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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'