15100162I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 7500 DUMAS DR
OWNER'S NAME: 4WAgM i d(s- �-- �%'<.(J�• `�
OWNER'S PHONE: 4089814977
F� LICENSED CONTRACTOR'S DECLLAARATION
(License Class W Lic. # "( —72q*
Contractor
L IdeatkNI(A(, Date 10Ejyf%A'�c�
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:
1. 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
j� performance of the work for which this permit is issued.
+i. 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
permit is issued.
APPLICANT CERTIFICATION
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 e City of Cupertino against liabilities, judgments,
costs, and expenses which accrue against said City in consequence of the
granting of this permi . tionally, the applicant understands and will comply with
all non -point sou r g ions per the Cupertino Municipal Code, Sectio 9.18.
Signature Date
❑ / WN -BUILDER DECLARATION
I hereby affir / tha am exempt from the Contractor's License Law for one of
the following two reasons:
1. 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)
2. I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
1. 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.
2. 1 have and will maintain Worker's Compensation Insurance, as provided for byG
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
3. 1 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
become subject to the Worker's Compensation provisions of the Labor Code, I
must forthwith comply with such provisions or this permit shall be deemed
revoked.
APPLICANT CERTIFICATION
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,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply with
all non -point source regulations per the Cupertino Municipal Code, Section 9.18.
Signature
Date
CONTRACTOR: LACAYO MECHANICAL PERMIT NO: 15100162
461 WILLIS AVE I DATE ISSUED: 10/20/2015
SAN JOSE, CA 95126 I PHONE NO: (408) 396-2220
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
REMOVE AND REPLACE (E) FURNACE, SAME LOCATION
Sq. Ft Floor Area: I Valuation: $2400
APN Number: 35926009.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 D YS FROM LAST CALLED INSP CTION.
r twi
jIssued by: ► Date: 13
RE -ROOFS:
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.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain complipyce with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safe kode, Sections 25505, 25533, and 25534.
Date: �v
CONSTRUCTION LENDING AGENCY
I hreby ffirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CUPERTINO
GENERAL PERMIT APPLICATION 6j()0j&a,
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - buildingOlcupertino.org
FI Pi I immm ; VC17CHANICAL nELECTRICAL Fl MISCELLANEOUS
MEP
MISC
PROJECT ADDRESS 7500 DUMAS DR
APN # 351*m.
OWNER NAME HELEN CHIANG
PHONE408-981-4977
E-MAIL
STREET ADDRESS
7500 DUMAS DR
CITY, STATE, ZIP
CUPERTINO, CA
FAX
CONTACT NAME
MILTON LACAYO
PHONE
408-658-7136
E-MAIL
LACAYO.MECHANICAL@GMAIL.COM
STREET ADDRESS
461 WILLIS AVE
CITY, STATE, ZIP
SAN JOSE, CA 95126
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT
/CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
MILTON LACAYO
LICENSE NUMBER
972426
LICENSE TYPE
C-20
BUS. LIC #
36172
COMPANY NAME
LACAYO MECHANICAL
E-MAIL
LACAYO.MECHANICAL@GMAIL.COM
FAX
STREET ADDRESS
461 WILLIS AVE
CITY, STATE, ZIP
SAN JOSE, CA 95126
PHONE
408-658-7136
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
PROJECT IN WILDLAND ❑ YES
PROJECT IN ❑ YES
IS THE BLDG AN ❑ YES
BUILDING: ❑ COMMERCIAL
URBAN INTERFACE AREA ❑ NO
FLOOD ZONE ❑ NO
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
REPLACE FURNACE. SAME SIZE, SAME LOCATION, SAME EFFICIENCY.
TOTAL VALUATION: $2,400.00
RECEIVED BY: ,
By my signature below, I certify to each of the followin 1 a the property owner or authorized agent to act on the operty owner's behalf. I have read this
application and the infonnation I have provide�disordinances
ct. I ave read the Description of Work and verify it is accurate. I agree to comply with all applicable local
and state laws relating to buildi do
I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
10-20-2015
Signature of Applic Z
IV Date:
SUPPLEM AL IN RMATION REQUIRED
OFFICE USE ONLY
pW, OVER-THE-COUNTER
F❑
EXPRESS
aC
U
w ❑ STANDARD
x
U
a❑ LARGE
o.
❑ MAJOR
MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO 151WI60'
Irmi FEE ESTIMATOR— BUILDING DIVISION
APPLIANCE / EQUIP TYPE
7500 Dumas Dr
DATE: 10/20/2015
REVIEWED BY: PAUL
JimADDRESS:
APN: 359 26 009
FBP#-
kVALUATION: 1$2,400
-
PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
#
PENTAMATION FURN/A
PERMIT TYPE:
WORK
Remove and replace E furnace Same location
SCOPE
Suppl. Insp Fee
APPLIANCE / EQUIP TYPE
FEE ID
"'Ranh. Plan Check
QTY
UNITS
BP FEES
Elec. Permit Tee:
Furnace, Forced -Air
1MFR=<100
Other Elec. Insp.
