B-2017-1102CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1102
22265 CARTA BLANCA ST CUPERTINO, CA 95014-1062 (326 13 049)
THERMA TECH INC
SAN JOSE, CA 95125
OWNER'S NAME: MARTINO LINDA A TRUSTEE
DATE ISSUED: 07/11/2017
OWNER'S PHONE: 650-888-3482
PHONE NO: (408) 629-5400
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C-20 Lic. #913$06
Contractor THERMA TECH INC Date 04/30/2018
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 FURNACE; 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.
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: $8000.00
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
326 13 049
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 Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
AMunicipal
Signatureor Date 7/11/2017
Issued by: Abby Mende
OWNER DECLARATION
Date: 07/11/2017
-BUILDER
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.
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: 7/11/2017
1 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, 25r77�
Labor Code, I must forthwith comply with such provisions or this permit shall
ADV\-
be deemed revoked.
Owner or authorized agen
APPLICANT CERTIFICATION
Date: 7/11/2017
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.
Licensed
Signature Date 7/11/2017
professional
CUPERTINO
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 M'
(408) 777-3228 • FAX (408) 777-3333 • buildincl &cupertino.orp
(OZ
❑PLUMBING ®MECHANICAL ELECTRICAL ❑MISCELLAlN7F_OUS
PROIECr ADDRESS 2 22 (075 Cay .tA -&ao s
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O" N -ER NAME L m o� 'Mf1Jl rtt � PHONE I , %— U - 3 S2
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STREET ADDRESS 2
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CITY! STATE,ZIP6LIPG► 1 LVID V, 15bI� FaX
CONTACT NAME 1
PHONE�+ �_ ��
E-NIAIL.
STREET ADDRESS
CITY, STATE, ZIP
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FAX
❑ OWNER ❑ OANER-BUILDER ❑ OIINER AGEN r CONTRACTOR ❑ CO\TRACTOR AGE',T ❑ ARCHrrECT EENGGLNEER ❑ DEtT_LOPER ❑ TE\ AI -r
CONTRACTORNAbIE inn
LICENSE N,:N7BERQ �2
LICENSE TYPE C_
2—C)
BUS. LIC
COMPANYNAAiE � —` _ E MAIL "Td�. j,,Cjq P *i 10D COM
FAX
STREET ADDRESS . C y o � ^ , ` t CITY, STATE, ZIP 12S
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PHONE h) 1 6 - j0^U _ �o
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ARCHITECT ENGINEER N.1 -ME
LICENSE NLTIBER
BUS. LIC =
COMPANY NAME E-MAIL
FAX
STREET ADDRESS CITY. STATE. ZIP
PHONE
USE Of ❑ SFD,. DUPLEX ❑ MULTI -FAMILY
BUILDING: ❑ CONLMERCIAL
PROJECT IN AU DLAND ❑ YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ ITS
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HONE' ❑ NO
DESCRIPTION OF WORK
-`
�f I yrlyi � '/ � �\yiG1 -Pfc1t e:l
TOTAL VALUATION: V W
RECEIVED BY:
By my signature below, I certit� to each of the fo owing: I am the-pwpprty owner or authorized agent to act on the property owner's behalf I have read this
application and the inforination I have provide s . I ve read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to build a representatives of Cupertino to enter the above-iden fied perty for inspection purposes.
Signature of Applicant Agent: Date: I
SUPPLEMENTORNIATION REQUIRED
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OFFICE USE QNLY
❑ OVER -THE -COULTER
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❑ STAA'DARD
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MEPMscApp_2011.doc revised 06121111
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Altera -Mons i:o Space CrE-rdiVoning Systernz (formerly CF -IR -ALT -HVAC) (Page 1 of 3)
Project Name: Unda ldTartiracb � Date Prepared: 2017-07-11
A- General Wor€nation
CF1R-AI_T-02 is applical.le tc, r ultiple space conditioning sys cr)s contained within a single dwelling unit. When multiple dwelling units must be documented, use one
Cr1R-ALT-02 document for each dwelling unit.
