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14080042I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10225 LEBANON DR CONTRACTOR: DBA BAY AREA PERMIT NO: 14080042 ENERGY GROUP OWNER'S NAME: SISSON HELEN P 448 KATO TERRACE DATE ISSUED: 08/06/2014 OWNER'S PHONE: 4082572136 FREMONT, CA 94539 PHONE NO: (408) 359 -7470 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL / pQ�y� 4Z REPLACE (E) SINGLE WALL HEATER, SAME LOCATION License Class Lic. # t00 (35K �-.,& BTU) Contractorml KZ" eNER-r1 lute 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. I hereby affirm under penalty of perjury one of the following two declarations: 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 Sq. Ft Floor Area: Valuation: $1500 performance of the work for which this permit is issued. 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 APN Number: 34214017 00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 M LAST ED INSPECTION. indemnify and keep harmless the City of Cupxrfino against liabilities, judgments, costs, and expenses which ccrue a st said City in consequence of the Date: r / granting of this permit ddit' nally a applicant understands and will comply with all non point s rce re lati per the Cupertino Municipal ode Section 9 18. l RE- ROOFS: Signature Date All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER- BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self - insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay A ir Quali anagement District I performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by will maintain compliance with the Cu tin Munici Code, Chapter .12 a d the Health & Safety Code, Sections 505, 5 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9 18. Signature Date lip GENERAL PERMIT APPLICATION EP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERT INO, CA 95014-3258 (408) 777-3228 • FAX (403) 777-3333 • bufldingacupetno.gra. m I S 17 PLTn,/,-Anzr. VM-1r-IT4 1, T,,TCALL 7 -hLl:-C= c,&j- F] l'us C-pnkN, --, au S M—FPMRsc-1pp_2011.doc revised 06121111 0 1 ov"I,ap, kAja i✓iL crry, STATE'T FAX CO214-1ACT CDmc si ST'?=jAD, DP. 2SS c -Irf TA �j M FAX olq,%MMAGM. -r ❑ C0\171PL4CTOIL Aa =--m= -m-:.i�'r BUS. Im FAX QTRZ- ZT ADDP FML*A! A-z IP I.CITY C 9 -A 415 11 V 6k:= Lica"SEM-hMER BUS. LIC4 B-MLA.IL I FAX ST?,----T 'A1)DRMS I MY, STA71-r, ZIP USE OF �KFD or DJPL-EX ❑ WUL-a F-11,my BUMMUNIGr. ❑ Coyf�p CLAL ?R0M=DW1LDL/--,M ❑ YES PPIOJ-ZC71 RN, I IWANI DM=RFACE AREA � o I LOOD ZONE ❑ YES IS T�-- BLDG AN ❑ Y:s Eic= Hollm? I)F-SCR271014 or WORK -T- (o TOTA-LVA-TUA-11ON: A/ n7y sim-naln-'re below, I =TtL�, to each of theKllo-wirk: 12 vmer or aiithoriz5d ann"o F th- -,Op-,-Ly mmer's By -7--b-VpOtS�-vt re-ad this application and the information ,on I have provi di 05ct I of Work and verifv it is acmaxnae!te. agree tolbo yAith all app T1-�.+4&JQczl - -)d sate 11a is , , f , i S,n, v, laws relating to build I �c coon. Lalives of Cupertino to enter the Pbc) orm- s oonpunposces. c)rdinances L I -ti L . I D et I: S i gmatare of ApplmantVkzent: S-LTPPL# tW-,-Ta-'rTF�MLkTION1 REQ=-D Qj-mi Owl FIRM- WMAM—M - - - - - M—FPMRsc-1pp_2011.doc revised 06121111 CITY OF CUPERTINO lown Ul IV UQ.'r71%4 A T%li2 _ RIIII .11INf n1V1C10N APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES Heater, Recessed Wall 1MRSUSHTR 1 # $72 TOTALS: $72.00 s UN Anas��r Mech. Plan Check 0.0 hrs $0.00 I'lwnb. I !an Crerr.'k ii'z ;, _ `tae ci FMech. Permit Fee: 1MPERMIT rther Mech. Insp. 0.0 hrs $48.00 0"'? "r T;urnb lrrs�c' NOTE: This estimate does not include fees due to other Departments (i.e. Funning, ruoac vvorKs, rere, aunuury .ewer "LJtrsu, —1-1 :t,.t.t, r.a 17—mot tho Dont fnr nddn'l info. "t3ti L(.L, GLI:. . 