B-2016-1684CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1684
6541 CLIFFORD DR CUPERTINO, CA 95014-4555 (369 26 003) A & H HEATING & AIR_
CONDITIONING
SERVICE INC
SAN JOSE, CA 95110
OWNERS NAME: Ronald M Waibel (Waibel Ronald M) I DATE ISSUED: 04/04/2016
OWNER'S PHONE: 4082531244 I PHONE NO: (408) 279-0722
19 Lai Dj&*i _ . 1X4113ell 11 IRT -ft e
License Class C-20 Lic. #304472
Contractor A& H HEATING &AIR CONDITIONING SERVICE INC Date
05/31/2017
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.
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
BUILDING PERMIT INFO:
BLDG —ELECT —PLUMB
MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
REMOVE AND REPLACE (E) A/C AND FORCED AIR FURNACE
(SAME LOCATION
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
_s Section 3700 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: Valuation: $3775.00
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 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 G Date 4/4/2016
I hereby affirm that I 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. 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.
s. 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
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.:
Date 4/4/2016
APN Number: Occupancy Type:
369 26 003
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LASTXALLED INSPECTION.
Issued by: PAUL O'SULLIVAN
Date: 4/4/2016
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 ofApplicant:
Date: 4/4/2016
ALL ROOF COVERINGS TO BE CLASS "A" OR
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 Health & Safety Code, Sections 25505, 25533, and 25534.
r or authorized agent:
414/2016
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
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
�� INO (408) 777--3228 . FAX (408) 777-3333 • buiidingQcupertino.org
CUPE
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PROJECT ADDRESS G' Q I r D n APN # J % ( — `6 OV
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CONTACT NAME ` ,� PHONE E -MATT,
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STREET ADDRESS A _ CITY, SLATE, ZIP _ /! �.� FAX
ARCHITECT/ENGINF.,E R:NAME LICENSE NUMBER BUS. LIC#
COMPANYNAME E-MAIL FAX
STREET ADDRESS CITY, STATE, ZIP PHONE
USE OF t-MUPLEX nMULTIFAMILY PROJECITINWILDLAND El YES PROJECTIN [� !YES JSTHEBLDGAN AYES
BUILDING: -COMMERCIAL - URBAN INTERFACE AREA tM� "" FLOOD -ZONE gas EICHI.ER HOME? I�
DESCRIPTION OF WORK
C0#0#JI_11C ro FY/ 4TA-9G. L .= TilP /tIJY 47� T /g/-( r r`T" 1
TOTAL VALUATION: 3 '77 a RECEIVED $Y 3
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating touilding construction. authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent bn4— � Date: / — 3; /(p
I � 1� ill aC�li►L I:� Y [f)�®.7 �[�Iil l.7 �I �7
13 OWNER 0 OWNERBUILDER ❑OWNER AGENT
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L7 CpN1RACTOR ❑CONTRACTOR AGENT
13ARCHITECT 13ENGINEER ElDEVELORER E3 TENANT
CON�RACoRFNAMET
NAME-72
LICENSE NUMBER 'Z/ 1 Li ([
LICENSE TYPEfJ
SUS. LIC # ! /� D J
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STREET ADD SS
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CITY, STATE, ZIP
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PHONE
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ARCHITECT/ENGINF.,E R:NAME LICENSE NUMBER BUS. LIC#
COMPANYNAME E-MAIL FAX
STREET ADDRESS CITY, STATE, ZIP PHONE
USE OF t-MUPLEX nMULTIFAMILY PROJECITINWILDLAND El YES PROJECTIN [� !YES JSTHEBLDGAN AYES
BUILDING: -COMMERCIAL - URBAN INTERFACE AREA tM� "" FLOOD -ZONE gas EICHI.ER HOME? I�
DESCRIPTION OF WORK
C0#0#JI_11C ro FY/ 4TA-9G. L .= TilP /tIJY 47� T /g/-( r r`T" 1
TOTAL VALUATION: 3 '77 a RECEIVED $Y 3
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating touilding construction. authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent bn4— � Date: / — 3; /(p
I � 1� ill aC�li►L I:� Y [f)�®.7 �[�Iil l.7 �I �7
CERTIFICATE OF COMPLIANCE CF111-Af T -02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 1 of 3 )
Project Name; Waibel Date Prepared: 2015.04-03
A, General Information
CFIR-ALT-02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented,
use one CFIR-ALT 02 document for each dwelling unit.
01
Project Name
Waibel
02
Gate Prepared
2016-04-03
03
Project Location
6541 Cliffford dr
04
Building Type
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
Waibel
O7
Zip Code
9504
08
Dwelling Unit Conditioned
1080
duct system?
SC system?
1
System I
Floor Area (ft2)
1084
Yes
Yes
Yes
No
Number of space conditioning
No
09
Climate Zone
4
10
(SC) systems in this dwelling
1
unit
B. Space Conditioning (SC) System inforrnation s
y
01 02 Q3 04u ,, 05 ` O6'. , 07',, ` 08 09 10 .
the
a
SC System
SC Systemr
CIA served
Systema'
refrigera
tnslkally g new SC
Installing
Installing
identification or
Location or Area
b this SC
ducted _
containin
g
s stem
more than 40
entirel ne N
entirely new
Name
Served
System (ft2)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
System I
Location 1
1084
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section1S0.2(b)1Dib)
_. This section does not apply to this project. APR Q 4 2016
Registration, Number: 216-A0123551A-000000000.0000 Registration Date/Time: 2016-04-03 15:44:39 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-04-03 15:44:49
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CFIR-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page Z of 3
D. Altered Space Conditioning_System (Sections 150.2(b)IE 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
Efftiency
Cooling
Cooling
Efficiency
Efficiency
Thermostat
Replaced
New Duct
or Name
Type
Components
Type
Value
System Type
'Components
Type
Value
Type
Duct Length
R -Value
Central gas
No heating
This field or
This field or
Central split
All new
This field or
This field or
System I
furnace
component
section is not
section is not
AC
cooling
SEER
14
Setback
section is not
section Is not
altered,
applicable
Applicable
components
applicable
applicable
liggluired6ocugientgtion:
CF211-MCH-01-E - Space Conditioning Systems Ducts and Far�i,
-Duct insulation requirement for new plenums: R6. J
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 ft of duct length is replaced.
