B-2016-2041 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2041
10441 STOKES AVE CUPERTINO,'CA 95014-1233(326 47 030) A&H HEATING&AIR
CONDITIONING
SERVICE INC
SAN JOSE,CA 95110
OWNER'S NAME: YADAV POONAM AND AGRAWAL DEEPAK DATE ISSUED:05/27/2016
OWNER'S PHONE:408-421-4712 PHONE NO:(408)279-0722
LICENSED CONIRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-2Q Lic.#BD447
Contractor A&H HEATING&AIR CONDITIONING SERVICE INC Date X BLDG _ELECT _PLUMB
05/31/2017 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. REPLACE FURNACE-GARAGE;NEW A/C SIDE YARD
I hereby affirm under penalty of perjury one of the following two declarations:
1. 1 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
E performance of the work for which this permit is issued.
y i 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 FIoor Area: Valuation:$9160.00
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 326 47 030
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 regulations per the Cupertino Municipal Code,Section 9.18.
- Issued by:Abby yende
Signature afe 5/27/2016 Date:05/27/2016
OWNER-B IIID R 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
following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
r. 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 ofApplicant:
z I,as owner of the property,am exclusively contracting with licensed Date:5/27/2016
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
r. 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. 1 have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will
Section n 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
s. 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 Code,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 -Or or authorized agent:
be deemed revoked, Date:5/27/2016
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
Signature Date 5/27/2016 Professional
GENERAL PERMIT APPLICATIONMEP
CCTViMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORPE AVENUE• CUPERTINO, CA 95014-3255
(408)777-3228-.,FAX(408)777-3333• buildind(d�cupertino.oro
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EIPLU�IIBING D ,NIECILkNIC..AL L?ELECTRICAL ❑MISCELLANTEOUS
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PROJECT.0.D APN-
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STREETADDRESSSTATE.ZIP
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STREET.ADDRESSCITY,STATEOEM "1
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Ov,NN`ER ❑ OWNER-BUILDER ❑ OR'NERAGENT til CONTRACTOR 0 CO\ZRACTORAGENT E) ARCHITECT ❑ENGr\EER. ❑ DFVELOPER C3 TE?C1UNT
CO'TRACTOR I AME I LICETSEW14 q-c 4® P y LIC SE TI E BL S.LIC
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STREET ADDRESS ?C ! 2 f CITY,ST. E,ZIP PH NE
ARCHITECT/ENGLNEER MAN;E LICENSE NL-I\4BER BUS.LIC
COMPANY NAME E-14AIL FAX
STREET ADDRESS CITY,STATE,ZIP i PHONE
USE OFSFL'orD1JPLEX ❑ MuLTI-FAMILY PROJECT.LN R'II.DLA.NT [] YES PROJECT 1314YES 70
ES— IS TIE BLDG AN 'YTS
BI=IN'G: .�CO1\i4.ERCLAL URBAN ITTERFACE AREA 0__1T_ FLOOD ZONE Eg� EICIILER HOME?
DESCRIPTION OF WORK
TOTAL VALUATION: ® RLCEI%-TD BI
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property udder's bed lf, I have read this
application and the information I have provided is correct. I have read the Description of�T,%ark and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relatin_a to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of'ApplicantlAgent: Date- "``f -7—
SUPPLEMENTAL INFOR�4ATION REQUIRED
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O 'ER THE-COtJ\TER
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C:C) ;1�ti1 'R E-L��.'F'MENT DEPARTMENT
BUILDING- '!VISION - CUPERTINO �l fVi
,PPIE ,
�hs spt ofY laps a"°;;spectf�catiors MLI-T be kept at the
site du mn9 „ [ Structior. It is unlawful to make any
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trerefrcm, vithoutrove!from th evtffi t
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The Stamping of!hts plan and specif cat ons SNALL N07
be hel, to ;permit o to be an approval!of the violation
of any pr. �;isars o"
By any City lJrdindnpe or State fay.
