B-2017-1046CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1046
1132 ELMSFORD DR CUPERTINO, CA 95014-4909 (362 09 021)
ATKINSON
CLIMATROLLERS INC
SAN JOSE, CA 95112
OWNER'S NAME: MAJUMDER SUMIT AND NEELANJANA TRUSTEE
DATE ISSUED: 06/29/2017
OWNER'S PHONE: 408-393-7121
PHONE NO: (408) 294-6290
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C -M Lic. #258540
Contractor ATKINSON CLIMATROLLERS INC Date 12/31/2018
X BLDG —ELECT —PLUMB
X MECH X RESIDENTIAL COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
_
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
REPLACE 2 FURNACES (SAME LOCATION)
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.
2. 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: $5562.00
permit is issued.
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
362 09 021
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.
Signatures `��� Date 6/29/2017
Issued by: Abby Ayende
OWNER -BUILDER DECLARATION
Date: 06/29/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RF 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.
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 (Scc.7044, Business & Professions Code).
Date: 6/29/2017
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
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
Q<(/
be deemed revoked.
/d�
Owner or authorized agent: �&L E, �4_
APPLICANT CERTIFICATION
Date: 6/29/2017
1 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 6/29/2017
Licensed
Professional
104(p
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 M'
CUPERTINO u
[—I PLUMBING ECHANICAL []ELECTRICAL MISCELLANEOUS
(408) 777-3228 •FAX (408) 777-3333 • building(a7cupertino.or
PROJECT ADDRESS 1 bl�
APN # �f 2 �'D /ZZ
�/
OWNER NAME '
PHONE q0b �G 2Q 121
E-MAIL
STREET ADDRESS �-+
lL.�
to
Il J\
CITY, STATE, ZIP C
FAX
CONTACT NAME
PHONE
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER
❑ DFVELOPER ❑ TFNANT
CONTRACTOR NAME
LICENSE NUMBER'aS, j
l.�
LICENSE TYPE
BUS. LIC # D
L
COMPANY NAMEjM101,
E-MAIL
FAXro
STREET ADDRESS
PQ"k__
CITY, STATE, ZIP
p E
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF SFD or DUPLEX ❑ MULTI -FAMILY
BUILDING: ❑ COMMERCIAL
PROJECT IN WILDLAND ❑ YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER IIOME'? ❑ NO
DESCRIPTION OF WORK
TOTAL VALUATION:
RECEIVED BY:564
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property ow er's be alf. 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 co�lstruction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: /- L�"Y� Date:
SUPPLEMENTAL INFORMATION REQUIRED
Olatsl�o LY
v
rJ
0 OVP-T1i"01IIN' Elt
d !Ems
STANDARD
a,
L"G' K
0 MAJOR
MEPMiscApp_2011.doc revised 06/21/11
U5
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.org
� -Zt-
PERMIT CANNOT BE FINALED UNTIL THIS CERTIFICATE HAS BEEN,
COMPLETED, SIGNED- AND RETURNED TO THE BUILDING DIVISION
PURPOSE
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide A
compliance with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior a
inspections are required.
GENERAL INFORMATION
- - Existing-_single-.famity_ancimuLtifamilyidwelhngs shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units E
$1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or
Monoxide Alarms be installed in the following locations:
( ( -(U-".6
s for
for
AREA
SMOKE_ ALARM
CO ALAI
M
Outside of each separate sleeping area in the immediate vicinity of
the bedroom(s)
X
X
On every level of a dwelling unit including basements
X
X
Within each sleeping room
X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply ith
CSC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery oper ted.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or ccrawl
space. Refer to CRC Section R314 and CSC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for
alarms which must be connected to the building -Wiring.
As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/haveeen
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms specified below have been tested and are operational, as of the
date signed below.
Addres_s_: �� �2 E L--yv'Ec';r/% Permit No
Specify Number-of-Alarmsa—� '# Smoke Alarms:#,-C-arbon Monoxide Detectors: `7—
I have read and agree to complyth rms and co atement
Owner-(orOwner-AMgent's)-Name:
Iv M17 ! �1qT(/Q'IIR Sign_a_ture................................ ............ ............................... ......................Daet 211
....................... .
Contractor Name:
Signature.................................................................. Lic.# ......................................Date:
.................................................................................
