B-2017-1164CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1164
10066 JUDY AVE CUPERTINO, CA 95014-3523 (375 11 012) ON-TIME AIR
CONDITIONING &
HEATING INC
PLEASANTON,CA
94588
OWNER'S NAME: AITKEN KEVIN B AND HART JUDrrH M TRUSTEE I I DATE ISSUED: 07/19/2017
OWNER'S PHONE: 408-623-9664 I I PHONE NO: (925) 598-1911
License Class C-20 Lic. #8JIM
Contractor ON-TIME AIR CONDITIONING & HEATING INC Date 09/30/2017
1 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 affir under penalty of perjury one of the following two declarations:
t. 1 Xve and will maintain a certificate of consent to self -insure for Worker's
ompensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
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.
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 a county ordinances
and state laws relating to building construction, an ereby authorize
representatives of this city to enter upon the ab a mentioned property for
inspection purposes. (We) agree to save indgAnify and keep harmless the
City of Cupertino against liabilities, judgme , costs, and expenses which
may accrue against said City in consequ ce of the granting of this permit.
Additionally, the applicant understandsAd will comply with all non -point
source regulations,pgr the Cupertino unicipal Code, Section 9.18.
Date 7/19/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
r. 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. 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
BUILDING PERMIT INFO:
X BLDG —ELECT —PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
t Q9P&$P9tlIR
2evv,tu &t1
Sq. Ft Floor Area: I Valuation: $3683.00
APN Number: Occupancy Type:
375 11 012
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: AbbyAAyende
Date: 07/ 19/2017
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 of Applicant:
Date: 7/19/2017
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF
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. 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. I 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, I 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.
Signature Date 7/19/2017
"A" OR BETTER
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 Di ct I
will maintain compliance with the Cupertino Municipal Code, Cha .12 and
the Health & Safety Code, Secti ns 25505, 25533, a 534.
Owner or authorized agent:
Date: 7/19/2017
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.
Licensed
CUPERTINO
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(a,cupertino.org
❑ PLUMBING k MECHANICAL
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❑ OWNER ❑ ONNER-BUILDER ❑ OWNER .AGENT
❑ CONTRACTOR ?vIRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENAI.7
CONTRACTOR NAMES �n ^ �
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BUS. LIC #
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PHONE
USE OF SFD or DUPLEX ❑ MULTI-FAMTLY PROJECT TN w1LDLANTD ❑ YES
BUILDING: ❑ COMMERCIAL URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
/
TOTAL VALUATION: —
RECEIVE
By my signature below, I certi to each of the following:
application and the information I have provided is correct.
ordinances and state laws relating to building co stru n.
Signature of ApplicandAgent:
I am the property owner or orized agent to act on the property owner's behalf. I have read this
I have read the Des cr' on of Rork and verify it is accurate. I ague to comply with all applicable local
authorize rep ntatives of Cupertino to enter the above- identifiedpro/rty for ' spection purposes.
Date:
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
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IIEPMiscAPP_2011.doc revised 06121/11
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CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC)
Project Name:
JUDY HART I Date Prepared:
CF1R-ALT-02-E
(Page 1 of 3)
2017-07-18
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
JUDY HART
02
Date Prepared
2017-07-18
03
Project Location
10066 JUDY AVENUE
04
Building Type
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
HOUSE
SC System
SC System
CFA served
system a
Dwelling Unit Conditioned
Installing new SC
07
Zip Code
95014
08
Floor Area (ft)
3589
by this SC
ducted
containing
system
Number of Space
entirely new
09
Climate Zone
4
10
Conditioning (SC) Systems in
1
component?
components?
feet of ducts?
duct system?
this Dwelling Unit:
Alteration Type
B. Space Conditioning (SC) System Information
01
02
03
04
05
06
07
08
09
10
Is the SC
Installing a
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
Altered space
SYSTEM 1
LOCATION 1
3589
Yes
Yes
Yes
No
No
No
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b)1Diib)
This section does not apply to this project.
