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B-2016-2049
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2049 10159 S FOOTHILL BLVD CUPERTINO, CA 95014-2601 (342 14 117) OWNER -BUILDER OWNER'S NAME: TANEJA VAIBHAV AND KOMAL DATE ISSUED: 05/31/2016 OWNER'S PHONE: 408-597-7105 PHONE NO: LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic. # Contractor OWNER -BUILDER Date X BLDG —ELECT —PLUMB 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 C Dde and that my license is in full force and effect. JOB DESCRIPTION: REPLACE FURNACE (SAME LOCATION); INSTALL (N) A/C UNIT - I hereby affirm under penalty of perjury one of the following ! IIo declarations: OUTSIEDE OF GARAGE 1. I have and will maintain a certificate of consent to self-ii)sure 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 Insura ce, as provided for by Section 3700 of the Labor Code, for the performance of lie work for which this Sq. Ft Floor Area: Valuation: $7500.00 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 coun y ordinances and state laws relating to building construction, and hereby authorize 42 34214 117 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 FORK IS NOT STARTED may accrue against said City in consequence of the granting �f this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the applicant understands and will comply with a non -point source regulations per the Cupertino Municipal Code, Sectio� 9.18. 180 DAYS FROM LAST CALLED INS i TION. Signature Date 5 3 20 Issued by: ALEX VALLELUNGA Date: 05/31/2016 / OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's Lice ns Law for one of the RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: 1. I, as owner of the property, or my employees with wage 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) /£ I, as owner of the property, am exclusively contracting th licensed Signature of Applicant: Date: 1 2 16 contractors to construct the project (Sec.7044, Business Professions Code). I hereby affirm under penalty of perjury one of the following t ee declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. I have and will maintain a Certificate of Consent to self-'nsure 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 Insura�ce, 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. I will is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the permit ts I certify that in the performance of the work for which this is 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 II subject tthe material. Additionally, should I use equipment or devices which emit hazardous defined by the Bay Area Air Management District I 1 air contaminants as Quality Worker's Compensation laws of California. If, after majcing this certificate of will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensa cns ion provisions of the the Health & Safety Code, Sections 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisi or this permit shall V �/ n be deemed revoked. p Owner or authorized agent: !w 1 1 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is Date: 5 31 2 1 CONSTRUCTION LENDING AGENCY correct. I agree to comply with all city and county ordinances �nd 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 andkeep 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 understands and will comply with all non -point source regulations per the ,pplicant Cupertino Municipal ARCHITECT'S DECLARATIONCode, Section 9.18. 1 understand my plans shall be used as public records. / ( 0 % � `` 4 Licensed Signature Date 5 31 201 professional ................. CONSTRUCTIO I PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • IIIICUPERTINO, CA 95014-3255 GUPERTINO (408) 777-3228 • FAX (40i) 777-3333 • building(cDcupertino.org _ �� fl w �_hli ❑ NEW CONSTRUCTION ❑ ADDITION TERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS 10 / S R .g ° 12 0 OT H I L ( a`L CUP£R't iN APN # // ^q o/ 3`�2- i`-1-11-- OWNERNAME KO M A-L TA tjv _TA PHONE � �$ 5^EJ � 41 pS E-MAIL -,La h e Q— u � hA v V %/+NEJA V &kooAco STREET ADDRESS / D,i S 9 S' POOTH I L L 8L-Vb CITY, STATE, ZIP C() P F2 r//V 010 CA q ! ' O /y FAX CONTACTNAMEVA/6Hhv TAmtJA PHONE/I��g �Q 7 �I7,D�' E-MAII QY►e�a_vAil�hnv a� �0� STREET ADDRESS CITY, STATE, ZIP I T it J Y FAX OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ C4TRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK t1 +h e O 1 LQl _1 u ,I('Yla C Q ck'� �y L oux Co�Yl CU li(o\'✓1QsiL ,i, tj 1 �� iAA_1 S51 l — d EXISTING USE PROPOSED USE CONSTR. TYPE F7777_ USE TYPE I OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL , AREA AREA. AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODF[L AREA PORCH AREA I DECK AREA I TOTAL DECK/PORCH AREA I GARAGE AREA: UDETACH ATTACH BEING ADDED? ❑ NO ADDITION? ❑ NO I r r PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS TH� BLDG AN ❑ YES RECEIVED B ! TOTAL, VALUATION' PLANNINGAPPL# ❑NO PLANNING APPROVAL LETTER ETCH _TER HOME? ❑NOL"oO By my signature below, I certify to each of the following: I am tle property owner or authorized agent it ac(A the opertyowner's behalf. I have read thi application and the information I have provided is correct. I have ead the Description of Work and verify it is acc ate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I auth o rize representatives of Cupertino to enter the above -identified property for inspection purposes. Al Applicant/Agent: mu &"t Date: Signature of SUPPLEMENTAL INFORMATION REQ1 FIRED .'