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14090210CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21697 RAINBOW DR CONTRACTOR: CALIFORNIA DELTA PERMIT NO: 14090210 MECHANICAL INC OWNER'S NAME: DON AND RITA LEE 6056 E BASELINE RD STE 155 DATE ISSUED: 09/30/2014 OWNER'S PHONE: 4082523972 MESA, AZ 85206 PHONE NO: (866) 692-5273 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑ INSTALL (N) MINI SPILT SYSTEM (DUCTLESS) WITH 3 License Class C - Li,. # (�/ ll. / OUTLETS Contractor Date 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 rformance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $12687 have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 36637010 00 Occupancy Type: Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WO NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 D IT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter 180 LLED INSPECTION. 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 may accrue against said City in consequence of the / �U Date: granting of this permit. Additionally, the applicant understands and will comply ss with all non-point source regulations per the Cupertino Municipal Code, Section 9 18. _ 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 1, 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. I 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 Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Muni ' I Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505,1553'3, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Dater 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I 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 GENERAL PE-RM1T APPLICATIONA E P v NO,! COMMUNITY DEVELOPMENT DEPAR 1 IJthiT • BUILDING DIVISION n O 50300 TORRE AVENUE • CUPERTINO, CA 95014-3255 D (408) 777-3228 • FAX (403) 7777-3333 • buildinolc cuoe-tno.ora m I S etJ�E�i C1St4 I I'DT TA1vi(^AT.nF7,7, RiCat 71,9SCELLANBOUS Ps -6-1 24 9 7 7o 6.7� Zef S-1-FS27- AJDF MS � Cl -i Y, i Si', i/��d/ cr-� � I C� C -4O FAX 7 CO v:ACT lt��,� e P On^ I v I42 X 0 2e = 1✓_�- S�=ci �> _CiTY,STAi b - l = "' 2 FAX !� OH`. i7 0��=rr==L'*_D 1� ow),- 4C�? ❑ C0\7?-AC0A ❑COTiTSCTORhC=hT ❑ hRCT-CI ❑--^1C^—?. ❑ D�—O?=e ❑ -FSS COIF CTORNAIf^ L:C \,SBNUIJ.3- LIMINSE T Y.112 BUS. LIC r S1 -=i AD ?.SS CITY, STI A7=-, Ay P30TH rs tC7F,BCi/m GD, =.FP.tiA1a I LiCBNSBNUT�BR. I BUS.LIC'� CM2- lagy NAr.S I E4YLA-TL I FAX STPE T ADDRESS I CITY, STATt, ZIP I FiiOrC ti Si Oa ❑ _sm or DUFI rx— ❑ 3LZT Dn G ❑ COi.OE.CiSI I�ULTI•F'U ZLY I ?ROIBC! DZ WEMLSND ❑ Y M I FROM=D" t n3t?3InT�LFA /PEA ❑ 0 ZOOD ZAl� ❑ YS ❑ 1 0 I IS TT BLDG AN ❑ 1^_S uGs 301 7 [3)"o DESCP.IPTION Or- WORK TOTtT VALUAiIO\: ��t^ a=,== _ "� -_ *'� - _ - - :_�^: �•��.u-�''�=� Vii: By my sim ati2re below, I ce,-4 to ead of oha fol10-,7, ,E: I am the property o:;•-er or author:z--d agen` ` � � on t-:r`s behalf. application and the infoi—nation I have provided is tori ect I have --_ uhe Description ofWork and very itis -I a_'ee to comply With all applicable local orcinaaces and s ate 1a ; s relati a to buildire consuvcfio a r . L,e representatives of SiCu er the -b--°e-identi ed propF, for Ls ec=�on peroses. mmeture of De A.pAllcut%1 ve^i. - - z:42 - �I T Ft�� " - - 1 ON �•QU1Z;D `�:'��co�c��n�� Vis. RM- —.. 1� �nlisc a� 2011.doc revised 06121171 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION 191 ADDRESS: 21697 RAINBOW DR DATE: 09/30/2014 REVIEWED BY: MELISSA UNITS APN: 366 37 010 BP#: `VALUATION: 1$12,687 PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: p # PENTAMATION FURN/AC PERMIT TYPE: WORK INSTALL N MINI SPILT SYSTEM DUCTLESS WITH 3 OUTLETS SCOPE APPLIANCE / EQUIP TYPE FEE ID 11h unh. 111(in Che( -A QTY UNITS BP FEES F,, A/C Units (<=10K cfm) 16REMAIR 0ii.��' ��=°<'-c� 1=i7 1 # $72 Heating System 1MRRAA 1 # $72 PME Unit Fee: $144.00 PME Permit Fee: $48.00 -F-T- Administrative Fee: ]ADMIN $45.00 Work Without Permit? 0 Yes 0 No $0.00 TOTALS: Travel Documentation Fee: ITRAVDOC $144.00 Strom; Motion Fee: IBSEISMICR ��IT, .: Mech. Plan Check 0.0 hrs $0.00 11h unh. 111(in Che( -A 1;iec. !'/an Chectt Mech. Permit Fee: IMPERMIT FCC. F,, r,lher Mech. Insp. 0.0hrs $48.00 Other Plumb fnsp� 0ii.��' ��=°<'-c� 1=i7 F"(", flhunh. hist). l`ee NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public works, fire, Nanitary Sewer vistrtct, acnoot e tc These ees are based on the relimina information available and are onl an estimate. Contact the Dept or addn'l info. is rrc , . FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS Plan C '/t2c/, PME Plan Check: $0.00 PME Unit Fee: $144.00 PME Permit Fee: $48.00 -F-T- Administrative Fee: ]ADMIN $45.00 Work Without Permit? 