B-2016-2012 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2012
10659 NATHANSON AVE CUPERTINO,_CA 95014-1330(326 43 073) T F F HEATING AND
AIR CONDITIONING
MILPITAS,CA 95035
OWNER'S NAME: POOSALA VISWANATH AND NANDAKURU DHARANI TRU DATE ISSUED:05/25/2016
OWNER'S PHONE:408-480-5217 PHONE NO:(408)515-5832
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class CC-20 Lic,#917350
Contractor T F F_HEATING AND AIR CONDITIONING Date 06/30/2016 X BLDG X 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:
ADD(N)A/C-RIGHT SIDE AND ELECTRICAL PANEL 30 AMP
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
____p
formance of the work for which this permit is issued.
i
' ave and will the
Worker's Compensation Insurance,as provided for by
L, Section 3700 of the Labor Code,for the performance of the work for which this
V
permit is issued. Sq.Ft Floor Area: Valuation:$4700.00
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 326 Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 326 43 073
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 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 the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 5/25/20 Issued by:Abb Ayende
f Date:05/25/2016 +�
OWNER-BUILDER 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
t. I,as owner of the property,or my employees with wages as their sole installed without first 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)
z. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date: /255 /2016
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
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 by
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued.
3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(x)should I store or handle hazardous
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 as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall =?
be deemed revoked. C Owner or authorized agent:
APPLICANT CERTIFICATION Date:5/25/2016
I 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 inspection purposes. (We)agree Lender's Name
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 understands ARCHITECT'S DECLARATION
and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records.
Code,Section 9.18.
Licensed
Signature Date 5/25/2016 Professional
GENERAL PERMIT APPLICATIONMEP
10 COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTIN (408)777-3228 FAX(408)777-3333•building(a),cupertino.org 'M Is C
PLUMBING jgJ10CHANICAL EIELEcTRICAL OMISCELLANEOUS
PROJECT ADDRESS APN II i
OWNER NAME � .�. � .,� 4 'a.� '€ PHONE �y�,�:' g(_)-`. E-MAIL
STREET ADDRESS CITY,STATE,11 ddZI'rP'P ^��I�'.�, FAX
CONTACT NAME m PHONE E-MAIL ' x
� �1
STREET ADDRESS r ,.y�.y� t' t � l CITY,STATE,ZIPa i 6 ra �A 9, 7� FAX � ��4.vy (1?a b
R
OWNER ❑ OWNE'r'-13URDERY� ❑ OWNER,
NAGENT 11 CONTRACTOR 'RCONTRACTTOOR AI` 11GENT ARCMTECT ❑ENGINEER 11 DEVELOPER DEVELOPER^f -[TENANT
CONTRACTOR NAME p u v `„ ;4 LICENSE NUMBER a LICENSE TYPE a BUS.LIC#,
COMPANY NAME ( E MAII 6 FAX r
T)rr � fi'oe � e. s d e4
STREET ADDRESS �,( , ,ya jil(i .y moi" � CITY,STATE,ZIP C ff r6,/ /C",!G s*•,: � PHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF 75LSFDor DUPLEX. ❑. MULTI-FAMILY PROJECT IN WII.DLAND ❑ YESPROJECT IN ❑YES IS THE SLOGAN ❑YES
BUILDING ❑COMMERCIAL URBAN INTERFACE AREA NOFLOOD ZONE &NO EICHLER ROME? 49 NO
DESCRIPTION OF WORK '
TOTAL VALUATION= y REt;EIY�D.SY' - _
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 to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: _f - Date:
SUPPLETVIENTAL 6ZOAKDMON REQUIRED
F iPxss
A, t
h �
MEPMiseApp_2011.doe revised 06121111
STATE OF CALIFORNIA
ALTERATIONS HVAC
CEG-CF R AL's'-W-E aAsed 45114 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE C11.11 ALj-03-E
Alterations-HVAC CZ 1,3 to 7 and 16(formerly CF-1R-A171-HVAC) (page 1 o 1)
Site Address_ Enforcement Agency Date Prepared::` Permit#:
New.Ducting,Plenums,Lineset Conditioned
EaulpmeniType - Equipment Effcpency Thermostat
Required R-value Floor-Area(sq ft)
0 Packaged System Evaporator Coit AFLIE CQP 0 R-6 JCL1,3-7)Ducts seared by sysj�am RISetback
Z16 f - (tfnotolready
II Split System II Condensing Unit QR-8'
SEER I' )Ducts. i i�sq it resent must
L7 R-5(all M)Plenums P
Furnace F3 Lineset HSPF EER - O R-5 or R7.5 iinesee beinstalled)
14ERS 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 Rand filled forms allowed)and a copy left an site.
