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B-2016-1323 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1323 10166 CAROL LEE DR CUPERTINO,CA 95014-2302(316 23 060) (FLANDERS HEAT AND AIR SYSTEMS INC) PLEASANTON,CA 94566 OWNER'S NAME: CHOTANI GOPAL KAND SHIBANI G TRUSTEE DATE ISSUED:02/08/2016 OWNER'S PHONE:408-873-0364 PHONE NO:925-461-3333 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class�Q Lie.#677502 Contractor(FLANDERS HEAT AND AIR SYSTEMS,INC Date 02/08/2016 X BLDG —ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing X MECH X RESIDENTIAL_COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: REPLACE(E)FURNACE,SAME LOCATION 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 performance of the work for which this permit is issued. 2.;' 1 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. Sq.Ft Floor Area: Valuation:$2000:00 APPLICANT CERTIFICATION certify that I have read this application and state that the above information is correct.I agree to comply with all city and county APN Number: Occupancy Type: ordinances and state laws relating to building construction,and hereby 316 23 060 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 PERMIT EXPIRES IF WORK IS NOT STARTED expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal 180 DAYS FROM LAST C INSPECTION.. Code,Section 9.18. Issued by:MELISS Signature-� Date 02/08/2016 Date:02/08/2016 OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed.If a roof is following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1. I,as owner of the property,or my employees with wages as their sole inspection. compensation,will do the work,and the structure is not intended or offered for sale(Sec.7044,Business&Professions Code) Signature of Applicant: 2. I,as owner of the property,am exclusively contracting with licensed Date:02/08/2016 contractors to construct the project(Sce.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the 2. I have and will maintain Worker's Compensation Insurance,as provided for California Health&Safety Code,Sections 25505,25533,and 25534. I will by Section 3700 of the Labor Code,for the performance of the work for which maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&Safety Code,Section 25532(a)should I store or handle hazardous this permit is issued. s. I certify that in the performance of the work fox which this permit is issued,I material. Additionally,should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the air contaminants defined the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,.Chapter 9.12 and. Worker's Compensation laws of California, If,after making this certificate of the Health&Safety Code,Sections 25505,25533,and 25534. 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 Owner or authori be deemed revoked. Date:02/08/2016 APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance correct.I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued(Sec.3097,Civ C,) relating to building construction,and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments,costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant ARCHPIECT'S DECLARATION understands and will comply with all non-point source regulations per the I understand my plans shall be used as public records. Cupertino Municipal Code ,Section 9.18. Licensed Professional Signature Date 02/08/201:6 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333 C� buildingPcupertino.org MISC CUPERTIN ❑PLUMBING EgMECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS 0 PROJECT ADDRESS APN# L i �t OWNER NAME j� 1 �� (11 PH t 67 v E All V L- Qyyy STREET ADDRESS d �� , CITY, STATE,ZIP � � FAX 110) 6 CONTACT NAME T�rC} PHO E-MAIL 1 �-'1 `f I 1` '�f1�✓� �f1��� jl 1.,�e' STREET ADDRESS CITY,STATE,ZIP �� C 674 V �'� C J ❑OwNER ❑ OWNER-BUHDER ❑ OWNER AGENT ircoNTRAcToR. ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER. ❑TENANT CONTRACTOR N l A^ t LICENSE NUMBS i - y..