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B-2016-1512 i CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1512 20368 CLAY ST CUPERTINO,CA 95014-4403(369 38 02 ) DELTA MECHANICAL INC 6056 E BASELINE RD, MESAAZ 8.5206 OWNER'S NAME: GROZMAN LENA DATE ISSUED:03/14/2016 OWNER'S PHONE:4159390969 PHONE NO:8888280707 LICENSED ONTR TOR' DECLARATION BUILDING PERMIT INFO: License Class C-20 Lic.# 18 1114 Contractor DELTA MECHANICAL INC Date X BLDG _ELECT X PLUMB I hereby affirm that I am licensed under the provisions oi]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: INSTALL(N)A/C UNIT;(1)FORCED AIR FURNACE WITH(I) I hereby affirm under penalty of perjury one of the following two declarations: DUCTWORK;(I)DEDICATED GAS LINE 20'TO FURNACE 1. I have and will maintain a certificate of consent tc 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. 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. Sq.Ft Floor Area: Valuation:$18767.00 APPLICANT CERTIFICATION certify that I have read this application and state that the above information is correct.I agree to comply with all city anc�county ordinances APN Number: Occupancy Type:. and state laws relating to building construction,and hereby authorize 369 38 028 representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save indemnify an keep harmless the City of Cupertino against liabilities,judgments,costs,a d expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and will comply with all non-point source regulations per th;epupertino Municipal C , 9.18. 180 DAYS FROM LAST CALLED INSPECTI N, OAtal Signature Date 3/14/2016 Issued by:PAUL O'SULLNAN 1 Date:3/14/2016 OWNER-BUYLDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1. I,as owner of the property,or my employees with wages as their sole installed without fust obtaining an inspection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended or offered for inspection. sale(Sec.7044,Business&Professions Code) 2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sce.7044,Bu iness&Professions Code). Date:3/14/201 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 performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE. 2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. 1 will permit is issued. I maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If,af�er making this certificate of will maintain compliance with the Cupertino Mum" al Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections ;25533, ;Chapter Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agen . APPLICANT CERTIFICATION Date:3/14/2016 1 certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.) to enter upon the above mentioned property for inspect'+on purposes. (We)agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally;the applicant understands and will comply with all non-point source regulations pe' the Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 3/14/2016 Professional f I CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 C[JPERTEhtC3 (408) 777-3228• FAX (408)777-3333• building a(�cupertino.org ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT 4 PROJECT ADDRESS APN n 0\ANERNAME A PHONE E-MAIL r S1REE1 ,AD�SS C� �- CuT U FAX CONTACT NAME PHOE-/MAIL ' 11A' � '002P-0'->0 STREETss �^` v CITY,STATE,ZIP R FAX ❑OWNER ❑ O'WNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGDTTEER ❑ DEVELOPER ❑ TENANT COAT CTOR TAME LICEN_ rLICENSE TYPE BUS.LIC# ' PI-61 2-0 CO ANY IE / J E-MAIL FAX S ET ADDS Ss CITY,STATE,ZIP 1p�I ' � © 0 0' f ARCHITECTXNGLNEER NAME LICENSE SEN'UMBER BUS.LIC r COMPAI TY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF VdORI: LJNF- EXISTING USE PROPOSED USE CONSTR.TYPE n STORIES -- USE TYPE OCC. SQ.FT. VALUATION(S) r EXISTG NEW FLOOR DEMOTOTAL AREA AREA AREA NET AREA. .. BATHROOM KITCHEN OTHER REMODELAREA REMODEL AREA REMODEL AREA PORCH,777CK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH F ATTACH DWELLING UNITS: ISA SECOND U\IT ❑YES SECOND STORY E]YES BEING ADDED? ❑No ADDITION? ❑NO PRE-APPLICATION ❑.YES IF YES:PROVIDE COPY OF I IS TAE BLDG AN ❑YES TAL VALUATION: PLANNING APPL r '❑NO PLANNING APPROVAL LETTER i EICHLER HOME? ❑NO a r / By my signature below,I certify to each of the following: I am the property owner or authorized agent to act ner's behalf. I have read this application and the information I have provided is correct. I I read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building c n. I authorize representatives of Cupertino to enter the above-identified property,for inspection purposes. Signature of Applicant/Agent: Date: l Z� SUPPLEMEI=TTAI IN M ORATIO RE UI Q PLAN CHECIsT]PE ROUTIIG SLIP n NTew SFD or Multifamily dwellings: Apply fo•demolition permit for 'O]ERTHE COU\TER *�� q BUILDIZGPLA'�:RE1� R �ffi -� existing building s). Demolition permit is required prior to issuance of building E £ permit for new building. ZIP iv 0'ff' LS\\L\GPLAn RE�IEZ� �� _Commercial Bldgs Provide a completed Hazardous Materials Disclosure L7 sTA\D ARD" puBLlc«oRl,s ' form.if any Hazardous Materials are being used as part of this project. I BARGE ` 'FIREDEPT Copy of Planning Approval Letter or Meeting} ith Planning prior to SEP — I� NLAJOR � ❑ SA\IT4R]SE�'�ERDISTRICT submittal of Building Permit application. n - x :. BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 20368 CLAY STREETDATE: 03/14/2016 REVIEWED BY: PAUL APN: 369 38 028 BP4: `"VALUATION: 1$18,767 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY PENTAMATION SFD or Duplex FURN/AC USE: PERMIT TYPE: y WORK INSTALL N A/C UNIT' (N)l FORCED AIR FURNACE WITH N DUCTWORK N DEDICATED GAS— SC PE ASSCOPE LINE 20' TO FURNACE L l Me h,Plan Check O.Q hrs $0.00 Plumb.Plan Check 0.0 hrs $0.00 Ek,,,; - Mech.Permit Fee: IMPERRIITI Plumb.Permit Fee: IPPERMIT Other Mech.Insp. �hrs $48,00 Other Plumb Insp. 0.0 hrs $48.00El :.a..r b, r't g,', NOTE This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These ees are based on the relimina information available and are only an estimate. Contact the Dat./or addn'l info. FEE ITEMS (Fee Resolution I:1-053.Lf. 7/1113 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 # Mechanical Suppl.PC Fee: (E) Reg. 0 OT 0.01 1 hrs $0.00 $72.00 IBREM4IR A/C Units(<=10K cfm) PME Plan Check. $0.00 = # Mechanical Permit Fee: $0.00 $143.00 IMFR=__1007Furnace,Forced-Air Suppl. Insp.Feer Reg. Q OT I 0,0 hrs $0.00 l ' I # Plumbing PME Unit Fee: $0.00 $72.00 1BPGAS Piping, Gas>4 Outlets PME Permit Fee: $96.00 Administrative Fee: 1ADMIN $45.00 0 Work Without Permit? Yes (F) No $0.00 E) Advanced.Plannin I'ee: $0.00 Select a Non-Residential E) Building or Structure 0 Travel Documentation Fee: 1TRAVDOC $48.00 ,II Strong Motion Fee: 1BSEISMICR $2.44 Select an Administrative Ite Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $192.44 $287.001TQTAL FEE: $479.44 _ Revise 409 STATE OF CALIFORNIA ALTERATIONS - HVAC CEC-CFIR-ALT-03-E Revised 06/14 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE CFIR-ALT-03-E Alterations-HVAC CZ 1,3 to 7 and 16(formerly CF-IR-ALT-HVAC) (Page 1 of 1) Site Address: s Enforcement Agency: Date Prepared: Permit#: New:Ducting,Plenums,Lineset Conditioned Equipment Type Equipment Efficiency Thermostat � ' Required R-value Floor Area(sq ft) ❑Packaged System ,11 Evaporator Coil AFUE COP EJ R-6 (CZ 1,3-7)Ducts Served by system Setback Split System ❑Condensing Unit SEER ! T I ❑R78' (CZ 16)Ducts 000 sq ft (If not already rElFurnace 0 Lineset EER ❑R-6(all CZ's)Plenums present,must Furnace ❑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=applicatiorrtMw +fo-Fm—is=all"owed=to-b`e-filled-outby-hand: For finall inspection all forms are to be registered(no hand filled forms allowed)and a copy left on site. 13 1.HVAC Changeout/Repair Required Compliance'Documents to be left on site for final: Can include new ducting All Equipment, CFIR-ALT-02-E Condenser Unit,Evaporator Coil, �F2R:MECH-01,MECH-20-HERS Air Handler/Furnace CF3R:MECH-20-HERS Installer Requirement:Duct leakage(:5_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 IJ 3.Existing duct