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15100174I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10125 POTTERS HATCH CMN OWNER'S NAME: MUKAI LORI A OWNER'S PHONE: 4085170416 rll� LICENSED CONTRACTOR'S DECLACRAT/IOON License Class Lic.# Contractor. Date I hereby affirm thab 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 erformance of the work for which this permit is issued. have and will maintain Worker's Compensation Insurance, as provided for by Section 3900 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 correct. I agree to comply with all city and county ordinances ands ws re 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 Cod Sec on Signature ►li Date ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: t 1, 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). 1 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. 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. 3. 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 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 convect. 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: AIR QUALITY HEATINGI PERMIT NO: 15100174 & AIR 720 NORTHRUP ST I DATE ISSUED: 10/21/2015 SAN JOSE, CA 95126 ' PHONE NO: (408)293-7138 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ REPLACE (E) FURNACE & A/C UNITS, SAME LOCATIONS Sq. Ft Floor Area: I Valuation: V 1000 APN Number: 34235047.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR LED INSPECTION. Issued Q 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 compliance with the Cupertino Municipal Code, Chapter 9.12 and the I Iealth & Safety Code, Sections 25505, 25533, and 25534. rpr authorized agent: Date: % bf CONSTRUCTION LENDING AGENCY I hereby affirm 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 _..................... _............... . GENERAL PERMIT APPLICATION 11RIVE13 E ep" COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 01A 60% (408) 777-3228 •FAX (408) 777-3333 • build ing(-Dcuoertino.org i� CUPERTEh10 � / M I %no 'wo El Pi'u'�BSIG CF_o NTIC A,L ❑ F-LECTRiCA-L ❑ bflSCELLA2\-E0US PROTECT ADDRESS AP. n V7 ` 7 l OCvTtRNAME � � //��jL/ I PHOTS � O 7 I n-I✓La.IL STREET ADDRESS /1 nv Jap � ,T CITY, STATE, ( F.4X CONTACT NAME PHONM E-MAIL STREETADDRESS I CITY, STATE, ZIP FAX ❑ OR'I`'r'i. t ❑ OV,NE.R-BUILDER ❑ ON ^N -E t ACMNTT CO*.'TRACTOR ❑ CO -.'TRACTOR AGM,'T ❑ ARCHI ECT ❑ nvM\M ❑ D_1 LLOFER ❑ ; _)� A2,7 CO? TRACTORrAJ,1E( _� LIC`'S_''��`� Ky� LTC�<'SE, 7;j I BUS. LIC; CONPi AI�Z' NAI✓E'��N -7 I E MAIL ( FAX STREET ADDRESS CITY, STATE, ZIP !��^�� ARCHITECT/ENGII.'EER N,A hM -- I LICENSE NUMBER I BUS. LIC R COMPANY NAME — EMAIL I FAX STREET ADDRESS CITY, STATE, ZIP PHOI\i USE OF FD o, DUPLEX ❑ MULTI-F.AJ M Y PROTECT N A ILDLAND ❑ YES B=190: �jCOA�J+TE7tCLAL I URB�1vA'TERFACEAREA �� NO PROTECT Lv FIAODZON3 ❑ YES ❑ NC IS THE BLDG AN ❑ '. =S I EiCHLERHOME7 I.] NO DESCRIPTION OF WORKJ^� A A F TOTAL VALUAT!ON: IV By my signature below, I certify to ead of the following: I am the property owner or a aee ct ner s behalf. I have read this application and the information I have provided is correct. I have read the Desc ' of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building conshuction. I authorize representatives of Cupertino to enter the above-identii:Ed p perty or inspection purposes. Si�a� re of Applicant/Agent: Date: / 0 1/ V14 44 SUPP EM TAI. D\TF•ORMATIONT REQUIRED f :a--� e� NO A-.: x MEPMiscApp_2011.doc remised 06121111. CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION APPLIANCE / EQUIP TYPE 10125 POTTERS HATCH CMN DATE: 10/21/2015 REVIEWED BY: MELISSA 4WADDRESS: 1 APN: 342 35 047 BP#: *VALUATION: Isi1,000 °PERMIT TYPE: Mechanical Permit --FPLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: SFD or Duplex # PENTAMATION PERMIT TYPE: FURN/A WORK REPLACE E FURNACE & A/C UNITS SAME LOCATIONS SCOPE SttppL Insp Fee APPLIANCE / EQUIP TYPE FEE ID i laamli. Plan Check QTY UNITS BP FEES Elec_ Permit Fee: A/C Units (<=10K cfm) 1BREMAIR Other Elec. Insp. 1 # $72 Furnace, Forced -Air 1 MFR=<100 SttppL Insp Fee 1 # $143 PME Unit Fee: $215.00 PME Permit Fee: $48.00 Construction Tax: Administrative Fee: IADMIN $45.00 Work Without Permit? Yes (F) No $0.00 TOTALS: i 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 