14120091CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 8134 PARK VILLA CIR
CONTRACTOR: CALIFORNIA DELTA
PERMIT NO: 14120091
MECHANICAL INC
OWNER'S NAME:
MESA, AZ 85206
PHONE NO: (866) 692-5273
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
LICENSED CONTRACTOR'S DECLARATION
REPLACE (E) FURNACE, SAME LOCATION
Q
License Class C' � d Lic. # O �f��
Contractor��jf ` (�(P 4 �Date/7 - � % • �y
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
performance of the work for which this permit is issued.
Sq. Ft Floor Area:
Valuation: $3437
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 35610016.00
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 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
180 D FROM LAST CALLED 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
Date: 2 l
granting of this permit. Additionally, the applicant understands and will comply
y'
with all non-pointsou5reations per the Cupertino Municipal Code, Section
9 18.
URE
Signature Date T
-ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
4#
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 Area Air Quality Management District I
of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
performance
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sectio�255"5�,33, a�25534d .
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date -:Z/
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
CUPERTINO
GENERAL PERMIT APPLICATION bbEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 V
ildin cu ertino.or �.!
(408) 777-3228 •FAX (408) 777-3333 • bu a a(�, pg \ misc
❑PLUMBING MECHANICAL ❑ELECTRICAL LMISCELLANEOUS
PROJECT ADDRESS /? y Pea` J� c --"C APN # ,/�� / /� O J
OWNER NAME ` i rrJ E-MAIL CJ
_
STREET ADDRES C/ CITY, STATE, ZIP FAX
CONTACT NAME //'' / PH-QITF- E-MAIL
/v/ �//7 ✓ f r: Z 7 7
STREET DRESSi C , STATE, ZIP FAX
5 q !/
❑ OWNER ❑ OWNER -BUILDER ❑ OW4RAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTR AM
LIC EN M ER TLI(f-,?
CEE TYED BUS. LIC #
E-MAIL FAX
COMP Y NA E Ale C / fin
7 !7 ,,
ST T ADDRESS
d /lie
CITY STATE, ZIP
D
P ONE
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX '❑ MULTI -FAMILY
BUILDING: ❑ COMMERCIAL
PROJECT IN WILDLAND ❑ YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN
FLOOD ZONE
❑ YES
❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
/n lc- `f`v� nn e'r 4 "t r
APA
TOTAL VALUATION: 3 2 D 0
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the prope d this
application and the information I have provided is correct. I have read the Description of Work and verify itis accur . I agree to comply with all applica e
ordinances and state laws relating to building constructi representatives of n erthe above -identified property for inspection purposes.
Signature of Applicant/Agent: Date: / �f' L/
S NT FORMATION REQUIRED OFFICE USE ONLY
MEPMiscApp 2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
APPLIANCE / EQUIP TYPE 1 FEE ID QTY UNITS BP FEES
Furnace, Forced -Air 1MFR=<100 1 # $143
TOTALS: - $143.00
iyc
8134 park villa cir
DATE: 12/17/2014
REVIEWED BY: melissa
119ADDRESS:
1 APN: 356 10 016
BP#:
*VALUATION: 1$3,437
*PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
p
111711;11,-). ) Fes I:dc=c- h3f: /'e
PENTAMATION FURN/AC
PERMIT TYPE: i
USE:
/ac'6'JYtYl 1'L'£''
WORK
REPLACE E FURNACE SAME LOCATION
PME Unit Fee:
SCOPE
PME Permit Fee:
APPLIANCE / EQUIP TYPE 1 FEE ID QTY UNITS BP FEES
Furnace, Forced -Air 1MFR=<100 1 # $143
TOTALS: - $143.00
iyc
;a
_
r
Mech. Plan Check 0.0 hrs $0.00
r C'
f'Irwill. 111a hcE -
Mech. Permit Fee: IMPERMIT
.Srtp/)l. PC ' PIT
Mech. Insp. 0.0 hrs $48.00
Other 7'lumb frru,r.itas
r,ther
. ec
111711;11,-). ) Fes I:dc=c- h3f: /'e
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public works, Fire, sanitary sewer tnstricy acnooc
-i'! Th— fa --b ad nw /ho nroliminary information available and are only an estimate. Contact the Dept.for addn'1 info,
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13)
FEE
QTY/FEE
MISC ITEMS
C%2(;ck 1"e3f':
.Srtp/)l. PC ' PIT
PME Plan Check:
$0.00
/ac'6'JYtYl 1'L'£''
PME Unit Fee:
$143.00
PME Permit Fee:
$48.00
(:r;,r tr r.rcfir;rr TUX:
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? ® Yes •, No
$0.00
�'[€:f1"tiFit;`e?Ge /'(LtrliaiTlfr Ft'',C'S:
Travel Documentation Fee: ITRAVDOC
$48.00
Strom Motion Fee: 1BSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
., .
$.,
285.50
$0.001" -''-TONAL FEE:
$285.50
Revised: 10/01/2014
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 -IR -ALT -HVAC) (Page 1 of 1)
Site Address:
Enforcement Agycv:
Date Prepared:
Permit#:
$!3`/
�Uffl," 7)`W
.l -/Y
/y/20o,7
Equipment Type
Equipment Efficiency
New: bucting, Plenums, Lineset
Conditioned
Thermostat
Required R -value
Floor Area (sq ft)
❑ Packaged System
❑ Evaporator Coil
AFUE
COP
*11-6 (CZ 1,3-7) Ducts
Served by system
0 Setback
❑ Split System
13 Condensing Unit
SEER
❑ R-8' (CZ 16) Ducts
/ d 0 s ft
O q
(If not already
HSPF
El R-6 (all CZ's) Plenums
present, must
'Furnace
❑Lineset
EER
❑ R-5 or R7.5 Lineset3
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.
