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B-2017-0641CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10539 LA RODA DR CUPERTINO, CA 95014-4430 CONTRACTOR: PERMIT NO: B-2017-0641 (369 33 023) ABC COOLING & HEATING SERVICES INC HAYWARD, CA 94545 OWNER'S NAME: BOEHM DALE A TRUSTEE DATE ISSUED: 04/24/2017 I OWNER'S PHONE: 408-446-1328 PHONE NO: (559) 292-9240 { LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class fes- 0 Lic. #382383 Contractor ABC COOLING & HEATING SERVICES INC Date 05/31/2017 X BLDG X ELECT X 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: I hereby affirm under penalty of perjury one of the following two declarations: REPLACE FURNACE AND A/C; (I) GAS LINE; INSTALL 1 OUTLET i i. 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 �'erformance of the work for which this permit is issued. 'Fhave 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: $20461.00 f APPLICANT CERTIFICATION j I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 369 33 023 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 this permit. Additionally, the applicant understands and will comply with all ll non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations er the Cupertino Municipal - ode, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 4/24/2017 Issued by: ABBY AYENDE Date: 04/24/2017 OWNER -B Tii DER 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. j sale (Sec.7044, Business & Professions Code) z. I, as owner of the property, am exclusively contracting with licensed Signature ofApplicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 4/24/2017 I hereby affirm under penalty of perjury one of the following three declarations: 1. I have and will maintain a Certificate of Consent to self -insure for Worker's ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 Worker's Compensation laws of California. If, after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municip Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety C , e, Sections 25505, 533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. C O_wner-or authorized agent: APPLICANT CERTIFICATION Date: 4/24/2017 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. Signature Date 4/24/2017 Licensed Professional GENERAL PERMITAPPLICATION PPL€CA,TIO COMMUNITY DEVELOPMENT. DEPARTMENT • BUILDING DIVISION E 10300 TORRE.AVENUE • CUPERTINO, CA 95014-3255 C jUPERTINO (408) 777-3228 • FAX (408) 777-3333 • buildinp(cDcupertino.org mist; u PLUMBING LSI MECHANICAL Ft ELECTRICAL I—I MISCELLANF.ni TS PROJECT ADDRESS Q� APN OWNERNANM B f^� {,1� � J'�j7 PHO? / J !, 12 P `�/.�IL MAIL STREET ADDRESS % FAX nm�� I CONTACT NA]%1E ONE E-MAII. STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR RACTORAGENT ❑. ARCHITEC-T- ❑`ENGINEER El DEVELOPER ❑ TENANT CONTRACTOR NAME/-, � /3 �� L C S> L E2 0 LIC SE TYP&� q O BUS. LIC # 6 �J COMPANY NAME /%� E-MAIL _ p� FAX STREETF 1313E CI , 'T. TE, ZIP L�r�J. t ✓� P�1 `' t �/ S7 ARCHITECT/ENGINEER NAME LICENSE N`UMBERJ V BUS. LIC =1 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF . /' SFD ur DUPLEX ❑ MULTI -FAMILY BUILDING: ❑ COMMERCIAL PROJECT IN WIIALAND ❑ AES PROJECT IN ❑ YES URBAN INTERFACE AREA ❑ NO FLOOD ZONTE/�- ❑ NO IS THE BLDG AN ❑ 1TS EICHHLER HOME? ❑ NO DESCRIPTION OF WORK -ls i Z l✓ C' �r 1 f r TOTAL VALUATION: ! / f RECEIVED Bl By my signature below, I certify to ea& of the fol owing: I am the property owner or authorized agent to act on the property owners beha £ I have read this application and the information I have provided is correct. I have read the Description of Wo Xc and verify it is accurate. I agree to co ly with all applicable local ordinances and state laws relating t 1rr tr �cti n. tho e o�/esentatives of C ertino to enter the a ve- entified prop for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMEN�TTAL INFORMATION REQUIRED / • f V ! --- OF'FTCE USE 01�L] © OVER THE COUIN R:,:,::, F _ ❑ E7.PRESS, z- - r �:- ❑ ;STA NDARD - 4 a: ❑ LARGE ❑ 1\I.4JOR - JATEPMiscApp_7011.doe remised 06/21/11 9W CERTIFICATE OF VERIFICATION CF3R-MCH-20-1-1 Duct Leakage Diagnostic Test (Page 3 of 3) Documentation Author's Declaration Statement 1.1 certify that this Certificate of Verification documentation is accurate and complete. Documentation Author Name: Richard Cunningham Documentation Author Signature: Company Date Signed: The Energuy CA LLC 2017-05-24 17:53:02 Address: CEA/ HERS Certification" Identification (if applicable): 1215 K St., 17th Floor CC2005596 City/State/Zip: Phone: Sacramento CA 95814 877-600-0123 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 Verification is true and correct. 