�02.HVAC ChangeoutjRepair Required'Compliance Dommen sto beleit on skefor Final:
Can include new ducting
All Equipment, CFIR-ALT-02-E
I Condenser Unit,Evaporator W11, 0:211:1V1ECH-0z,MECH-20-HERS
Air HandlerlFurnace CF3R:MECH-24-HERS
.Installer Requirement:Duct Ieakage(-,,_15%or,<1f7g5to outside;or seal all access"stale leaks}
Exempted from duct leakage testing if
171-Duct system registered with HERS provider as previously seated,or-0 2-There is less than 40 linear laet of ductin unconditioned
space,ori 3.Existing ductsystems are cflnsaucted,insulated or sealed With asbestos(llstmanufacture data of buildingL%111
Q 2.New RVACSysEem Required Compliance Documentsto be left on site for Final:
All new equipment and All Deur Ducts CFI11-ALT-02 E ,
CF2R MECH-01,MECH-20 HERS,MECH 22-HERS,MECH-123 or 24)-HERS
CE3R MECH-2i-HERS,MECH-22 HERS,MECH-123 or24)-HERSz
Installer Requinament;Duct leakage<6%,Fan Efficacy(-59W/CFM),Air flow;:350 GFMjton(or Standards Table?SILO-C j D alternative)
0 3.All Maw Ducts u tit Replacement Required Compliance Documents to be left on site for Final:
Includes replacing or installing 91 New CFIR-ALT-02-E
Ducts2 and one or more of the following: CF211 MESH-OL MECH 2€}-HERS MECH423 or24}HERS
Condenser unit Evaporator Coil,Furnace CF3ft MECH-20-HERS,MECH-(23or24)-HERS
Installer Requirernenfi-Duct leakage.:S 5 a Air Floes>35D GPM]ton[or Standards Table 150.0-C J D alternative}
Q Exempted from duc'leakage#es5ng l existing duct systems are constructed,insulated or sealed with asbestos.
CI 4.New Ducting over 40 feet Required Compliance Documents to be tett on site for Final:
Addling car replacing ducts in unconditioned CRR;
_
space but less than All New Ducts CCRR:*IIII;ME -2
� CRR:*
Installer Required to:Duct leakage(c 35 a or,< 0;a to outside,lar seat all accessibleleaks}
1 El Exemptedfrom duct leakage testing I existing duct systems are constructed,insulated`-or sealed with asbestos.
'All new ducting R-S required when more than 40 ft installed and R-6 when less than 40 ft installed.This includes inwalls,between floors etc.
aft 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.
R-5(I thick insulation}for linesets 1'and less. R-7.5(I.Sthick insulation)for linesets over 1 inch. Most mfg will require Suction line Diameter
with insulation as the folloiknng LS-2T-2Aa,2-S3T-2f,3S to 4T-27A',ST-Wfr
t.{Jn=ctor(Documentation Author's jliespor0bie Destgnees Declaradon Statement)
I certify the following under penalty of perjury,underthe laws ofthe State of California:
1. The information provided on this Certificate o€Compliance is true and correct
2. I am eligible under Division 3 of the California Business and Professions Code to accept responsibiliityfor the information on this document
3. Thatthe energy features and performance specifications forthe design identified on this Certificate of Compliance conform tothe
requirements offTitle 24,Pacts 1 and 5 ofthe California Code of Regulations(CCR).
4. Thatthe energy features and performance specifications,materials,components,and manufactured devices forthe 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-
S. The building design features or system design features identified on this Certificate of Compliance are consistentwith the information
provided an outer applicable compliance documents,workshects,calculations,plans and specifications submitted to the enforcement
agency for approval with this building permit;application_
Respansible33asignert+Fame:.. - Responsiblenesigner5ignature:.. taate5igned - Eicens�.. .
4 _
Company_ Address GiY/SSnEefp: Phone:
i
t F - t`,'V. C., 147,"l 6,-,,t, m4i f ef, e � `�S� �j D
For assistance or questions regarding the Energy Standards,contact the Energy Hotline at:2-8011-772-3300
CECO'Pt.OT DEANS CHE D BY
GOMIV UNITY DEVELOPMENT DEPARTMENT
I BUILDING DIVISION-CUPERTINO
DATE APP-'- OVE
PLANNING DEPT '
�!1 sed. f p sa. s and spec`€ications MUST be kept at the
CUIaERTINC� o ui�constructi n. It is unlawful to make any
charges or alteration on same,or to deviate
therefrom,without appro fall from the Building Official.
T'ie stamping of this plan nd spq�ificatlons SHALL NOT
�o held to�,m k orAo b an a'roval of the violation
�egroi �of a tty lnanoe or State Law.
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PE14' lT 14_r. ���-- � � j-01�
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�TFF l HVAC
Heahng,Air Conditioning&Sheet Imetal
lei
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Tony Ferreira � .( fi�(✓'0 elft p �
Lic 917350q ( �
SMOKE / CARBON MONOXIDE ALARMS FIL
OWNER CERTIFICATE OF COMPLIANCE _..,7 N
;7�!Ivm
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION f
CtiPERTtII O 10300 TORRE AVENUE CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)7773333 building(a)cupertino.org
Address ®. AlPermit No. Qib l b s o2 0 a
( L � wv o- '�- #of arms-Smoke Carbon Monoxide��
YERNIIT CANNOT BE FI
l'+1ALED AND COMPLETER.U,NT TflS CERTIFICATE _
� HA �SEE RC3'T 7RI+', O THF P,IIHHDIN IVIiO
T xi
n. h77
a
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
$1000.001 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
ocations.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 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 andthat
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
�f7 N4NjPKVRv Signature.........I.. ....:.............................................................Date: .✓l.r.�..
Contractor Name:
Sinature...................................................................Lic.#......................................Date: ...................
Smoke and CO form.doc revised 03118114
WATER-CONSERVING PLUMBING FIXTURES Ian
3
OWNER CERTIFICATE OF COMPLIANCE ^L
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
dCtlPERTiINC3 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•F (408)777-3333• building(cDcupertino.orq
Owner Name'' _ G' - � (� v� r-� Permit No. d-0�(�J
Address f®6-5-`1 r-,n raw)
1. Is your real property a registered historical site?
Yes .i Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
CNo 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..
iNo 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.
OI/ es 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:
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
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 following page.
Owner or Owner Agent's Signature: Date: E IS 1116
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit.
SB407 2015.doe revised 08/26115