DATE I A-
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CUPERTINO
CERTIFICATE OF COMPLIANCE CFIR-ALT 02-E
Alterations to Space Conditioning Systems(formerly CF-1R-ALT-HVAC) (Page 1 of 3)
Project Name: AGRAWAL Date Prepared: 2016-05-27
A.General Information
CF113-ALT 02 is applicable to multiple space conditioning systems contained within a single dwelling unit.When multiple dwelling units must be documented,
use one CF1R-ALT 02 document for each dwelling unit.
01 Project Name AGRAWAL 02 Date Prepared 2016-05-27
03 Project Location 10441 STOKES AVE, 04 Building Type Single family
05 CA City Cupertino 06 Dwelling Unit Name AGRAWAL
07 Zip Code 95014 08 Dwelling Unit Conditioned 1890
Floor Area(ft2)
Number of space conditioning
09 Climate Zone 4 10 (SC)systems in this dwelling 1
unit.
B.Space Conditioning(SC)System Information
D5 X06 '
07
01 02 03 a � 0$ �� 09 10
04�,, Qfl
�t1V-1.1111 d' „+e'uo 'ra,N*'dJ ,,4„ ;^., uYb '31na r
r, ,f�Is the SC Installing a All
SCS stem SCS stem CFA served ��� ����
Y Y systema r' frigeratit ,nstalUng hew SC xlr staling Installing rinstalling
Identification or Location or Area by this SC ducted containing system _ more than 40 entirely view entirelynew
Name Served System(ft2) system? component? components? feet of ducts? duct system? SC system? Alteration Type
System 1 Location 1 1890 Yes Yes Yes No No No Altered space
conditioning system
C.Extension of Existing Duct System,Greater Than 40 Feet(Section1S0.2(b)1Diib)
This section does not apply to this project.
F I FICE" COPY
Registration Number:216-A0197135A-000000000-0000 Registration Date/Time: 2016-05-27 07:02:17 HERS Provider:CalCERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-05-27 07:02:09
Schema Version:0.555SDD
CERTIFICATE OF COMPLIANCE CFIR-ALT 02-E
Alterations to Space Conditioning Systems(formerly CF-1R-ALT-HVAC) (Page 2 of 3)
D.Altered Space Conditioning System(Sections 150.2(b)1E 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 Efficiency Cooling Cooling Efficiency Efficiency Thermostat Replaced New Duct
or Name Type Components Type Value System Type Components Type Value Type Duch Length R-Value
Central gas
All new Central split All new This field or This field or
System 1 furnace heating AFUE 0.8 cooling SEER 17 Setback section is not section is not
components AC components applicable applicable
Required Documentation:
CF2R-MCH-01-E-Space Conditioning Systems Ducts and Fans
-Duct insulation requirement for new plenums:R6.
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:515%,or 510%leakage to outside,or seal all accessible leaks.
CF2R-MCH-25-H&CF3R-MCH-25-H Refrigerant Charge Verification required when refrigerant containing components are installed or altered(applicable in CZ 2,8-15).
CF2RCF3R-MCH-23&CF311-MCH-23 Air Flow z 300 CFM/ton required when MCH-25 is required..
Exceptions:
-Duct systems registered with HERS provider as previously sealed are exempt from,MCHG 20 Duct Leakage Testing requirements pry.
Heating only systems and Air Handler/Furnace changes do not require verrficat,oft of Air FI,Qw MCH,,23,tai`Reffigeta"fipht Charge MECH 253 4 f
Existing duct systems constructed,insulated or sealed with asbestos>are exempt from MCH-201�uct Leakage Testlhg Capuiremetlts, ur ^� Nrk?
x&,
E.Entirely New or Complete Replacement Duct System,with or without,Equipment Chiangeout(Sections 150 2(b)1Dua aa
�
nf` d
nd 150 2(b)1E,f)
Ye
This section does not apply to this project.
