15030072CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 931 NOVEMBER DR
CONTRACTOR: SERVICE CHAMPIONS
PERMIT NO: 15030072
OWNER'S NAME:
PLEASANTON, CA 94588
PHONE NO: (925) 444-4444
lb LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
REMOVE AND REPLACE FURNACE IN SAME LOC.
�e
License Class Lic. # (� t-70 -lD
Contractor v1-4w01'1S Date 3" 1 H 5
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: $4403
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: 36213040.00
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 D S 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 DAY A CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
Issued by: Date:
with all non -point source regulations per the Cupertino Municipal Code, Section
RE-ROOFS:
918.
94t4m,�)
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)
1, 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
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25505, 25533, and 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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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
918.
Signature Date
CUPERTINO
GENERAL PERMIT APPLICATION ,?, ME P
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
��i(
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(Mcuaertino.org \�
I%11C/117A1hrrrnrr r ==r•M-t1-AI 1 I1Mi.'q( R.1.ANMUS
MISC
PROJECT ADDRESS a 3, n ov em h �l r
APN# tQZ_ 13 a Nv -6--`
OWNERNAME
-?
E-MAM
STREET ADDRESS
CITY. STATE ZIP
� yb (� SU (�
FAX
CONTACT NAME
E-MAM
STREET ADDRESS
CITY, STATE, ZIP
FAX
09 owNER ❑ OwNER-B=Dm ❑ owma Amu
❑ CONTRACTOR ❑ CoNTRACmR.Awff ❑ ARcmEcr ❑ FST zNm ❑ DEVELOPm ❑ TENANT
CONTRACTOR N OV-0 / P( 1 jryls
LICENSE NUMBER p I ^ �O
D 1
LICENSE TYPE A ��
`
BUS. LIC lJ
COMPANY NAME
E-MAIL
FAX
STREET ADDR l� rt� l��
` 2a an�c� 9�fSg�
PHONE
V5
ARCHTT MENGINEERNAME
LICENSE NUMBER
BUS. LTC #
COMPANY NAME
E-MAM
FAX
STREET ADDRESS
CrfY, STATE. MP
PHONE
USE OF fijSFD0rDunxx D wawAmmy
m;nx COMMERCIAL
❑
PRWE(TINWBJx.AND ❑ YEs
URBWERFACEMM ❑ NO
AN
❑ YES
7�-❑ NO
ISUMBLDOAN ❑YESNCX
EICHI.MHOME? ❑ No
DESCRIPTION OF WORK
TOTAL VALUATION: 03, ®V
RECEIVEUBY-.
By my signature below, I certify to each ofthe following I an the property owner or authorized agent to act on the property owner's behalf I have read this
application and the information I have pavided is correct I have read the Desc ipdw of Work and verify it is arcuate. I agree to comply with all applicable local
ordinances and state laws relating to r�resentatives of Cupertino to enter the above-identifiydproperty for inspection purposes.
Signature of Applicam/Agent: Date: J�
SUPPLEMENTAL INFORMATION REQUIRED
0MCRUS2 onu.Y
a
a OVER-TRDCOUNTER
STANDARD
o LARGE
0 MAJOR
MEPM=4pp 201Ldoc revised 06121111
CITY OF CUPERTINO
go. FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 931 november dr
DATE: 03/10/2015
REVIEWED BY: Mendez
APN:
BP#:
"VALUATION:
1$4,403
*PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION FURN/AC
PERMIT TYPE:
WORK
remove and replace furnace
SCOPE
in same loc
APPLIANCE / EQUIP TYPE
FEE ID
QTY
UNITS
BP FEES
Furnace, Forced -Air
1MFR=<100
1
#
$143
TOTALS:
$143 00
f~
��
m mA
r. .'si`"s ,: ,.
_
° �8 deer'•= � .� L ,� .
Mech. Plan Check 0.0 1 hrs $0.00
Plumb. flan Check
77ec. Plan Check
Mech. Permit Fee: IMPERMIT
Plumb, Permit Fee:
L=lec, Permir Fee
Other Mech. Insp. 0.0 hrs $48.00
Other Plumb Insp.Li
0", 1;(ec. Insp.
Me& Insp. Fee:
Plumb. Insp. Fee:
Elec. Insp, Fee:
NOTE: This estimate does not include fees due to other Departments (i e. Planning, Public Works, Fire, Sanitary Sewer District, School
District etc )_ These feet are hated an the nreliminary information available and are only an estimate Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check P'ee:
,5uppl. P( I ee
PME Plan Check:
$0.00
Permit 14'ee:
suppl.Insp Tee
PME Unit Fee:
$143.00
PME Permit Fee:
$48.00
Construction .Tax:
Administrative Fee: IADMIN
$45.00
Work Without Permit? ® Yes (E) No
$0.00
Advanced Planning I4'ees:
Travel Documentation Fee: 1TRAVDOC
$48.00
Strong Motion Fee: 1BSEISMICR
$0.57
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
y
$285.57
AM
$0.00 : jTo SEE
$285.57
Revised: 02/14/2015
Address 9
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTI NO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building Mcupertino.org
PT�_ p,n Permit 1\0.
u� -t/NU �7 D
r3 R 1 # of Alarms Smo e� �: Carbon Monoxid,'J'
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
I SMOKE ALARM
CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the
bedroom(s)
d
?:
On every level of a dwelling unit including basements
X
X
Within each sleeping room
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.
t have read and agree to comply with the terms and conditions of this statement
Owner (or Owner Agent's) Name:
� . Dater'
Contractor Name:
Signature...................................................................Lic.#...................................... Date: ...................