�f
Smoke and CO fomsn.doc revised 09127116
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC)
Project Name:
2016-0816 Neela Majumder I Date Prepared:
CF1R-ALT-02-E
(Page 1 of 3)
2017-06-28
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
CF1R-ALT-02 document for each dwelling unit.
01
Project Name
2016- 0816 Neela Majumder
02
Date Prepared
2017-06-28
03
Project Location
1132 Elmsford Dr
04
Building Type
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
2016-0816 Neela Majumder
07
Zip Code
95D14
08
Dwelling Unit Conditioned
2300
=
`t
,
Floor Area (ft)
SC System
SC System
CFA served
•
refrigerant
Number of Space
�
Installing
09
Climate Zone
4- - •- -
30
Conditioning (SC) Systems in
2
ducted
containing
system
more than 40
this Dwelling Unit:
entirely new
r77 7t
B. Space Conditioning (SC) System Information t
01
02
03
_ 04
05 -
06
07
H 08
09
10
"i3 the SC
Installingia -
=
`t
,
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 (W)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
Furnace
upstairs
1100
Yes
No
Yes
No
No
No
Altered space
replacement
conditioning system
Furnace
downstairs
1200
Yes
No
Yes
No
No
No
Altered space
replacement
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b)1Dilb)
This section does not apply to this project.
Registration Number: 217-A020219925A-000-000-0000000-0000 Registration Date/Time: 2017-06-28 11:09:55 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards- 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-06-28 11:09:35
c�hon,a uar��„n rP„1n/9F
CERTIFICATE OF COMPLIANCE
CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC)
(Page 2 of 3)
D. Altered Space Conditioning System (Sections 15O.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
Furnace
Central gas
All new
No cooling
This field or
This field or
This field or
This field or
replacement
furnace
heating
AFUE
81
No cooling
component
section is not
section is not
Setback
section is not
section is not
components
altered
applicable
applicable
applicable
applicable
Furnace
Central gas
All new
No cooling
This field or
This field or
This field ar
This field or
replacement
furnace
heating
-. AFUE
81
No cooling
component
section is not
section is not
Setback
section is not
section is not
components
altered
applicable
applicable
applicable
applicable
Required Documentation
CF211-MCH-01-E - Space Conditioning Systems
- Duct Insulation requirement for the new portiops.pfsupply air andreturn.air,ducts or plenums: R6 (CZ 1-10, 12 and 13) and R8 (CZ 11 and 14-16)
CF2R and CF3R-MCH-20-14- Duct Leakage Td34-Cequireifwhen heating or cooling comp'btlehts 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 seahall accessible leaks
_
CF2R and CF3R-MCH-2S-H Refrigerant Charge verig tion required wiled refrigerant containing in' CZ
components are in;falled ora teted `apphcalile
CF2R and CF3R-MCH-23 Airflow Rate >= 300 CFM peCton required when MCH 25 is regwrcdW
2 8-15).,
Exceptions:
- Duct systems registered with HERS provider as pre"viodsly s6led aregxempt frorit:MC� 20, Dgc( Leakage'�estmg req. ,mEnts '; _
—
—
_
- Heating -only systems and Air Handler Furnace changes do not requitaverification of Air Flow MCH -23, or Refrigerant Charge MCH 25.
-Existing duct systems constructed, insulated or sealed with asbestos arg,exemptfrcm�fvlCH3&Duftaeakage;7estingregturemenEs' -
E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 15O.2(b)1Diia and 15O.2(b)1E, F)
This section does not apply to this project.
F. Entirely New or Complete Replacement Space Conditioning System (Section 15O.2(b)1C)
This section does not apply to this project.
Registration Number: 217-A020219925A-000-000-0000000-0000
Registration Date/Time:
2017-06-28 11:09:55
HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-06-28 11:09:35
c�Ho,.,a vcr¢Ino• ra„ t n/1 F
CERTIFICATE OF COMPLIANCE CF1R-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:
Documentation Author Signature:
/?zwOgQ
Faulkner, Cindy
K"A
Company:
Signature Date:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL
2017-06-28 11:09:55
Address:
CEA/ HERS Certification Identification (if applicable):
1171 NORTH 4TH STREET
City/State/Zip:
Phone:
SAN JOSE CA 95112
408-294-6290
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 og .this Cerbft6ate of Compliance... is true and correct.