� LICENSE TYPE,. US.LIC , 7 2 COMPANY NA V� � E-MAIb—� (� - 461-74 11 STREET ADDRESS r��w '1 �� �� ��. CITY,STATE,ZI � Q CN���^ �_` �/ ' PHONE ARCMTECT/ENGINEERNAME J_—� LICENSE NUMBER G \ (' BUS,LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE;ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WI DDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING:. ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK Yt' _ TOTAL VALUATION: By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on th e a . I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurat . agree to comply,with all applicable local ordinances and state laws relatin building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: -SU LEMENTAL INFORMATION REQUIRED ER-ItiE COUNTER [- ,E EXPRESS, IT,STANDARD A+ MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR BUILDING DIVISION ,- ADDRESS: 10166 CAROL LEE DR DATE: 02/08/2016 REVIEWED BY; MELISSA APN: 316 23 060 BP# 'VALUATION: $2,000 ,-PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: FURN/AC WORK REPLACE E FURNACE SAME LOCATION SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air !MFR=<100 1 # ° $143 TOTALS: $143.00 Mech.Plan Check 0.0 hrs $0.00 I'v,lvrA Pkv {.s.leei'r Mech.Permit Fee: IMPERMIT ;>.AF =r tic,: Lther Mech.Insp. 0.0 hrs $48.00 Odd,-Phof b frr». r) �r l; ins"'), frt i7:, f'e,e,: _. t.=`[wdt mo't:c'<'; NOTE:This estimate does not include fees due to other Departments(i.a Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These ees are based on the prelimina information,available and are onL an estimate. Contact the Dept-for addn'l info. FEE ITEMS (Fee Resolution11-053.Ci f. 711/13) FEE QTY/FEE MISC ITEMS `tura c hec /`ee: PME Plan Check: $0,00 1. In'%p r .> PME Unit Fee: $143.00 PME Permit Fee; $48.00 Administrative Fee: IADMIN $45.00 Work Without Permit? 0 Yes Q No $0.00 Travel Documentation Fee: ITRA VDOC $48.00 r Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBEC $1.00 ...SUBTOTALS: $285.50 " $0.00 TOTAL FEE: $285.50 Revised: 01/01/2016 4 CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E Alterations to Space Conditioning Systems(formerly CF-111-AI.Y HIVAQ, (Page 1 of 3) Project Name: CHOTANI-10166 CAROL LEE DRIVE Date Prepared: 2016-02-03 A.General Information CF1R-ALT-02 is applicable to multiple space conditioning systems contained within a single dwelling unit.When multiple dwelling units must be documented, use one CHR-ALT-02 document for each dwelling unit. 01 Project Name CHOTANI-10166 CAROL LEE DRIVE 02 Date Prepared 2016-02-03 03 Project Location 10166 CAROL LEE DRIVE 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name CHOTANI-10166 CAROL LEE DRIVE 07 Zip Code 95014 08 Dwelling Unit'Conditioned 2989 Floor Area(ft2) Number of space conditioning 09 Climate Zane 4 10 (SC)systems in this dwelling. 1 unit. °. B.Space Conditioning(SC)System Inf,Qrmation ,- 01 02 03 l 04'`;.:.. v 06 0 09 10 'gnFIs the SC stalling a SCS stem SCS stem CFA served stem r' rigeia3 tnstalli' a Irtstah g nstalh g 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 System 1 Location 1 2989 Yes No Yes No No No Altered space conditioning system C.Extension of Existing Duct System,Greater Than 40 Feet(Section150.2(b)1Diib) This section does not apply to this project. Registration Number:216-AO04437OA-000000000-0000 Registration Date/Time: 2016-02-03 12:09:27 HERS Provider:CaICERTS CA Building Energy Efficiency Standards 2013 Residential Compliance Report Version:2013-1.006 Report Generated:2016-02-03 12:09:33 Schema Version:0.555SDD CERTIFICATE OF COMPLIANCE CF11R-ALT 02-E Alterations to Space Conditioning Systems(formerly CF-1R-ALT-HVAC) (Page 2 of 3 D.Altered Space Conditioning System(Sections 150a2(b)1E 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 Centrals lit No cooling This field or This field or This field or This field or System 1 Central gas Gas furnace p furnace AHU AFUE 80 AC component section is not section is not Setback section is not section is not altered applicable applicable applicable applicable