15030172 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20652 PARK CIR WAY CONTRACTOR:FLANDERS HEAT&AIR PERMIT NO: 15030172
SYSTEMS,INC
OWNER'S NAME:
PLEASANTON,CA 94566 PHONE NO:(925)161-3333
�4 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL E]
// UNIT#2-REPLACE(E)WALL FURNACES,SAME
License Class Lic.# !�� LOCATION
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
erformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$1700
\� 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 APN Number:32632016.20652 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 O + T 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 DA L LED INSPE TION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 2 /
costs,and expenses which may accrue against said City in consequence of the Issued Date: S
granting of this permit. Additionally,the applicant understands and will
with all non-point source regulations per the Cupertino Municipal Code,Section
918.
j RE-ROOFS:
Signature—;—.'r `moo Dat �� 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. 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 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: Dated �
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 stat 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
�v
GENERAL PERMIT APPLICATION (�� MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 950143255 1
C:UPEFiTIAtO (408)777-3228• FAX(408)777-3333•building a(�.cuoertino.ora ��
misc
❑PLUMBINGMECHANICAL r ❑ELECTRICAL ❑MISCELLANEOUS
PROJECTADDRESS D S P0
1L (
E-MAII
4L 1
STREETADDRESSr ( 1 ( CITY,STATE, ZIP�� T� FAX
13Owm ❑�0 •WNERJ-BBUILDER ❑ O%WERAGENTXCONTRALTOR ❑CANTRAcToRAGarr ❑1ARCI-Tfi:LT ❑r.NGildF.i3t ❑ D-eVELOPER ❑ TENANT
CONTRACTORNAME r I /q �Q n LICENSENUMBER �14rj�D q LIC(NSETYE 3 BUS.LIC
COMPANY !li ki d Q r s d fw E-MAIL [Y d' FAX Cr�S—I�6�-74/(
v v, �a C1TY i3 , 9.a'4an CA I Y J 4 PHONE?
ARCHTTECT/ENGINEER.N _E LICENSE NUMBER I BUS.LIC'
COMPANY NAME' E-MAIL FAX
STREFT ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX MULTI-FAMILY PROJECT IN WILDLAND ❑ ym PROJECT IN ❑YFS IS THE BLDG AN ❑ Y'S
BUIL-DING. ❑COMMIERm"L URBAN INTERFACE AREA ❑ NO I FLOOD ZONE ❑No EICHLErt HOME? ❑NO
DESCRff110N OF WORK � �/V W`/`' ✓J � �u
TOTALVALUATION-
By my signature below,I certify to each of the following: I am the property owner or authorized ages to act7on the prop er's behalf. I have read this
application and the information I have provided' I have read the Description of Work and verify it is accigoopTagTeeio comply varith all applicable local
ordinances and state laws Tela' T'%�ohoze representatives of Cupertino to enter the above-identi- dprop .l�inspection pui'•poses.
Signatw-e of ApplicanttAgent: Date: 7;6
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
OVER-THE-COUNTER
F
❑ EXPRESS
U
❑ STANDARD
U
❑ LARGE
❑ NWOR
MEP.ViscApp=011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 20652 PARK CIR W APT 2 L DATE: 03/27/2015 REVIEWED BY: MELISSA
APN: 362 32 016 BP#: *VALUATION: 1$1,700
*PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY Multi-FamilyDwellin Buildina is PENTAMATION FURN/AC
USE: 9 >3 Stories ® Yes ® No PERMIT TYPE: i
WORK UNIT#2- REPLACE E WALL FURNACES SAME LOCATION
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Heater, Recessed Wall 1MRSUSHTR 1 # $72
TOTALS: $72.00
MORI
�d n,-
` t
Mech.Plan Check Fo.0 hrs $0.00 Plumb. Plran Check Elec. Plan Check
Mech.Permit Fee: IMPERMIT Plumb. Permit hes: Vec. f ermia Fee:
Lr Mech.Insp. 0.0 hrs $48.00 (?tier•Plumb Irup_ Other l lec.Insp. Li I
.lash. hasp. Fee: Llec.Insh.Fee:f Fee: Plumb.
