B-2017-1991 •
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1991
901 COTTONWOOD DR CUPERTINO,CA 95014-4666(369 17 040) ATKINSON
CLIMATROLLERS INC
SAN JOSE,CA 95112
OWNER'S NAME: DING XIAOMING AND ZHANG XIAOHUI DATE ISSUED: 11/16/2017
OWNER'S PHONE:408-219-7109 PHONE NO:(408)294-6290
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class ELECTRICAL Lic.#258540
. ContractorATKINSON CLIMATROLLERS INC Date 12/31/2018 X BLDG _ELECT _PLUMB
X MECH X RESIDENTIAL_COMMERCIAL
1 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:
RELOCATE FURNACE TO ATTIC,NEW 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. •
41-611/.2. 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:$21000.00
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 369 17 040
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.
Signature P Le��Date Issued by: Kim Dunbar
• Date: 11/16/2017
OWNER-BUILDER DECLARATION -
I hereby affirm that I ant exempt from the Contractor's License Law for one of the RE-ROOFS:
• All roofs shall be inspected prior to any roofing material being installed.If a roof is
following two reasons:
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:
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
permifis 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. Owner or authorized agent: �, ,��✓
APPLICANT CERTIFICATION Date:
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'ezpenses which,may accrue against said City in Lender's Address
consequence of the granting'of till's permit. Additionally,the applicant understands
and will complyiwith 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 Professional
CONSTRUCTION PERMIT APPLICATION"'' COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (�,J
,;::,-;,;,..1,!,,v.:-
(408) 777-3228 • building@cupertino.org PEMIT#B- .` 1/-- 1 9'
CUPERTINO REV# DEF#
❑ NEW CONSTRUCTION ❑ADDITION 1 ALTERATION ❑T.I. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS n I / J!�. / A 1 r APN# .3 L -0 0
�1 �llv It /`/(�'j�Y�^Qhs ob 9 -1�
OWNER..Z.-1LC1An, vt y P (J'(�—Z1��Z1o� . E-MAILl tnd� x.�2h0\n. 0� .17wia 1• Ili
STREETlADDRE�� I C Y STATE,eec-4\ o CA e7s l 1 i
01 G or cvv��� uuu
®CO TRACTOR NAME ❑OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
DEREK-VALLEY HEATING VALLEY HEATING 258540 C20 I
ISTREET ADDRESS CITY,STATE, ZIP '
1171 N 4TH ST SAN JOSE, CA 95112
E-MAIL PHONE BUS.LIC#
DDANIELS@VALLEYHEATING.COM 408-294-6290 400003
❑ARCHITECT 0 OWNER ❑OWNER AGENT IX CONTRACTOR AGENT 0 ENGINEER ID DEVELOPER❑TENANT
CONTACT NAME E-MAIL . '
DEREK-VALLEY HEATING DDANIELS@VALLEYHEATING.COM
STREET ADDRESS CITY,STATE,ZIP PHONE
1171 N 4TH ST SAN JOSE, CA 95112 408-294-6290
DECRIPTON J T 1
o(-in cik_a__ - o 04c.,' / ok.401 a•f.c-- c(Dnot'14)\\0' 'verj
Ge- l oVA., duc,-61,,, o r I_' ..
•
�INGLE-FAMILY/DUPLEX ❑MULTI-FAMILY INDUSTRIAL ElCOMMERCIAL
IS
I
TING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES It TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED ( 0/� `!1
BATHROOM SF SF SF SF 0 DETACHED ,5"2_,/ o vo 0
EXI ❑ NO.
ISPRINKLERS 0 NO EICHLER
FIRE 0
YES SECOND STORY ADDITION OYES
NO
DWELLING SECOND DWELLING ❑YES 0 ATTACHED DETACHED..OTHER
UNITS# UNIT ADDITON:. 0 NO S F
POOLS( 0 FIBERGLASS ❑VINYL-LINED 0 GUNITE 0 PREFABRICATED
POOL-SF SPA-SF I SPA ATTACHED❑YES 0 NO I TOTAL-SF .
RECEI�F,Yi�yc� TOTAL VALUATION:
Commercial or Multi-Family Buildings with Public Swimming Pools requires Department of Environmental Hegtlrgpprq-vgf J(�I /11 //U/ ,
RE-ROOF(EXISTING,ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY)
REMOVE/REPLACE 0 NO IF NO PLYWOOD ❑'A" ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
0 yEs #OF LAYERS THICKNESS❑5/8" OTHER ❑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 #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 purpo es. I cknowledge and authorize all information contained on this application form
to be made available for public record., � 6.17.-
6. �' / I i /I //l 7
Signature of Applicant/Agent: , //` lll/// QQQ(((//J ✓ Date: / 6 G y
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: 2017-0307 Cindy Zhang Date Prepared: 2017-11-14
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 2017-0307 Cindy Zhang 02 Date Prepared 2017-11-14
03 Project Location 901 Cottonwood Dr 04 Building Type _ Single family
05 CA City Cupertino 06 Dwelling Unit Name 2017-0307 Cindy Zhang
07 Zip Code 95014 08 Dwelling Uni ZConditioned 1925
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 ~`
01 02 03 04 05 06 07 08 09 10
, to E
-'ii the SCS . Installing°a •. - .' ,,..