2. 1 am the certified HERS -Rater who performed the verification identified and reported on this Certificate of Verification (responsible rater). 3. The, installed feature's, materials, components, manufactured devices, or system performance diagnostic results that require. HERS verification , identified ion -this.Certificatej'of�Verification comply with theapplicable requirements in Reference Appendices RA2, RA3, and the requirements specified "on'the Certificate of Compliancefc�r-the'liuilding approved by the enforcement agency. 4. The informafion,�reported on applicable sections",, 6fhe Ce rtificA6 (s) ofefrisfalIafion:(&ZR)-sign.edraK&.'06''mii etby the persgn(s) responsible forthe iW construction or ifistallation conforms to the rdquirement3-sped ed -,on the Certificate(s)of Compliance (C approved by thetenf r-cementa_agency. 5. [will that d this Ce ificate Veriflcationsliall be de Guilding );issued ensure registered copyof of posted or m ayadatile with the permit( for the building, and made availableyto the enforcerbgn$;agency forall applicable inspections Ihderstand' at as is' e`re • copy ofiths;CertGficaY of Verification is required to be documentation the builder'provides to the building owner at occupgncy. Ind with the � Builder Or Installer Information As Shown Orf The-Certif tate Of Installation Company Name (Installing Subcontractor, General Contractor, or Builder/Owner): A B C COOLING HEATING & PLUMBING INC Responsible Builder or Installer Name: CSLB License: Michael A Girard 1017332 HERS Provider Data Registry Information Sample Group Number (if applicable): Dwelling Test Status in Sample Group (if applicable) Tested HERS Rater Information HERS Rater Company Name: The Energuy CA LLC Responsible Rater Name: Responsible Rater Signature: Richard Cunningham Responsible Rater Certification Number w/ this HERS Provider- Date Signed: CC2005596 2017-05-24 17:53:02 Digitally signed by Ca10ERTS. 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- Registration Date/Time: 2017-05-24 17:53:02 HERS Provider- CaICERTS 217-A020110329A-000-001-M20001A=M20A CA Building Energy Efficiency Standards Report Version: 2016.1.005 Report Generated: 2017-05-24 17:51.20 2016 Residential Compliance Schema Version: rev 03/16 Neq ME CERTIFICATE OF VERIFICATION CF3R-MCH-20-H Duct Leakage Diagnostic Test (Page 2 of 3) C. Additional Requirements for Compliance 01 System was tested 'in its normal operation condition. No temporary taping allowed. Outside air (OA) duct connections to the central forced air duct system shall not be sealedAaped-off during duct leakage 02 testing. OA ducts used for Central Fan Integrated (CFI) Indoor Air Quality ventilation systems, or Central Fan Ventilation Cooling Systems, that utilize dampers that open only when OA is required and automatically close when OA is not required, may configure the CA damper to the closed position during duct leakage testing. 03 if a complete replacement, all supply and return register boots were sealed to the drywall. 04 Building cavities were not used as plenums or platform returns in lieu of ducts. 05 If cloth backed tape was used it was covered with Mastic and draw bands. 06 All connection points between the air handler and the supply and return plenums are completely sealed. If the system complies:using the Smoke Test method, the smoke test was conducted in accordance with the requirements 07 of Reference Residential Appendix RA3.1.4.3.6. Systems that comply using smoke test shall not be included in sample groups for HERSverificat'ion co: mpliance♦ 08 Verification Status; Pas !lappl ca ereij0trernedts are met- his 09 ...,�, k §�;& Correction Nates Q .i R 4 # r j ,� ;. i „„ a 111V-1111-1 .,1h ' k '.4 .; .-m.vrs.-. E'a. c. F'*a"'o- f..v.. �?;3 i?s. rm'Kc� na4r4 �. rY, .._'*�.r-'ki i,-.: .�k vsfS'v v;in" 'Y.# tx' "t='i�si g 5.. Z The responsible per on s signatures h this compliance docuKnent affirms tha all applicable requiryements m this�table have i '�`+ [ vu Tr?' n'� been met unless otherwise noted in the Verifici n S(at'us UA the Correcd s Noes inLthls tale. l D. Determination of HERS Verification Compliance All applicable sections of this document shall indicate compliance with the specified verification protocol requirementsin order for this Certificate of Verification as a whole to be determined to be in compliance. 