The URL can be used to link to this page

B-2017-1273CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1273 1195 STAFFORD DR CUPERTINO, CA 95014-4951 (362 11 027) ATKINSON CLIMATROLLERS INC SAN JOSE, CA 95112 OWNER'S NAME: SMITHSON JOAN A TRUSTEE DATE ISSUED: 08/02/2017 OWNER'S PHONE: 408-891-9703 PHONE NO: (408) 294-6290 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-2Q 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 FURNACE & AC (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 a 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 Sq. Ft Floor Area: Valuation: $7706.00 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 11 027 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 understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. � ZZ-1Y Si a C/ Date 8/2/2017 Issued by: Jasmine Archbold OWNER-BUILDER DECLARATION Date: 08/02/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the RF ROOFS: roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons:All t. 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 ofApplicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 8/2/2017 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 z. 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 Co , Sections 25505, 255533�and 225534. Labor Code,,l must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized ��i� Cw lJ Gt/'�Z�% le APPLICANT CERTIFICATION Date: 8/2/2017 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance correct. I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this, city 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 $/2/2011 Professional GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTI Nt7 (408) 777-3228 •FAX (408) 777-3333 • building (a-cupertino.orq misc ❑PLUMBING ECHANICAL V&LECTRICAL ❑MISC"ELLAN?Qj PROJECT ADDRESSC�q APN # �� P OWNER NAME PHON 7 E-MAIL STREET ADDRESS CITY, STATE, ZIP - '� FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER L LICENSE TYPE BUS. LIC # O o COMPANY NAME E-MAIL FAX l S U t'" STREET ADDRESS �j�� CITY, RATE, ZIP �I PHONE^ ARCHITECT/ENGINEER NAME 1 " LICENSE NUMBER BUS. LIC # ` I COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF FD.r DUPLEX ❑ MULTI -FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑ YES IS THE BLDG AN ❑ YES BUILDING: ❑ COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO EICHLER HOME? ❑ NO DESCRIPTION OF WORK (j, r Q_'EMPQ 0�, 14 CI -Lr- (MaA1M_k1r JR oite TOTAL VALUATION: By my signature below, I certify to each of the following: I 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 In i g cons ction. I a horize 1 resentatives of Cupertino to enter the above -identified jproperty for inspection purposes. Signature of Applicant/Agent: ��/� l/�IZ Date: $ Z/ 1 SUPPLEMENTAL INFORMATION REQUIRED s �a MEPMiscApp_201 Ldoc revised 06/21/11 O CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E Alterations to Space Conditioning. Systems (formerly CF -IR -ALT -'HVAC) (Page 1 of 3) Project Name: 2017- 0076 Bill Smithson rDate Prepared: 2017-07-24 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 2017- 0076 Bill Smithson 02 Date Prepared 2017-07-24 03 Project Location 1195 Stafford Drive 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name 2017- 0076 Bill Smithson ter. Dwelling Unit Conditioned 07 Zip Code 95014 08 Floor 1600 SC System SC System CFA served Area-(ft2) refrigerant Installing new SC Installing Installing Installing Number.of-Space Identification or 09 Climate Zone 4 ' , 10 Conditioning (SC) Systems in 1 entirely new entirely new Name this Dwelling Unit: System (ft) B. Space Conditioning (SC) System Information Wl xf �' -01 02 03 04 05 06 �07 08 x'09 10 .. .. moo. ter. els the SC. IhstaII Ing 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 Furnace and A/C whole house 1600 Yes Yes Yes No No No Altered space replacement 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: 217-A020250985A-000-000-0000000-0000 Registration Date/Time: 2017-07-24 14:40:06 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2016 Residential Compliance Report -Version: 2016.1.006 Report Generated: 2017-07-24 14:40:03 Crhamn \/arcinn• raw 1n/1 F, 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 Furnace andCentral - gas All new Central split All new This field or This field or ASC furnace heating AFUE 80 AC cooling SEER 14 Setback section is not section is not replacement components components 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 MR -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 oiit'side„,or seal all accessible leaks. CF211 and CF311-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 pert6n requiQ whe[� MCH-25is required. Exceptions: Duct systems registered with HERS provider as previously sealed are exempt fr6' CH 20 Duct Lgakage Testipg reAU d„uigementts Heating -only systems and Air Handler furnace changes do not require v'erificatitth b Air Flow MCH -23, pr Refn a ant Char e g� g -Existing duct systems constructed, insulated or seated with as6estgvre exempt from MC1f=20 AuC Lr #age Testtrig fequirement � ' .. ,s ?:, a:,, E. Entirely New or Complete Replacement Duct System, with or without, qulipment Changeout (Sections 150 2(b)1Du and450.2(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-A020250985A-000-000-0000000=0000 Registration Date/Time: 2017-07-24 14:40:06 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.006 Report Generated: 2017-07-24 14:40:03 rrhomn Vorcinn• row inti •, CERTIFICATE OF COMPLIANCE CFiR-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: Gwdy cGfy�%LP/L Faulkner, Cindy CJ'LU Company: Signature Date: ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL 2017-07-24 14:40:06 Address: CEA/ HERS Certification Identification (if applicable): 1171 NORTH 4TH STREET City/State/Zip: Phone: SAN JOSE CA 95112--q 408-294-6290 Responsible Person's Declaration statement I certify the following under penalty of perjury, under the lawsof.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 Busmes"sand Profess"ions'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 manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the • «s w a . =�. z 7n requirements of Title 24,'Part land Part6;of the California Code of I guta tons. 4. The building design features or stem desi n features identified on lis Certificate of Cam fiance are consistebt wiktf►''the i or on,'crovided ori othe ., g g y g Rs p �sapplicalle compliance documents, worksheets, calculations, plans and specifications submitted to_the �rforcement,agency for' pptovalWiti this budding permit applicaLoA 5. I will ensure that a registered copy ofthis'Certificatef Copliance shIlb'e triode �srail2iile wif4tii� btiiClg prmit(S),issued for this bidding, am.triad avatabie tbeaiforcement agency for all applicable inspections. I understand that a registered copy of tWCertificate of Compliance is,recIgufed to be ncluded with the documpr>tation the buiider provides to ne building owner at occupancy. Responsible Designer Name: .> Responsible Designer Signature �a �D Faulkner, Cindy�CG�l� Company: Date Signed: ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL 2017-07-24 14:40:06 Address: License: 1171 NORTH 4TH STREET 258540 City/State/Zip: . Phone: SAN JOSE CA 95112 408-294-6290 Easy to Verify at CalCERTS.com Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document, and in no way implies Registration Provider responsibility fc r the accuracy of the inforrji Registration Number: 217-A020250985A=000-000-0000000-0000 Registration Date/Time 2017-07-24 14:40:06 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.006 Report Generated: 2017-07-24 14:40:03 Crhamn Varcinn• rav 1rill r C5 2,o t '�Vt flIj wool ewlirmj 1 4 le --