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B-2017-1731 • CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1731 753 STENDHAL LN CUPERTINO,CA 95014-4658(375 42 038) ATKINSON CLIMATROLLERS INC SAN JOSE,CA 95112 OWNER'S NAME: VIRSHUP GARY F AND ANITA T TRUSTEE DATE ISSUED: 10/06/2017 OWNER'S PHONE:650-799-5774 PHONE NO:(408)294-6290 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-20 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: (N)HP MINI-SPLIT SYSTEM-DUCTLESS 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. 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. Sq.Ft Floor Area: Valuation:$13606.00 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 375 42 038 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. Signat �u22. e Date 10-6-2017 Issued by:Kim Dunbar Date:10/06/2017 OWNER-BUILDER DECLARATION 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 i. 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: 10-6-2017 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. I will permit is issued. maintain compliance with the Cupertino Municipal Code,chapter 9.12 and the a. 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 T use equipment or devices which emit 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 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 25505,25533,and 25534. Code,I must forthwith comply with such provisions or this permit shall be d be deemed revoked. Owner or authorized agen APPLICANT CERTIFICATION Date:10-6-2017 I certify that I have read this application and state that the above information'is CONS CTION 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. I understand my plans shall be used as public records. Licensed Signature Date 10-6-2017 Professional \0.:// GENERAL PERMIT APPLICATION - M P . COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 MI �[ SC iv . UPERTU4 O (408)777-3228•FAX(408)777-3333•buildinga,cupertino.orq ❑PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS EDm LC31 Li 31 PROJECT.ADDRESS C 5 \ P 0 1 he l Ln n APN# !,� OWNER NAME /� �,�� / Gaol PHONE�5-O 17 9 9 r 577(yE-MAIL STREET ADDRESS 7.53 � / CITY, S ATE,ZIP 5 O FAX (_tire-h, A 19 CONTACT ey f/.AI NAME I ' PHON l �4 E-MAI f��l ]ILJ! tkeszA ',6014,1 ��-f'�JMv lc n `CYD STREET ADp ESS Ai 1 54/ CITY,ST TE, ZIP FA '^ cAA ❑OWNER 0 OWNER-BUILDER 0 OWNER AGENTld CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER LI DEVELOPER El TENANT LICENSENUMBERLICENSE YPE BUS.LIC# CONTRACTOR ME /! -zg5y0 �0�003 COMPANY NAME VE-MAI I F STREET ADDRESS ADD1 5 ,7x. 44-11 1l541 CITYJCO,ATE,ZJIP GA/ 5.. `.InI✓ PHONlJ s__21/1 .......,4)20.q0 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESSSS FDCITY,STATE,ZIP PHONE USE OF Ju Sor DUPLEX 0 MULTI-FAMILY PROJECT IN WILDLAND El YES PROJECT IN 0 YES ISTIIE BLDG AN 0 YES BUILDING: /❑COMMERCIAL /) IJD• URBAN INTERFACE AREA 0 NO FLOOD ZONE 0 NO EICHLER HOME? 0 NO (A)DESCRIPTION OF WORK. � t_J /� I n l ` _ fluc1( )� -t7P TOTAL VALUATION: if (,3 (0.L Q QRE EIVBCIB'1' ,;.* ,... 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 building co struction, I authorize representatives of Cupertino to enter the above-identiy roperty for inspection purposes. Signature of Applicant/Agent: 6&, -i j,tV Date: 7-0 SUPPLEMENTAL INFORMATION REQUIRED °OVER4tl,,- v,<':< k;W r - 4 is L EXPRESy a fi � SrANDR�F 037 ©!LARGE x air MEPMiscApp_2011.doc revised 06/21/11 STATE OF CALIFORNIA ALTERATIONS. HVAC. GEGCFI R-ALT 04 E{Revised D6113) • • : CALIFORNIA ENERGY,COMMISSION , • CERTIFICATE OF COMPLIANCE;: ::: ' , CF1R=ALT-04-E' • Alterations-'HVAC CZ 2;and 8 15.