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B-2017-1990 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1990 10205 SCENIC BLVD CUPERTINO,CA 95014-2724(357 09 009) ATKINSON CLIMATROLLERS INC SAN JOSE,CA 95112 OWNER'S NAME: JONES RONALD E AND BARBARA M TRUSTEE DATE ISSUED: 11/16/2017 OWNER'S PHONE:408-257-4478 PHONE NO:(408)294-6290 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C20 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: 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. �/ ., 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:$7000.00 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 357 09 009 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 r; / 4-' Date 11-16-2017 Issued by:Kim Dunbar Date: 11/16/2017 OWNER-BUILDER DECLARATION • I hereby affirm that I ani 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:11-16-2017 • 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. 1 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 1 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 / be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date: 11-16-2017 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. • Licensed • Signature Date 11-16-2017 Professional CONSTRUCTION PERMIT APPLICATION tV . COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION .. . 10300 TORRE AVENUE ® CUPERTINO,CA 95014-3255 �IPs• SO( q - / 5i 9a k ? (408)777-3228 • building@cupertino.org PEMIT#B- CUPERTINO REV# DEF# PROJECT ADDRESS NEW CONSTRUCTION ❑ADDITION ALTERATION ❑T.I.• AI❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA (o 05 SCR, c6Cv4 35 0`� 'Dd9 OWNsi ER W 1 P og-q 57- 4 1 7-U E-MAIL /J STIEoET Ci DADDRESS C�40 I /3 C TY, S ZIP ICLJ(Qer4 no ct U 50 (LI CONTRACTOR NAME 0 OWNER- BUILDER COMPANY NAME I LICENSE NUMBER LICENSE TYPE ZS S 540 STREET A�ESS �� C TY1ATE, P C� y c 3.5-Q ( 5 // E-MAIL I I J / PHONE r ' BUS.LIC# o't d Qin i`-ei k PUq 1) 4l I)Ai..u►v, yo 7—.2_7 I '' ‘L at 0 0 005 0 ARCHITECT 0 OWNER 0 OWNER �pENT CO ACTOR AGENT ENGINEER 0 DEVELOPER I❑�TENANTT I l �j / CONTACT ME _ , /� v ff 64 �� �yq E-MAIL I cd "l iNi e, 4�0 V ot, i l�� '`� i I'PHONE h G Vow) STREET ADDRESS ./ CITY,S(s�/oTE, h IP 0,0 -c CIA 51)2. O V f 7 �i 9 -‘2, 9 v • 11 N 94A 11 DECRIPTON et() /f J i ! SINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL I J EXIS NG USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES# TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($) lr REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE 0-ATTACHED G' BATHROOM SF SF SF SF 0 DETACHED //900 D� EXISING ❑YES EICHLER 0 YES SECOND STORY ADDITION ❑YES 1— FIRE SPRINKLERS 0 NO 0 NO 0 NO DWELLING ISECONDDWELLING / ❑YES 0 ATTACHED❑DETACHED OTHER UNITS# UNIT ADDITON: El NO S F POOLS! ❑FIBERGLASS ❑VINYL-LINED ❑GUNITE 0 PREFABRICATED POOL-SF SPA-SF I SPA ATTACHED 0 YES 0 NO TOTAL-SF _ REC I'VE 1 x TOTAL VALUATION: Commercial or Multi-Family Buildings with Public Swimming Pools requires Department of Environmental Heath nom oval // RE-ROOFI EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES LI WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY) REMOVE/REPLACE Q NO IF NO PLYWOOD ❑1" ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS ❑YES #OF LAYERS THICKNESS❑5/8" OTHER ❑OSB ❑CDX OTHER :12 A PROPOSED ROOF TYPE:❑BUILT-UI'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 purposes. I acknowledge and authorize all information contained on this application form to be made available for public record �� / le - A-....4././ ( / /I Signature of Applicant/Agent: Q(7' �(�(7� li ILA" 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 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: - - - 2017-0265 Ron Jones Date Prepared: _ 2017-11-02 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 - 2017-0265 Ron Jones 02 Date Prepared 2017-11-02 03 Project Location 10205 Scenic Blvd 04 Building Type Single family 05 CA City - Cupertino - 06 Dwelling Unit Name ; 2017-0265 Ron Jones Dwelling Unit Conditioned 07 Zip Code 95014 08 - 1200 Floor Area(ft2) Number of Space 09 Climate Zone 4 - 10 Conditioning(SC)Systems in 1 this Dwelling Unit: a,. ,, 412- ,u.