. PLAN,CHEexTYPE RouTiNc sLiP ovElz r1[E couN7C> fi BUILDING PLAN REv1EW _ New SFD or Multifamily dwellings: Apply for demolition permit for[j existing building(s). Demolition permit is required prior tic issuance of building ❑' �LANNTNG permit for new building. EXPRESS � PLANREVIW Commercial Bldgs: Provide a completed Hazardous aterials Disclosure ❑: STANDARD ❑ PUBLIGwORKS _ form if any Hazardous Materials are being used as part of &s project. ❑," LARGE ❑ FIRE J) _ Copy of Planning Approval Letter or Meeting with Pinning prior to ❑F MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. kL BldgApp_2011.doc revised 06121111 CUPERTINO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.org Dear Property Owner(s): An application for a building permit has been s bmitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS ' ,1 97/ 6 qp'[' N01o� /� &_v� APN l l O _ I �1 _ BP# OWNER NAME t<O MAt VAIM AV -NN 1' JA T&^)LTA OWNER ADDRESS °5 s, F©o% y I LL 81-v b C'.UPf.k DESCRIPTION OF WORK: RekLOL69,tA L Old U'rna ee 0-t akL 0 Oyl dj%' one I ,in �h kO tee_ . TWO (A CIS olzf We are providing you with an Owner -Builder 'cknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. Please read and initial each W1. I understand a frequent practice of Builder" building permit that erroneously it personally. I, as an Owner -Builder, may bi an unlicensed person and his or her empli provide coverage for those injuries. I am v insurance coverage for injuries to workers 2. 1 understand building permits are r the copstruction and are not hiring a licen., 3. I understand as an Owner-Buildei protect myself from potential financial risk nameinsteadof my own. KV[4. I understand Contractors are requi numbers on permits and contracts. 5. 1 understand if I employ or otherwi: total value of my construction is at least fi% considered an "employer" under state and kt6. 1 understand if I am considered an federal government, withhold payroll taxeE unemployment compensation for each "en metoserious financial risk. Kl 7. I understand under California Cont residential structures cannot legally build t licensed subcontractors and the number o is performed under contract with a license . I understand as an Owner -Builder L8 any financial or personal injuries sustainer defects in the workmanship or materials. ,N OF INFORMATION below to signify you understand or verify this information.) unlicensed persons is to have the, property owner obtain an "Owner- iplies that the property owner is providing his or her own labor and material held liable and subject to serious financial risk for any injuries sustained by yees while working on my property. My homeowner's insurance may not illfully acting as an Owner -Builder and am aware of the limits of my on my property. required to be signed by property owners unless they are responsible for Contractor to assume this responsibility. I am the responsible party of record on the permit. I understand that I may y hiring a licensed Contractor and having the permit filed in his or her by law to be licensed and bonded in California and to list their license engage any persons, other than California licensed Contractors, and the hundred dollars ($500), including labor and materials, I may be deral law. E)mployer" under state and federal law, I must register with the state and provide workers' compensation disability insurance, and contribute to )loyee. I also understand my failure to abide by these laws may subject actors' State License Law, an Owner -Builder who builds single-family em with the intent to offer them for sale, unless all work is performed by structures does not exceed four within any calendar year, or all of the work general building Contractor. I sell the property for which this permit is issued, I may be held liable for by any subsequent owner(s) that result from any latent construction OwnerBuilderForm 2010.doc revised 04114110 1£ C -kin. 1 understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial AOdents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. 10. 1 am aware of and consent to an wner-Builder building permit applied for in my name, and understand that am the party legally and financially respon' ible for proposed construction activity at the site address listed above. 111. 