2. I am eligible under Division 3%f the Bus! -ii and Professions Code to a."gRvrosponsibility for the building design or system design identified on this Certificate of Compliance (responsible designer).
3. That the energy features and performance specifications, matenals,'ccomponents, and manufactured devices for the budding design or system design identified on this Certificate Compliance
of conform to the
requirements of Title 24, Par[ 1 and Part hof the Caldorp{a=Cbde of Regotatfons
4. The building design features orsystem design features identified ontLhta
is Certite of do-mphance arewpji stent wnifthe li formatlan provided oii_'other cf llcab0c66mpliance documents,
worksheets,
calculations, plans and specifications submrtte Yto thee 7rforcemenfagency foraporova'Iwlt'h this building perrolt application. _
5. will ensurethata registered copy of this.Cerfificaterof Compliance sh2lkk[a'mad aai+aiiable with t-rb.buill permd issued foifi#eprwldu'fg and-S'nade avaifa6re`tnShaenforcemenC agency for all applicable
inspections. l understand that a registered copy of this-Cre[fdicate of Compllanceis_requirgd to-Jnduded,ydlh the docume#pjption,theirmlder provides to, tlfe bu lf,ding owner at occupancy.
Responsible Designer Name: - s.g..
Responsr'le Designer Signature:
Faulkner, Cindy
cfiCr(AL
Company: -
Date Signed:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL
2017-06-28 11:09:55
Address:
License:
1171 NORTH 4TH STREET
258540
City/State/Zip:
Phone:
SAN JOSE CA 95112
408-294-6290
Easy to Verify �r
at CaICERTS.com
5_
Digitally signed by DaICERTS. This digital signature is provided in order to secure the content of this registered document, and in noway implies Registration Providerresponsibility f
the accuracy of the Wave.
Registration Number: 217-A020219925A-000-000-0000000-0000
Registration Date/Time:
2017-06-28 11:09:55
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-06-28 11:09:35
Crhem. \/orcinn rcv 1n1ir
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC)
Project Name:
2016-0816 Neela Majumder I Date Prepared:
C FI R -ALT -02-E
(Page 1 of 3)
2017-06-28
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
CHR -ALT -02 document for each dwelling unit.
01
Project Name
2016- 0816 Neela Majumder
02
Date Prepared
2017-06-28
03
Project Location
1132 Elmsford Dr
04
Building Type
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
2016- 0816 Neela Majumder
07
Zip Code
95014
08
Dwelling Unit Conditioned
Floor Area (W)2300
SC System
CFA served
system a
refrigerant
Installing new SC
Number of Space
Installing
09
Climate Zone
4w a-9 p.
10
Conditioning (SC) Systems in
2
containing
system
more than 40
entirely new
this Dwelling Unit:
B. Space Conditioning (SC) System In€ormatibn 3 ;
0102
03
04
b5
06
" 07
08
- 09
10
t
::
..
fS the SC
Installing�a 1
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 (ft)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
Furnace
re
replacement
p
upstairs
1100
Yes
No
Yes
No
No
No
Altered s p ace
conditioning system
Furnace
replacement
downstairs
1200
Yes
No
Yes
No
No
No
Altered space
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)1Diib)
This section does not apply to this project.
Registration Number: 217-AO20219925A-000-000-0000000-0000 Registration Date/Time: 2017-06-28 11:09:55 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-06-28 11:09:35
CrhPmn 1larcinn• rP%t 1 n/1r,,
CERTIFICATE OF COMPLIANCE CF1R-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
it
12
Heating
Cooling
System
Heating
Altered
Heating
Minimum
Altered
Cooling
Minimum
Required
New or
Identification
System
Heating
Efficiency
Efficiency
Cooling
Cooling
Efficiency 1
Efflciency
Thermostat
Replaced
New Duct
or Name
Type
Components
Type
Value
System Type
Components
Type
Value
Type
Duct Length
R -Value
Furnace
Central gas
All new
No cooling
This field or
This field or
This field or
This field or
replacement
furnace
heating
AFUE
81
No cooling
component
section is not
section is not
Setback
section is not
section is not
Components
altered
applicable
applicable
applicable
applicable
Furnace
Central gas
All new
No cooling
This field or
This field or
This field or
This field or
replacement
furnace
heating
AFUE
81
No cooling
component
section is not
section is not
Setback
section is not
section is not
components
altered
applicable
applicable
applicable
applicable
Required Documentation:
CF2R-MCH-01-E -Space Conditioning Systems
Duct Insulation requirement for the navy Porfitons afsltpply-air andreturg�oirducts or plenums: R6 (CZ 1-10, 12 and 13) and R8 (CZ 11 and 14-16)
CF2R and CF3R MCH -20-H Duct Leakage TdSS regwred when heating or cooling G.grnp0itel Es are installed in ducted systems, or when more than 40 ft of duct length is replaced
-Leakage rate compliance: <= 15% or <= 104 lea up to outside, or seal a;ll accessible leaks.