0 Yes 0 No $0.00 Ac:7Voll("(1d /"Jttrming 1'c'.es: Travel Documentation Fee: ITRAVDOC $48.00 Strom; Motion Fee: IBSEISMICR $1.65 Select an Administrative Item 131dy- Stds Commission Fee: IBCBSC $1.00 $287.65 $0.00 TOTAL FEE: $287.65 Revised: 08/20/2014 STATE OF CALIFORNIA ALTERATIONS - HVAC CEC-CFIR-ALT-03-E Revised 06/14 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: Z 7 Enforcement Agency: Date Prepared: Permit#: / 9 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 Setback ❑ Split System ❑Condensing Unit SEER ❑ R - CZ 168' ( ) Ducts� sq ft (If not already HSPF ❑ R-6 (all CZ's) Plenums present must 11 Furnace ❑Lineset EER ❑ R-5 or R7.5 Lineset; 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'byha-fi& For final inspection all forms are to be registered (no hand filled forms allowed) and a copy left on site. E3 1. HVAC Changeout/Repair Required Compliance Documents to be left on site for Final: Can include new ducting All Equipment, CF1R-ALT-02-E Condenser Unit, Evaporator Coil, CF2R: MECH-01, MECH-20-HERS Air Handier/Furnace CF3R: MECH-20-HERS Installer Requirement: Duct leakage (L15% 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 unconditioned space, or 113. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building ❑ 2. New HVAC System Required Compliance Documents to be left on site for Final: All new equipment and All New Ducts' CFIR-ALT-02-E CF211-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 2 350 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 CF1R-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 2 350 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: 10 Adding or replacing ducts in unconditioned CF1R-ALT-02-E space but less than All New Ducts' CF2R: MECH-20-HERS CF3R: MECH-20-HERS Installer Required to: Duct leakage L15% or, < 10% to outside, or seal all accessible leaks) ❑ Exempted from dud 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. 2 A New Duct system is when the duct system is constructed of at least 75 percent new dud 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%8", 5T-4%8" 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 Certificate of Compliance are consistent with the information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. Responsible Designer Name: Responsible Design Si nature: Date Signed: License: c6rrq4ny : Address: City/State/Zip: Phone: v For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300 nCn,nnTMENT '�'I^ ,rat �� '•+o � � (� .. + e ' e "Wo 0Ln ri•.;-•baw or 'LA QSao4 S"co ee : Rl/ 2c1s CAM Gov . . . . . . . . . `. W Nov PLOT PLA -Nb CHECKED BY i GATE PLANNING DEPT. I SATE Rl'"cl. OF". SEA 3 0 ?014 �y 40-orlIf SMOKE /CARBON MONOXIDE ALARMS FILE OWNER CERTIFICATE OF COMPLIANCE _ COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION f 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 - FAX (408) 777-3333 - building a(-cupertino.org �/ Permit No. � yy � � �'� O Address A 1 6 �'•� ��'1 w ��` # of Alarms Smoke: 3 Carbon Monoxide:.3 PERMIT CANNOT BE FLNALED AND COMPLETED UNTIL THIS CERTIFICATE _ HAS BEEN C AND ]2 TURNFD TO THE BUILDING DIVISION,g� y 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 8314 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 agree to (or Owner Agent's) Name: the terms and conditions of this statement JI(IG LU1C ..... I.... .. ............................................................... _-.-. �.�.......... _. Contractor Name: SinnatlirP.-................................................................. Lic.#...................................... Date: ................... Smoke and CO form.doc revised 03/18/19 CUPERTINO WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 FILE _t-6/ - dr naf (408) 777-3228 • FAX (408) 777-3333 • buildingAcuoertino.or4 Owner Name � ke- I Permit No./ `1 D ( 6 2l o Address L PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE HAS BEEN SIGNED AND RETURNED TO THE BUILDING DIVISION Please refer to the attached California Civil Code Sections 1101.1- 1101.8 which are part of this Certification form. 1. Is your real property a registered historical site? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form. Owner' Signature: ,/ ✓°,..P�2- Date: ZNo Go to Question 2. ' l 2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the properly or its plumbing, installation of water -conserving plumbing fixtures is not technically feasible? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. ❑ The licensed plumber's certification has been provided to the Building Division. Sign below and skip the rest of the form. ,,_,/ Owner' Signature: P ]►�� No Go to Question 3. ' 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Owner' Signature:A • , VNo Go to Question 4. ...c'L`✓,_Zpe� Date: & _ 4 _ / 6 - Sign Sign below and skip the rest of the form. Dater _ 4. Is your real property built and available for use or occupancy on or before January 1, 1994? ❑ No My real property is built and available for use or occupancy after January 1, 1994. Civil Code Sections 1101.1 through 1101.8/do no apply. Sign below and skip the rest of the form. Owner' Signature: ) J�-1 Date: — / 15,L�Yes My real property is built and available for use or occupancy on or before January 1, 1994. Civil Code Sections 1101.1 through 1101.8 apply. Refer to the attached. IQ My property is a single-family residential real property. See Civil Code Section 1101.4. On and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1, 2017, all non-compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless of whether property undergoes alterations or improvements). ❑ My property is a multifamily residential real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water - conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). ❑ My property is a commercial real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. SB407 2014.doc revised 03118/14 On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). I/We, the owner(s) of this property, certify under penalty of perjury that non-compliant plumbing fixtures have been replaced with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 through 1101.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's installation requirements, and that the water -conserving plumbing fixtures c ply with the requirements as indicated in the table below. Owner's (or Owner Agent's) Signature: Date: e . _ /G /-5-- Upon S Upon completing and signing this Certificate, please return it to the Building Division in order to final your permit. 1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shown, it is not required to be upgraded. SB4072014.doc revised 03/18114 Non -Compliant Water -Conserving Plumbing Fixture Plumbing Fixture (Fixture Complying with Current Code Applicable to New Construction) Maximum Water Usage/Flow Rate Fixture Type Water Usage 2013 CPC Ch. 4 2013 CPC Ch. 4 2013 CPC Ch. 4 /Flow Rate 2013 CALGreen Div. 4.3 2013 CALGreen Div. 4.3 2013 CALGreen Div. 5.3 Single -Family Multi -Family Commercial Residential Residential Water Closets Exceed 1.6 Single flush toilets: 1.28 gallons/flush (Toilets) Gallons/flush Dual flush toilets: 1.28 gallons/flush effective flush volume (the composite, average flush volume of two reduced flushes and one full flush Urinals Exceed 1.0 0.5 gallons/flush Gallons/flush Showerheads Exceed 2.5 2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of gallons per minute U.S. EPA WaterSense Specification for Showerheads (A hand-held shower is considered a showerhead.) For multiple showerheads serving one shower, the combined flow rate of all showerheads and/or other shower outlets controlled by a single valve shall not exceed 2.0 gallons per minute @ 80 psi, or the shower shall be designed to allow only one shower outlet to be in operation at a time. Faucets — Exceed 2.2 gallons Maximum 1.5 gallons per Within units: 0.5 gallons per minute @ 60 Lavatory per minute minute @ 60 psi; minimum Maximum 1.5 gallons psi Faucets 0.8 gallons per minute @ per minute @ 60 psi; 20 psi minimum 0.8 gallons per minute @ 20 psi In common and public use areas: 0.5 gallons per minute @ 60 psi 1.8 gallons per minute 60 psi Faucets — Exceed 2.2 gallons 1.8 gallons per minute @ 1.8 gallons per minute 1.8 gallons per minute @ 60 Kitchen per minute 60 psi @ 60 psi psi Faucets May temporarily increase May temporarily up to 2.2 gallons per increase up to 2.2 minute @ 60 psi, and must gallons per minute @ default to maximum 60 psi, and must 1.8 gallons per minute @ default to maximum 60 psi 1.8 gallons per minute Where faucets meeting @ 60 psi the above are unavailable, Where faucets meeting aerators or other means the above are may be used to achieve unavailable, aerators or reduction. other means may be used to achieve reduction. 1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shown, it is not required to be upgraded. SB4072014.doc revised 03/18114