1 LL— — — VLLJCU V,r r,ra. •..rr„r..1 FEE ITEMS (Fee Resolution 11 -053 E . 711113) ADDRESS: 10225 LEBANON DR DATE: 08/06 /2014 REVIEWED BY: MELISSA Nmr [ hcc,, /.(�C APN: 342 14 017 BP #: *VALUATION: 1$1,500 'PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Du lex p PME Plan Check: PENTAMATION FURN /AC PERMIT TYPE: USE: r, WORK REPLACE E SINGLE WALL HEATER SAME LOCATION 35K BTU SCOPE PME Unit Fee: APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES Heater, Recessed Wall 1MRSUSHTR 1 # $72 TOTALS: $72.00 s UN Anas��r Mech. Plan Check 0.0 hrs $0.00 I'lwnb. I !an Crerr.'k ii'z ;, _ `tae ci FMech. Permit Fee: 1MPERMIT rther Mech. Insp. 0.0 hrs $48.00 0"'? "r T;urnb lrrs�c' NOTE: This estimate does not include fees due to other Departments (i.e. Funning, ruoac vvorKs, rere, aunuury .ewer "LJtrsu, —1-1 :t,.t.t, r.a 17—mot tho Dont fnr nddn'l info. "t3ti L(.L, GLI:. . 1 LL— — — VLLJCU V,r r,ra. •..rr„r..1 FEE ITEMS (Fee Resolution 11 -053 E . 711113) .. --. --- FEE --- - -- - - - - -- - -- - QTY/FEE - MISC ITEMS Nmr [ hcc,, /.(�C PME Plan Check: $0.00 r, PME Unit Fee: $72.00 PME Permit Fee: $48.00 Administrative Fee: IADMIN $45.00 Work Without Permit? ® Yes (j) No $0.00 tct' f area 1','<tr r irtg 1 "ees: i Travel Documentation Fee: ITRAVDOC $48.00 Stronp_ Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 Lr $214.50 $0.00 TOTAL FEE: $214.50 Kevised: U(71U/ZU14 STATE OF CALIFORNIA ALTERATIONS - HVAC h 1 K 1, CEC -CFIR- ALT -03 -E Revised 06114 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE CF1R- ALT -03 -E Alterations - HVAC CZ 1, 3 to 7 and 16 (formerly CF -1R- ALT -HVAC) (Page 1 of 1) Site Address: Enforcement Agency: Date Prepared: Permit #: Equipment Type Equipment Efficiency New: Ducting, Plenums, Lineset Conditioned Thermostat Required R -value Floor Area (sq ft) ❑ Packaged System ❑ Evaporator Coil AFUE COP ❑ R -6 (CZ 1,3-7) Ducts Served by system WSetback ❑ Split System ❑ Condensing Unit SEER -8' (CZ 16) Ducts \266sq ft (If not already HSPF ❑ R -6 (all CZ's) Plenums present, must urnace ❑ Lineset EER ❑ R -5 or R7.5 Lineset3 I I be installed) HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this form is allowed to be filled out by hand. For final inspection all forms are to be registered (no hand filled forms allowed) and a copy left on site. HVAC Changeout /Repair Required Compliance Documents to be left on site for Final: Can include new ducting All Equipment, CFIR- ALT -02 -E Condenser Unit, Evaporator Coil, CF2R: MECH -01, MECH -20 -HERS Air Handler /Furnace CF3R: MECH -20 -HERS Installer Requirement: Duct leakage (: 15% or, < 10% to outside, or seal all accessible leaks) Exempted from duct leakage testing if: ❑ 1. Duct system registered with HERS provider as previously sealed, or ❑ 2. There is less than 40 linear feet of duct in na-onditioned space, or 3. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building "l5 ❑ 2. New HVAC System Required Compliance Documents to be left on site for Final: All new equipment and All New Ducts' CF111- ALT -02 -E CF2R- MECH -01, MECH -20 -HERS, MECH -22 -HERS, MECH -(23 or 24) -HERS CF3R- MECH -20 -HERS, MECH -22 -HERS, MECH -(23 or 24) -HERS' Installer Requirement: Duct leakage < 6 %, Fan Efficacy (.58W /CFM), Air Flow >_ 350 CFM /ton (or Standards Table 150.0 -C / D alternative) ❑ 3. All New Ducts with Replacement Required Compliance Documents to be left on site for Final: Includes replacing or installing