B-2017-0246CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT_ NO:
B-2017-0246
10250 S FOOTHILL BLVD APT B CUPERTINO, CA (357 03 053)
RANDO AAA HVAC
INC
JOSE, CA 95125
1SAN
OWNER'S NAME: PARK KEE W AND JIN O
DATE ISSUED:
02/10/2017
OWNER'S PHONE: 408-398-0522
PHONE NO: (40
) 293-4717
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C-43 Lic. #768871
Contractor BANDO AAA HVAC INC Date 09/30/2017
X BLDG _ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
X MECH X RESIDENTIAL — — CO
.
RCLAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
(E) FURNACE - ATTIC
I hereby affirm under penalty of perjury one of the following two declarations:REPLACE
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: $4800.00
APPLICANT CERTIFICATION
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
357 03 053
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
ORK IS NOT STARTED
may accrue against said City in conseqpacof the granting of this permit.
Additionally, the applicant underst�ad"a ill comply with all non -point
WITHIN 180 DAYS OF PERMIT
ISSUANCE OR
source regulationsper the C i -Municipal Code, Section 9.18.
180 DAYS FROM LAST
CALLED INSPECTION.
.Signature Date 02/10/2017
Issued by: Kim Dunbar
OWNER -BUILDER DECLARATION
Date: 02/10/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
RE -ROOFS:
All roofs shall be inspected prior to any r
fing 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,
inspection.
I agree to remove all new materials for
compensation, will do the work, and the structure is not intended or offered for
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: 02/10/2017
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO
L 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. 1 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.
I in for is issued, I
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
�
Health & Safety Code, Section 25532() should I store or handle hazardous
s. certify that the performance of the work which this permit
material. Additionally, should I use equt went 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 � ea Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the Cupe lino Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Seel 2550&25513, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall _
be deemed revoked. (�
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 02/10/2017
1 certify that I have read this application and state that the above information is
CONSTRUCTION I1ENDING AGENCY
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
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
SiSignature Date 02/10/2017
9
Professional
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - building@cuperfino.oW
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STRUCTURE.: El Commercial
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DESCRIPTION OF WORK
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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 I behalf. J have read this
application and the information I baYA-Provided is coiTeci. 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 4 bu i constructio, I a thoric representatives ofCupcifino to enter the above, 'd tiped prop4liy for inspection purposes.
Signature ofApplicant/Agent: �= Iff Date:
SUNtEMENTAL INFORMATION REQUIRED
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MEPMiscA,6p 2017.doc revised 03116111
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CERTIFICATE OF COMPLIANCE
CFIR-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT HVAC) (Pagel of 3) 1
Project Name:
KEE PARK I Date Prepared:
2017-02-09
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
CF111-ALT-02 document for each dwelling unit.
01
Project Name
KEE PARK
02
Date Prepared
2017-02-09
03
Project Location
10250 S. FOOTHILL BLVD
04
Building Type
Multi -family
05
CA City
Cupertino
06
Dwelling Unit Name
KEE PARK
SC System
SC System
CFA served
system a
Dwelling Unit Conditioned
Installing new SC
07
Zip Code
95014
08
Floor Area (ft)
1200
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
07
08
09
10
Is the SC
Installing 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 (ftZ)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
CARRIER
WHOLE HOUSE
1200
Yes
No
Yes
No
No
No
Altered space
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b)1Diib)
This section does not apply to this project.
Registration Number: 217-A020045263A-000-000-0000000-0000
Registration Date/Time: 2017-02-09 13:20:00
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-02-09 13:20:18
Schema Version: rev 10/16
Wi
r
CERTIFICATE OF COMPLIANCE CFIR-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -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
Central gas
Gas furnace
Central split
No cooling
This field or
This field or
This field or
This field or
CARRIER
furnace
AHU
AFUE
81
AC
component
section is not
section is not
Setback
section is not
section is not
altered
applicable
applicable
applicable
applicable
Required 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-2S-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, or Refrigerant Charge MCH -25:
-Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCN-20Duct 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-A020045263A-000-000-0000000-0000 Registration Date/Time: 2017-02-09 13:20:00 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-02-09 13:20:18
Schema Version: rev 10/16
r�
CERTIFICATE OF COMPLIANCE CFIR-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:
�j
Documentation Author Signature:/e�1
Rando, Eric
Company:
Signature Date:
RANDO AAA HVAC INC
2017-02-09 13:20:00
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 land Part 6 of the California Code of Regulations.
4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on otherapplicable compliance 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 shall be made available with the building permit(s) issued 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 required to be included with the documentation the builder provides two the building owner at occupancy.
Responsible Designer Name:
Responsible Designer Signature:
Rando, Eric
Company:
Date Signed:
RANDO AAA HVAC INC
2017-02-09 13:20:00
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 Provider
responsibility for the accuracy of the information.
Registration Number: 217-A020045263A-000-000-0000000-0000 Registration Date/Time: 2017-02-09 13:20:00 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-02-09 13:20:18
Schema Version: rev 10/16