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These fees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 a.' 711113) FEE QTY/FEE MISC ITEMS
Plan Check 1,ee:
:Suppl. PC'Fee FA
PME Plan Check: $0.00
Permit Fee:
Suppl. Insp I"ec
PME Unit Fee: $72.00
PME Permit Fee: _F_T_ $48.00
Construction
Administrative Fee: 1ADMIN $45.00
Work Without Permit? ® Yes (F) No $0.00
,ldva11ek'd Planning Fees:
Travel Documentation Fee: 1TRAVDOC $48.00
Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
$214.50 $0.00 �d 'I�SoT' em FEE: $214.50
. ,
. � „ : .
Revised: 02/14/2015
STATE OF CALIFORNIA
ALTERATIONS - HVAC
(3C)► -72
01?
CEC -CFIR- ALT -03 -E Revised 06/14 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CFIR- ALT -03 -E
Alterations - HVAC CZ 1, 3 to 7 and 16 (formerly CF -1R- ALT -HVAC) (Page 1 of 1)
Site Address:
k 1P, WQs
Enf cement Agency:
Date Prepared:
Permit #:
r o-
P1 p
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 (Q 1,3 -7) Ducts
Served by system
0 Setback
• Split System
❑Condensing Unit
SEER
❑ R -8' (CZ 16) Ducts
s q ft
(If not already
HSPF
❑ R -6 (all CZ's) Plenums
present must
❑ Furnace
❑ Lineset
EER
❑ R -S 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 by hand. For final inspection all forms are to be registered (no hand filled forms allowed) and a copy left on site.
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, Evaporato Coil,
CF2R: MECH -01, MECH -20 -HERS
Air Handl r /Furna a
CF3R: MECH -20 -HERS
Installer Requirement: Duct leakage (<_15% or, L10% 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 ❑ 3.. Existing dud 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 Duds'
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: Dud leakage < 6 %, Fan Efficacy (.58W /CFM), Air Flow t 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, Fumace
CF3R- MECH -20 -HERS, MECH -(23 or 24) -HERS
Installer Requirement: Dud leakage < 6 %, Air Flow 2 350 CFM /ton (or Standards Table 150.0 -C / D alternative)
❑ Exempted from dud leakage testing I existing dud 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
CF1R- ALT -02 -E
CF2R: MECH -20 -HERS
space but less than All New Duds'
CF3R: MECH -20 -HERS
Installer Required to: Dud leakage (1515% or, L10% 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 Dud 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 dud system (e.g., registers, grilles, boots, air handler, plenums, duct material.
9 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- 2Y.. ", ST-4y."
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.
S. The building design features or system design features identified on this Certificate of Compliance are consistent with the information
Energy Hotline at: 1- 800 -772 -3300
CUPERTINO
Address
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 )cuoertino.org
1W 2S �
02o i72_
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 agree to comply with the terms and conditions of this statement
# ....... ............................... Date: ...................
Smoke and COform.doc revised 03118114
D)5
WATER - CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE C„
I
COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISIONS
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
CUPERTINO
Permit No. 1--r6 "K 61 1 12
Address ?LOGS1-
Circle ri/l� , Cu�xr �� cp\ s-o)q
Please refer to the attached California Civil Code Sections 1101.1 1101.8 which are part of this Certification form. .
1. Is youvreal 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:
Vr No Go to Question 2.
Date:
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: Date:
A"'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. Sign below and skip the rest of the form.
Owner' Signature:
6-No Go to Question 4.
Date:
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:
❑ 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.
❑ 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 properly 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 re laced with water - conserving plumbing fixtures.
On or before January 019, 11 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 03118114
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).
UWe, 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 110 L8, 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: < 1 Date:
Upon completing and signing this Certificate, please_.retum it to the Building Division in order to final your permit.
-
Non -Com liant
P
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.
i. It the existing piumnmg rixture water usage/rlow rate is equal to or lower than the tigure shown, it is not required to be upgraded.
SB40 7 2014. doe revised 03118114