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B-2017-0552
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0552 11057 FLOWERING PEAR DR CUPERTINO, CA 95014-0492 (323 45 039) ATKINSON CLIMATROLLERS INC SAN JOSE, CA 95112 OWNER'S NAME: OLSSON FREDRIK KAND JEANETTE DATE ISSUED: 04/07/2017 OWNER'S PHONE: 408-799-5976 PHONE NO: (408) 294-6290 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B C20 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); ADD (I) A/C TO SIDE I hereby affirm under penalty of perjury one of the following two declarations: YARD 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 Section 3700 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: Valuation: $8166.00 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 323 45 039 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. WITffiN 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 ED INSPECTION. Signature G�/�i /X/ iii Date 04/07/2017 Issued by: MELISS OWNER -BUILDER DECLARATION Date: 04/07/2017 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 m. 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: 04/07/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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. HAZARDOUS MATERIALS DISCLOSURE z. 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 wiH 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, t/� APPLICANT CERTIFICATION Date: 04/07/2017 I certify that 1 have read this application and state that the above information is CONSTRUCTION LENDING 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 of work's for which this permit is issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city 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 AR DECLARATION ARCHITECT'S and will comply with all non -point source regulations per the Cupertino Municipal I understand my plans shal1l1 bbe e used a as public records. Code, Section 9.18. Signature Date 04/07/2017 9 Licensed Professional COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION . � I 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 1 (408) 777-3228 • FAX (408) 777-3333 • building0cupertino.org CUPERTINO�a aa �- MISC 2-0/7-. a 515'-zZ nPLUMBING I IMECHANICAT. I IFTPCTRICA I IA4KI'MT ATTUTATTe PROJECT ADDRESS �"" �1� APN# —S9�I Y5 ✓ O'%3 G• OWNERNAME PHONE E -MA STREET ADDRESS I Ikq.f fWACITY, STATE, ZI FAX ��✓ �pW�laU insCIA CONTACT NAME ) �J pfd /j , //y ' \ /- ,? ,A+ -, _ --- —� PH (� (! "` i✓1 E-MAIL moi` 05P—L 41 6 - STREET ADDRESS n — CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT >: CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT 1 CONTRACTOR NAME V/"tJj �j r LICENSE NUMBER S P7� LICENSE PE BUS. LI(' ' a�d -3 COMPANY NAME ,9 / / E-MAIL sc— FAX STREET ADDRESS 4. CITY, STATE, ZIP 4., PHONE / `® ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC #" COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEXMULTI-FAMILY BUILDING ❑COMMERCIAL �aLe 0` -+--WA PROJECT IN WILDLAND 57S AN INTERFACE AREA ❑ NO PROJECT IN FLOOD ZONE ❑ YES ❑ NO IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO DESCRIPTION OF WORK adz TOTAL VALUATION: By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the prope er's be ave read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. o comply with all applicable local ordinances and state laws relating to b ilding co struction. I a orize representatives of Cupertino to enter the a o e -identified property for inspection purposes. Signature of ApplicantJAgent: __o �J Z 74 - " Date: C / / 1 7 SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY D OVER-TH&COUNIER a< ❑ EXPRESS ca --- - ©- S'FhTV7i.A ID ©=1ARcx © AOR MEPMiscApp_201 Ldoc revised 06/21/11 -y 000 COI'-AMUNITY MANAGEMENT SERVICES, INCORPORATED March 31, 2017 Fredrik and Jeanette Olsson 11057 Flowering Pear Drive Cupertino, CA 95014 Re. Cupertino Countrywood Homeowners Association Dear Mr. & Mrs. Olsson, The Cupertino Countrywood Homeowners Association has approved your architecturat request to install an air conditioner condenser unit on the a/c slab by the front door of your residence, subject to the following conditions: I The installation being performed by a licensed contractor. (Valley Heating, license #258540 was noted on your request.) 2. Any necessary City of Cupertino permits being obtained. 3 Any damage or maintenance resulting from the air conditioner installation being your responsibility to repair. 4. Any exposed plumbing and electrical lines being enclosed in a duct that is painted to match the building. 