- ,gam .. B.Space Conditioning(SC)System Information ` 4 - - 01 02 '- 03 a 04 05 06_ 07 08 09 10 -Is the SC Installingi . v , ' E .. 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? feetofducts? duct system? SC system? Alteration Type Add A/C whole house 1200 . Yes Yes 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-A020378745A-000-000-0000000-0000 Registration Date/Time: 2017-11-02 09:06:12 HERS Provider:CaICERTS CA Building.Energy Efficiency Standards-2016 Residential Compliance Report Version:2016.1.006 Report Generated:2017-11-02 12:06:26 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 No heating This field or This field or - All new This field or This field or Central gas Central split Add A/C component section is not section is not cooling SEER 16 Setback section is not section is not furnace altered applicable applicable 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 whenfeating 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-25-1-I 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 tonirequired when'MCHa25 is required Exceptions: -Duct systems registered with HERS provider as previously sealed are exempt from MCH-20 Duct Leakage Testing requiremen is x -Heating-only systems and Air Handler Furnace changes do not require verification of M Air Flow Cf23 or Refrigerant Charge MCH\25 -Existing duct systems constructed,insulated or sealed withasbestos are exempt from MCH120 Duct;Leakage Testing requirements "{ a E. Entirely New or Complete Replacement DucfSystem,with or without;Equipment Changeout(Section50 2(b) a and 150 2(b)1E, F) �...k, s 11Dn '" 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-A020378745A-000-000-0000000-0000 Registration Date/Time: 2017-11-02 09:06:12 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2016.1.006 Report Generated:2017-11-02 12:06:26 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 isaccurateand complete. Documentation Author Name: Documentation Author Signature: �o Faulkner,Cindy • C�� �t�� Company: -- - Signature Date: ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING&ELECTRICAL 2017-11-02 09:06:12 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 lawsiof the State of California: • 1. The information provided on this Certificate of Complianceuis true and correct. 2. I am eligible under Division 3 of the Business"and Professions Code to accepttresponsibility 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 of 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 on this Certificate of Compliance are consistent With the irdf ,�ormation_provided on r�app othelicable compliance documents,worksheets, calculations,plans and specifications submittetl to,the enforcement agency forapprovalwiththis building permit application. 5. I will ensure that a registered copy of this Certificate of Compliance shallbe♦Wade availa ble with the building per`mit(S)`issued for the,building,and made available tothe enforcement agency for all applicable inspections.I understand that a registered copy of this Certificate of Compliance.is.required to be,included_wi th the documentation�the builder provides to the building owner at occupancy. Responsible Designer Name: Responsible Designer Signature: -c gy�pp Faulkner,Cindy (?Gy c� f�/yLP/t� Company: Date Signed: ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING&ELECTRICAL 2017-11-02 09:06:12 Address: - - - License: 1171 NORTH 4TH STREET 258540 City/State/Zip: Phone: SAN JOSE CA 95112 • 408-294-6290 • Easy to Verify ID�, at CaICERTS.com } 744:0 Digitally signed by Ca/CERT$. 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. © c. ■, Registration Number:217 A020378745A-000 000 0000000 0000 Registration Date/Time: 2017-11-02 09:06:12 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2016 Residential Compliance - Report Version:2016.1.006 Report Generated:2017-11-02 12:06:26 Schema Version:rev 10/16