S
Smoke and COfomn.doc revised 03118114
4
CUPERTINO
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(alcugertino.org
Owner Name Permit No /5 0_37Fym7 2-
Owner' Signature:
Y No Go to Question 2. -,
Date: j
2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the property or its
vlumbffig, installation of water -conserving plumbing fixtures is not technically feasible?
es 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:
D 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:
'N*,No Go to Question 4.
Date: 1"�'� _ Zo 1
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 not apply. Sign below and skip the rest of the form.
Owner' Signature: Date: ( 0�" 201
Yes My real property is built and available for use or occupancy on or before January 1, 1994.
Civil Code Sections 1101.1 through 110 1. 8 apply. Refer to the attached.
'9�T 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 Januaiy 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 03118114
i
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 110I A 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 requirementsas indicated in the table below.
Owner's_ (or Owner Agent's) Signature:?
Upon completing and signing this. Certificate, please -return it to the Building Division in order to final your permit:_
- -
No.n-Gom leant
p
Water-Conse-rving-Plumbing-Fixture-`
-
1
Plumbin Fixture
.._.
Fixture Com I in with Current Code A lieable to New Construction
p y 9 Pp
fNazimurn Water Usa.e/Flow Rate F : -
Type'2013
VI/ater Usage -
CPC Ch 4"
�2013 CPCCh'-4
CFxtue PC Ch.-4
'
/Flow Rate
2013nCALGfeen Div. 4.3
2013 CALGreen Div. 4.3
2013 CALGreenv. 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 uaELY;gilable,.
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.
SB40 7 2014. doc revised 03118114
STATE OF CALIFORNIA
ALTERATIONS - HVAC
--A CM00nW f ^AA 1001^IJ
CEGCF7R-ALt-W-E
MWOM 1+ -" —" "
FICATEOF COMPLIANCECFiR-ALT-03-E
9C1
tions s- HVAC CZ 1, 3 to 7 and 16 (formerly CF-1R ACT HVAC) (Page 1 of 1)
Sith
Address:
q:z �oambtr
fNr
Enforcement Agency:
Date Prepared:
3-(U-6
PermitiP
New: Ducting, Plenums; Ulneset
New-
Conditioned
Eq ipment Type
Equipment Efficiency
Reaulred R value
Floor Area ( ft
Thermostat
0 P ickaged System
0 Evaporator Coil
q0 AFUE
COP
C3 R-6(CZ 1,3-7) Ducts
Served by system
Setback
(if not already
❑ S)Alt System
0 Condensing Unit
SEER
HSPF
0 R-81 (CZ 16) Ducts
p R-6 (all CZ's) Plenums
sq ft
present, must
Of F irnace
(7 Uneset
EER
p R-5 or R7.5 Unesee
be Installed)
H
RS VERIFICATION SUMMARY installer determines work to be completed and matches to one of the options below. At permit application this
foim
is allowed to be filled out by hand. For finaI Inspection all forms areto be registered (no !land filled forms allowed) and a copy
left on site.
i. HVAC ChangeaWitepair '
Required t-romphance Documents to be left on site for Flnel:
6.6
include new ducting
AI�
Equipment,
CFIR-ALT-02-E
Cc(ndenser
Unit, Evaporator Coll,
CF21t: MECH-01, ME04-20-HERS
I liar Requirements Duct leakage LS 15%or,: 10%to outside, or seal all accessible leaks)
Exempted from duct leakage testing IP
L Duct system registered with HERS provider as previously sealed, or IS 2. There Is less than 40 linear feet of duct in unconditioned
s ce or 3. Existin . duct are constructed Insulated or sealed with asbestos list manufacture date of bulldin
❑ 2. New HVAC System Required Compliance Documents to be left on site far Final:
All new equipment and All New Ducts' I MR-ALT:02=E
` CF2R-MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24YHERS
InOdW Requirement: Duct leakage <6%, Fan Efficacy (.SSW/CFM), Air Flow Z 350 CFM/ton (or Standards Table 150.0-C / D alternative)
O 3. All New Ducts with RePlacament Required Carp lance Documents to be left on site for Final:
Ecndenser
udes replacing or installing All New CFIR-ALT-02 E 2 and'one or more of the efollowing: CF2R-MECH-01, MECH-21 -HERS, MECH-(23 or 24)-HERS Unit, Evaporator Coll Furnace CF3R-MECH-20-HERS, ME 23 or 24)-HERS
Inkodw Requirement: Duct leakage a 6%, Air Flow a 350 CFM/ton (or Standards Table 150.0-C / D alternative)
Exempted from d0dleak@2910009.1 existinaductsystems are constructed, insulated or sealed with asbestos.
I _ CFIR-ALT 02-E
Adding or replacing ducts in unconditioned CF2R: MECH-20-HERS
3 ce but less than All New Ducts2 I MR: MECH-20-HERS
Installer Required to-- Duct leakage S.15% or, <10%`to outside, or seal all accessible leaks)
0 Exempted from dud leakage tenj I e"ng duct systems are oonstructed, insulated or sealed with asbestos.
1 new ducting R 8 required when more than 40 ft installed and R-6 when less than40ft installed. This includes In walls, between floors etc
2 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 unles exisdng dud system (e.g., registers, grilles, b, air handler, plenums, duct material.
(r thick insulation) for linesets r and less. R•7S (1.5" thick insulation) for Nnesets over 1 inch. Most mfg will require Suction One Diameter
-..-
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
I rdfy 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.J 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.
51 The building design features or system design features identified on this Certificate of Compliance are consistent with the inforration
provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement
agency for approval with this building it application.
Re pon We Definerfanw Rerpons Desk» O Date Signed: Uteme:
Phone:
�i`L)r� burn» xhv5 p Dr �l�q �cwl t� y� ZS iLiy
For assistance or questions regar&V the Energy standards, canted the Energy Hotline at:1-800-772-3300