systems are constructed, insulated or sealed with asbestos(list manufacture date of building 1 ❑2.New HVAC System IRequired Compliance Documents to be left on site for Final: All new equipment and All New Ducts' CFIR-ALT-02-E CF2R-MECH-01,MECH-20-HERS,MECH-22-HERS,MECH-(23or 24)-HERS CF3R-MECH-20-HERS,MECH-22-HERS,MECH-(23 or 24)-HERS' Installer Requirement:Duct leakage<65'o,Fan Efficacy(.58W/CFM),Air Flow>_350 CFM/ton(or Standards Table 150.0-C/D alternative) ❑3.All New Duds with Replacement Required Compliance Documents to be left on site for Final: Includes replacing or installing All New CFIR-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!l existing duct systems are constructed,insulated or sealed with asbestos. 114.New Ducting over 40 feet {Required Compliance Documents to be left on site for Final: Adding or replacing ducts in unconditioned ICFIR-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. I R-5(1"thick insulation)for linesets 1"and less.l 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-2%-,3.5 to 4T-2%",5T-4%" Contractor(Documentation Author's/Responsible Designer's Declaration Statement) I certify the following under penalty of perjury,Linder 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 perrnIit application. Responsible Designer Name: Responsible De' Signature: Date Signed: License: Company: ` Address: City/State/Zip: c( Phone: v For assistance or questions regarding he Energy Standards,contact the Energy Hotline at:1-800-772-3300 i 03/07/2015 -0.41-5- F' CE 4097 PAGE 03 W U r IN, y s ee c cz U i � i i z A - t {{ S tom, • -.� ! C L t � r 03 LL Ll Lill, t� V kw- U) t 3-t-1 I I E- } LU > Ln � rte' U •� O 2 ,.— u) CL � c > Lit . Q v OQ m c Fa 1J < � n s (^ cc 5 - u ctj c O c U' —h. o ca zp _ t1I n m c F- n f SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION- CUP R"1"Ill~ O 10300 TORRE AVENUE CUPERTINO,CA 95014-3255 (408),777-3228•FAX(408)777-3333•building(ab-cupertino.org ry f i Permit No. B -o o 16 Address #of Alarms Smoke: LF Carbon Monoxide: PERi1',IfT GAN�iOT BK PST". LED AICD C0IVIPLETED'UI�TT�L'I'�-II$GERTIF�GATE 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 8314 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 X X bedroom(s) _ On every level of a dwellin .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. I have read and agree to comply with the terms and conditions of this statement Owner(or Owner Agent's)Name: Le-viaV 0`:-'_1 W pX Si nata .... .. ..yv.r...........,. .............. ....................... .... ..............Date:f.&laji Contractor Name:f� Signature.............................. ..Lic.#......................................Date: Smoke and CO fonn.doc revised 03118114 WATER-CONSERVING 'PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE EW COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION - 10300 TORRE AVENUE CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333- building(aDcupertino.org Owner Name - e_Vt ex ,m--i a t'k Permit No. — Address o 0 q ( L f1`oerr iKG C I. Is your real property a:registered historical site? El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. X 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? El 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. 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. 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: 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). El 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 unprovements). El My property is a commercial real property. See Civil Code Section 1101.5. On and after January 1,2014,specified building altertions 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). 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 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-conserving plumbing fixtures comply with the requirements as indicated in the table on the following page. Owner or Owner Agent's Signature` ; ;F° Dater o Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit. SB40 7 2015,doc revised 08126115