01 1 Complies: All specified verification protocol requirements on this document are met. Registration Number: Registration Date/Time: 2017-05=24 17:53:02 HERS Provider: CaICERTS 217-A020110329A-000-001-M20001A-M20A . CA Building Energy Efficiency Standards Report Version: 2016.1.005 Report Generated: 2017-05-24 17:51:20 2016 Residential Compliance Schema Version: rev 03/16 ,VW�vtut 6 A)I-L-V994 t EM CERTIFICATE OF VERIFICATION CF311-MCH-20-1-1 Duct Leakage Diagnostic Test (Page 1 of 3) Project Name: 10539 La Roda Dr Enforcement Agency: Cupertino City of Permit Number:: PENDING Dwelling Address: 10539 La Roda Dr City: Cupertino Zip Code: 95014 A. System information 01 Space Conditioning System Identification or Name System 1 02 Space Conditioning System Location or Area Served Location l 03 Building Type from CF -111 Single family 04 Verified Low Leakage'Ducts in Conditioned Space (VLLDCS) Credit from CF1R? No, credit is not taken 05 Verified Low Leakage Air Handling Unit Credit from CF1R? No, credit is not taken 06 DuctSystem.ComplfahceCategory,- , Replacement ,. B. Duct Leakage Diaghostic Test es W �, M �� n � �� z. � - �,.w-t _ 5 _.x' ORT1.fl.m Hasa 01 MCH -20d - Complete}`Replacerrfent or AltreDuct Sy�erri� 4 a _ Heating Capacity (kBtu/h) s 03 Conditioned Floor Area served by this HVAC system (ft) 2011 04 V. -4, M 1-� 41 & " A -0 0 ;A MW ,. B. Duct Leakage Diaghostic Test es W �, M �� n � �� z. � - �,.w-t _ 5 _.x' ORT1.fl.m Hasa 01 Condenser Nominal Cooling Capacity (ton) 4 02 Heating Capacity (kBtu/h) 78 03 Conditioned Floor Area served by this HVAC system (ft) 2011 04 Duct Leakage Test Conditions Test final 05 Duct Leakage Test Method Total leakage 06 Leakage Factor 0.05 07 Air Handling Unit Airflow (AHUAirflow) Determination Method Heating system method 08 Measured AHUAirflow This field or section is not applicable 09 Calculated Target Allowable Duct Leakage Rate (cfm) 85 10 Actual Duct Leakage Rate from Leakage Test Measurement (cfm) 79 11 Compliance Statement: System passes leakage test 12 '' Notes: Registration Number: Registration Date/Time: 2017-05-24 17:53:02 HERS Provider: CaICERTS 217-A020110329A-000-001-M 20001A -M 20A CA Building Energy Efficiency Standards Report Version: 2016.1.005 Report Generated: 2017-05-24 17:51:20 2016 Residential Compliance Schema Version: rev 03/16 CERTIFICATE OF COMPLIANCE CFIR-ALT 02-E I Alterations to Space Conditioning Systems (formerly CF -IR -ALT HVAC) (Page 3 of 4) I Project Name: 10539 La Roda Dr I Date Prepared: 2017-04-05 A. General Information CFIR-ALT-02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented, use one CF -IR -ALT -02 document for each dwelling unit. 01 Project Name 10539 La Roda Dr 02 Date Prepared 2017-04-05 03 Project Location 10539 La Roda Dr 04 Building Type Single family 05 CA City Cupertino .06 Dwelling Unit Name 10539 La Ro COMMUNITY DEVELOPMEN 07 Zip Code 95014 08 Dwelling Unit Conditioned 2011 Identification or Location or Area by this SC ducted containing. system Floor Area (ft) entirely new �gppRO Name 09 Climate Zone 4 10 Number of Space Conditioning (SC) Systems in This set of plans and specifications MUS 1site during construction. It is unlawful to m duct system? SC system? Alteration Type this Dwelling Unit: alterations on same, or to deviate therefro TDEPARTMENT UPERTINO ED be kept at the job ke any changes or i, without approval 8. Space Conditioning (SC) System Information The stamping of this plan and specificatio s SHALL NOT be held to permit or to be an approval of thi violation of any 01 02 03 04 05 06 07 08 09 .10 tate Law. Is the SC Installing a SC System SC System CFA served system a refrigerant. Installing new SC Installing Installing 4i24i17 Identification or Location or Area by this SC ducted containing. system more than 40 entirely new eIJUMV -2017-0641 Name Served System (ftZ) system? component? components? feet of ducts? duct system? SC system? Alteration Type Entirely new or complete System 1 Location 1 2011 Yes No Yes Yes Yes No replacement duct system with or without equipment changeout Registration Number: 217-A020110329A-000-000-0000000-0000 Registration bate/Time: 2017-04-05 16:27:07 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version; 2016.1,005 Report Generated: 2017-04-05 16:27:23 Schema Version: rev 10/16 CERTIFICATE OF COMPLIANCE CFIR-ALT-02-E Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 