All New CFIR- ALT -02 -E Ducts' and one or more of the following: CF2R- MECH -01, MECH -20 -HERS, MECH -(23 or 24) -HERS Condenser Unit, Evaporator Coil, Furnace CF3R- MECH -20 -HERS, MECH -(23 or 24) -HERS Installer Requirement: Duct leakage < 6 %, Air Flow >_ 350 CFM /ton (or Standards Table 150.0 -C / D alternative) ❑ Exempted from duct leakage testing I existing duct systems are constructed, insulated or sealed with asbestos. ❑ 4. New Ducting over 40 feet Required Compliance Documents to be left on site for Final: Adding or replacing ducts in unconditioned CFIR- ALT -02 -E space but less than All New Ducts' CF2R: MECH -20 -HERS CF3R: MECH -20 -HERS Installer Required to: Duct leakage C.-L15% or, < 10% to outside, or seal all accessible leaks) ❑ Exempted from duct leakage testing I existing duct systems are constructed, insulated or sealed with asbestos. ' All new ducting R -8 required when more than 40 ft installed and R -6 when less than 40 ft installed. This includes in walls, between floors etc. ' A New Duct system is when the duct system is constructed of at least 75 percent new duct material, and up to 25 percent may consist of reused parts from the dwelling unit's existing duct system (e.g., registers, grilles, boots, air handler, plenums, duct material. 3 R -5 (1" thick insulation) for linesets 1" and less. R -7.5 (1.5" thick insulation) for linesets over 1 inch. Most mfg will require Suction line Diameter with insulation as the following 1.5- 2T -2 % ", 2.5- 3T -2% ", 3.5 to 4T -2%0, 5T -4%" Contractor (Documentation Author's /Responsible Designer'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 Compliance is true and correct. 2. 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the information on this document. 3. That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations (CCR). 4. 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 CCR. 5. The building design features or system design features identified on this Cprtif icate of Compliance are consistent with the information provided on other applicable compliance documents, w eets, ca tions, plans and specifications submitted to the enforcement agency for approval with this building permit applica 'on. Responsible Designer Name: ^ Responsible D Igoe ignatur . Dat e : Lice omp any : Address: City /State /Zip: Phone: rc??A-Y ( C N C �� ' V-A' c kzk- -c �i �5 If y-J For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1- 800 - 772 -3300 CUPERTINO SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 •FAX (408) 777 -3333 • building ancupertino.org j Permit No. 1 l (( O MO V?— Address - f0 "&A Df # of Alarms Smoke: Carbon Monoxide: PURPOSE This affidavit is a self- certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314,2013 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 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 bedroom(s) X X On every level of a dwelling unit including basements 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 907.2.11.4 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 alarms have been tested and are operational, as of the date signed below. I have read and aaree to comply with the terms and conditions of this statement Owner (or Owner Agent's) Name: y MiNMWI. •Sivv� Signature ... A. .. ......................... ............................... Dater . J..� . Contractor Name: V C7W { Si nature ............... Ar ..................... :.......................... Lic.# ....... ............................... Date: ..!.1� C.So�0w :1 � h r Smoke and CO form.doc revised 03118114