01 I Project Name Linda Martino v ` ! 02 1 bate Prepared 12017-07-11
0_, J Project Location 22265 Carta Blanca St 04 Building Type
05 Cis: City Cupertino 06 Dwelling Unit Name
Dwelling Unit Conditioned
07 Zip Code 95014 ! ®& Floor Area (W)
Number of Space
09� Climate Zone �-..�..._ 4 10 Conditioning (SC) Systems in
this Dwelling Unit:
NB, Space ur:oriditionirig (SC) System Information
01
02
03
Oaf•
Is the SCM
05
Installing a
Installing
installing
SC Sy°sterry
SC System
CFA: sPr,,ed
s f;tern a
refrigerant
Identification or
Location or Area
by this SC
ducted
CoMaining
Name
Served
Systerll (fiz)
Sys enI'
component?
_
Location 1
I 2421
--'iSysterr 1-
II
IYes�
Yes
Single family
T
Linda Martino
2421
1
l66 @W Yal_
Installing new SC
^v07_�®--
08
._._s 09
10
Installing
installing
Installing
systenfr
roore than 40
entirely new
entirely new
components?
feet of ducts?
duct system?
SC system?
Alteration Type
No
Altered space
i
-- --__Yes ..._ ..v!
No__�..---No-
conditioning system
C; E-irterrsion of Cxkting %Furry 4ystera, GireaWe€r T4rvaro 40 Feet: (Secl:f m150.2(Ie)1Diib)
This section does not apply to this project.
Registration Number: 217-A020233420A-000-000-0000000-0000
Registration Date/Time: 2017-07-11 08:37:26
HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-07-11 08:37:14
Schema Version: rev 10/16
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i_.'e Crri'Y't[LIl f:P:`, : ar's.r.r1� IF' 4.tIC'':u 50. (E))avid F)
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Central gas
All new
Central split
_ —
All new
_____ --
____ -____ _f______b`_�__
System 1
furnace
!seating
AFUE
80
cooling
SEER
14
Setback
i
components
AC
components
I Ree uired Documentation:
MR -MCH -01-E - Space Conditioning Systems
- Duct insulation ienuirement for the nevi portions Of supply-a.ir and return -air duds or plenorns: RG (CZ 1-10, 12 and 13) and R8 (CZ 11 and 14-16)
C-F2R and F'3R MC 1-20-H - Duct LCako;;e T:•si requimc§ wlicn healing or cooling con-ronenis arc it stalled in ducted systems, or when more than 40
ft of duct length is
replaced
�-Leakage rate compliance: r_ 15% or <- 110% leakage to outside, or seal all accessible leaks.
CF211, and CF -,R MCH -25-H Refdger::nt Ch:,rge verificakiun required when refrig(rant containing con-ponents are installed or altered (applicable in CZ
2, 8-15).
CF2R and CF3R MCH -23 Airflov. Rate >-- 300 CFM per ton required when MCH -25 is required.
Exceptions:
Duct systen-S registered with HERS provider as previously haled arp exen-gri from Mcri-2n Dud Leakage Testing requirements.
Heating -only systems and Air Handler Furnace changes do not require verificatinn of Air Flow MCH -23, or Refrigerant Charge MCH -25.
} -Existing duci systems constructed, insulated or sealed with'tshestos are exemp- from MCH -20 Duct Le, kage Testing requirements.
Iticew or
Replaced New Duct
f.ur,t f c'I��i:f I P�-\/aPue
Less than of j
equal to 40 R-6
feet _ ___
E. Et,''iic Pr• ```r_vv C' I'Co P}'i`_'i�c.trc ',,T, 1)
�::'it)rt!'l'? Pic,_., ,r7r}� �;.ri?", i':- •: P Cori' rCrrii�?'r'ICC'ITi til-`.tt �--C`.I�12 r��:r.r'i'FCrl$ !.�„i�. ��p�.�E�ll�i and 13Q.Z()IE�1,
jV o M
Thi,� section does noi: apply to this project.
