B-2017-1274CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1274
22938 CRICKET HILL RD CUPERTINO, CA 95014-2637 (342 35 007)
ATKINSON
CLUVATROLLERS INC
SAN JOSE, CA 95112
OWNER'S NAME: ARRAMREDDY VASUDEVA R AND ROHINI TRUSTEE
DATE ISSUED: 08/02/2017
OWNER'S PHONE: 408-315-3802
PHONE NO: (408) 294-6290
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C-20 Lic. #258544
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 (SAME LOCATION; REPLACE AC (SAME
I hereby affirm under penalty of perjury one of the following two declarations:
LOCATION
1. I have.and will maintain, a certificate of consent to self -insure for Worker's
mpensation, as provided for by Section 3700 of the Labor Code, for the
erformance 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 Cade, for the performance of the work for which this
Sq. Ft Floor Area:
Valuation: $9621.00
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
342 35 007
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.
� � �
Signa�.i 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
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)
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: 8/212017
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
r. 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. 1 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. 1 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
thealth & Safety Code, Sections 25505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Ownr authorized agent:��
,APPLICANT CERTIFICATION
D 8/2/2017
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. 3087, 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.
I understand my plans shall be used as public records.
Licensed
Signature Date 8/2/2017
Professional
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 MISC
(408) 777-3228 • FAX (408) 777-3333 • building0-cupertino.org
❑PLUMBING MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUSr�
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT XCONTRACTOR 11 CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
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ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC #
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY, STATE, ZIP PHONE
101 14,
USE OF SFD or DUPLEX: MULTI -FAMILY PROJECT IN W ILDLAND ❑ YES PROJECT IN ❑ YES IS THE BLDG AN ❑ YES
BUILDING: COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD Z NE ❑ NO EICHLER HOME? ❑ NO
DESCRIPTION OF WORK o
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TOTAL VALUATION: / f
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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 ullding co struction. I uthorize presentatives of Cupertino to enter the above -identified property for inspection purposes.
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Signature of Applicant/Agent: ��' (gyp`/ U s�y,G� Date: 1`2,1)
SUPPLEMENTAL INFORMATION REQUIRED\ www
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CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 1 of 3)
Project Name: 2017- 0119 Vasudeva Arramreddy Date Prepared: 2017-08-02
A. General Information
CF111-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- 0119 Vasudeva Arramreddy
02
Date Prepared
2017-08-02
03
Project Location
22938 Cricket Hill Rd
04
Building Type
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
2017- 0119 Vasudeva Arramreddy
Dwelling' Unit Conditioned
07
Zip Code
95014 x
08 -
2
Floor Area.(ft-),
1500
SC System
Number of Space
CFA served
09
Climate Zone
4
10
Conditioning (SC) Systems in
1
Identification or
Location or Area
by this SC
this Dwelling Unit:
containing
system
more than 40
AN.. _ _ _ _ .
entirely new
B. Space Conditioning (SC) System InformatEion�IRA
01
02
.. 03 5
F ., 04
05 '.
06
01
; 08.'
09
10
Is the SCr
installing
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 (ft2)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
Replace Furnace
and Air
Whole House
1500
Yes
Yes
Yes
No
No
No
Altered space
Conditioner
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-A020265087A-000-000-0000000-0000 Registration Date/Time: 2017-08-02 10:40:37 HERS Provider: CaICERTS
CA Building Energy. Efficiency Standards - 2016 Residential Compliance Report Version:- 2016.1.006 Report Generated: 2017-08-02 10:40:17
Schema Version: rev 10/16
CERTIFICATE OF COMPLIANCE CFiR-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -1R -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
Replace Furnace
Central gas
All new
Central split
All new
This field or
This field or
and Air
f
furnace
heating
AFUE
80
AC
cooling
SEER
14
Setback
section is not
section is not
Conditioner
components
components
applicable
applicable
Required Documentation:.
CF2R-MCH-01-E - Space Conditioning Systems
- Duct insulation requirement for the new portions of supply -sir 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 whenheating 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 >=330U CFM pe4 tDlt eequrred when MCH -25. is required
Exceptions:
- Duct systems registered with HERS provider as previously sealed are exempt from M-20 Duct Leakage Testing quirments
�, _•i
Heating -only systems and Air Handler Furnace do not equirewenficatl of Air Flow MC 23 orRefng0Fnt Chai,ge MCH 25 �•
changes
Existing duct systems constructed, insulated.or sea#ed 'with as6esto are exemp ?from MC Ib u�Lea�Cage Testlrt equirerpe is.
V .` s.
w..., , ,,
E. Entirely New or Complete Replacement Duch stem, wth or without Equlfpment Changeaut (Sections 1 0 2(b:)1Dna and 150.2(b)1E, F)
:.
This section does not apply°to this project.
F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)X)
This section does not apply to this project.
Registration Number: 217-A020265087A-000-000-0000000-0000
Registration Date/Time
2017-08-02 10:40:37
HERS Provider:.CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.006 Report Generated: 2017-08-02 10:40:17
Schema Version: rev 10/16
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT HVAC) (Page 3 of 3)
Documentation Author's Declaration Statement
1. I certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
Faulkner, Cindy
Company:
Signature Date:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL
2017-08-02 10:40.:37
Address:
CEA/ HERS Certification Identification (if applicable):
1171 NORTH 4TH STREET
City/State/Zip:
Phone:
SAN JOSE CA 95112
408-294-6290
Responsible Person's Declaration statemeti«C
I certify the following under penalty of perjury, under the laVus Crf;the State of California:
1: The information provided gn this Certificate of Compliance is true and correct.
2. lam eligible under Division 3"afiffe Rusine"ss;and Professions Code to accept rsponsibityfor the building design or system design identified on this Certificate of Compliance (responsible designer).
3. That the energy features and performance specifications matenals, 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 Cahforn�a Code of gu1ati ns F : �1
y , 0\ u:.
4. The building design features or system design fealErbs'identified of "his Certi r f 'mi l ante are�rrlsiste Wi the i"IrmattDnprowded on`btherapplicats compliance documents, worksheets,
�Sfarcemeni
calculations, plans and specifications s4bmitted to the w
dgency fo va�uvlth this bwl ng perr�t a icati.4
'm
S. I will ensure that a registered copy ofYttfs Certificats sf pliance siief ail t le wlttf bpitdpg''pi rmit( ;issu d forte ldlRg and, a�e avaiTab tjle' iforcement agency for all applicable
inspections. I understand that a registe€ecJcopyof this ricatb of Co pliant, req ,' fid to enduded with theocumentation,the,builder provides to the building owner at occupancy.
:\..
...,4
Responsible Designer Name: ,
Responsible DeRON r Si €sati re. = -•, --
Faulkner, Cindy��
Company:
Date Signed:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL
2017-08-02 10:40:37-
0:40:37Address:
Address:
License:
1171 NORTH 4TH STREET
258540
City/State/Zip:
Phone:
SAN JOSE CA 95112
1408-294-6290
Easy to Verify
at CaICERTS.comDigitally
a,,
signed'by CaICERTS. This digital signature is provided in order to secure the content of this registered document, and in noway implies Registration Provider responsibility f
the accuracyof the info
Registration Number: 217-A020265087A-000-000-0000000-0000
Registration Date/Time:
2017-08-02 10:40:37
HERS Provider: CaICERTS
CA Building Energy. Efficiency Standards - 2016 Residential Compliance Report Version: 2016:1.006 Report Generated: 2017-08-02 10:40:17.
Schema Version: rev 10/16