5.: The air conditioner being a very quiet model compatible for a townhouse community, city noise ordinances, and close proximity of neighboring residences. (Model #EL I 6XC 1 -024. 71 DB was noted on your request.) Thank you for submitting your architectural request to the Board of Directors. It is suggested that you keep this approval letter for your records and disclosure purposes. If you have any questions, please contact me at (408) 559-1977. Sincerely, Community Management Services, Inc, Teresa Mezzatesta, Administrative Assistant for Bob Soares, Senior Association Manager Cupertino Countrywood Homeowners Association cc: Board of Directors 1935 Dry Creek Road, Suite 203 9 Campbeil CA * 95008-3631 * voice (408) 559-1977 * fax (408) 559-1970 CERTIFICATE OF COMPLIANCE CFiR-ALT 02-E Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Pagel of 3) Project Name: 2016- 0642 Fred Olsson I Date Prepared: 2017-04-06 1 A. General Information CF111-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 2016- 0642 Fred Olsson 02 Date Prepared 2017-04-06 03 Project Location 11057 Flowering Pear Drive 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name 2016- 0642 Fred Olsson Dwelling Unit Conditioned 07 Zip Code 95014 ®B F1oorArea (ft2) 1400 Z ,,, 31E'`i Number of Space SC System 09 Climate Zona 4 „e 10 Conditionin g SC ( ) Systems in 1 LU Installing Installing Identification or this Dwelling Unit: by this SC ducted containing system more than 40 entirely new entirely new B. Space Conditioning (SC) System Irjlforrna#ion l; it 1 !, �i Irn 01 02m' . 03 ii1`�l 04 05 06 " 07'> 08 'i)9 /J 11 i.the SCi Istalla ,,, 31E'`i 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 Furnace Altered space replacement add whole house 1400 Yes Yes Yes No No No conditioning system A/C C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)1Diib) This section does not apply to this project. 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Documentation Author Name: Documentation Author Signature: G / �fUGIXi�/%1P/L Faulkner, Cindy O Company: Signature Date: ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL 2017-04-06 13:15:31 Address: CEA/ HERS Certification Identification (if applicable): 1171 NORTH 4TH STREET City/State/Zi p: Phone: SAN JOSE CA 951.12 408-294-6290 lZ Responsible Person's Declaration statement,, I certify the following under penalty of perjury, under thel' ofthe State of California: 1. The information provided on this Certificate of Compliance is true and correct. 2. 1 am eligible under Division 3 Othe Business and Professors Code to,accept:responsfbfrityfor the building design or system design identified on this Certificate of Compliance {responsible design 3. That the energy features and performance specifications, materials, components and manufactured devices far t;he bu€ld€ng design or system design identif ed on this Certificate of Compliance c rm the ,�,: is requirements of Title 24, Parti 1 and PaitE 6,of the California Code of Regulatrons. s' jP f i i1; I' € c 1 f,�, Es; f ,.E s€ _ r 4. The building design features or system 06sign features Identified oriL his Certiefhfeof <%pr l fiance areean isterEtwith the igl armal:pni frov>ded ortoth rap} €icabid cdmpl€ance documents, worksh s,` Ir" 4i #. calculations, plans and specifications submitted to #ie enfprcementlagency foria`pprovaliwith this bu€Id3Ing permit apo-catich. S. I will ensure that a registered copy otthis Certificat iq# Coi7lpliance sl7 ll t!inracle iiai[able Wi h,ttse bulWIh; 0,perm€t(sj,.issued forth iiuildl fig, and naCEe aval able ip3l hie!,pnforcement agency fo inspections. I understand that a registered copy ofthlgsiE' lijlif irate of Co npliance s req to beginduded with thea dgcumer4>atior the [i l er p Guides tq,,rhe building owner at occupancy. uifed Responsible Designer Name: sit .. i Respon le De �gr�erS€gna ure. '45 ;,F " Faulkner, Cindy �f Company: Date Signed: ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL 2017-04-06 13.15:31 Address: License: 1171 NORTH 4TH STREET 258540 City/state/zip: Phone: SAN JOSE CA 95112 408-294-6290 Digitally signed byCaICEHTS. 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-A020111825A-000-000-0000000-0000 Registration Date/Time 2017-04-06 13:15:31 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-04-06 13:13:39 Schema Version: rev 10/16 0 U LU 0 a PD cro 0M'VI'UN!TY DEVELOPMENT D! I 1AAR IWA K"""m JR Q QQplans -my_wn 11� SeNof s! LJ J. tt �ngq' 0r ai J--jS ns jo n A-0 I - A �rrhn i P 0 v f Tj 'h4 CU , y"21 Ton J I J rem S t * e Q. 0