B-2016-1961 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1961
7406 RAINBOW DR APT 3 CUPERTINO,CA 95014-5331(366 19 017) AT C SERVICE INC
SUNNYVALE,CA
94085
OWNER'S NAME: NELSON KENNETH N TRUSTEE DATE ISSUED:05/17/2016
OWNER'S PHONE:408-396-3792 PHONE NO:(650)968-1100
LICENSED CONTRACTOR'S DECLARATION BUILDING PEP-NUT INFO:
License Class WARM-AIR HEATING,VENTILATING AND AIR-CONDITIONING
Lic.#5 62X BLDG _ELECT _PLUMB
Contractor AT C SERVICE INC Date 03/31/2018 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 JOB DESCRIPTION:
license is in full force and effect. APT 3(R)FURNACE-CLOSET AND A/C-BACK YARD
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. 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 Sq.Ft Floor Area: Valuation:$6500.00
permit is issued.
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 ordinances 366 19 017
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 PERMIT EXPIRES IF WORK IS NOT STARTED
City of Cupertino against liabilities,judgments,costs,and expenses which WITHIN 180 DAYS OF PERMIT ISSUANCE OR
may accrue against said City in consequence of the granting of this permit.
Additionally,the applicant understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION.
source regul tions per the Cupertino Municipal Code,Section 9.18.
/n�!/�` Issued by:Abby Ayende'c�1 Q40val—
OWNER-BUILDER
Signature �"��' ' \ Date 5/17/2016 Date:05/17/2016 G DECLARATION RF.-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:5/17/2016
contractors to construct the project(Sec.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
z. I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will
Section 3700 of the Labor Code,for the performance of the work for which this maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous
3. I certify that in the performance of the work for 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 as defined by 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 Co e,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 authorized age
be deemed revoked. Date:5/17/2016
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 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
Professional
Signature Date 5 17 2016
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 Ptk 10:11
(408)777-3228• FAX(408)777-3333• building cDcuDertino.orq
CUPERTINO -20�(p-
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LUDBING ❑MECHANIC.AL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS �r PNnr �JrA _l"V�r�
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OINTiERNAA6E 06 E P " 3q6 g- � E-N4-AJL
STREET ADDRESS 7- Ct �C A L� CITY,STATE,ZIP
CO?\'TACT N4U,E—II UA" / V P tr79 0,S 7 / E-MAIL
ST �SS clrr AV ZIP,,,
❑ owl.'ER ❑ ORANER1.BuJLDER ❑ OR'?.'ERAGENT CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGB.'EER ❑ DEVELOPER ❑ TENANT
CONTR4 V ti /� I LIC E�aS
LICETlZ- L BUS,jIE*
COMP.0.1v 'pA4�n ( � E-MAIL FAX
ST =Tq,V SS(r 1 lZ pkC1� $ ATE,ZIP r CITSUN� �l 6 C (�V HONE
ARCHITECT/ENGLNEERN.06E LICENSE NUMBER BUS.LIC
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD o DUPLEX ❑ MULTI-FAMILY PROJECT IN wILDLAN'D ❑ 1'ES PROJECT A ❑1'7ES IS THE BLDG AN ❑-vEs
BUILDL�G: ❑CO11v11ERC7-SI, URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLERHOME? ❑ NO
DESCRIPTION OF WORK
TOTAL VALUATION: � Q d
By my signature below,I certify to each of the following: I am the properly owner or authorized agent to act e property owner's behalf. I have read this �
application and the information I h ve provided is correct I have r d the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating uilding constructs zutho 'ze re resentatives of Cupertino to enter the above-identified property for inspection purposes.
r
Signature ofApplicant/.4o Cites--- Date:
SUPPLEMENTAL INFORMATION REQUIREDTCE LSE.'oI.LZ-,,J-.}
` ❑ 01 ER THECOU�TER xy ':>,
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,A EF.MiscApp_2011.doc revised 06121/11
STATE OF CALIFORNIA
ALTERATIONS - HVAC
CEC-CF1R-ALT-03-E(Revised 06/14) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ALT-03-E
Alterations-HVAC CZ 1,3 to 7 and 16(formerly CF-IR-ALT-HVAC) (Pagel of 1)
Site Address: Enforcemen Agency: Date Prepared: Permit#:
Q r� ►� ��� G 6-p- J b 's-117 r t(o
Equipment TypeA I Equipment Efficiency New:Ducting,Plenums,Lineset Conditioned Thermostat
Required R-value Floor Area(sq ft)
❑ Packaged System I-Evaporator Coil �4FUE COP El R-6 (CZ 1,3-7)Ducts Served by system Setback
❑R-8' (CZ 16)Ducts 1�00, sq ft (If not already
❑Split System -gCondensing Unit SEER HSPF El 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 application this
form is allowed to be filled out by hand. For final inspection all forms are to be registered(no hand filled forms allowed)and a copy left on site.
.HVAC Changeout/Repair Required Compliance Documents to be left on site for Final:
Can-include new ducting
All Equipment, CF1R-ALT-02-E
Condenser Unit,Evaporator Coil, CF2R:MECH-01,MECH-20-HERS
Air Handler/Furnace CF3R:MECH-20-HERS.
Installer Requirement:Duct leakage(<_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 ❑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 site 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
CFBR-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 z 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.
114.New Ducting over 40 feet Required Compliance Documents to be left on site for Final:
Adding or replacing ducts in unconditioned CFIR-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.
8 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
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,under 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 permit application.
Responsible Designer Name: Resp nsible Designer Signature Date Signed: License:
Company: Address: City/State/Zip: Phone:
1 L SEgwc� roc /8�Lr►i��l� �� ;� S c�1 I�a� 6�o�l&�s��/�o
For assistance or questions regarding the Energy Standards,contact the Energy Hotline at:1-800-772-3300
chi - zlcg-,>-w-713 1
SMOKE 0 CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION .....,.�,'
CUPERTit40 11300 TORRE AVENUE•CUPERTINO,CA 95G14-3255
(408)777-3228.FAX(408)777-3333•building(ftupertino.ar�r.
' t €rt No, -12016 I q C ,
Address : ,. .� i!I-1ho� , o .Al rs . rnoke Catbcn Mona irl
PER TIT CANNOT BE FINALED AND CQP►IPLETED UNTIL THIS CERTIFICATE
HAS BEEN SIGIN ANDT4 THE BUILDING llIV[SI�N
PURPOSE
This affidavit is a self-certification for-the installation of.all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section 8314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
inspections are required,
GENERAL INFORMATION
Existiuig 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 I
Outside of each separate sleeping area in the immediate vicinity of the X X 1,
bedrooms s
I F On ever level ofa X X i
Withjneachsltp'rt; 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 alai-ins 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 poorer 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.Defer to CRC Section 8314 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.
'r As owner of the above-referenced property,I hereby certify that the alarm(s)referenced above has/have been
�r 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 elate signed
below.
I have read and agC to C W-TIPlYrOh the terms and iadr fliias:statement
Fz'
a Altars .._
y r Date:
.; —Uots3Y6 .10
g ViI
Smoke artcf GC)for rr>doe revised 03118114
i
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•building(a.cupertino.org
Owner Name , 1 Permit N o.C1 { '_ ` ` 3-LI
Address , 2-22;Q_ ss.el"r.�►
1. Is your real property a registered historical site?
El YA Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
UI/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?
❑ JYes 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?
❑ N-, 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. Ple e 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).
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 # Date; z
Upon completing and signing this Certifi at ase return it to the Building Division in order to final your building permit.
SB4072015.doe.revised 08126115