B-2017-1730 •
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1730
22086 LINDA VISTA PL CUPERTINO,CA 95014-4022(356 08 007) ATKINSON
CLIMATROLLERS INC
SAN JOSE,CA 95112
OWNER'S NAME: RADTKE PATRICIA M.AND DAVID D DATE ISSUED: 10/06/2017
OWNER'S PHONE:408-142-3837 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:
REPLACE FURNACE SAME LOCATION;INSTALL(N)AC UNIT
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.
•
OW-00(00010 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
tyt permit is issued. Sq.Ft Floor Area: Valuation:$16150.00
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 356 08 007
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 :: Aree/�"rtV `'2 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
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)
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
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 Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall .. y— w
be deemed revoked. Owner or authorized agent: /
•
APPLICANT CERTIFICATION Date:10-6-2017
I certify that I have read this application and state that the above information is CONSTRj;d ":P ON 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
\k wM GENERAL PERMIT APPLICATION M E P
, Net,
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
C
y4.ts� \ 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildinq(a.cupertino.orq I S
❑PLUMBING MECHANICAL 0ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS rJ 2' /) / L t vi0L VIS-tOfl APN# 35Y -D }t D6
OWNER NAME \�ck 1 k j poofticl PHO@] 0 ric_...7 1 , 0.3,g 37 E-MAIL
STREETADDRES�n� 6 li �[�� ll 5-%� 1 , c✓(fie %f),STATE„ZIP L/t Q ' u FAX
CONTACT NAME 1 I � / �� i n PHONE t3 _,�Q/ ��O)O E-MAILol joi 1 el3 @ va 11 /" I^C fc9
IY/ V l/ G ��+ '�/
STREET DRES CITY TATE,ZIP `
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21 q-‘2,7 ci
❑OWNER 0 OWNER-BUILDER 0 OWNER AGENT /CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTRACTOR NA tE�`n I��,r /ak2j? 1`ill LICENSE NLJ BE�g5,){0 LICENSE TYPE✓I O BUS.LIC#9,0 0 9 3
COMPANY NAMED V E MAIILL ✓11 lJ V�I `(\ V I 1Jld/ FAX @J U v17 ?
Vw��t�YIA ��d 1 e e� Jll 1 i�tyaCom 11 /
STREET ADDRESS L 9 7 j l / c/1)1,, 4 CI S� P)oSt /1 1✓ 1 I/7PHONE ,f`Q Er 2�7J J 1 n
ARCHITECT/ENGINEER NAME V/� LICENSE NUMBER /�V�V BUS.LIC`## l V
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF XSFD or DUPLEX 0 MULTI-FAMILY PROJECT IN WILDLAND 0 YES PROJECT IN 0 YES IS THE BLDG AN 0 YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA 0 NO FLOOD ZONE 0 NO EICHLER HOME? 0 NO
DESCRIPTION OF WORK r // �� 11
C____02.1) 1 J'vL,,Ge. io LA 04 0 r C 1oSt4
c e
CS ol10 c° l\a ) .)s1 t.i-- moi,dt-17)ca-xe,C-
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TOTAL VALUATION: aL n 0 0 y'.
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 ccon traction. I authorize epresentatives of Cupertino to enter the above-identified property for inspection purposes.
t
Signature of Applicant/Agent: W o1/ 72y Date: /0 `P .- r
SUPPLEMENTAL INFORMATION REQUIRED 60 ''...a otSt *EitA
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4} ass 4440
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• MEPMiscApp_2011.doc revised 06/21/11
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to.Space Conditioning Systems(formerly CF-1R-ALT-HVAC) (Page 1 of 3)
Project Name: 2017-0237 David Radtke Date Prepared: 2017-09-21
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 2017-0237 David Radtke 02 Date Prepared 2017-09-21
03 Project Location 22086 Linda Vista PI 04 Building Type Single family
05 CA City Cupertino 06 Dwelling Unit Name 2017-0237 David Radtke
07 Zip Code 95014 08 Dwelling Unit Conditioned 1700
:, Floor Area(ft2)
Number:of Space
09 Climate Zone srov -4s!,,,',%,:;‘, 1 =a,,. 10 Conditioning(SC)Systems in 1 - -
this Dwelling Unit:
B.Space Conditioning(SC)System Information ,' f a 4
01 02 03 4 04 05 `.-4— ''' ''� -07 1 7' 08 ',; "09 10
s the SC I stalling)a '� ,. .,p ., ,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(ft2) system? component? components? feet of ducts? duct system? SC system? Alteration Type
Furnace Altered space
Replacement,Add Whole House 1700 Yes Yes Yes No No No conditioning system
A/C
C. Extension of Existing Duct System,Greater Than 40 Feet(Section150.2(b)1Diib)
This section does not apply to this project.