Required Documentation: MR-MCH-01-E-Space Conditioning Systems Ducts and Fans, -Duct insulation requirement for new plenums:R6. CF2R-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 ftof ductlength is replaced. -Leakage rate compliance:<_15%,or<_10%leakage to outside,or seal all accessible leaks. CF211-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 Flout! t;300 CFMJton regi"cl whgn;MCH-25 is required. , Exceptions: Duct systems registered with HERS provider as previously sealed are eXempf'from 20 Duct L age ti, r qul mg -Heating onlysystems and Air Hand ler/Furnace cha es do not re ue verificat' ofr Flo MC,s 3,- efnge�nta e�M8GH�5 Existing duct systems constructed,insulated or sea kd wit h asE?estq re exema•from MCIi Z u;'yleage TesttygwrE' ------------- b WRI q 'pment Ch n eout ectrons 1''5 2 Duauand 150.2 b 1E,F) E.Entirely New or Complete Replacement Duc ., em wl#h r%1"o-t E 4 ( ) ;r r ?e ,. ,a. 5 m> s. 01 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:216-AO04437OA-000000000-0000 Registration Date/Time: 2016-02-03.12:09:27 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013-1.006 Report Generated:2016-02-03 12:09:33 Schema Version:0,555SDD 1 au f M { CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E Alterations to Space Conditioning Systems(formerly CF-1R-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: c7-Ca Kazares,Marg v' l U Company: Signature Date: FLANDERS HEAT AND AIR SYSTEMS INC 2016-02-03 12:09:27 Address: CEA/HERS Certification Identification(if applicable): 555 PETERS AVENUE#255 '" 677502 City/State/Zip: Phone: PLEASANTON CA 94566 925-461-3333 Responsible Person's Declaration statement:. I certify the following under penalty of perjury,under the 1,,"aw5 of.the State of California: 1. The information provided on this Certjficate of Compliance is true and correct. 2. I am eligible under Division 3 of tad Busness"and Prifessons Code to aoeptresponsiblit9 for the building design or system design identifiedon this Certificate of Compliance(responsible designer). . 3. That the energy features and performance specifications,materials;components,and manufactured devices for the building design r system desi n identified on this Certificate of Compliance conform to the x # i � �,: air ", w•` '"' ,' is requirements of Title 24,Part 1 and Part 6.af the California-code of 13+Sf�ItlaYibns s••' 4. The building design features or system design features Identified o€jhis Certi#)eate�f "mCiace areR`qs#ens �jthe irm rovided onith [ca compliance documents,worksheets, calculations,plans and specifications suhmittddto the enrcementagency fo 15pt,v is bw ng per 'aid icati r ` 5. I will ensure that a'registered copy of thisrtrficat� Gmpliance shalrt aXai le vi iClB pImrt{ issu fo tl g and iiia av'ab� zi tdhforcement agency for all applicable S inspections.I understand that a registered copy of this,; icate of C p(ianc 'seggyred to be included vu th the dgcumen ation the jatti er prp,,y t o bu' ing owner at occupancy. Responsible Designer Name: a Respon' le De'Jgrer Signature.If 9�* v Kazares,Marg Company: Date Signed: FLANDERS HEAT AND AIR SYSTEMS INC 201$-02-03 12:09:27 Address: License: 555 PETERS AVENUE#255 677502 City/State/Zip: Phone: PLEASANTON CA 94566 925-461-3333 Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document and in no way implies Registration Provider responsibility for the accuracy of the information. Registration Number:216-AO04437OA-000000000-0000 Registration Date/Time: 2016-02-03 12:09:27 HERS Provider:CaICE'RTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013-1.006 Report Generated:2016-02-03 12:09:33 Schema Version:0.555SDD S 011: OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT►BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE►CUPERTINO,CA 95014-3255 (408)777-3228 m FAX(408)777-3333• building(a.cupertino.org adz db 40166 Chf-OL. L-e-5 q @ PERTAUT CANNOT DE I'll"5avD AND COMPLETE!)UNTIL THIS CERTIFICATE 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 