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B-2017-1795 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1795 10516 WHITNEY WAY CUPERTINO,CA 95014-4442(369 39 027) ATKINSON CLIMATROLLERS INC SAN JOSE,CA 95112 OWNER'S NAME: RIOPEL DAVID P TRUSTEE&ET AL DATE ISSUED: 10/19/2017 OWNER'S PHONE:408-255-1825 PHONE NO:(408)294-6290 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class CC=20 Lic.#258540 Contractor ATKINSON CLIMATROLLERS INC Date 12/31/2018 x BLDG _ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH RESIDENTIAL_COMMERCIAL 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 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 13' g�/ performance of the work for which this permit is issued • . „�// I have and will maintain Worker's Compensation Insurance,as provided for by cY/ Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$3807.00 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 36939 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. Si at f f ‘e .6)-11Z Date 10/19/2017 Issued by:,Abby Ayende . Date: 10/19/2017 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 roofmg 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:10/19/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A”OR BETTER t.; 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 Califomia. 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 be deemed revoked. • ;`' authorized agent: G�R �/ �if��G , APPLICANT CERTIFICATION c a'e:10/19/2017 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.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. Signature Date 10/19/2017 Licensed Professional CONSTRUCTION PERMIT APPLICATION �- ,fir COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION B . . , 10300 TORRE AVENUE • CUPERTINO,CA 95014-3255 -::, ', (408)777-3228 • building@cupertino.org PEMIT.#B-20 11- - /1 ' ) CUPERTINO REV# DEF# ❑ NEW CONSTRUCTION ❑ADDITION ALTERATIONl ❑T.I. ❑MEP .❑RE-ROOF ❑SWIMMING POOL/SPA PROJECT ADDRESS 1 © � J, '� t , / !�� ' i A /�� APN it s /� �f] � • OWNER NAM �/ �PI3 E �/� L p,\,,,,.., STREET ADDRESS / CITY,STATE,ZIP G CONTRACTOR NAME 0 OWNER-BUILDER COM ANY NAME C(/ee�EN NUMBER )1 50 1 4 TYPE D e _ Uo,1 1v/ 1 0e-04 .1,J CITY,STATE,ZIP STREET ADDRESS / I I,`;1 � �- S0\n,JV- R-, Gtr 9 5 i 1 Z E-MAONE IL, l(t V5 eV a�/ly�/ l( OH�VI l LI D^_�� 1 J�i�i� BUS.LIC/t 4 EJ ° © 0 3 0 ARCHITECT 0 OWNER 0 OWNER/AGENT'� COI ACTOR AGENT ENGINEER 0 DEVELOPER❑6TENANT CONTACT NAME .9e0/k---/f _� A 14 J I F7�F E-MAIL 400 11,t5 ®V L L heA/ i�� STREET ADDRESS CITY, 0STATE,,ZIP 30.� • l PI40NE Y-- ✓�2q 1171 I�� � S DECRII'TO L nil avce, SINGLE-FAMILY/DUPLEX ❑MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL I EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES# TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($) REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE 0 ATTACHED BATHROOM SF SF SF SF 0 DETACHED EXISING. ❑YES EICHLER ❑YES SECOND STORY ADDITION 0 O FIRE SPRINKLERS 0 NO ❑ NO , • DWELLING SECOND DWELLING ❑YES 0 ATTACHED DETACHED OTHER UNITS# UNIT ADDITON: 0 NO ,S F ' POOLS' ❑FIBERGLASS ❑VINYL-LINED 0 GUNITE 0 PREFABRICATED + , POOL-SF SPA-SF I SPA ATTACHED❑YES 0 NO TOTAL-SF RECEI D BT•. L.30154; Commercial or Multi-Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval (AMR -•:' %✓> RE-ROOF'EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES TILE THER(SPECIFY) REMOVE/REPLACE❑NO IF NO PLYWOOD ❑1" EI3/8" PLYWOOD TYPE: PITCH: ROOF CLASS ❑YES I#OF LAYERS THICKNESS❑5/8" OTHER ❑OSB 1:1CDX OTHER •12 A PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES ❑OTHER • *Provide a signed copy of the Cupertino's Tear-Off Policy SF #of 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 acknowled e and authorize all information contained on this application form ' ' ' to be made available for public record. /f (Q / � • Signature of Applicant/Agent: /� � Date: )o/ jq7 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 , BldgApp_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) Project Name: ` Dave Riopel Date Prepared: 2017-10-19 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 . Dave Riopel '02 Date Prepared 2017-10-19 03 Project Location 10516 Whitney Way 04 Building Type Single family ' 05 CA City Cupertino 06 Dwelling Unit Name Dave Riopel Dwelling Unit Conditioned 07 Zip Code 95014 ` 08 Floor Area(ft2) 1889 Number of Space 09 Climate Zone 4 t 10 Conditioning(SC)Systems in 1 this Dwelling Unit: B.Space Conditioning(SC)System Information .' g111 ; , 01 02 03 s 1 tot 04 05 '� '' 06 07 08 09 10 'Is the SCEs Instalingaa ,.,. 