -1R -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: (?�y,/!2P/t� Faulkner, Cindy Company: Signature Date: ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL 2016-12-22 16:49:20 Address: CEA/ HERS Certification Identification (if applicable): 1171 NORTH 4TH STREET City/State/Zip: Phone: SAN JOSE CA 95112 408-294-6290 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 3 of the rBusiness 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 6ofthe California Code of Regulations. 4. The building design features or system design features identified on this Certificate of Compliance are'consistenf with the information provided on other applicable 'Compliance documents, worksheets, calculations, plans and specifications submitted to the a iforcementagency for approval with this building permit application. 5. 1 will ensure that a registered copy of this Certificateepf Compliance shall be made available with the bulldlrig permitts) issued for:the:building, and made availabletothe,enforcement agency for all applicable inspections. I understand that a registered copy of this Certificate of Compliance is.required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Designer Name: Responsible Designer Signature: .; Faulkner, Cindy Company: Date Signed: ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL 2016-12-22 16:49:20 Address: License: 1171 NORTH 4TH STREET 258540 City/State/Zip: Phone: SAN JOSE CA 95112 408-294-6290 Digitally signed by Ca10ERTS. 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-AO47464OA-000000000-0000 Registration Date/Time: 2016-12-22 16:49:20 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-12-22 16:49:16 Schema Version: 0.555SDD