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B-2017-1764 , CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1764 908 PROVIDENCE CT CUPERTINO,CA 95014-4028(356 11 061) ATKINSON CLIMATROLLERS INC i SAN JOSE,CA 95112 OWNER'S NAME: GRANT THOMAS J AND MELINDA K TRUSTEE DATE ISSUED: 10/12/2017 OWNER'S PHONE:650-722-0762 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,AC UNIT AND HALF OF DUCT WORK-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 Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 0r, I have and will maintain Worker's Compensation Insurance,as provided for by Vv ,fr ' Section 3700 of the Labor Code,for the performance of the work for which this permit is issued: . Sq.Ft Floor Area: Valuation:$15894.00 APPLICANT CERTIFICATION I certify that I have read this application andistate that the above ' informationis correct.I agree to comply with all city and county ordinances APN Number: Occupancy Type: and state laws relating to building'constrtction,and hereby authorize 356 11 061 representatives of this city to enter upon they 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 consequende 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're9ulations per the Cupertino M �unicip al , Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. ON.lgnature �"-+� ca),.-- Date 10/12/2017 Issued by:Abby Ayende Date: 10/12/2017. ' OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: follo'witig,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 employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for ,'i ,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 tlie'property„ani exclusively contracting with licensed Signature of Applicant: -i , • contractors to construct the project(Sec.7044,Business&Professions Code). Date:10/12/2017 I hereby,affirm under penalty of perjuryone of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A”OR BETTER i. I have and will maintain a Certificate'of Consent to self-insure for Worker's I' '., Compensation,as provided for by,Section 3700 of the Labor Code,for the r' i ,, 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 s. 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 bf 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� � lt 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall Q�g ��P/ —s�� be deemed revoked., oraner or authorized agent: , APPLICANT CERTIFICATION Date:10/12/2017 I certify that 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.3097,Civ C.) to enter upori;the above mentioned property for inspection purposes. (We)agree Lender's Name to save indemnify and;keep harmless ttiei City of Cupertino against liabilities, judgments,costs,and expense's which may accrue against said City in Lender's Address consequence;of the gilanting 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. e Signature Date 10/12/2017 Licensed Professional CONSTRUCTION PERMIT APPLICATION /� COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISIONB . ( 10300 TORRE AVENUE • CUPERTINO, CA 95014-32551 • f—Ric/ „wg rr,= 408 777-3228 • buildin (t�'cu ertin.o.org PEMIT#B CUPERTINO REV DEF# ❑ NEW CONSTRUCTION ❑ADDITION ALTERATION ❑T.I. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA -t3 {� PROJECT ADDRESS 7 l/ 2.:27.:. O v I 1 en 6-n i ci , APN A b — 11 0 I`f` I OWNER NAME vx� �" lOy,„„„5 CPHONE /5 ( L7� ©' I� "L STREET ADDRESS g e v"\ ct inW C CITY,STATE, P su e ,(vv" CI9 5 V 1 CONTRAAOLLlICTOR NAME 0 OWNER-BUILDER COMPANY NAME C LICENSE NUMBER LICENSE PE V ft U ZY 7 42.--4 1 — peire, ISTREET ADDRESS CITY,STATE, ZIP /� I E-MAIL V ll� VIVVJI � ) (Jo�1 Lt��" �� X17��0 BUS.LICg 0 0 Q D 3 PHONE 0 ARCHITECT 0 OWNER 0 OWNER AGEN/❑CONTRACT AGENT El ENGINEER 0 DEVELOPER ❑ITENANT �J CONTACT•NAME 'r,' I ( 1 lLe S.eJk7 tj E-MAIL 1 ate; 1 V o tei A { BUJ / C0 STREET ADDRESS V 1, v-, 91 Q CITY,STATE,ZIP,V` PHONE ✓ 171 ,i Lt- Ik r szN.� J� CA fIk.-4, Y-12-9,'-1-42-10 DECRIPTON J i L ,,, 0 no ovc/e_. / 4 r- (0,d I( c 1, 1)4,0 r`14-- INGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL I EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES A TOTAL NET SF USE TYPE OCC SQ:FT. VALUATION(5) REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE 0 ATTACHED ,j.{ 5� nQj )`] BATHROOM SF / SF SF SF 0 DETACHED ,�1 fCXI I 7 ® 0 o EXISiNC ❑YES EICHLER 0 YES SECOND STORY ADDITION OYES NO ii{ FIRE SPRINKLERS 0 NO 0 NO ,DWELLING SECOND DWELLING ❑YES ❑ATTACHED❑DETACHED IOTHER UNITS A UNIT ADDITON: ❑NO S F POOLS' 0 FIBERGLASS 0 VINYL-LINED 0 GUNITE 0 PREFABRICATED POOL-SF SPA-SF 1 SPA ATTACHED❑YES 0 NO I TOTAL-SF RECEIVED BY:n TOTAL VALUATION:( Commercial or Multi-Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval I A Q�� ( A` ' vp f I �/ j/y RE-RO ad EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES WOOD SHAKES❑WOOD SHINGLES LTILE OTHER(SPECIFY) REMOVE/REPLACE❑NO IF NO ; PLYWOOD ❑"i" ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS 1 yEs A OF LAYERS THICKNESS❑5/8" OTHER El OSB ❑CDX OTHER :12 A PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 OTHER *Provide a signed copy of the Cupertino's Tear-Off Policy SF Sof SQUARES 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 construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. I acknowl ge and authorize all information contained/ on this application form to be made available for public record. ---6._ � Lo/ ( 2/f Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED *New SFD/Second Dwelling Units/Multifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction. "Commercial Buildings: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. . *Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. • *HOA-Provide