Registration Number:217-A020326768A-000-000-0000000-0000 Registration Date/Time: 2017-09-21 12:29:22 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2016.1.006 Report Generated:2017-09-21 15:29:18
Schema Version:rev 10/16
r -
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems(formerly CF-1R-ALT-HVAC) - (Page 2 of 3)
D.Altered Space Conditioning System(Sections 150c2(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--
Furnace All new All new This field or This field or
Central gas Central s
Replacement, heating AFUE 96 split Replacement, SEER 20 Setback section is not section is not
Add A/C furnace components AC 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 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 outsider 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 y 300CFM perton requ dwhen MCH-25 is required
ate. ,,• , ,
Exceptions: •
Duct systems registered with HERS provider as•previously sealed are exempt from MC4-20 DuctLeakage TT,RRepst' g•fe ,uir is
-Heating-only systems and.Air Handler Furnace changes do not require verification of Air Flow MCH-23,or Re>rigerantt h- a MGH 25 �'
-Existing duct systems constructed,insulated or sealed with asbestosF,are exempt from MCH-20 uct�LeakageTestifng uire2mt ents. .
< a `.SYS¢'. ,z.: . 4� .�.: ;,A;s � �
E. Entirely New or Complete Replacement Duct:4Stem,with 9r without Equipment ,h ngeout(Sections1511.2(p, )1Dna and150 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-A020326768A-000-000-0000000-0000 Registration Date/Time: 2017-09-21 12:29:22 HERS Provider:CaICERTS
CA Building Energy Efficiency-Standards-2016 Residential Compliance Report Version:2016.1.006 Report Generated:2017-09-21 15:29:18
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. 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 2017-09=21 12:29:22
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 statement
I certify the following under penalty of perjury,under the laws of the State of California:
1. The information provided onllis Certificate of Compliance.is true and correct. - -
2. I am eligible under Division 3 ofthe 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 buil�ding design o�rsystem design identified on this Certificate of Compliance conform to the
requirements of Title 24,Part land Part 6of the California Regulationsw_= 5 &' ":'
4. The building design features or system,design features identified on this Certificate cif Compliance are consistent with�the informationuprovided on othervapp`licabie-compliance documents,worksheets,
calculations,plans and specifications submitted to the ekaarcemen Yagency forappfovafwiRhthis building permit apl5lication. - r ! *r
aa
this fi
5. I will ensure that a registered copy of Certifica f Co pliance steel# `bla a .piieOle�� he bu l In pgrmrt( �issu l forit}t Juilding andimade aveliab�e.,t9ytla nforcement agency for all applicable
inspections.I understand that a registered copy of this Certificate of Compliancei requ ed to*included with theciocumentatiorithe builder provides toihe budding owner at occupancy.
Responsible Designer Name: Responsible Designer Signature:
Faulkner,Cindy
Company: Date Signed:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING&ELECTRICAL 2017-09-21 12:29:22
Address: License:
1171 NORTH 4TH STREET 258540 -
City/State/Zip: Phone:
SAN JOSE CA 95112 -
- --- ---- - -- -- - . :408-294.6290------ _- --
Easy to Verify ;
atCaICERTS.comti airy a_
Digitally signed by CaJCERTS. This digital signature is provided in order to secure the content of this registered document,and in no way implies_ - z+l.
'�A'•""y
Registration Provider responsibility for the accuracy of the information. ®
Registration Number:217-A020326768A-000-000-0000000-0000 Registration Date/Time: 2017-09-21 12:29:22 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2016.1.006 Report Generated:2017-09-21 15:29:18
Schema Version:rev 10/16 -