SC System SC System CFA served system a refrigerant Installing new SC Installing InstallingY 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
Relocate furnace, Entirely new or
add air Whole House 1925 Yes Yes Yes Yes Yes Yes complete
conditioner, - replacement space
replace duc - conditioning system
C. Extension of Existing Duct System,Greater Than40Feet(Section150.2(b)-1Diib)"
This section does not apply to this project. •
Registration Number:217-A026535247A-000-000-0000000-0000 Registration Date/Time: 2017-11-14 12:01:41 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2016.1.006 Report Generated:2017-11-14 15:02:02
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)
This section does not apply to this project.
E. Entirely New or Complete Replacement Duct System,with or without Equipment Changeout(Sections 150.2(b)1Diia 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)
01 02 03 04 05 06 07 08 09 10 11
Heating , Cooling
System Heating Minimum- Cooling Minimum Required
Identification or Heating System Altered Heating Efficiency Efficiency Cooling Altered Cooling Efficiency Efficiency Thermostat New Duct
Name Type =Component " Type =Value System Type -Component Type Value Type R-Value
Relocate furnace, Annual Wel
add air Central gas All new heating Utilization Central split Alf new coling 14 -SetbackTher R-6
conditioner, furnace components Efficiency 96 p SEAR
• AC � component � Y mostat
•
replace duc (AFUE) .. _ , .:y �. 9 " :�� ..M 'a
Required Documentation: € y. xr
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
-Leakage rate compliance:<=5%. -
CF2R and,CF3R-MCH-22 Fan Efficacy
CF2R and CF3R-MCH-23 Airflow Rate Verification
-Compliance:Fan Efficacy<=0.58 W per cfm and System Airflow>=350 cfm per ton.
-Alternative Compliance:CF2R and CF3R-MCH-28 Return Duct Design verification is an alternative to MCH-22 and MCH-23 verification.
CF2R and CF3R-MCH-25-H Refrigerant Charge verification required when refrigerant containing components are installed or altered(applicable in CZ 2,8-15).
Exceptions:
Heating-only systems are exempt from the 0.58 W per cfm and 350 cfm per ton requirements:
Note:An"entirely new or replacement duct system"means at least 75%of the duct system is new duct material,and up to 25%may consist of reused parts from the dwelling unit's existing duct system(e.g.,registers,
grilles,boots,air handler,coil,plenums,duct material)if the reused parts are accessible and can be sealed to prevent leakage
•
Registration Number:217-A026535247A-000-000-0000000-0000 Registration Date/Time: 2017-11-14 12:01:41 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2016.1.006 Report Generated:2017-11-14 15:02:02
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: andy C1'000GL//!i
Faulkner,Cindy -
Company: Signature Date:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING&ELECTRICAL 2017-11-14 12:01:41
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 ofCompliance is true andcorrect.
2. I am eligible under Division 3 of theBusiness 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 tie building design or system design identified on this Certificate of Compliance conform to the
:
requirements of Title 24,Part 1 and Pait"i6 of the Cahfornia'Code of Regulations. � �10M0 �
4. The building design features or system design features identified on this Certificate,of Compliance are consistent with the information provided other aplicabte compliance documents,worksheets,
calculations,plans and specifications submitted to the enforcementagency forapprovaLiwitlithis buildhg permit application. .
5. I will ensure that a registered copy of this Certificate of Co°mpliance shall be made•avaifable with the hti lding permit(5}issued forthe building and made avallableto;the enforcement agency for all applicable
inspections.-I understand that a registered copy of this Certificate of Compliance is required to beincluded.with the documentationthe builder pravldes to;the building owner at occupancy.
Responsible Designer Signature:
��� --
Faulkner,Cindy - - - -- O
Company: Date Signed:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING&ELECTRICAL 2017-11-14 12:01:41
Address: License:
1171 NORTH 4TH STREET 258540 •
City/State/Zip: Phone:
SAN JOSE CA 95112 • 408-294-6290
Easy to Verify
at CaICERTS.com 04.. •
br
rr
•
Digitally signed by CaICERTS. This digital signature is provided in order to secure-the content of this registered document and in no way implies - •o
•
Registration Provider responsibility for the accuracy of the information. ® . _.l. ° -
Registration Number:217-A026535247A-000-000-0000000-0000 Registration Date/Time: 2017-11-14 12:01:41 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2016.1.006 Report Generated:2017-11-14 15:02:02
Schema Version:rev 10/16