(formerly CF 1R=ALT-HVAC) " • : • (Page:1.of 1) Site Address ' Enforc ment�lgenty: Date Prepared:rerPermit# -- - 1 tENew Ducting,:Flenums,Lineset: Conditioned Equip mentEquipment Efficiency :. Termostat - 0Required R-value .Floor Area(sq ft) • 0 Packaged System 0 Evaporator-Coil AFUE COP ,0 R-6-(CZ2;•8_-13)Duct•ing S rved by system ,•S•etback 0 Split System 0 Condensing Unit , (If not already 0 R-8 (CZ 14=15)Ducting. - . �� 5 sgft, • • `Mini Split L7 Compressor > SEER J SPF 0 R-6(all.CZ's).Ple • present must r Hums pr installed)0 Furnace ineset be installed) � ... - set" O:. EER " R -5 orR75Jline HERS V,ERIFICATION:SUMMARY Listed below are Four HVAC Alteration Options.-.The installer determines the work to be completed and:matches it to one of the options below. All formds to be registere (no hand filled forms allowed) ms Copy of forto be-left on site for final"inspection. 51.HVAC Changeout/Repair Required Compliance Documents to be left on site for Final:".••,' All Equipment,.; •CF1R-ALT-02�E ,. , • -Condenser Unit;Evaporator Coil,', CF2R: MECH-01 MECH-20-HERS,,MECH-(23 or 24)2-HERS,MECH-25-HERS2 " Compressor TXV,tineset, r r CF3R: MECH?20-HERS,MECH-(23 or;24)-HERS2;MECH-25-HERS2 - Air Handler/Furnace?(Can include new ducting) • . , Installer Requirement;"Duct leakage(<15%,or,<1.09'4-to outside,or seal all accessible leaks),AirFlow7 300 CFM/ton,Refrigerant Charge Exempted from duct leakage testingifi - 01:Duct system.registered with HERS provider as previously sealed,or •2.There is less:than 40 linearfeet`of duct in unconditioned space,or Ci:3.Existing duct systems are constructed,insulated or sealed with asbestos(list manufacture date of building I.,' -0 2.New HVACSysteniRequired Compliance Documentsto be left on site for:Final: All new equipment and All New Ducts ' CFIR-ALT-02-E. ' including Mini.Split CF2Rc "MECH-01,MECH=20 HERS,MECH.:22 HERS;MECH-(23.or24)-HERS2,MECH 25-HERS :" CF3R:'.MECH 20'H„ERS;MECH-22-HERS,MECH-(23 or_24)-HERS2,MECH-2S,HERS2 • .: .,. Mini Splits"require CFIR-ALT-02=E,CE2R-MECH=01;and (CF2R-CF3R)MECH 25-HERS .,Installer Requirement•Duct leakage<6%,'Fan Efficacy(.58W/CFM);Air Flow?350 CFM/ton +alternative);Refrigerant Charge' •0 3.AU New Ducts with Replacement Required•Compliance Documents to be left on sitefor Final • All New.Ducts3 and one or more of the following 'CF1R-ALT-027( ' `' • replaced:'Condenser Unit,Evaporator Coil; CF2R: MECH-01;MECH 20-HERS;MECH-(23.or 24)-HERS,MECH-25-HERS • Compressor,TXV.Lines'et,Furnace2 CF3Ri MECH-20=HERS,MECH-(23.or 24)-HERS,MECH-25-HERS. 'Installer Requirement;•Duct leakage:E 6%,Ai'r Flow a 350 CFM/ton(or alternative),Refrigerant Charge ' Exempted from duct leakage'testing if:0-1.',Existing duct systems,are constructed,insulated or'Sealed with.asbestos • 0 4.New Ducting over 40 feet .Required Compliance Documents to be left on site for Final: ;:• ". .':New ducting but less than Ducts3 •; .CF1R-ALT-02-E;CF2Rr.MECH-20-HERS,CF3R:.MECH-20-HERS.- • installer Required to:Duct:leakage(.<_155,6 or,<10%to outside'or,or seal all accessible leaks)". . .0 EXCEPTION:Existing_duct systems constructed;insulated.or sealed withasbestos. • 'Alf newducting R 8 required when.more than 40 ft installed and R=6 when less than 40 ft installed.:This includes in walls,between floors etc:, 2 Heating only systenisandAir Handler/Furnace changes do not require Air-Flow MECH7(23 or 24);or Refrigerant Charge verification MECH-25 3 All New Ducts is when'at least 75 percent of the duct system isnew ductmaterial;and upto.25 percent,may.consist of reused parts from the - dwelling unit's existing duct system(e,g:,registers;grilles,boots,.air handler;coil;plenums,duct materia)): <R-5(1"-thick insulation)for linesets 1"and less:•R-7:5,(15":#hick insulation)forlinesets over 1 inch,,Nio!sf mfg will require Suc#ion line Diameter with insulation as thefollowing.1.5-2T=2%'.',2.5 3T-2%",3.5,to 4T-2%"•,ST=4W'•:‘ Contractor(Doeumentatiou'Author's/.