B-2017-0389U
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:.
CONTRACTOR:
PERMIT NO: B-2017-0389
10362 NOEL AVE CUPERTINO, CA 95014-1231 (326 47 047)
THERMA TECH INC
SAN JOSE, CA 95125
OWNER'S NAME: GUTIERREZ PETER P AND KATHLEEN S TRUSTEE
DATE ISSUED: 03/09/2017
OWNER'S PHONE: 408-257-7339
PHONE NO: (408) 629-5400
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C --2Q Lic. #913806
Contractor THERMA TECH INC Date 04/3012018
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; INSTALL (N AC UNIT
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.
%z I have and will maintain Worker's Compensation Insurance, as provided for by
�n Section 3700 of the Labor Code, for the performance of the work for which this
Sq. Ft Floor Area:
Valuation: $13000.00
permit is issued.
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
326 47 047
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.
�1 ��t
,SignatureyV1�� Date 3/9[2917
Issued by: Abby43&nde
Date: 03/09/2017
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 ifor '
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: 3/9/2017
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
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
�fl^ j
be deemed revoked.
'y' O `�V,.
Owner or authorized agent:
c
APPLICANT CERTIFICATION
Date: 3/9/2017
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
1 understand my plans shall be used as public records.
Code, Section 9.18.
Licensed
Signature Date 3/9/2017
Professional
t_
GENERAL PERMIT APPLICATION I MEP
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.org
MISC
PROJECT ADDRESS gym rgyl _^ n , D -c 1 a APN # 52 / _ / 1,q- 0 / I
OWNERNAI��i%I Ic 1�iI� l?is�YY6cYl6 PHONE /6���fA�;[�
"[ V
STREET ADDRESS a g {, ;ry� L �, �,� CITY, STATE, ZIP _ /mac:^' fy 1 FAX
CONTACT NAME PHONE E-
1 P11 A lett - (02cl -151 c "Lr
STREET ADDRESS rI i� _ ` CITY, STATE, ZIP cl __ �^ ry ®� C n Is
C €�s Ft y ���
'OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ CA
i ❑ ENGINEER `G❑ DEVELOPER ❑. TENANT
C N'rRACTOR NAME C -01
LICENSE NUMBER ib� U 4 �LSICe SEgT��E r BUS. LIC
COMPANY NAME �-9-� E-MAIL `G ' 1 i 8 U FAX
r ` -eCil �1 Vl c_ ttee^Iyt a-Tcct� ad im• co C(o v4-2-' �
STREET ADDRESS CITY, STATE, ZIP PONE
� ��1 Wi t ► I,s e is 05 b � (0 t5j 0
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC #
I' COMPANY NAME I E-MAIL I FAX I
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD.r DUPLEX ❑ MULTI -FAMILY
PROJECT IN WH,DLAND
❑ YES
PROJECTEl YES
IS THE BLDG AN ❑ YES
BUILDING: 1-1COMMERCIAL
URBAN INTERFACE AREA
El NO
ON
FLOOD ZONE ❑ NO
I
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK � _ A 4 a n .„
s,.., „ace
av d
ad (h 0 A
TOTAL VALUATION: RECEIVED
Ilk 15 i
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property own is beh if 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 constructiion.—I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: l /t/ 'r—i Date:
SUPPLEMENTAL INFORMATION REQUIRED nF FrrF .ls ONLY.
MEPMiscApp_2011.doc revised 06121/11
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF-lR-ALT-HVAC} (Page I of 3)
Project Name: Kathleen Gmble Date Prepared: 2027-03-07
A. General lnforffatlon
CF1R-Al-T-02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented., use one
CFIR-ALT-02 document for each civielfing unit,
01
Project Name
..........
Kathleen Gmble
02
Date Prepared
2017-03-07
03
Project Location
10362 Noel Ave
04
Building Type
Single family
05
.
CA City
. . . ................. 4-UHHHHHHHHM
Cupertino
06
Dwelling Unit Name
Kathleen Gmble
Installing
Installing
Identification or
Dwelling Unit Conditioned
by this SC
07
Zip Code
95014
08
Floor Area (ft)
2080
Name
Served
system (ft2)
Number of Space
component?
FO9
Climate Zone
4 y.
10
Conditioning (SC) Systems in
1
4
this Dwelling Unit,
f bn 4`0
B. Space Conditioning ormaill
oning (SQ System It_,
01 02 03 04 n 05 06 07 08 9 10
the S16
Ins,t, a I I J
t77
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 (ft2)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
Altered space
System 1
Location 1
2080
Yes
Ye. s
Yes
Yes
No
No
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (SeCtlon150.2(b)1Dl1b)
This section does not -apply to this project.