1
#
$143
I'er•mit Fee:
Suppl. Insp Fee
PME Unit Fee:
$143.00
PME Permit Fee:
$48.00
Construction Tax:
Administrative Fee: IADMIN
$45.00
Work Without Permit? Yes (j) No
$0.00
TOTALS:
Travel Documentation Fee: ITRA VDOC
$143.00
Stroniz Motion Fee: IBSEISMICR
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the nreliminary information available and are onlv an estimate: Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 a.- 11,7;'132
Mech. Plan Check Rolhrs $0.00
"'Ranh. Plan Check
Elec. Plan Check
Mech. Permit Fee: IMPERMIT
Plumb. Permit I°'ec,
Elec. Permit Tee:
Other Mech. Insp. 0.0 hrs$48.00
( her Plumb Insp.
Other Elec. Insp.
11ech. Insp. Fe("':
" Ilanb. hisp. 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 fees are based on the nreliminary information available and are onlv an estimate: Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 a.- 11,7;'132
FEE
QTY/FEE
MISC ITEMS
Plan Check ee:
.Suppl..f t" /' cit..
PME Plan Check:
$0.00
I'er•mit Fee:
Suppl. Insp Fee
PME Unit Fee:
$143.00
PME Permit Fee:
$48.00
Construction Tax:
Administrative Fee: IADMIN
$45.00
Work Without Permit? Yes (j) No
$0.00
,4dvaneed Phinning Fees:
Travel Documentation Fee: ITRA VDOC
$48.00
Stroniz Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
1 1
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$285.50
$0.00 TOTAL FEE:
$285.50
Revised: 10/01/2015
STATE OF CALIFORNIA
ALTERATIONS - HVAC
CEC-CFIR-ALT-03-E (Revised 06/14) UALIt-UKNIA LNLKUY UUMMIb6lUN
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:
PY,07-
Enforcement Agency:
Date Prepared:
Permit#:
75Db A s
EquipmentType
Equipment Efficiency
New: Ducting, Plenums, Lineset
Conditioned
Thermostat
Required R -value
Floor Area (sq ft)
❑ Packaged System
❑ Evaporator Coil'QAFUE
COP
❑ R-6 (CZ 1,3-7) Ducts
Served by system
❑ Setback
I-] Split System
I-] Condensing Unit
SEER
El R-8' (CZ 16) Ducts
s ft
q
(If not already
HSPF
❑ R-6 (all CZ's) Plenums
present, must
urnace
❑ 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 by hand. For final inspection all forms are to be registered (no hand filled forms allowed) and a copy left on site.
HVAC Changeout/Repair
Required Compliance Documents to be left on site for Final:
Can include new ducting
All Equipment,
CFIR-ALT-02-E -�����•� Tr�
Condenser Unit, Evaporator Coil,
CF2R: MECH-01, MECH-20-HERS �/ %'
Air Handler/Furnace
CF3R: MECH-20-HERS
Installer Requirement: Duct leakage (.<_15% or, < 10% to outside, or seal all accessible leaks) a CT 0 0 2015
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'
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 CF111-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 >_ 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 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 (< 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.
z A New Duct system is when the duct system is constructed of at least 7S 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.
' 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-23/", 3.5 to 4T -2y8", ST -4y8"
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, worksheetcalculations, plans and specifications submitted to the enforcement
agency for approval with this building permit application.
Responsible Designer Nme:
�nGA
Responsible Designer
d:
Date SiZ;2
License:
e12-E2
o
�0U /5
72-
Company:
Ad r ss: "
i((�
City/State/Zi
�/1 ( `157?�,
Phone:
�� 3
d 111 h1i6th
l�V �Cr.f (�.iC
,1 >C,
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300
CUPERTINO
Owner Name
Address
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
i (408) 777;,3238 • FAX (408) 777=3333 • building(c cupertino.org
//,"T Permit N
/S/�di62-
0 3 r�/
1. Is your real property a registered historical site?
❑s Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of fonn.
U"No Go to Question 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.
— / Skip the rest of the form and sign bottom of form.
Q' No Go to Question 3.
3. Is water service permanently disconnected for your building?
❑,�._ llYes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
6—' o Go to Question 4.
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. Skip the rest of the form and sign bottom of form.
es 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. Check one of the three following statements and sign
bottom of form..
Pled check ONE of the following:
691* 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.
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, as the owner or owner's agent 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 requirements, and that the water-conefing plumbing fixtures comply with the requirements as indicated in the
table on the following nage. . I i , ,
I Owner or Owner Agent's Signature: �k vc"�_ _ C - � Date: - // �
Upon completing and signing this Certifi te, please return it to the Building Division in order to fnal vour h„ildinar nf-rmit
SB407 2015.doc revised 08/26/15
BUILDING PER_NfIT CANNOT BE FINALED AND CONIPLETED UNTIL THIS
CERTIFICATE HAS BEEN SIGNED AND RETURNED TO THE BUILDINNG DIVISION
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 upgr
SB4072015.doc revised 08/26/15
Non -Compliant
Water -Conserving Plumbing Fixture
Plumbing Fixtured
(Fixture Complying with Current Code Applicable to New Construction)
Maximum
Water Usage/Flow Rate
Fixture Type
2013 CPC Ch. 4
2013 CPC Ch. 4
2013 CPC Ch. 4
Water Usage
2013 CALGreen Div. 4.3
2013 CALGreen Div. 4.3
2013 CALGreen Div. 5.3
/Flow Rate
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 si
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 upgr
SB4072015.doc revised 08/26/15