C-. 'rE;t*§,.Gv c\rekrr (-j,[. r���,f-,;E C_ Cup_ E,, _.r§: ^L, ,,.c- ` rll��€t€akRir, Sys-, e'.n'E (Section 150.2(b)IC)
P i; sr,ci_ion does nui apply to this project.
egisliatinn Number: 217-AO%.023'"l_OP: OiiJ 000-0000000 0000
l,e�;strz;tion Date/Tine: 2017-07-11 08:3726
HI -RS Provider: CaIG_RTS
CP, Bui:'JiPie Energy L=fficicnc;+S,;anu',ds-2016 Residential Con- pliance Report Version: 2016.1.005 keport Generated: 2017-07-9.1 08:37:14
Schema Version: rev 10/16
CL.i1i {F; CPLT G, Q'! Cl}IliiPL4i9N 4.E.�---_-'--�...�.��--_-s'""---
�.itoraE:;^.._. ._, _ ,,acr' C' rt�,i�:.c;i;ir�� Srs7ersls 4forto;cely CF-16�-/ALT•-i��.rA,C)f -- _. _
CFIR-ALT-02-E
(Page 3 of 3)
DOCU[rter,f 't:e,"i P%Uth0i-':3 PoutRFF-~ti0ri Statement
is .a:C;: :.'' and complete.
e. `
!
Documentation Author Dame: T
Don mentation Author Signature: 4 -~
Elia , Henry
Company:
Signature Date:
THERMA TECH INC
2017-07-11 08:37:26
Address:
CA/ HERS Certification Identification (if applicable):
1224 Reno Ave Suite P
-- - ------ ------- - — -- - -- - -
--- -'
City/State/Zip:
Phone:
Modesto CA 95351
209-571-5400
I I<esperttisit�tfe Per>r�r,'s R'cci 4v��tiore statement
I certify the following under penalty of perjury, under the laws of the State of California:
1. The infoi mation provided on this Certificate of Compliance is true and correct.
2. 1 cpm eligible under Division 3 of the Rusiness and Processions Code to arcc,pt responsibility
for the building design ni system design identified on this Certificate of Compliance (responsible designer).
3. That the anergy features and performance specifications, materials, components, and inanufactured
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 California Code of Regulations.
4. The building design featuros or system design features Wei t;, ed on this Certificate of Conipliance
are consistent wish the information provided on nther applicable compliance documents, worksheets_,
calculatiuns, pians and specifications submitter; to the elifu ceinent agency for dPPnwal with
this building permit application.
5. 1 will ensw,- thai a registered ropy of chis Certificate of Cc 'npi n e shall ': 11'lOe availabl.!
w7ih the building t—nlii( issu,�.l for the building, end rnade available to the enforces cent agency for all applicable
inspections. I understand that a registered copy of ibis Cc- tificate of Compliance is rrquirr_d to he included with the dncumentation the builder provides to the building owner at occupancy.
Responsible Designer Name:
Elia Henry
Responsible Designer Signature:
,
Company:
Date Signed:
THERMATECH INC
2017-07-11 08:37:26
Address:
License:
1224 Reno Ave Suite P
913806
City/State/Zip:
Phone:
Modesto CA 95351
! 209-571-5400
Easy to Verify
at CaICERTS.com
ti4. `;
Digitally signed by CaICERTS. This digital signature is provided in order to secure iirc content o; this registered document, and in no way implies Registration Provider responsibility for the accuracy of the inform .,
Registration Number: 217-A020233420A 000-000-0000000-0000 Registration Date/Tirne: 2017-07-11 08:37:26 HERS Provider: CaICERTS
CA Building Energy Ffficiency Standards - 2016 Residential Compliance Repor' Version: 2016.1.005 Report Generated: 2.017-07-11 08:37:14
Schema Version: rev 10/16