1'-' ` 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 Whole House 1889 Yes No Yes No No No Altered space 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-A020362459A-000-000-0000000-0000 Registration Date/Time:. 2017-10-19 09:55:12 HERS Provider:CaICERTS __ .__CA'Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2016.1.006 Report Generated:2017-10-19 12:54:34 __ _. - 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 All new No cooling This field or This field or This field or This field or Replace Furnace Central gas heating AFUE 90 Central split component section is not section is not Setback section is not section is not furnace components AC altered applicable applicable 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 ere 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 per ton"required when MCH-25-is required Exceptions: �- Duct systems registered with,HERS provider as previously sealed are.exempt from MCH 20 Duct Leakage Te tting re�qui ements -Heating-only systems,and Air Handler Furnace changes do not require verificattiioi of Air Flow MCH-23,or Re rigerant"Charge MCH-25. • &„ -Existing duct systems constructed,insulated or seated with=asbestos,€€are exemptfrom.MCH 2 Duct.Leakage Testingjrequirementi BMs. ,Ja ¢ 1': c E. Entirely New or Complete Replacement DuSystem,with orwithout Equipment Chan eout Sections,-150 2(b} Dii ,andd150.2(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-A020362459A-000-000-0000000-0000 Registration Date/Time: 2017-10-19 09:55:12 HERS Provider:CaICERTS CA Building-Energy Efficiency Standards-2016 Residential Compliance Report-Version:2016.1.006 Report Generated:2017-10-19 12:54:34 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. ��jj" ��QQ�� �� Documentation Author Name: Documentation Author Signature: a C1'LU.G1bleAi' Faulkner,Cindy Company: Signature Date: ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING&ELECTRICAL 2017-10-19 09:55:12 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 on this Certificate of Complianceis true and correct. 2. I am eligible under Division-3 of the Business and Professions 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 requirements of Title 24,Part 1 and Part 6 of the California Code of Regulations. �° r '"°y°, " i' - 4. The building design features or system design features identified on this Certificate of Compliance are consistent wit�hthe information provided cit other app(icabte compliance documents,worksheets, calculations,plans and specifications submitted to the enforcementagency forapprovat¥with this building permit applicatior. r .�§ a a„ R T c n x� wz' 5. I will ensure that a registered copy of ibis,Certificate of Compliance shatt „ madeauaila#ile witkl the bulldi g pe mit(S issued forthe htiilding,and na*available t0be nforcement agency for all applicable inspections.I understand that a registered copy of this Ceftificate of Cornpljance is,requ red to bey included,with the documentation the,builder provides to the b_ujj inngg owner at occupancy. Responsible Designer Name: 'N _.. Responsible DesignerSignatiure _ (? �CGGL1Z62 /L Faulkner,Cindy - Company: Date Signed: ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING&ELECTRICAL 2017-10-19 09:55:12 Address: License: 1171 NORTH 4TH STREET 258540 City/State/Zip: Phone: SAN JOSE CA 95112 408-294-6290 Easy to Verify ; " . 0= at CaICERTS.com . r: 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 for the accuracy of the information. 0_ Registration Number:217-A020362459A-000-000-0000000-0000 Registration Date/Time: 2017-10-19 09:55:12 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2016.1.006 Report Generated:2017-10-19 12:54:34 Schema Version:rev 10/16