Registration Number: 417-A020103861A-000-000-0000000-0000
CA Building Energy Efficiency Standards - 2016 Residential Compliance
Registration Date/Time: 2017-07-18 16:17:55
Report Version: 2016.1.006
Schema Version: rev 10/16
HERS Provider: CHEERS
Report Generated: 2017-07-18 16:17:55
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)lE 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
This field or
No heating
This field or
This field or
This field or
This field or
SYSTEM 1
section is not
component
section is not
section is not
Evaporative
direct
Indoor coil
SEER
14
Setback
section is not
section is not
applicable
altered
applicable
applicable
applicable
applicable
Required Documentation:
CF2R-MCH-01-E - Space Conditioning Systems
- Duct insulation requirement for the new portions of supply -air and return -air ducts or plenums: R6 (CZ 1-10, 12 and 13) and R8 (CZ 11 and 14-16)
CF2R and CF3R-MCH-20-H - Duct Leakage Test required when heating or cooling components 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 seal all accessible leaks.
CF2R and CF3R-MCH-25-H Refrigerant Charge verification required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15).
CF2R and CF3R-MCH-23 Airflow Rate >= 300 CFM per ton required when MCH -25 is required.
Exceptions:
Duct systems registered with HERS provider as previously sealed are exempt from MCH -20 Duct Leakage Testing requirements.
Heating -only systems and Air Handler Furnace changes do not require verification of Air Flow MCH -23, or Refrigerant Charge MCH -25.
-Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH -20 Duct Leakage Testing requirements.
E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)iDiia and 150.2(b)lE, 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: 417-A020103861A-000-000-0000000-0000 Registration Date/Time: 2017-07-18 16:17:55 HERS Provider: CHEERS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.006 Report Generated: 2017-07-18 16:17:55
Schema Version: rev 10/16
CERTIFICATE OF COMPLIANCE CF111-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:
April Rodriguez
Ap"zRoc1'`y4Ae'h,
Company:
Signature Date:
I Permit E Raters
2017-07-18
Address:
CEA/ HERS Certification Identification (if applicable):
31225 La Baya Drive
City/State/Zip:
Phone:
Westlake Village CA 91362
818-735-7876
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 under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible designer).
3. 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 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 available 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:
Responsible Designer Signature:
Lyndy Rose
Lyndy Robe'
Company:
Date Signed:
On -Time Air Conditioning & Heating Inc dba Service Champions
2017-07-18
Address:
License:
7020 Commerce Drive
817040
City/State/Zip:
Phone:
Pleasanton CA 94588
925-444-4444
Digitally signed by CHEERSTM. 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: 417-A020103861A-000-000-0000000-0000 Registration Date/Time: 2017-07-18 16:17:55 HERS Provider: CHEERS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.006 Report Generated: 2017-07-18 16:17:55
Schema Version: rev 10/16
CERTIFICATE OF VERIFICATION CF3R-MCH-20-H
Duct Leakage.Diagnostic Test o
Project.Name: / JUDY HART nforcement Agency: Cupertino Permit Number: B2017-1164
(C ty of)
•
Dwelling Address: 10066 JUDY AVENUE ity: 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 1
03 Building Type from CF-1R Single family
04 Verified Low Leakage Ducts in Conditioned Space(VLLDCS) No,credit is not taken
Credit from CF1R?
05 Verified Low Leakage Air Handling Unit Credit from CF1R? . No,credit is not taken •
06 Duct System Compliance Category „_: Alteration
MCH-20d-Complete Replacement or Altered Duct System
B. Duct,Leakage Diagnostic Test �•
01 , Condenser Nominal Cooling Capacity(ton) 5
02 HeatingCapacity kBtu h i
03 Conditioned Floor Area served by this,H{VAC syste,n14f )„,d}359k l .,„i.=4
04 Duct Leakage Test Conditions Test final
05 Duct Leakage Test Method Total leakage
06 Leakage Factor 0.15
07 Air Handling Unit Airflow(AHUAirflow) Determination Cooling system method
Method
08 Measured AHUAirflow - This field or section is not applicable
09 Calculated Target Allowable Duct Leakage Rate(cfm) 300
10 Actual Duct Leakage Rate from Leakage Test 50
Measurement(cfm)
11 Compliance Statement: System passes leakage test •
12 Notes:
Registration Number: Registration Date/Time:2017-08-10 15:38:04 HERS Provider:CHEERS
417-A020103861A-002-000-M20000A-M20A
CA Building Energy Efficiency Standards Report Version:2016.1.006 Report Generated:2017-08-10 15:38:04
2016 Residential Compliance Schema Version:rev 03/16
CERTIFICATE OF VERIFICATION ry 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 riot be sealed/taped 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 OA 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 usedas 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 accordancewith 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 HERS verification compliance.