Registration Number: 217-AO20073204A-000-000-0000000-0000 Registration Date/Time: 2017-03-07 07:55,46 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards- 2016 Residential Cornpliance Report Version- 2016.1.005 Report Generated: 2017-03-07 08:00:40
I n1l r-
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-AO20073204A-OC)MOO-0000000-(3GOO
CA Building Energy Efficiency Standards - 2016 Residential Carnpliance
Registration DateJTime: 2017-03-07 07:55:46
Report Version: 2016.1.005
1 nllr-
HERS Provider: CaICERTS
Report Generated: 2017-03-07 08:00:40
CERTIFICATE OF COMPLIANCE
CF111-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF-lR-ALT-HVAC}
(Page 2 of 3)
D. Altered Space Conditioning System (Sections 150.2(b)IE and F}
01
02
03
04
05
06
07
08
09
10
11
12
Heating
Cooling
System
Identification
Heating
Altered
Heating
Minimum
Altered
Cooling
Minimum
Required
New or
or Name
System
Type
Heating
Components
Efficiency
Type
Efficiency
Cooling
Cooling
Eff lciency
Efficiency
Thermostat
Replaced
New Duct
Value
System Type
Components
Type
Value
Type
Duct Length
R -Value
System I
Centralgas
furnace
All new,
heating
AFUE
96
Central split
All ne,
cooling
SEER
16
Setback
Greater than
. . . ..............
cc rnponents
AC
components
40 feet
R-6
. .............
Re -TU& e_CLD___ L-1 in,
MR -MCH -01 -E - Space Conditioning Systems
- Duct insulation requirement for the new portions of supply -air and return -air ducts or plenums, R6 (CZ 1-30',12 and 13) and R8 fCZ 31 and 14-161
CF2R and CF3 R—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 MR-MC4-25-14 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.
KxS90tia—WK
Duct systems registered with HERS provider as previously sealed are exempt from,MCJJA-20 Duct Leakage Testing reqyiperriepts,,
Heating -only systems and Air Handler Furnace changes do not require rigarant Cha MC
-everificatt'666 14" 25
-Existing duct SySteMS constructed, insulated or sealed with a5best5s,are exem, from NICI L ge Testrl7g gquiremer is'
,
V
E. Entirely New or Complete Replacement Duct to it m, with or without,,Equipment Chpingeout (Sections, A0.2(b) 113ii a,,.a nd,,150.2(b)IE, F)
�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-AO20073204A-OC)MOO-0000000-(3GOO
CA Building Energy Efficiency Standards - 2016 Residential Carnpliance
Registration DateJTime: 2017-03-07 07:55:46
Report Version: 2016.1.005
1 nllr-
HERS Provider: CaICERTS
Report Generated: 2017-03-07 08:00:40
CERTIFICATE OF COMPLIANCE CFIR-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:
Ella, Henry
Docurnentation Author Signature:
4,ecr
Company:
Signature Date:
THERMA TECH INC
2017-03-07 07:55:46
Address:
CEA/ HERS Certification Identification (if applicable):
1224 Reno Ave Suite P
------------
City/State/Zip;
..........
Phone:
Modesto CA 95351
209-571-5400
Responsible Person's Declaration statement
I certify the following under penalty of perjury, tinder the laws of the State of California:
11 The information Provided an this Certificate of Compliance is true and correct.,
21 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 energVfeatures and performance specifications, materials, components, and M.,anufactul-ed devices forthe building design ors stem design identified on thIsCertificate ofComplia ce co f rm to the
requirements Title 24, Part I Part qvw-
of and 6 of the California Code of =x fens
4. The building design features or system design features identified orf is Certi-19bfrn�hance are .,6risistAwitAhe Mbtiler OPPfica4le compliance documents, worksheets,
rovided o
calculations, plans and specifications submitted to the gra tarcent-n V this bujl� ng"'
p(q pernyt app. Iration,
5, 1 will ensure that a registered copy of this CerflfiraN,
n
11 n i�ail g pl -t h forcement agency for all applicable
inspertirns. I understand that a registered copy of 11 s, icat ofCompliance-isieclu to ncluded v -4th the,docurnqjp [on.—tle,Wrld
10, budder 0,ie building
'T es tg_
W R�q, owner at Occupancy.
Responsible Designer Name: 4,
7 777,
Responsible Designer Signature. r.:"
Esta
Elia,,Henry
Company:
Date Signed:
THERMA TECH INC
2017-03-07 07:55:46
Address:
License:
1224 Reno Ave Suite P
913806
C.Ity/State/Zips
phone:
Modesto CA 95351 . .... ..... ...... . 1209-571-5400
Digitally signed by CalCERTIS. This digital signature is provided in order to secure the content of this registered document, and in no way implies Registration Provider
responsibility for the accuracy of the information.
Registration Number., 217-A920073204A-000-000-OC)000O0-Orjoo Registration Date/Time: 2017-03-07 07:55:46 HERS Provider: CaICERTS
CA Building Energy Efliciency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-03-07 08:00:40'