B-2017-1092CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: /� g
7640 SHADOWHILL LN CUPERTINO, CA 95014-5062 (362 24 024) RESIDENTIAL S
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SERVICES OF
CALIFORNIA INC
MEMPHIS, TN 38120
OWNER'S NAME: MELL BONNIE D ET AL DATE ISSUED:
OWNER'S PHONE: 408-987-8990 PHONE NO: (408) 286-88931
License Class C -2Q Lic. #742039
Contractor R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC
Date 10/31/2017
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.
I hereby affirm under penalty of perjury one of the following two declarations:
t. 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.
2. 1 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
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
and state laws relating to building construction, and hereby authorize
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
may accrue against said City in consequence of the granting of this permit.
Additionally, the applicant understands and will comply with all non -point
source regul ' ns per the Cupertino Muni ' 1 Code, Section 9.18.
Signature Date 07/10/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
t. I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project(Sec.7044, Business & Professions Code).
1 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
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
permit is issued.
3. 1 certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the
Worker's Compensation laws of California. If, after making this certificate of
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, l must forthwith comply with such provisions or this permit shall
be deemed revoked.
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 and state laws
relating to building construction, and hereby authorize 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 may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
BUILDING PERMIT INFO:
BLDG —ELECT —PLUMB
MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
REPLACE AIR CONDITIONING UNIT -SAME LOCATION
Sq. Ft Floor Area: I Valuation: $8303.00
APN Number: Occupancy Type:
362 24 024
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: JASMINE ARCHBOLD
Date:
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature ofApplicant:
Date: 07/10/2017
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 !pit
the Health & Safety Code, ions 25505, 25533, and 25534.
Owner or authorized agent:
Date: 07/10/2017
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
i
CUPERTINO
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPt✓ENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildingZcupertino.org
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DESCRIPTION OF WORK
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TOTAL VALUATION:
RECEIVED BY:
By in), signature below, I cert to each of the following: 1 am the property owner or authorized agent to act on the property owner's behalf. 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 construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Sienatw-e of Applicant%Agent: Date:
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SUPPLEMENTAL P-\IFORMATION REQUIRED
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ALTERATIONS - HVAC
CEC-CFIR-ALT-03-E (Revised 01/16) CALIFORNIA ENERGY COMMISSION _" _
CERTIFICATE OF COMPLIANCE CFIR-ALT-03-E
Alterations - HVAC CZ 1, 3 to 7 and 16 (Page 1 of 1)
Site Address:
Enforcement Agency:
Date Prepared:
Permit#:
Equipment Type
Equipment Efficiency
New: Ducting or Lineset
Required R -value
Conditioned
Floor Area (ft)
Thermostat
❑ Packaged System
Evaporator Coil
AFUE
COP
❑ R-6 (CZ 1-10,12&13) Ducts
Se ed by system
etback
_If System
Voudensing Unit
SEER❑
HSPF
R-8' (CZ 11,14-16) Ducts
❑ > R-2.8 Lineset3present,
�ft2 1
(if not already
must
❑ Furnace
neset
EER
be installed)
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this
form is allowed to be filled out by hand. For final inspection all forms are to be registered (no hand filled forms allowed) and a copy left on site.
HVAC Changeout/Repair
Required Compliance Documents to be left on site for Final:
(Can include new ducting)
All Equipment,
CF1R-ALT-02-E
Condenser Unit, Evaporator Coil,
CF2R: MCH -01, MCH -20-H
Air Handler/Furnace
CF3R: MCH -20-H
_
Installer Requirement: Duct leakage (< 15% or, :510% to outside, or seal all accessible leaks)
Exempted from duct leakage testing if:
❑ 1. Duct system registered with HERS provider as previously sealed, or 112. There is less than 40 linear feet of duct in unconditioned
space, or ❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building
❑ 2. New HVAC System
Required Compliance Documents to be left on site for Final:
All new equipment and All New Ducts'
CF113-ALT-02-E
CF2R-MCH-01-E, MCH -20-H, MCH -22-H, MCH -(23 or 24)-H
CF3R-MCH-20-H, MCH -22-H, MCH -(23 or 24)-H'
Installer Requirement: Duct leakage < 5%, Fan Efficacy (0.58W/CFM), Air Flow >_ 350 CFM/ton (or Standards Table 150.0-B / C alternative)
❑ 3. All New Ducts with Replacement
Required Compliance Documents to be left on site for Final:
Includes replacing or installing All New
CF1R-ALT-02-E
Ducts' and one or more of the following:
CF2R-MCH-01-E, MCH -20-H, MCH -(23 or 24) -FI
Condenser Unit, Evaporator Coil, Furnace
CF3R-MCH-20-H, MCH -(23 or 24)-H
Installer Requirement: Duct leakage < 5%, Air Flow _:350 CFM/ton (or Standards Table 150.0-B / C alternative)
❑ Exempted from duct leakage testing if existing duct systems are constructed, insulated or sealed with asbestos.
❑ 4. New Ducting over 40 feet Required Compliance Documents to be left on site for Final:
Adding or replacing ducts in unconditioned CF1R-ALT-02-E
space but less than All New Ducts' CF2R-MCH-20-H
CF3R-MCH-20-H
Installer Required to: Duct leakage (< 15% or, < 10% to outside, or seal all accessible leaks)
❑ Exempted from duct leakage testing if existing duct systems are constructed, insulated or sealed with asbestos.
' All new ducting requires R-8 insulationwhen more than 40 ft installed in CZs it & 14-16 and R-6 in CZs 1-10, 12 & 13, and R-6 insulation when less
than 40 ft installed. This includes in walls, between floors etc.
' A New Duct system is when the duct system.is constructed of at least 75 %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, plenums, duct material.
a R-2.8 (1" thick insulation) for linesets 1" and less.
Contractor (Documentation Author's./Responsible Designer'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 under Division 3 of the California Business and Professions Code to accept responsibility for the information on this document.
3. That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24, Parts 1 and 6 of the California Code of Regulations (CCR).
4. That the energy features and performance specifications, materials, components, and manufactured devices for the building design or
system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the CCR.
5. 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 applicatio .
Responsible Designer Name:
Responsible Desi er Si nature:
Date ed/�
Lic�ns
Company:
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ty/State/ p:
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For assistance or questions regard! *the Energy Standards, contact the Energy Hotline at: 1-800-772-3300