• 4x I ,
08 Verification Status: -Pass-all applicable requirements are met , '
09 Correction Notes: " (
The responsible person's signature on this compliance document affirms that all applicable requirements in this table have
been met unless otherwise,noted in the Verification Status and the Corrections Notes in this table. '
t f � `9d
D. Determination of HERS Ve'rificationNCompliance m d f I
•
Allapplicable sections of this document shall indicate compliance with the specified verification protocol requirements in order
for this Certificate of Verification as a whole to-be::determined;to beinycompliancea
01 Complies:All specified verification protocol requirements on this document are met. -
Registration Number: Registration Date/Time:2017-08-10 15:38:04 HERS Provider:CHEERS
417-A020103861A-002-000-M20000A-M20A '
CA Building'Energy Efficiency Standards Report Version:2016.1.006 Report Generated:2017-08-10' 15:38:04
2016 Residential Compliance Schema Version:rev 03/16 - .
CERTIFICATE OF VERIFICATION CF3R-MCH-20-H
Duct Leakage Diagnostic Test (Page 3 of 3)
Documentation Author's Declaration Statement
1. I certify that this Certificate of Verification documentation is accurate and complete.
Documentation Author Name: Documentation Author Signature:
April Rodriguez Apra Rodriquek
Company: Date Signed:
I Permit E Raters 2017-08-10
Address: CEA/HERS Certification Identification(if applicable):
31225 La Baya Drive
City/State/Zip: Phone:
Westlake Village CA 91362 818-735-7876
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. I am the certified HERS Rater who performed the verification identified and reported on this Certificate of Verification(responsible rater).
' 3.• The installed features,materials,components,manufactured devices;or system performance diagnostic results that require HERS verification
identified on this Certificate of Verification comply with the'applicable requirements in Reference Appendices RA2,RA3,and the requirements
specified on the ofCertificate. ompliance for the building by.the enforcement agency.
4. The'information reported on applicable sections of the Certificates)offlnstallation(CF2R)signed and submitted by the person(s)responsible for the
construction or installation conforms to the requirements specified.onfthe Gertificate(s)of Compliance(CF1R)approved by the enforcement agency.
5. I will ensure that a registered copy of this Certificate of Verificatwnfshall be posted,or made available with the building permit(s)issued for the
'�`'.L,«was P'.'
building,and made available to the enforcement agency for all'applicable inspections.I understand that a registered copy of this Certificate of
•
Verification is required to be included with the documentation the builder provides to the building owner at occupancy.
Builder Or,Installer Information As Shown On The,Certificate Of Installation
Company Name:(Installing Subcontractor General Contractor,('or Builderf/Owner) g "
Im 5
On-Time Air Conditioning&Heating Inc dfaaService Champions
Responsible Builder or Installer Name: CSLB License:
Lyndy Rose4r 1. tfr i") d ., i"v'iC i:,847041] « ci L
HERS-Provider Data Registry Information
Sample Group Number(if applicable): Dwelling Test Status in Sample Group(if applicable)
N/A
HERS Rater Information
i
HERS Rater Company Name:
I Permit E Raters
Responsible Rater Name: Responsible Rater Signature:
Josh Lertzma'n josh,Lert-enou ,
Responsible Rater Certification Number w/this HERS Provider: Date Signed:
RCN13251 •
2017-08-10
•
Digitally signed by CHEERSTM. 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:2017-08-10 15:38:04 HERS Provider:CHEERS
•417-A020103861A-002-000-M 20000A-M 20A
,CA Building Energy Efficiency Standards Report Version:2016.1.006 Report Generated:2017-08-10 15:38:04
2016 Residential Compliance Schema Version:rev 03/16