B-2016-1392 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1392
10056 CRESCENT RD CUPERTINO,CA 95014-1012(326 17 035) (COBALT HEATING
AND COOLING)
SAN JOSE,CA 95123
OWNER'S NAME: IWAHASHI DAVID S AND LINDA G TRUSTEE DATE ISSUED:02/18/2016
OWNER'S PHONE:408-253-2937 PHONE NO:408-227-7573
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class CC-20 Lie.#991115
Contractor(COBALT HEATING AND COOLING)Date 02/18/2016 X BLDG _ELECT —PLUMB
X MECH X_RESIDENTIAL_COMMERCIAL
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. JOB DESCRIPTION:
REPLACE(E)FURNACE,SAME LOCATION
I hereby affirm under penalty of perjury one of the following two declarations:
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,fI 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:$4200.00
i
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above APN Number: Occupancy Type:
information is correct.I agree to comply with all city and county 326 17 035
ordinances and state laws relating to building construction,and hereby
authorize representatives o his city to enter upon the above mentioned
property for inspection pu So es. (we)agree to save indemnify and keep
harmless the City off Cup rti o against li '''es,judgments,costs,and PERMIT EXPIRES IF WORK IS NOT STARTED
expenses which m y a ru against s 'd Cit in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this per it. d nall e a li nt understands and will
comply with all non point source regulations er the Cupertino Municipal 180 DAYS FROM LAST CAL INSPECTION.
Code,Section
f
Issued by:MELIS
Signature Date 02/18/2016 Date:02/18/2016
' I
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
installed without first obtaining an inspection,I agree to remove all new materials for
following two reasons: inspection.
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(See.7044;Business&Professions Code) Signature of Applicant
2. I,as owner of the property,am exclusively contracting with licensed Date:02/18/2016
contractors to construct the project(Sce.7044,Business&Professions Code).
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 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(,) ould I store or handle hazardous
this permit is issued. material. Additionally,should I use eq ent or devi es which emit hazardous
3. I certify that in the performance of the work for which this permit is issued,I air contaminants as defined by the ay r Air lity anagement District I
shall not employ any person in any manner so as to become subject to the will maintain compliance with the u e ti o icipal ode,Chapter 9.12 and
Worker's Compensation laws of California. If,after making this certificate of the Health&Sa 25505,255 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 authorized agent'
be deemed revoked. Date:02/18/2016
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION agency for the performance
I certify that I have read this application and state that the above information is of work's for which this permit is issued(Sec.thereby affirm that there is a construction lending ing Civ C.)
correct.I agree to comply with all city and county ordinances and state laws Lender's Name
relating to building construction,and hereby authorize representatives of this city
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Address
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in ARCHITECT'S DECLARATION
consequence of the granting of this permit. Additionally,the applicant I understand my plans shall be used as public records.
understands and will comply with all non-point source regulations per the
Cupertino Municipal Code,Section 9.18.
Licensed
Professional
Signature Date 02/18/2016
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildingCM)cupertino.ora misc
CUPERTIkll10 f3 - 2 b f " f`3'C�
PLUMBING NMCHANICAL ELECTRICAL ONUSCELLANEOUS
F8TRELTADDRESS
ADDRESS` f APN#
p {� (° FAX
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CONTACT NAME PHO E C�
STREET ADDRESS s_ CITY,STATE,ZIP FAX
11 OWNER ❑ OWNER BUILDER ❑OWNERAGENT ❑ CONTRACTOR D CONTRAOTORAGENT ❑ ARCHITECT ❑ENGINEER Il DEVELOPER ❑TENANT
LI SE TYPE BUS. IC
CONTRACTORNAME
COMPANY NAME E-MAII F
CI ,;STATE,ZIP
TRF�ET RESs °s Z � PONE -7 0`7S Z
t BUS.LIC# C
ITE GIA �`� f LICENSE NUMBER
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE.OF .SFDorDUPLEX 0 MULTI-FAMILY PROJECT IN WILDLAND ® YES. PROJECTIN - ❑.YES IS TBE BLDG AN E3 YES
BUILDING: IA COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE 0.NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK
, .<
TOTAL VALUATION: �
m the roe owner or authorized agent to act on a I have rea
By my signature below,I certify to each of e f owing: property ria
application and the information I have pro ' e c e read the:Description of Work and verify it is accurate_ I agree to comply with all applicable local
ordinances and state laws relating to bui ons j n. a rze representatives of Cupertino to enter the above-identified property for inspection purposes.
Date: z
Signature of Applicant/Agent:
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PLEMENTAL INFORMATION REQUIRED ?
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MEPMiscApp 2011.doc revised 06121111
STATE OF CALIFORNIA To I
ALTERATIONS - HVAC
CEC-CF1R-ALT-03-E(Revised 06114) 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: Enforcement Agency: Date Prepared: Permit#:
Equipment Efficient New:Ducting,Plenums,Lineset Conditioned Thermostat
Equipment TypeMent' Q 4 iP y Required R-value Floor Area(sq ft)
❑Packaged System ❑Evaporator Coil AFUECOp )
❑R-6 (CZ 1,3-7)Ducts Served by system Setback
O R-8' (CZ 16 Ducts (If not already
13S Split stem 11 CondensingUnit SEER sq ft
P y HSPF ❑R-6(all CZ's).Plenums present,must
urnace ❑Lineset EER ❑R-5 or R7.5 Lineset3 be installed)
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At=per-mit=applicatiorr_this;
form-is allowed=to-be`filled�out-by-h n Forfir al inspection all forms are to be registered(no hand filled forms allowed)and a copy left on site.
