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150801174� CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 942 FORT BAKER DR CONTRACTOR: BELLOWS PLUMBING, PERMIT NO: 15080117 HEATING, & SEWER OWNER'S NAME: MOWRER MARTHA K TRUSTEE 2652 RESEARCH PARK DR DATE ISSUED: 08/14/2015 OWNER'S PHONE: 6509433191 SOQUEL, CA 95073 PHONE NO: (831) 477-7150 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL 3 �� ` REPLACE (E) FURNACE WITH (N) - SAME LOCATION AND �LZy License ClaClassII,, Lie. # INSTALL (1) OUTDOOR A/C IN NEW LOCATION Contracto,&00wS 0444mkl `j %A A Date 8 q 5 I hereby affirm that I am licensedund�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. 1 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: $7438 performance of the work for which this permit is issued. 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: 35611026.00 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 WITMN 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 DAYS FROM LAST CALLED INSPECT ON. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which rqAy accrue against said City in consequence of the Issued b LAa— CJ"' G=`� y: Date: granting of this permit. A itionally, the applicant understands and will comply with all non -point sourc gulations per the Cupertino Municipal Code, Section 9.18. r f �` 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. 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 Cup tiro Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 259b5, 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 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 10$01 �. COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - buildinga-cupertino.om F-1 w i (n,rarNc V MRCWANI(`AI Q F.I.RCTRICAL F-1 MISCELLANEOUS MEP misc I'ItC211 -.(, AIADRI-.SS ^ i APN49 OaV_ OWNER NAMI: Ck' �1 A l `' el PHONE 50_q 113 -3)1) E-MAIL s11l1I i \Kiwi.," 4 � 111 V� CITY, STA"FE,ZIP � e V�� (C].\ I NAMI! ein1�LO "t W PI 77 i J E CIL Dr. b CITY,S76 top 01 CA 1 ✓V FAX ❑ (I"Ni It ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANI lt�'I(�IZ NAME�U LICE SE B �R� LICENS � "PYPE BUS. LIC# (�MI'ANI NAME E-MAIL FA S I _Lj �oAS tiS C/�e f� a ��- CITY, TE=MP v /� , ` ? "� �,J PHONE \RC'I II'I'I[C"I /ENGINEER NAMES LICENSE NUMBER BUS. LIC # (()MPAN) NAMI. E-MAIL FAX tilltll-.1.\Iri..'S CITY, STAT HONE ,ION" FD or DUPLEX ❑ MULTI -FAMILY I1 1 r 1'\., I ❑ COMMERCIAL PROJECT IN WILDLAND ❑ YES URBAN INTERFACE AREA ❑ NO PROJECT IN ❑ YES FLOOD ZONE PirNO IS THE BLDG AN [3YES EIC/yHLER HOME? [I NO III �I P1 ['I ION OF WORK e i ti n rn I nw uyi %i I'Ata11 - w e- d I(II \1 \ \IJ \HOiN -7 3 _ RECEIVEDBY: 11c me �i�nature below, I certify to each of the following: I am the property owner or authorized agent to act on the pr perty owner's behalf. 1 have read this �Ihl'lication and (be information I have provided is correct. I have read he Description of Work and verify it is accurate. I agree to comply with all applicable local oidinanccs and state laws relating to buildingc ru ti I autho resent v s ofC erti enter the above -id e tified pr erty for inspection purposes Si,,naturc of Applicant/Agent: Date: 13 SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY OVER-THE-COUNTER - ❑ EXPRESS 1 U ❑ STANDARD L ❑ LARGE ❑ MAJOR MEPMiscApp_201I.doc revised 06/21/11 ,(CV CITY OF CUPERTINO 15owl (q-. FEE ESTIMATOR — BUILDING DIVISION 191 ADDRESS: 942 FORT BAKER DR. DATE: 08/14/2015 REVIEWED BY: PAUL UNITS APN: 356 11 026 BP#: *VALUATION: 1$7,438 PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex p # PENTAMATION FURN/AC USE: Furnace, Forced -Air PERMIT TYPE: WORK Re lace E Furnace with N - Same Location and Install N Outdoor A/C in New Location # $143 SCOPE PME Unit Fee: APPLIANCE / EQUIP TYPE FEE ID 11larmb. Plan Cheek T QTY UNITS BP FEES Elec. Permit Fee: A/C Units (<=10K cfm) 1BREMAIR Other Elec, Insp.Lj I 1 # $72 Furnace, Forced -Air 1MFR=<100 1 # $143 PME Unit Fee: $215.00 PME Permit Fee: $48.00 'rtrtslraac°nota l iet: Administrative Fee: /ADMIN $45.00 Work Without Permit? Yes (F) No $0.00 TOTALS: Travel Documentation Fee: ITRA VDOC $215.00 Strong, Motion Fee: 1BSEISMICR NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School k rh-t ete ► These fo are hasod on the nreliminary information available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution I1-053 Eff. 7/1/13) Mech. Plan Check 0.0 1 hrs $0.00 11larmb. Plan Cheek T Elec. New Check Mech. Permit Fee: I MPERMIT Plumb. Permit Fee: —I__ Elec. Permit Fee: Other Mech. Insp. 0.0 hrs $48.00 >iirer Plumb .1risp.Ll Other Elec, Insp.Lj I PME Plan Check: $0.