(tesponsible:Designer's Declaration Statement),: . 1 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. I.am eligible under,Division 3 of the.California,Rusiness and.Professions Code to accept responsibility for the information on this document: 3: "That the energy features'and performance specifications for the:design identified on this Certificate"of Compliance conform tothe - - •"requirements of Title 24;Parts 1 and'6 of:the California Code of Regulations,(CCR). • 4. Thatthe 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 land Part 6.of,theCCR. •,;•.•_- 51 ;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. Re onsibleDesignerName Responsible Designer,Signature: Date Signed: " license: : � r, ls I �lZ ' :. to ' z5 • :0 company;: Address: City/StateJZip: Phone. " -Valley Heating,Coolingi.Eiectricai 1771N,.4th Street, San`Jose,CA 'F95112- assistance :95112 assistance or guestions,regarding the,Energy Standards,contact the Energy Hotline,ati 1-800=772-3300 -" • r , SMOKE / CARBON MONOXIDE ALARMS 1,'3 '41 OWNER CERTIFICATE OF COMPLIANCE ir COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION �� O 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 C (408)777-3228•FAX(408)777-3333•buildings cupertino.orq PERMIT CANNOT BE'-FINALED UNTIL.THIS CERTIFICATE HAS BEEN COMPLETED,SIGNED,AND RETURNED TO THE.BU.ILIMNG DIVISION PURPOSE This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2016 CRC Section R314,R315,2016 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections are required. GENERAL INFORMATION Existing single-family and multi-family dwellings shall be provided with Smoke Alarms and Carbon - --IVlonox-ide-alar-ins When-the-valuation-of-additions,al±er-ations,--ar=repairs to-€xisting_dwellng-units_exceeds- $1000 00, CRC Section R314,R315, and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations. AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the X X bedroom(s)-(Smoke alarms shall not be located within 3 feet of bathroom door) On every level of a dwelling unit including basements and habitable attics X X Within each sleeping room X Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420 6 and shall be approved by the Office of the State Fire Marshal. Power Supply In dwelling units with no commercial power supply, alarm(s)may be solely battery operated. In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic,basement or crawl space.Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for T� alarms which must be connected to the building wiring As owner of the above-referenced property,I hereby certify that the alarm(s)referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes. The alarms specified below have been tested and are operational, as of the date signed below 11 Address -7S 3 5 I'd t l4 t L- I- C v(J, "n if d (v,/�- Permit No.g 2 Di 7 -/7 31 Specify Number of Alarms #Smoke Alarms. I Lk I #Carbon Monoxide Detectors f / I have read and agree to comply with the terms a conditions of this statement V Owner(or Owner Agent's)Name: GA.e 1� l Y vV' Signature__ ... ... .. ............ Date:/®/4././9.. Contractor Name: Signature Lic.# Date: - Smoke and COform.doc revised 01/10/2017