sirigle-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 AI ARM Outside of each separate sleeping area in the immediate vicinity of the X X bedroom(s) 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 existingdwellingunits 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 90'7.2.11.4 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 cerffy that the alarm(s)referenced above has/have been installed in accordance with the n,anufacturer's instructions ani,an compliance with the Cal forn a,Building acid Ca.kfonaiia,Residential Codes.The a lar:rns have been,tested and are operational, as of the date signed below.: have,read an:ch a cqmf ply,cornwith_bye Perms and'conditions of.this;statement i n2t1r >.. 31 ....... Gantracfor Name: f V let ,a..7.7.150.. 2,6zte. .Sbwke,and 00f7mv.d&crel=ised 0311=18hjXj' WATER-CONSERVING PLUMBING FIXTURES 5r uvt OWNER CERVICATE OF COMPLIANCE Lo GOitit MUNiTY DEVELO F-, T�DEPARTME-NT#:BUILDING.DIU1StON C U P E R,TI N O 10340 TORR:E.AVENUE-O'UPER INO,CA 950'14-3255 '(408)777-.3228•FAX 0408)777-3333®hsaitcltnei�cur3ertirxJ.orc? ` Owner Name Permit No �l� �. Address A 10146 C-A-F—OL 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. VNo Go to Question 2. 2. Does your real property have a licensed plumber certifying that,due to the age orconfiguration 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. Ta 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. 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. EINN .,�/ Civil Code Sections 1101.1 through 110.1.8 do not apply. Skip the rest of the form and sign bottom of form. I L 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. Check one of the three following statements and sign bottom of form.. 5. Please check ONE of the following Nlyproperty is a.si gle fart4Ely residential real property, See Civil Code Section 110+1.4: On and after January 1, 2044„building alterations or improvements shall require all,non-compliant plumbing.fixtures to be replaced with wafer-conserving plumbing fixtures throughout the buildm+g On or'before January 1,2017,all non- compliant pluwmbing, fixtures shall be replaced with. water-conserving pturnbing fixtures (regardless of whether property undergoes alterations or,improve,ments). ❑ My propertyis a m-ultifamily residential real property., See Civil Code Section 110115.. ' On and after January 1,20 L4,,specified building alterations or improvements shall require non:compliant plumbing fixtures to be replaced witht water-conserving plumbing fixtures. On or fief©re January 1,2019;all':non-cornpliantplumbing fixtures shall lie replaced w�tli..water- conserving,plumbing,fixtures throughout the building(regardless ofwhetherr property umdergoes alterations or improvements). ❑ My property ia-a cammercial reale proper=ty. See Civil Code Section 110+1.5. On and after,Jannxary 1,;2014,,specified building alterations or improvements shall regrune non compliant plumbing fixtures to be replaced with water-conserving plumbing fixtures. On or befam Jxnuiary, 1„ 201119',, all non-compliant plumbing fixtures shall, be replaced with water,- conserving plunnbi'ng fixtures tlirougheiat the;building(regardless ofwhether property undergoes alterations or.improvements),. 1,as the owner or,owner's agent of this property,certify,under penalty of perjury that non compliant plumbing fixtures will be rep-lacedprioir to.dhtespeei+fieri abovecwith water•_conserving plumbing futures in accordance with Civil Code Sections 110`1.1 through 110%1.&„the current California Plumbing Code and Califomia Green:Bui+ld ng.Standards Code,.and manufacturer's. installation:requirements;.and that the.water-conserving pliumbing fixtures comply with the;requirements as indicated in the table on the;follow,iri ,a e:. Owner or, D.Wrer=Agent?s Si'gnaturo D.at���� 3 fS Upson comp,etibg;anad signing this Certif caro,please return,it to,the Building Division in order to,final your building,permit. " SB40,7201.5:doc revised 08/2.6/15