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B-2017-1243CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1243 21094 MARCY CT CUPERTINO, CA 95014-1658 (326 54 027) ON-TIME AIR CONDITIONING & HEATING INC PLEASANTON,CA 94588 OWNER'S NAME: TSING JOHN YUAN-HAO ET AL DATE ISSUED: 07/28/2017 OWNER'S PHONE: 408-393-8882 PHONE NO: (925) 598-1911 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-20 Lic. # 18 7040 Contractor ON-TIME AIR CONDITIONING & HEATING INC Date 09/30/2017 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 I license is in full force and effect. JOB DESCRIPTION: REPLACE FURNACE (SAME LOCATION); REPLACE AC UNIT; I hereby affirm underpenalty of perjury one of the following two declarations: REPLACE COIL (SAME LOCATION) i. I have d will maintain a certificate of consent to self -insure for Worker's Co ensation, as provided for by Section 3700 of the Labor Code, for the p ormance of the work for which this permit is issued. 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: $14278.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above AFN 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 326 32654 027 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 u ers ands and will comply with all non -point source regulations peIthe upertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signatur Date 07-28-2017 Issued by: Kim Dunbar OWN TILD DECLARATION Date: 07/28/2017 EWB .R I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: 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) z. 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: 07-28-2017 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. 1 will permit is issued. I 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 material. Additionally, should I use equipment or devices which mit hazardous shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Ma gement District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino Municipal C de, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, SCatiqns 25505, 2156, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date: 07-28-2017 1 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 CON TRrCT.ON LENDING AGENCY 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 1 understand my plans shall be used as public records. Code, Section 9.18. Licensed Signature Date 07-28-2017 Ad COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • buildingaa"cupertino.org MISC B -7v t -1 -IN 3 [:1 PLUMBING ,MECHANICAL P!�!LECTRICAL ❑MISCELLANEOUS PROTECT ADDRESS I ©� / J'�J�% ^tna=APN / e r c C[ — O �S -_ i OWNERNATIE A /� ✓ `v` PHI K6 - ! J (/(�10. Z C' E-MAIL STREET ADDRESS C STATE, ZIPS ( F�Jt� CONTACT NAME // PHQ�/j _ ,cC� M�/1.��/CL�G�./Pre. STREETADDRESSL/1i (�❑ C�T / „r/X ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTTRACTOR NTP -ACTOR AGENT ❑ ARCHITECT ❑(/ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME /jeelG Q c%� / ` LICENSE NUMBEIt.I//7� o LICENSE TYP1C.y ?a G�/ BUS. LIC # ' COMPANY NAME �i�HtiQ E-MAIL STREET ADDRES Zd /I� C CIT}/BATE'Z j d' �G ARCHITECTIENGINEER NAME LICSENUMBER BUS. LTC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF CSzQor DUPLEX ❑ 1%4ULTI-FAMILY BUILDING: ❑ COMMERCIAL PROJECT TN WTLDLAND ❑ YESPROJECT URBAN INTERFACE AREA ❑ NO IN 13YES FLOOD ZONE ❑ NO iS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO DESCRIPTION OF WORK c)d 6�Zr TOTAL VALUATION: Z V� 09 RE B .. By my signature below, I ce" rtify to each of the following: I am the pro met- 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 the Description of Work and verify it is accurate, I agree to comply with all applicable local ordinances and state laws, relating to bu' d' �oonstruction. t orize representatives of Cupertino to enter the above -id etyti d Xperty inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY W❑ ON " ' ❑ E�TRESS ❑ STANDARD ❑ LARGE c �❑ RLA,iOR MEPMiscApp_2011.doc revised 06/21/11 Awl CERTIFICATE OF COMPLIANCE Alterations to Space Conditioning Systems (formerly CF -1R -ALT HVAC) Project Name: MICHELLE TSING I Date Prepared: CKR-ALT 02-E (Page 1 of 3) 2017-07-27 A. General Information CFI11=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 MICHELLE TSING 02 Date Prepared 2017-07-28 03 Project Location 21094 MARCY COURT 04 Building Type Single family. 