1 agree that, as the party legally E bkfplicable laws and requirements & 12. I agree to notify the issuer of this information I have provided on this form. I you contract with someone who does not assist you with any financial loss you may Contractors may be in civil court. It is also employee of that individual or firm is injure you obtain a permit as Owner -Builder and those Contractors are properly licensed a (DIRECTIONS: Please complete the I hereby affirm that there is a construction (Sec 3097 Civ.) Lender Name: d financially responsible for this proposed construction activity, I will abide t govern Owner -Builders as well as employers. form immediately of any additions, deletions, or changes to any of the icensed contractors are regulated by laws designed to protect the public. If lave a license, the Contractors' State License Board may be unable to sustain as a result of a complaint. Your only remedy against unlicensed important for you to understand that if an unlicensed Contractor or d while working on your property, you may be held liable for damages. If wish to hire Contractors, you will be responsible for verifying whether or not d the status of their workers' compensation insurance coverage. construction lending agency information.) ng agency for the performance of the work for which this permit is issued Lender Address: I� Before a building permit can be issued, thiform must be completed and signed by the property owner and returned to the agency responsible for lSSL Ing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptale to the city may be required to be presented when the permit is issued to verifv the oroDerty owner's siglnature. �� Property Owner's Signature: 7 _O NA-U Iq!L, 'k Date: D5 f 311"tt NOTE: The followingAuthorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder). Excluding the Notice to Property Owner, the e authorize the following person(s) to act as my Owner -Builder Permit for my project. Scope of Construction Project (or Description Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: i of which I understand is my personal responsibility, I hereby ) to apply for, sign, and file the documents necessary to obtain an Work): Tel No I declare under penalty of perjury that I am the; property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwnerBuilderForm 2010.doe revised 04114110 5/31/2016 Maps http://anduse.cuperfino.org/xajaxGridfindex.php?section=maps11 1/1 WOKE I CARBON MONOXIDE ALARMS ` R CERTIFICATE OF COMPLIANCE INCE COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION CUPIERTINQ 10300 TOR -RE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 m FAX (408) 777-3333 - buildina(a)cuoertino.org A00THILL &-Vl) CyP 7rnqd ,c> iist ioke 4 Caxlxou M PEitWT CANNOT BE FINALED AND CflMPLF TED UNTIL THIS CERTIFICATE PURPOSE This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide compliance with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior inspections are required. GENERAL INFORMATION Existing single-family and multi -family dwellings shall be provided with Smoke Alarms and C Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling $1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms Monoxide Alarms be installed in the following locations: AREA Outside of each separate sleeping area in the immediate vicinity of the On every level of a dwelling unit including basements Within each sleeping room SMOKE ALARM X X X CO 0is -20yq (arms for ,cess for exceeds Carbon FLARM X _X_' '_�. Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliaric es and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall cornly 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, basemei it or crawl space. Refer to CRC Section R-314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is re ,aired for alarins w1lich must be connected to the building wiring. As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has ave been installed in accordance with the rnanufacturerrs instructions and in compliance with the California u ldi - and Californua Residential Codes. The alarms have been tested and are operational, as of the date signed below. t hava- re -a a'nd aorpe fa rmmnfv with tha t'errn ' arrd rrnnrli}inin,c of fhro cP�fc _f ` 3 rAgpgtp- Nam 0 or-1 AL �! CSihor hian'e i naftl�e:. ... ... ......... Sa csat�re,. Li .................................... .._..�.� ............................... ...... ate: ..............._ is Smoke aiid COfoi tdbc •evised 03Y1'8%I'4i WATER -CONSERVING PLUMBING FIXTURES ' OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION CUPERTINO 10300 TORREAVENUE • CU'PERTINO, CA 95014-3255 �408) 777-3228 - FAX (408) 777=3333 m'buildintAJ&JA V a�cupertino.oro Owner Name ,? 0 iJ"A 7a N&T, � Yermit No. 0� w 6 — 0, Address { ? (C,161 �a � �tf e� L . / v }� OU P6&lrly"D C4 1. 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 nn. 9-Ro 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 plumbing, installation of water=conserving plumbing fixtures is not technically feasible? 11 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. J1,2`15o Go to Question 3. 