]PI.HVAC than eout/Repair Required Compliance Documents to be left on site for Final:
lCan-include new ducting_
"All Equipment, CF1R-ALT-02-E
Condenser Unit,Evaporator Coil, CF2R:MECH-01,MECH-20-HERS
AirNandler/Furnace CF3R:MECH-20-HERS
Installer Requirement:Duct leakage L<15% <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 112.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 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 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
CF2R:MECH-20
space but less than All New Ducts' 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 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.
3•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
Fcertify
h iulation as the following 1.5=2T-2%",2.5-3T-2%",3.5 to 4T-2%",5T-4%"
ctor(Documentation Author's/Responsible Designer's Declaration Statement)
the following under penalty of perjury,under the laws of the State of California:
e information provided on this Certificate of Compliance is true and correct.
m 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 docu nts,worksheets,calculations,plans and specifications submitted to the enforcement
agency for approval with this building permit a lica ' n.
Responsible Designer Name:
Re on- le D igne`r Signatur Da a Signed License:
ci State/Zip:
Company: s�T 5 �5_"" .n�c.��
For assistance or questions regarding the Energy Standards,contact the Energy Hotline at:1-800-772-3300
'Rmfm>- f AKt1UWMUN0XIDE ALARM
OWNER CERTIFICATE OFCOMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT'BUILDING DIVISION
CUP RTINO 10300 TORRE AVENUE®CUPERTINO,CA 95014-3255
(408)777-3228 W FAX(408)777-3333 building(a.cupertino.ora
11"EI IAIT CANNOT DE FINALED AND COMPLETED UhTDl THIS CELT IFCCAT f
IlFl �`
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 IN FORMATION
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:
ARIA SMOKE ALARM CO'AILARM
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 slee i:n_g room X
Carbon Monoxide alarms are not required v1 dwellings which do not contain fuel-burnuzg 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..
Rower Supply In dwelling units with no commercial power supply, alarmf 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 w I'and ceiling finishes or, there is no access by means of attic,basement or crawl
space.Refer to C1,C Section R314 and CBC Sections.907.2.11.4 and 420.:6.2.An electrical permit is required for
alarms wlucli m-ufstbe comiectecl to the building wiring.
As owner of the abovve-referenced property,I hereby certify that the alarm(s))refeie1�ced above has/have beeiz,
installed,u1 accordance with the i- anufactur.er`s instructions arid,in com1�_ili ,-.ce with the,Ca'
j i i 1? lrfornia B?uildlirig
an�dl C'ahfomlia I;esiclentrna=1 Codes.The almms,have been testedln t,d are operational as.o.f the date signedl
below.,
e
t1 Maier read'ant a,dee.tQ care y:l' with tie, r�msr and condiliz�m ofr tJhis state�nent
iafure;....
lry r
Cbnfraclofxl?lern'e:; '
........ .........Date.
S w,ke and C&'fbrnv db.a reuise403118/l4
' TEi VING PLUMBING fIXTURES
OWNER CERTIFICATE OF COMPLLAMCp
,y
COMMU,NiTY D£VEL0 F-wT D-EPA•RTMENT-:B 3iLDING.DIVISMN
CUPS RTIINO 10300 TORRE AVENUE-CUPERTINO,CA.9W-14-3255
(408)777-3228•FAX�408)777-3333 m builttina r�i cuggq no.og
Owner Nam 1 i/� 1 , \11 A H AS 14 l Permit No '��� � 1,`meq I
Address
L Is your real property a registered historical site?
❑ Yes Civil Code Sections 110 1.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
No Go to Question 2.
2. Does your real property have a licensed plumber certifying
p 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.
V 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 ofthe form and sign bottom of form.
KNo 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.
m.
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..
5. Please check ONE of the following:
M property is as single fam, 'residential real property, See Civil Code Section 1101.4.
On and after January 1, 2014,building alterations or improvements shall require all non-compliant plumbingfixtures
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 phmbnng fixtures (regardless of whether
property undergoes alterations or iknprovements).
❑ My propertyis:a.midtifami•ly residential real property. See Civil Code Section 1101.5 .
On and after January 1,2914,,specified,,building alterations or improvements shall require non-compliant
plumbing.fixtures to be replaced;with water-conserving plumbing fixtures.
On or before January 1,29,19,•all.non-compliantplumbing fixtures shall be replaced with;water-
conserving plumb-ing fixtures throughnutthe building(regardless of whetherpropertyi nrd'ergoes 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 requirre non compliant
plumbing.fixtures to be replaced with water-conserving plumbing fixtures.
On or before,January 1,, 201 , all non-compliant plumbing fixtures shall be replaced with water- conserving,
plumbing.fmtnresi through-out the building(regardless,of whether 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
replaced prior.to date specified above;with watsr-conserving plumbing fixtures in,accordance with,Civil.Code Sections,1101.1
theough 110.1.$,the:current California Plumbing Code and California Green Building Standard's C'ode,,; ,m
anufacturer"sinstallation requirements,and that the,water=conserving plumbing fixtures comply with the requiremenas:m;cated vn the
table on the followin <. a E:
OOwneror0:vrne�r�Agent's Signature .: D t r
Upon,completiing arid,signing this Ceitifieate,please return it to the Building Division in,order to finalyour building,permit. '
SB407 2015sdoe revised 08/26115