05 CA City Cupertino -06 Dwelling Unit Name HOUSE Identification or Location or Area .: iir..x_-­k— ducted containing system 07 Zip Code95014 entirely new Dwelling Unit Conditioned Served System (ftZ) system? . .component?_ . 08 1 i Area (ftZ) 2835 SC -system? Alteration Type r.,Floor 1 2835 2835 Yes Yes Yes No ( Number of Space Altered space 09 Climate Zone 4 ° �` `� €10 Conditioning (SC) Systems in 1 conditioning system this Dwelling Unit: B. Space Conditioning (SC) System Information ! ! I ! 01 02 03 04 '' I _U 05 ' i ! 06 a 07 08 09 10 SC System SC System CFA served Is the SC ,)J,F�ri system a Installing a 1 `I .ter:,+j re i rigerant -e +, `�Z ! t2 r l; -Installing new SCS Installing Installing Installing Identification or Location or Area by this SC ducted containing system more than 40 entirely new entirely new Name Served System (ftZ) system? . .component?_ . _ _ components?- feet.of.ducts? _ duct system? SC -system? Alteration Type SYSTEM 1I 1 2835 2835 Yes Yes Yes No No No Altered space 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-A020106045A-000-000-0000000-0000 Registration Date/Time: 2017-07-28 06:38:49 HERS Provider: CHEERS CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.006 Report Generated: 2017-07-28 06:38:49 , Schema Version: rev 10/16 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 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 Central gas All new Central split All new This field or This field or SYSTEM 1 furnace heating AFUE 0.8 AC cooling SEER 14 Setback section is not section is not components components applicable applicable Required Documentation: j CF2R-MCH-01-E - Space Conditioning Systems cry�r �R6 - Duct insulation requirement for the new portions of supply -air and return -air ducts or plenums (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 £nstalled inducted 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.4� i 1J , S.r..-��i ra t 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. Ducts stems registered with HERS provider as previously sealed are exempt from MCH720 Duct Leakagge�:„T�e_sting 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. EntirelyNew or Complete Replacement Duct System, with or)without E� ui � ent Chan •eout Sections 150.2 b 1Diia and 150.2 b 1E F p p Y q p g ( () () ) ThIS,�Cfi'°I'7,'=�� �sl•,�'t•�aa 9,s�':filv'<<'r'+` section does not apply to this-pr�rCoject. 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-A020106045A-000-000-0000000-0000 Registration Date/Time: 2017-07-28 06:38:49 HERS Provider: CHEERS CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.006 Report Generated: 2017-07-28 06:38:49 Schema Version: rev 10/16 CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E Alterations to Space Conditioning Systems (formerly CF -1R -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 Apr&ROd#tgue* Company: Signature Date: I Permit E Raters 2017-07-28 Address: CEA/ HERS Certification Identification (if applicable): 31225 La Baya Drive City/State/Zip:: Phone: Westlake Village CA 91362 i,r> `,',4-, p818735-7876 Responsible Person's Declaration statement I certify the following under penalty of perjury, under the laws of the State of California: r 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 responsibilityfor 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 maiiufectuf*ed 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;forlapproval with this building permit application. Pr 3 J4 I 5. I will ensure that a registered copy of this Certificate of Compliance shall be made available with th'e`6uilding!li pFri ermit(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'fo be included with'the documentation the builder provides to the building owner at occupancy. Responsible Designer Name: Lyndy Rose Uninal:chc-,>cl S-,ar �d�;�� Responsible Designer Signature: •�y,, ,R ;�Ir! ',� Company: Date Signed: On -Time Air Conditioning & Heating Inc dba Service Champions 2017-07-28 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-A020106045A-000-000-0000000-0000 Registration Date/Time: 2017-07-28 06:38:49 HERS Provider: CHEERS CA.Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.006 Report Generated: 2017-07-28 06:38:49 Schema Version: rev 10/16