-Leakage rate compliance: & 15946, or <_ 10% leakage to or outside, seal all accessible leaks.
I L
CF2R-MCH-25-H & CF311-MCH-25-HRefrigerant Charge Verification
t!6n required when refrigerant containing components are installed or altered (applicable In CZ 2, 8-15).
CQRCF311-MCH-23 & CF3RMCH-23 Alr-Fl6W 300 CFM/ton requirodwhgp_MCKm25 is required.
Exceptions:
,Duct systems registered with 1-115PS prpvIdergs'pre'viously sealed are .exempt ,,from'VCH7 20 Duct Leakage, Testing requirements,
-Heating-only systems and Air Handler/Furnace ehangiis do notxequire-v6ililcatjo : of Air Flo MCH23ilor, R4frigera n�t C6ig6'MkH-25,"
-Existing duct systems constructed, insulated or sealed� with asbestos are exempt,from MCH=20 DuiLeakageTest
Tes ,re ina S.
pir. ment'
E. Entirely New or Complete Repla ent DudSystem, with,or without fqt�fpment Chan I b)IE, F)
150.2(
geout($ectionsJ5 .2(4) piWand,
This section does not apply to this project.
F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)IC)
This section does not apply to this project.
Registration Number: 216-A0123551A-000000000,0000 Registration Date/Time: 2016-04-0315:44:39 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards- 2013,kesidential Compliance Report Version: 2013 Rev 2.007 Report Generated: 2016-04-03 15,44:49
Schema Version: 0.555SDD
v CERTIFICATE OF COMPLIANCE
CF11i,,,�;1�T!LA-1E.
(Page of
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC)
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
Phelps, Dale
Company:
A & H HEATING & AIR CONDITIONING SERVICE INC
Signature Date:
2016-04-03 15:44:39
Address:
CEA/ HERS Certification Identification (if applicable):,
770 CHESTNUT STREET
City/State/Zip:Phone:
SAN JOSE CA 95110 ``,
408-279-0722
Responsible Person's Declaration statement f
I certify the following under penalty of perjury, under the laws of the State of California:
1. The information provided on this Certificate of Compiiancels true, and correct.
2. 1 am eligible under Division 3 -of the Business and Professions Code .to accept, resp6n's'ibility for the building design or system design identified on this Certificate of Compliance (responsible designer).
3. 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 Californiq,Code of Regulations, rk
features Certificate Compliance are consistent.with the ififormatxon provided on other a pP livable cornpiiance documents, wo sheets,
4. The building design features or system design identified on this 4f
p envy for approval with this building permit application.
calculations, plans ands specifications submitted to the enforcernentag
; ,. : ;� t - " 'hforcement a enc for all applicable
`
S. I will ensure that a registered copy of this Certifacate,of.Complignce shall be,m6c q, '? I' ble with the. bulldi,[tgpermit(s) sssued for khe bui►dins, and made availgble q the.e g y pp
inspections. I understand that a regietered'copy of tgi's Certificate of Cquirpd to be, cIgded with the documentation thebuilder provides to.the building owner at occupancy.
Responsible Designer Name:. =' ' 'Responsible
Designer Signature. ' '
IDA
Phelps, Dale�
Company:
Date Signed:
A & H HEATING & AIR CONDITIONING SERVICE INC
2Q16-04-03 15:44:39
Address;
License;
770 CHESTNUT STREET
304472
City/State/Zips
Phone:
SAN JOSE CA 95110
408-279-0722
Digitally signed by CaICE'RTS. This digital signature is provided in order to secure the content of this registered document, and in noway implies Registration Provider responsibility for the accuracy ofthe information.
Registration Number: 216-AO123551A-OOOOOOOg0-0000 Registration Date/Time: 2Q16-04-0315:44:39 HERS Provider; CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-04-03 15^,44:49
Schema Version: 0.555SDD
CtipERTINO
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT. BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • 'building(a�cupertino.org
ILE
-rl:_r
W_,Mr'sir
FICATU
1�
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.
I have read and arrrPa to rmmnly with thn fPem.s and mn litinnr of this ctgtPmPnt
0waerjor Civtmer 1 gent Name:_ _
�d11
_ Q'
i nafure ...!�"' QT Y .. ......... ......... ......... ......... ............ ba%: ..0..':6...
-Gdn11a00r Name:
Tq.7Z.....
a
Smoke and COform.doc revised 0311811'4
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
10300 TORRE AVENUE • CU.PERTINO, CA 95014-3255
(4^08)1777-3228 • FAX (408) 777-3333 • buildingfa)cupertino.orp
M
CC Is your real property a registered historical site?
Yes Civil Code Sections 1101.1 through1101.8 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?
Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
El 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.
Is water service permanently disconnected for your building?
El Yes Civil Code Sections 110 1. 1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
X No Go to Question 4.
Is your real property built and available for use or occupancy on or before January 1, 1`994?
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).
❑ 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 -conserving plumbing fixtures comply with the requirements as indicated in the
table on the followine naee.
I (0`wner or Owner A ent sSgnature j IGn. 'JJA kt l Daf�E 6 I
Upon completing and- signing this Certificate, please return it to the Building Division in order to final your building permit.
SB4072015.doe revised 08126/15