F.Entirely New or Complete Replacement Space Conditioning System(Section 150.2(b)1C)
This section does not apply to this project.
Registration Number:216-A0197135A-000000000-0000 Registration Date/Time: 2016-05-27 07:02:17 HERS Provider:CalCERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-05-27 07:02:09
Schema Version:0.555SDD
CERTIFICATE OF COMPLIANCE CFIR-ALT 02-E
Alterations to Space Conditioning.Systems(formerly CF-IR-ALT-HVAC) (Page 3 of 3)
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: Signature Date:
A&H HEATING&AIR CONDITIONING SERVICE INC 2016-05-27 07:02:17
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
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, i am eligible under Division 3 of the Business and Professions Code to accept responsibility 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
g7
requirements of Title 24,Part 1 and Part:6 of the California Code of 11e9ui9fions.
4. The building design features or system design features identified on this Certificate of Compliance are consisterii with the ity#armat�r5 rovided on Ether opplicabie Compliance documents,worksheets,
calculations,plans and specifications submitted to the Ar Orceme4,,`,` ncy foribpf ifovaCFwi h,this building permit applicatid . �t k,' ;` r
5. i will ensure that a registered 02
copy of this Certificate of Cotrpfiance All be4'maclefa+lailable oiritlt„tlri?biiilding:permit(s);,issui.d forsthelliuild dig,11 ad availabletpLthemforcement agency for all applicable
Inspections.I understand that a registered copy of this Certificate of Compliance is required to be„included w)th th@rdocumentation the ybri�der prou_jdes to the building owner at occupancy.
g '` �P,',,= Res onsible Desi iter Si nature.
Phelps, a
Responsible Designer Name: ��;,
Dale p g g
Company: Date Signed:
A&H HEATING&AIR CONDITIONING SERVICE INC 2016-05-27 07:02:17
Address: License:
770 CHESTNUT STREET 304472
City/State/Zip: Phone:
SAN JOSE CA 95110 408-279-0722
Digitally signed by CaICERTS. 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 of the information.
Registration Number:216-A0197135A-000000000-0000 Registration Date/Time: 2016-05-27 07:02:17 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-05-27 07:02:09
Schema Version:0.555SDD
p
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
9
(408)777-3228•FAX(408)777-3333.building(c�cugertino org
Address t4(°e Vit`�!� 4 =
Permit No. -0) -101 6
AQr #of Alarms Smoke Carbon Monoxide
PERMIT CANNOT JBF TINALEL AND COMPLETED UNTIL TRIS CERTiEICA I E
HAS REN Sim .s r
'
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:
E
AREA SMOKE ALARM CO ALARM
pbeddroom(s)
of each separate sleeping area in the immediate vicinity of the X 1
X
y level of a dwelling unit including basements
each Slee m room —� X
X
a
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 CSC 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.
l have read and agree-to comp/ with the terms and conditions of this statement
Owner(or Owner Agent's)Name:
IZ r9 Signature. r_r �41
........ . Date:
6
Contractor Name: ` .........................................................
Sinature.............................. ....................Lia#.................. ............Date:
0
Smoke and COfonn.doc revised 03/18114
i
f
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTIINO 10300 TORRE AVENUE CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333• building(a)cupertino.org 7
Owner Name _�f :� !+ d, Permit No. ftp Y 2016 -20141
Address To K F_F_ AVE—
1. Is your real property a registered historical site?
11 Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
R 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 11.01.1 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.
ISL No Go to Question 3.
3. Is water service permanently disconnected for your building?
11 Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
-ANO 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..
. Please check ONE of the following:
Myproperty 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 plurnbin .fixtures comply with the requirements as indicated in the
table on the followingpage. 'IN
Owner or Owner A ent's Signature: °�:'i`Y..ti��}'r
J 9 f ,, Date: to,
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit.
SB4072015.doc revised 08126115