B-2017-0147CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0147
10146 CARMEN RD CUPERTINO, CA 95014-2760 (357 09 061) RANDO AAA HVAC
INC
SAN JOSE, CA 95125
OWNER'S NAME: MARSEILLES SBIRLEYATRUSTEE DATE ISSUED: 01/26/2017
OWNER'S PHONE: 408-202-6733 PHONE NO: (408) 293-4717
LICENSED CONTRACTOR'S DECLARATION BUILDING PERNHT INFO:
License Class C20 C43 Lic. #768871
Contractor RANDO AAA HVAC INC Date 09/30/2017 X BLDG —ELECT _ PLUNIB
X MECH X RESIDENTIAL _ 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
license is in full force and effect. JOB DESCRIPTION:
REPLACE FURNACE W/DUCT WORK - GARAGE
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.
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: $6500.00
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 357 09 061
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 – IT ISSUANCE OR
Additionally, theme�. licant understands and will comply with all non -point
sourcereg auTtions p r the upertino Municipal Code, Section 9.18. 180 DAYS F 1 1 zsiu D INSPECTION.
`Signature% Date 01/26/2017 Issued by:
Date: 01/26/2017
OWNER -BUILDER DECLARATION
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)
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: 01/26/2017
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
s. 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 & Saf sle Sections 255 , 5533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or auth rized agent: on
APPLICANT CERTIFICATION Date: 01/26/2017 ;
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct. I agree to comply with all city and county ordinances and state laws 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 01/26/2017 Professional
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, EA. 95014-3255
(408) 777-3228 • FAX, (408) 777-3333 • bWIdlnq((7)cupertino.org misc
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USE OF SFD or Duplex ❑ Multi -Family
STRUCTURE: ❑ Commercial
PROJECT IN WILDLAND
URBAN INTERFACE AREA ❑ Yes ❑ No
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FLOOD ZONE ❑ Yes ❑ NO
DESCRIPTION OF WORK
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TOTAL VALUATION:
By signature below, I certify to each of the following:; I am the property owner or authorized agent to act on the property owner's behalf. I have read this
is correct I have read the Description oi'Work and verify it is accurate, I agree to comply with. all applicable Iocal
application and the information I havMil�dg
ordinances and state laws relating tomtructlooA I a _ ize representatives of Cupertino to enter the abovjje��-id •ntified roperiy for uispection purposes.
Signature of ApplicantlAgent: Date: tJ
SUPPLEMENTAL INFORMATION REQUIRED
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CERTIFICATE OF COMPLIANCE CF111-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 1 of 3)
Project Name: STACEY HOWARD Date Prepared: 2017-01-06
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
STACEY HOWARD
02
Date Prepared
2017-01-06
03
Project Location
10146 CARMEN ROAD
04
Building Type
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
STACEY HOWARD
SC System
SC System
CFA served
system a
Dwelling Unit Conditioned
Installing new SC
07
Zip Code
95014
08
Floor Area (ftZ)
2053
by this SC
ducted
containing
system
Number of Space
entirely new
09
Climate Zone
4
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
04
05`
06
67'
08
09
10
Is the SC
Installirig,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 (ft)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
Altered space
TRANE
WHOLE HOUSE
2053
Yes
No
Yes
Yes
No
No
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)1Diib)
This section does not apply to this project.
Registration Number: 217-A020024284A-000-000-0000000-0000 Registration Date/Time: 2017-01-06 11:28:52 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1:005 Report Generated: 2017-01-06 11:29:11
Schema Version: rev 10/-16 - --
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4
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CERTIFICATE OF COMPLIANCE CF1R-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)
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
TRANE
Central gas
Gas furnace
AFUE
81
Central split
No cooling
component
This field or
section is not
This field or
section is not
Setback
Greater than
R-6
furnace
AHU
AC
altered
applicable
applicable
40 feet
Reauired Documentation:
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 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 and CF3R-MCH-25-H Refrigerant Charge verification required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15).
CF2R and CF3R-MCH-23 Airflow Rate >= 300 CFM per 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,:orRefrigeraht Ch : MCH=25..
-Existing duct systems constructed, insulated or sealed with asbestos are exempt.from MCH-20'Duct Leakage Testing requirements.
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: 217-A020024284A-000-000-0000000-0000
CA Building Energy Efficiency Standards - 2016 Residential Compliance
Registration Date/Time: 2017-01-06 11:28:52
Report Version: 2016.1.005
Schema Version: rev.10/16
HERS Provider: CaICERTS
Report Generated: 2017-01-06 11:29:11
h,
I
CERTIFICATE OF COMPLIANCE CF111-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -IR -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:j`'�Ff�G6t�0�
Rando, Eric
Company:
Signature Date:
RANDO AAA HVAC INC
2017-01-06 11:28:52
Address:
CEA/ HERS Certification Identification (if applicable):
1712 STONE AVENUE
N/A
City/State/Zip:
Phone:
SAN JOSE CA 95125
408-293-4717
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 Code of Regulations.
4. The building design features or system design features identified on this Certificate of Corripliance are:consistent.witli the information provided on 6th erapplicable`co'mpliance documents, worksheets,
calculations, plans and specifications submitted to the enforcement.agency for approval with,this building permit application.
S. I will ensure that a registered copy of this Certificate of,Compliance shail:,be made"available'with the building permit(s)Jssued for the building, and,.made available to the;enforcement agency for all applicable
inspections. I understand that a registered copy of this,Certificate of Compliance is regyired to be,included with the documentation the builder provides to the building owner at occupancy.
Responsible Designer Name:
Responsible DesignerSignature:
Rando, Eric
Company:
Date Signed:
RANDO AAA HVAC INC
2017-01-06 11:28:52
Address:
License:
1712 STONE AVENUE
768871
City/State/Zip:
Phone:
SAN JOSE CA 95125
408-293-4717
Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered document, and in noway implies Registration Providerresponsibility for the accuracy of the information.
Registration Number: 217-A020024284A-000-000-0000000-0000
Registration Date/Time: 2017-01-06 11:28:52
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-01-06 11:29:11
- - - - --Schema Version: rev 10/16--