3. Is water service permanently disconnected for your building? El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of Clio 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 es 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 bottom of form.. 5. Please check ONE of the following: P-MY property Y is a single-family residential real property. Y•See Civil Code Section 1101.4. On and after January 1 2014, building alterations or improvements shall require all non -compliant plumbing to be replaced with water -conserving plumbing fixtures throughout the building.. On or before January 1, 2017, compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless of property undergoes alterations or improvements). My property is a multifamily residential real property. See Civil Code Section 11013. 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). El 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- copse; plumbing fixtures throughout the building (regardless of whether property undergoes alterations or iinproveinei non- 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 age Owner or Owner Agent's Signatu`r ,_1 .f Date: p' 6 / / 2 / 6 Upon completing and signing this Certificate, please ret* it to the Building Division in order to final your building `permit. SE407 2015:doc t vised 08126115 BUILDLNG PER,181IT CANNOT BE FINAl , D AND COMEPLETED UNTIL T S CERTIFICATE HAS BEEN , :NW :A-N pia 1[ = lM EM TO THE BUILDING IN71SIO3 Non -Compliant Water -Conserving Plumbing Fixture Plumbing Fixture1 (Fixture Complying with Current Code Applicable to New Constr tion) Fixture Type Maximum Water Usage/Flow Rate 2013 CPC Ch. 4 2013 CPC Ch. 4 2013 CP Ch. 4 Water Usage /Flow Rate 2013 CALGreen Div. 4.3 2013 CALGreen Div. 4.3 2013 CALGr n Div. 5.3 Single -Family Multi -Family Commercial Residential Residential Water Closets Exceed 1.6 Single flush toilets: 1.28 gallons/flush (Toilets) Gallons/flush Dual flush toilets: 1.28 gallons/flush effective flush volume (the coinposite, average flush volume of two reduced flushes and one full flu h Urinals Exceed 1,0 Gallons/flush 0.5 gallons/flush Showerheads Exceed 2.5 2.0 gallons per minute @ 80 psi. Also certified to the performance crite ia'of gallons per minute U.S. EPA WaterSense Specification for Showerheads (A hand-held shower is considered a showerhead.) For multiple showerheads serving one shower, the combined flow rate of all showerheads and/or other shower outlets controlled by a single valve sliall not exceed 2.0 gallons per minute @ 80 psi, or the shower shall be designed to allow only one shower outlet to be in operation at a time. Faucets — Exceed 2.2 gallons Maximum 1.5 gallons per Within units: 0.5 gallons per rrinute @ 60 Lavatory per minute minute @ 60 psi; minimum Maximum 1.5 gallons psi Faucets 0.8 gallons per minute @ per minute @ 60 psi; 20 psi minimum 0.8 gallons per minute @ 20 psi In common and public use areas: 0.5 gallons per minute @ 60 psi 1.8 gallons per minute 60 psi Faucets— Exceed 2.2 gallons 1.8 gallons per minute @ 1.8 gallons.per minute 1.8 gallons per rr inute @ 60 Kitchen per minute 60 psi @ 60 psi psi Faucets May temporarily increase May temporarily up to 2.2 gallons per increase up to 2.2 minute @ 60 psi, and must gallons per minute @ default to maximum 60 psi, and must 1.8 gallons per minute @ default to maximum 60 psi 1.8 gallons per minute Where faucets meeting @ 60 psi the above are unavailable, Where faucets meeting aerators or other means the above are may be used to achieve unavailable, aerators or reduction. other means may be used to achieve reduction. 1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the tigure shown, it is not requires to oe aaea. SB407 2015. doc ievised 08126115 0LIG CERTIFICATE OF COMPLIANCE MR-ALT 02•E Alterations to Space Conditioning Systems (formerly CFIR-ALT HVAC) (Page 1 of 3 Project Name: Global Taneja I Date Prepared: 2016-06.13 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 Global Taneja n 02 Date Prepared 2016-06-13 03 'Project Location 10159 S. Foothill Blvd <, ;- 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name Taneja Residence 01 Zip Code 95014 08 Dwelling Unit Conditioned 2100 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 01 02 03 04 06 — 07—- --08 _ , 09 - ---10- _ Is the SC Installing a SC System SC System CIA served system a refrigerant Installing new SC installing Installing Installing Identification or Location or Area by this SC ducted containing system more than 40 entirely new entirely new Name Served System (ft2) system? component? components? feet of ducts? duct system? SC system? Alteration Type System 1 whole house 2100 Yes Yes Yes Yes .; No No Altered space conditioning system I - t CERTIFICATE OF COMPLIANCE MR-ALT 02-E Alterations to Space Conditioning Systems (formerly CF-iR-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 Repla ced New Duct or Name Type Components Type Value System Type Components Type Value Type Duct U ngth R-Value System 1 Central' as g furnace All new heating. AFUE .80 Central split All new cooling. SEER 14 Setback Create than R-6 wmponents AC components 40f at ReauiredDocumentation•- 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 orcooling components are installed in ducted systems, or when more than 40 ft of duct length. is replaced. -Leakage rate compliance: 515%, or!