2 of 4) C. Extension of Existing Duct System, Greater Than 40 Feet (Sect1on150.2(b)1Diib) This section does not apply to this project. D. Altered Space Conditioning System (Sections 150.2(b)1E and F) This section does not apply to this project. E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)1DIla and 150.2(b)1E, F) 01 02 03 04 05 06 07 08 09 30 11 Heating Cooling System Heating Minimum Cooling Minimum Required Identification or Heating Altered Heating Efficiency Efficiency Cooling Altered Cooling Efficiency Efficiency Thermostat New Duct Name System Type Component Type Value System Type Component Type Value Type R -Value This field or This field or Systeml Central gas All new heating AFUE 96 Central split AC No coolingsection Is section is SetbackTher R-6 furnace components component altered not not mostat applicable applicable Required Documentation, CF2R-MCH-01-E -Space Conditioning systems -Duct Insulation requirement for the new portions of supply-alr and return -air ducts or plenums: R6 (CZ 1-10, 12 and 13) and R8 (CZ 11 and 14-16) CF2R and CF3R-MLN-20-H Duct Leakage Test required - Leakage rate compliance: <= 5%. CF2R and CF3R-MCH-22 Fan Efficacy CF2R and CF3R-MCN-23 Alrflow Rate - Compliance: Fan Efficacy <= 0.58 W per cfm and System Airflow >= 350 cfm per ton. -Alternative Compliance: CF2R and CF3R-MCH-28 Return Duct Design verification is an alternative to MCH -22 and MCH -23 verification. CF2R and CF3R-MCH-25-H Refrigerant Charge verification required when refrigerant containing components are Installed or altered (applicable In CZ 2, 8-15). Exceptions: Heating -only systems are exempt from the 0.58 W per cfnl and 350 cfm per ton requirements. Rote: An "entirely new or replacement duct system" means at least 75% of the duct system is new duct material, and up to 25% may consist of reused parts from the dwelling unit's existing duct system (e.g., registers, grilles, boots, air handler, coil, plenums, duct material) If the reused parts are accessible and can he sealed to prevent leakage Registration Number: 217-A020110329A-000-000-0000000-0000 Registration Date/Time: 2017-04-05 16:27:07 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-04-05 16:27:23 Schema Version: rev 10/16 CERTIFICATE OF COMPLIANCE CFIR-ALT-02-E Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 3 of 4) F. Entirely New or Complete Replacement Space Conditioning System (Section 15O.2(b)lC) This section does not apply to this project. Registration Number: 217-A020110329A-000-000-0000000-0000 Registration Date/Time: 2017-04-05 16:27:07 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-04-05 16:27:23 Schema Version: rev 10/16 CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 4 of 4) Documentation Author's Declaration Statement 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: da4ilnbh,�a "' a �LJa w - Company: Signature Date: The Energuy CA LLC 2017-04-05 16:27:07 Address: CEA/ HERS CertlRcatlon Identification (If applicable): 1215 K St., 17th Floor City/State/Zip: Phone: Sacramento CA 95814 877-600-0123 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 ander Division 3 of the Business and Professions Code to accept responsibility for the building design or system design Identified an this Certificate of Compliance (responsible designer). 3. That the energyfeatures and performance specifications, materials, components, and manufactured devices for the building design orsystem 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 Compliance are consistent with the information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. 5. 1 will ensure that a registered copy of this Certificate of Compliance shall be made avallabie 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 to the building owner at occupancy. Responsible Designer Name: Dizdarevic, Jasmina Responsible Designer Signature: rnrn 9) 6CC//9041 lU77lYr LG Company: Date Signed: The Energuy CA LLC 2017-04-05 16:27:07 Address: License: 1215 K St., 17th Floor Clty/State/Zlp: Phone: Sacramento CA 95814 877.600-0123 Digitally signed by CoICERTS. This digital signature is providedin 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-A020110329A-000-000-0000000-0000 Registration Date/Time: 2017-04-0516:27:07 HERS Provider: CaICERTS CA Building Energy Efficiency Standards- 2016 Residential Compliance Report Verslon: 2016,1.005 Report Generated: 2017-04-05 16:27:23 Schema Version: rev 10/16