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School k rh-t ete ► These fo are hasod on the nreliminary information available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution I1-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS 101a a Check Tee., `vtppl. P(.' fee PME Plan Check: $0.00 PME Unit Fee: $215.00 PME Permit Fee: $48.00 'rtrtslraac°nota l iet: Administrative Fee: /ADMIN $45.00 Work Without Permit? Yes (F) No $0.00 I(1v aneed Planning fees: Travel Documentation Fee: ITRA VDOC $48.00 Strong, Motion Fee: 1BSEISMICR $0.97 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $357.971 $0.00 TOTAL FEE: $357.97 Revised: 07/02/2015 ?"MiT 4 15080114 CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 1 of 3 ) Project Name: 942 Fort Baker Dr I Date Prepared: 2015-08-13 A. General Information CFiR-ALT 02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented, use one MR -ALT -02 document for each dwelling unit. 01 Project Name 942 Fort Baker Dr 02 Date Prepared 2015-08-13 03 Project Location 942 Fort Baker Dr 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name 942 Fort Baker Dr 07 Zip Code 95014 08 Dwelling Unit Conditioned 1880 Installing Installing Installing Floor Area (ft2) Location or Area by this SC ducted containing system Number of space conditioning entirely new 09 Climate Zone 4 10 (SC) systems in this dwelling 1 component? components? feet of ducts? duct system? unit. Alteration Type B. Space Conditioning (SC) System Information 01 02 03 04 05 06 07 08 09 10 Is the SC Installing a SC System SC System CFA served system a refrigerant Installing new SC Installing Installing Installing Identification or Location or Area by this SC ducted containing system more than 40 entirely new entirely new Name Served System (ft2) system? component? components? feet of ducts? duct system? SC system? Alteration Type Altered space System 1 Location 1 1880 Yes Yes Yes No No No conditioning system C. Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b)1Diib) Registration Number: 215-A0226350A-000000000-0000 This section does not apply to this project. Registration Date/Time 2015-08-13 12:37:25 AUG 1 VS HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-08-13 12:34:13 Schema Version: 0.555SDD CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 2 of 3 ) D. Altered Space Conditioning System (Sections 150.2(b)lE and F) 01 02 03 04 05 06 07 08 09 10 11 12 Heating Cooling System Heating Altered Heating Minimum Altered Cooling Minimum Required New or Identification System Heating Efficiency Efficiency Cooling Cooling Efficiency Efficiency Thermostat Replaced New Duct or Name Type Components Type Value System Type Components Type Value Type Duct Length R -Value Central gas Gas furnace Central split Outdoor This field or This field or System 1 furnace AHU AFUE 0.78 AC condensing SEER 14 Setback section is not section is not unit applicable applicable Required Documentation: CUR -MCH -01-E - Space Conditioning Systems Ducts and Fans -Duct insulation requirement for new plenums: R6. CUR -MCH -20-H & CF3R-MCH-20-H — Duct Leakage testing required when heating or cooling components are installed in ducted systems, or when more than 40 ft of duct length is replaced. -Leakage rate compliance: < 15%, or <_ 10% leakage to outside, or seal all accessible leaks. CF2R-MCH-25-H & CF3R-MCH-25-H Refrigerant Charge Verification required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15). CF2RCF3R-MCH-23 & CF3R-MCH-23 Air Flow >_ 300 CFM/ton required when MCH -25 is required. Exceptions: -Duct systems registered with HERS provider as previously sealed are exempt from MCH -20 Duct Leakage Testing requirements. -Heating-only systems and Air Handler/Furnace changes do not require verification of Air Flow MCH -23, or Refrigerant Charge MECH-25. -Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH -20 Duct Leakage Testing requirements. E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)1Diia and 150.2(b)1E, F) This section does not apply to this project. F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)1C) This section does not apply to this project. Registration Number: 215-AO22635OA-000000000-0000 Registration Date/Time: 2015-08-13 12:37:25 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-08-13 12:34:13 Schema Version: 0.555SDD CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 3 of 3 ) Documentation Author's Declaration Statement 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: �f Schlunt, Jason �� (((//J Company: Signature Date: GREG BELLOWS PLUMBING INC 2015-08-13 12:37:25 Address: CEA/ HERS Certification Identification (if applicable): 2652 RESEARCH PARK DRIVE City/State/Zip: Phone: SOQUEL CA 95073 (831) 477-7150 Responsible Person'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 Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible designer). 3. 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 California Code of Regulations. 4. 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. 5. 1 will ensure that a registered copy of this Certificate of Compliance shall be made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a registered copy of this Certificate of Compliance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Designer Name: Responsible Designer Signature: Schlunt, Jason Company: Date Signed: GREG BELLOWS PLUMBING INC 2015-08-13 12:37:25 Address: License: 2652 RESEARCH PARK DRIVE 483881 City/State/Zip: Phone: SOQUEL CA 95073 (831) 477-7150 Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document, and in noway implies Registration Provider responsibility for the accuracy of the information. Registration Number: 215-AO22635OA-000000000-0000 Registration Date/Time: 2015-08-13 12:37:25 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-08-13 12:34:13 Schema Version: 0.555SDD RECEIVED aue 4 2015 1) COMM NiTY DEVELOPMENT DEPART ENT \ B Il -DING DIVISION - CUPERTIN APPRUVED This set of pl . s and specifications MUST t a kept at the job site dr+rl a construction. It is unlawful o make any che, or alterations on same, or to eviate therefrcr. ithout approval from the Buil ing Official. Tho stem- of this plan and specificatio SHALL NOT be hold . +>:rmit or to be an approval p�proval of he violation of a dons of any Citnce r State Law. BY ' DATE PERMIT NOI nxxY ptope-'Vq i\r�- PLANNING DEPT CUPERTINO FFICE COPY C Co �a� �-c 0 I � C �L( C.:�-� tel' 570 1 � CU PERTIINO Owner Name WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 1)777-�32�28 • FAX (408) 777-3333 • building(aD-cupertino.or4 T,� a i �sl e( Permit No. I Q� 90 —7 Address 4- Z oft RJ e r D✓, (_u p e r t o CA 7 A -D 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 110 1. 1 through 1101.8 do not apply. Sign below and skip the rest of the form. Owner' Signature: No Go to Question 2. Date: 0 q j (6 1 7,0 i !- 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: by 11 1� /1"o! A 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: Date: O q I I6 l to l S No Go to Question 4. _t� 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. P09/ [ 6�,ar5 Owner' Signature: � � ,%+ Date: XYes My real property is built and aiiableor 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 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 2015. doc revised 02104115 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 will be replaced prior to date specified above 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 reauirements, and that the water-conservine nlumbinz-fixtures comply with the requirements as indicated in the table below. Owner's (or Owner Agent's) Signature: ��(/�� Date: 0 5.1 161 Ig C^ I 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. SB407 2015.doc revised 02/04/15 Non -Compliant Water -Conserving Plumbing Fixture Plumbing Fixtured (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 ata 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. SB407 2015.doc revised 02/04/15