�a
Refrigerant g q g t containing corYtponents are entailed at ateted appfica6le iri CZ 2, 8-15).12-'_-"-,
_-
CF21R and CF3R-MCH-23 Airflow Rate >C 300 CFMpentonre, ufed hen MCH 25 i'
Exceptions: `_� ,:- � � ,r� maw �P€ �--..3
- Duct systems registered with HERS provider as previously sealed ar &xempt frorr[rJvlCY 20 Dui Leakage (es ufg rep i rrt nts
- Heating -only systems and Air Handler Furnace changes do not—e "., everification of Air Flaw MCH 23 or Refrigerant Charge MCH -25.W
-Existing duct systems constructed, insulated orsealed with asbestosaiexempt f�nm MCH' 3 Ductleakaasting relremets -
-;
E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)lDiia 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-A020219925A-000-000-0000000-0000
Registration Date/Time:
2017-06-28 11:09:55
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-06-28 11:09:35
- CrhPmR Vcrainw rcu 1n/1F
CERTIFICATE OF COMPLIANCE CF1R-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:
Documentation Authar Signature: /n�.. ����Q ��p
Faulkner, Cindy
{.:.� Cl�C.L(f.C.fine,,i
Company:
Signature Date:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL
2017-06-28 11:09:55
Address:
CEA/ HERS Certification Identification (if applicable):
1171 NORTH 4TH STREET
City/State/Zip:
Phone:
SAN JOSE CA 95112
408-294-6290
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 o arty{ s Certifjgaje of Cornphahce�istrue and correct.
2. 1 am eligible under Division 3 nf:fhe 130sii fss and Professions Code tojaccppt respbnsibilityfor the building design or system design identified on this Certificate of Compliance (responsible designer).
3. That the energy features and performance specifications maAtefgaA Components, and manufactured devices for the building design or system design identified on this Certificate Compliance to the
�- �;� - of conform
requirements of Title 24, Part 1 and Pati &of the CaliforAi WCode of I�egu1att7ns. -
, W
4. The building design features or system design feaitdres identified ordhis Certifit'a"te of ce are% ,Ubdeia with the rriformation.provided ori 0th- $pp[rcabl- compliance documents, worksheets,
calculations, plans and specifications submittedto the etiiorcementagency for;�pprnvalwith this building perrt}jt applicatiori.
5. 1 will ensure that a registered copy of this Certifie&t fCampfiance shalf e mad available wifht builditsg'peEmitri-issu2d f 44WCUildiri`g, ands' aiie av dabTe t%-ttj dhforcement agency for all applicable
inspections. I understand that a registered copy of this Ca>3rtificate of Cornpliance,is regL4ft to - included, t the d cume CiorLthe-V Ider provides t¢ �e buffing owner at occupancy.
_. _ m .. -
r° ..
Responsible Designer Name: r _
Responsive DesigirerS'I n' fure. i
Faulkner, Cindy�G/X!�/!ZP/rr
Company :
Date Signed:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL
2017-06-28 11:09:55
Address:
License:
1171 NORTH 4TH STREET
258540
City/State/Zip:
Phone:
SAN JOSE CA 95112
408-294.6290
Easy to Verify M: '.
at CaICERTS.com
R-.
Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document and in noway implies Registration Provider responsibility fthe
r
accuracy of the infor�
Registration Number: 217-A020219925A-000-000-0000000-0000
Registration Crate/Time
2017-06-28 11:09:55
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1,005 Report Generated: 2017-06-28 11:09:35
Crhama llprcinn• ra%r 1n1iF;