1. HVAC ClSangeout/Repair
Required Compliance Documents to be left on site for Final:
Canwinclude new ducting
All Equipment,
CF1R-ALT 02-E
Condenser Unit, Evaporator Coil,
CF2R: MECH-01, MECH-20-HERS
Air Handler/Furnace
CF3R: MECH-20-HERS
Installer Requirement: Duct leakage C,5_15% or, < 10% to outside, or seal all accessible leaks)
Exempted from duct leakage testing if:
❑ 1. Dud system registered with HERS provider as previously sealed, or ❑ 2. There is less than 40 linear feet of duct in unconditioned
space, or ❑ 3. 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'
CF1R-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 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 2t 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 duds 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 (< 15% 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.
2 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-2344", 3.5 to 4T-2YO, 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 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 Designer Signature:
Date Signed:
License:
Company:
Address:
City/State/Zip:
Phone:
17'& �
D �'
of 2b' -Q >0
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300
Address
r � 131(5,
SMOKE / CARBON MONOXIDE ALARMS FILE
OWNER CERTIFICATE OF COMPLIANCE 6 -,5 -,1s -
COMMUNITY
_,:,,1s --
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 07i7
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 \
(408) 777-3228 • FAX (408) 777-3333 • buildingQcupertino.org j j` `
(� 13:�
�) rPermit No:. / A2 o�1 44- '7/ f- a"I 6) 1*7 # of Alarms Smoke: VeFoi Carbon Monoxide: 10
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: Ri 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.
1 have read and agree to comply with the terms and conditions of this statement
Sinature ... .................. ............................................................................... Date:..�.��,�
Contractor Name:
Sinature................................................................... Lica...................................... Date: ...................
Smoke and CO fa•mdoc revised 03/18/14
CUPERTINO
Owner Name
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(
Permit No.`�
a,
6-5-15,
Al
Address 7 (4- P, V C, y C reiS-D % V— \
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:
VNo Go to Question 2.
Date: 6 ( d, /C y-
2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the property 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:
®No Go to Question 3.
Date:
3. Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form.
Owner' Signature: -�
.VNo Go to Question 4.
Date: G / k &-
4.#01's -
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 110{1.j1 through 1101.8 do not apply. Sign below and skip the rest of the form.
Owner' Signature:f I Date:
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.
oMy 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
fixtuf' I to be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1,
2017, 5Fl non-compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless
of whether property undergoes alterations or improvements).
❑ My property is a nzultifaniily residential real properly. 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. doe revised 03/18/14
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 comply with the requirements as indicated in the table below.
Owner's (or Owner Agent's) Signature: Date: `
Upon completing and signing. this Certificate, please return it to the Building Division in order to final your permit.
1
WIf the existin7plumbing fixtu�'rF'Tater usage/flow rate is equal to or lower than the figure shown, it i t required to be upgraded.
SB407 2014. doe revised 03/18/14
iVan=C mpliant
Water -Conserving Plumbing Fixture
rplumbing Fixturel
(Fixture Complying with Current Code Applicable to New Construction)
Maximum Water Usage/Flow Rate
Fixture Type
yp
Water Usage
2013 CPC Ch. 4
12013
2013 CPC Ch. 4
2013 CPC Ch. 4
/Flow Rate
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
Urinalss
,l Exceed 1.0
Gall ns/flush
0.5 gallons/flush
Showerhead i
C Exceed 2.5
2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of
!gallons per minute
1U.S. EPA WaterSense Specification for Showerheads
Y
(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
='M
, exceed 2.0 gallons per minute @ 80 psi, or the shower shall be designed to
1 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
Aminute @ 60 psi; minimum
Maximum 1.5 gallons
psi
Faucets -;j0.8
gallons per minute @
per minute @ 60 psi;
t
p 0 psi
minimum 0.8 gallons
per minute @ 20 psi
In common and public
use areas: 0.5 gallons
`•F
per minute @ 60 psi
"S
1.8 gallons per minute
a@
60 psi
Faucets — ��- Exceed 2.2 gallons
1.1per
' 1.8 gallons per minute @
1.8 gallons per minute
1.8 gallons per minute @ 60
Kitchen minute
60 psi
@ 60 psi
psi
Faucets ; Al
May temporarily increase
May temporarily
`
up to 2.2 gallons per
increase up to 2.2
k
inute @ 60 psi, and must
gallons per minute @
tlefault to maximum
60 psi, and must
.8 gallons per minute @
default to maximum
60 psi
1.8 gallons per minute
here faucets meeting
@ 60 psi
he above are unavailable,
Where faucets meeting
I
aerators or other means
the above are
may be used to achieve
unavailable, aerators or
reduction.
other means may be
j
used to achieve
reduction.
1
WIf the existin7plumbing fixtu�'rF'Tater usage/flow rate is equal to or lower than the figure shown, it i t required to be upgraded.
SB407 2014. doe revised 03/18/14