District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept For addn'l info. FEE ITEMS (Fee Resolution 11-053 E(f. 7/1/13) Mech. Plan Check 10.0-1hrs $0.00 i laamli. Plan Check G7ec. I'lan Check Mech. Permit Fee: IMPERMIT F/l/mb. Pel -mit 1°ee: Elec_ Permit Fee: Other Mech. Insp. 0.0 hrs $48.00 Other Plunab bash. Other Elec. Insp. loch. Insp. fire: Numb. Insp. Fire. Flea 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 preliminary information available and are only an estimate. Contact the Dept For addn'l info. FEE ITEMS (Fee Resolution 11-053 E(f. 7/1/13) FEE QTY/FEE MISC ITEMS Phin Check Fee: 'A :Supp/. PC.' Fee -T PME Plan Check: $0.00 Permit Fee: SttppL Insp Fee PME Unit Fee: $215.00 PME Permit Fee: $48.00 Construction Tax: Administrative Fee: IADMIN $45.00 Work Without Permit? Yes (F) No $0.00 .4dvanced Planning Fees: i Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: 1BSEISMICR $1.43 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $358.43 $0.00 TOTAL FEE: $358.43 Revised: 10/01/2015 STATE OF CALIFORNIA ALTERATIONS - HVAC �a CEC-CF1R-ALT-03-E (Revised 06114) 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: � ` �.� �/ r/,� Enforceknt Agengj: Date P epare Permit#: Equipment Type Equipment Efficiency New: Duct g, Plenums, Li eset Condition Thermostat Required R -value Floor Area (sq ft) ❑ Packaged System Evaporator Coil AFUECOP [IR -6 (CZ 1,3-7) Ducts Served by system Setback Split System Condensing Unit SEER ❑ R-8' (CZ 16) Ducts sq ft (If not already Furnace ❑ Lineset 0—EER HSPF ❑ R-6 (all CZ's) Plenums ❑ R-5 or R7.5 Lineseta � present must 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, 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 (:<_15% or, < 10% 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 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 CFBR-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 >_ 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. ' 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. a 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 -2y.", 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. Resp on ible esigner Nam Resp o ible gner Signature: Date signe License: Company: Ad ess: City/State/Zip: Phone: For assistance or que#tions regarding the Energy Standards, cintact the Energy Hotline at: 1-800-772-3300 / vzz CUPERTINO Owner Name Address 09 12--' WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 f (4{ 8) 77 28 •FAX (408) 777-3333 • buildinc7(aDcupertino.org iil Imo+ w cel, f- Permit No. 0 CE 1. Is your real property a registered historical site? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. /7Z No Go to Question 2. 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. 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. Skip the rest of the form and sign bottom of form. [ L No 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. Et -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. Check one of the three following statements and sign bottom of form.. Please check ONE of the following: VL 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 110 1. 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 pl bing fixtures comply with the requirements as indicated in the table on the following pave. . , �� I I Owner or Owner Agent's Signature: ` 1 ) �� I lil- Date: 1I�U LL7 [7 I Upon completing and signing this Certificate, please return it to the Building Division in order to final your building permit. SB407 2015. doe revised 08/26/15 BUILDING PERMIT CANNOT BE FINALED,AND COMPLETED UNTIL. THIS CERTIFICATE SAS BEEN ST AND RETURNED TO THE BUILDING DIVISION _I 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 08/26/15 Non -Compliant 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. 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 08/26/15 r SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION 10300 TORRE AVENUE ^ CUPERTINO, CA 95014-3255 Cd PERT@NO (408) 777-3228 -.FAX (408) 777-3333 o building (a)cupet no.ong s Il I'D COlY PLETED UNTIL THIS CERTIFICATE PERMIT CANNOT BE FINAI,ED A HAS BEEN .q GNE AND RF3: JRNED TO THE BUILDING DIVISION 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. Smoke and CO fornn.doe remised 03/18/14