a letter of approval from the Home Owner's Association BIdgApp_2017.doc revised 08/01/17 CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E Alterations to Space Conditioning Systems(formerly CF-1R-ALT-HVAC) (Page 1 of 3) �� T Project Name: 2017-0254 Thomas Grant Date Prepared: 2017-10-10 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 2017-0254 Thomas Grant 02 Date Prepared 2017-10-10 03 Project Location 908 Providence Ct 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name 2017-0254 Thomas Grant 07 Zip Code 95014 08 Dwelling Unit Conditioned 2500 - Floor Area(ft2) Number of Space 09 Climate Zone 4 . - 10 Conditioning(SC)Systems in 1 this Dwelling Unit: B.Space Conditioning(SC)System Information , tleZ $_OA p ;‘ , 01 02 03 04 05 06� 07 08 09 10 ��. •rte ��:. ..., -�� A -Is the SC , Installing:a 4- V W ,.. 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,A/C, whole house 2500 Yes Yes Yes Yes No No Altered space Duct Replacement - conditioning system 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-A020350855A-000-000-0000000-0000 Registration Date/Time: 2017-10-10 1122:34 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2016.1.006 - Report Generated:2017-10-10 14:22:51 Schema Version:rev 10/16 - 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 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 Furnace,A/C, All new Central split All new Central gas Greater than Duct heating AF_UE _ _ 96 cooling SEER 16 Setback R-6 Replacement furnace- components - . - - - AC components 40 feet 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 wheri`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 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>=300 CFM peri ton:required when MCH-25.is required Exceptions: - -Duct systems registered.with HERS provider as previously sealed are exempt from MCH-20 Duct Leakage Testii?g jequirements -Heating-only systems and Air Handler Furnace changes do not require venficatf©n of Air Flow MCH23 orRefrigerant Charge MCH-25 -Existing duct systems-constructed,insulated or sealed with asbestos are exempt`,from MCI4-20 Duc Leakage Testlrfg sit_ 3 ,s . E. Entirely New or Complete Replacement Duct System,with or without,Equipment Changeout(Sections 150.2(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)1C) _ • This section does not apply to this project. • Registration Number:217-A020350855A-000-000-0000000-0000 Registration Date/Time: 2017-10-10 11:22:34 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2016.1.006 Report Generated:2017-10-10 14:22:51 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 (?Uy OCll��2P� Company: - _ - Signature Date: ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING&ELECTRICAL 2017-10-10 11:22:34 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•lawsof,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 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 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 ortthis Certificate of Compliance are COnsisterlt with the information.provided on otherappficable?a'5 pliancedocuments;worksheets, calculations,plans and specifications submitted to the enforcement`gency for;approval wit\this building permit application. 5. I will ensure that a registered copy of this Certificat of Cote`pliance shall be made available Witty.Lite bu(! Jli°p rmit(S):issued for he•buildit g,and made available t the'''enforcement agency for all applicable inspections.I understand that a registered copy of this Certificate of Compliance;is required to besincluded with the.documentetiorttheabuilder prquides to the buildding owner at occupancy. nat sible Designer Si ure. '?` pD Responsible Designer Name: Res on```l "�. p g g Faulkner,Cindy CPPti Company: Date Signed: ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING&ELECTRICAL 2017-10-10 11:22:34 Address: License: 1171 NORTH 4TH STREET 258540 • City/State/Zip: Phone: - SAN JOSE CA 95112 • 408-294-6290 • • Easy to Verify ��; ❑: at CaICERTS.com L r: 1 Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered document,and in no way implies r 'o Registration Provider responsibility for the accuracy of the information.• Registration Number:217-A020350855A-000-000-0000000-0000 • Registration Date/Time: 2017-10-10 11;22:34 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2016 Residential-Compliance Report Version:2016.1.006 Report Generated:2017-10-10 14:22:51 Schema Version:rev 10/16 \,\ SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE ., COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION � O 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 C (408)777-3228•FAX(408)777-3333•buildinci cupertino.orq PERMIT CANNOT BE FINALED UNTIL THIS CERTIFICATE HAS BEEN COMPLETED,SIGNED;AND RETURNED TO THE BUILDING 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 Monoxide alarms.-When-the valuation of additions, alterations,or repairs to existing-dwelling-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 907.2.114 and 420.6.2.An electrical permit is required for 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 alaints specified below have been tested and are operational,as of the date signed below Address: 97� � �� ��� (/6% Permit No. g -2611-130 Specify Number of Alarms #Smoke Alarms. I b I #Carbon Monoxide Detectors. I 1 I have read and agree to comply with the terms and conditions of this statement Owner(or Owner Agent's)Name: I. 0)23) a Signature t �,:.:. .. • Date: Contractor Name: Signature Lic.# Date: Smoke and COform.doc revised 01/10/2017