-10% leakage. to outside, or seal all accessible leaks. CF211-MCH-25 H & CF3R-MCH-25-H Refrigerant Charge Verification required when refrigerant containing components are installedor altered (applicable in CZ 2, 8-15). CF2RCF3R-MCH-23 & CF3R-MCH-23 Air Flow 2 300 CFM/ton. required when MCH-25 is required. Exceptions: -Duct systems registered with HERS provider as previously sealed are exempt from MCH-20 Duct Leakage Testing requirements. -Heating-only systems and Air Handler/furnace changes do not require verification of Air Flow MCH-23, or Refrigerant Charge MECH-25. -Existing duct systems constructed, insulated orsealed with asbestos are exempt from MCH-20 Duct Leakage Testing requirements. E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections iS0.2(b)1Diia and 150.2(b)1E, f) This section does not apply to this project. F. Entirely New or Complete Replacement Space Conditioning System (Section 150.21(b)1C) - --- This section does not apply to this project. Registration Number: 316-A3026867A-000000000-0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Date/Time: 2016-06-13 05:44:27 Report Version: 2013 Rev 1.007 Schema Version:O.SSSSDD �016-06-12l ER5 Provider: USERA Report Generated:05:44:36 CERTIFICATE OF COMPLIANCE CF1R-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: _ Joe Novelo Date: Company: .'Signature California Air Duct Testers 2016-06-13 Address: CEA/HERS Certification. Identification. (if applicable): 1630 Oakland Rd,Suite A205-3 410231432 City/State/Zip: 'Phone: .. San Jose CA 95131 408-824-0740 Responsible Person's Declaration statement i certify the following unifier penalty of perjury, underthe 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 Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (respon ible. designer). 3. That theenergy features and performance specifications; materials, components, and manufactured devices for the building design or system design Identified on this Certificate ofCornpliance conform to the requirementsofTitle 24, Part land Part 6.of the California Code of Regulations. - 4. The building design features or system design features identified on thisCertificate of Compliance are consistent with the information providedon other applicable compliance documents, worksheets, calculations, -plans and specificationssubmitted to the enforcement agency for -approval With this building permit 6PPI165tidn— - 5.. 1 will ensure that registered copy of this Certificate of Compliance shall be made available with the buildingpermit(s) issued for the building, and made available to the enforcement' gency for all applicable inspections. I understand that a registeredcopy of this Certificate. of Compliance is required to be included with the documentation the builder provides to the building owner at occur ancy. Responsible Designer Name: -. _ Responsible Designer Signature: nyy y.' Ram Giovanni Piazza r Company:. `. Date Signed: __.... Global. Heating And Cooling Services - -.. 2016-06-13 - Address: .:License: .. .. - 3153 Mount Oso Dr _ _ __. c-20#1014692 City/State/Zip: Phoney San Jose CA 95148 408-896-3744 This digital signature is,pxDtiaidod in order to sectim. tho content of tfiifs registercif documon , and in no - -- gray implies Registration Provider responsibility for _ -- the accuracy of theinfarmaifon." Registration Number: 316-A1026867A-000000000-0000 Registration Date/Time: 2016-06.13 05:44:27 CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Schema Version: 0.555SDD Provider: USERA 06-13 05:44:36 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 1 of 7 j Project Name: Global Taneja Enforcement Agency: Cupertino Building Department Permit Number: b-2016-2049 Dwelling Address: 10159 S. Foothill Blvd City: Cupertino Zip Code: 950 44 A. General information 01 Dwelling Unit Name Global Taneja 02 Climate Zone 4 03 Dwelling Unit Total Conditioned Floor 2100 Number of Space Conditioning 1 Area (ft2) Systems in this Dwelling Unit. 05 Certificate of Compliance Type Prescriptive alterations (CFIR-ALT) 06 Method used to Calculate HVAC Loads NotApplicableEci ApmentChangeout 07 Calculated Dwelling Unit Sensible 0 08 Calculated Dwelling Unit Heating Load 0 Cooling Load (Btuh) (Stuh) 09 Dwelling Unit Number of Bedrooms 4 MCH-01b Prescriptive Alterations --Space Conditioning Systems Ducts and Fans B. Space Conditioning (SC) System Information 01 02 03 04 . 05 06 07 08 09 10 SC System SC System CFA served is the SC system a - Installing a refrigerant Installing new SG Installing;more installing Installing identification or Location or Area by this SC system than 40 feet of entirely new entirely new SC Alteration Type Name Served System ft2 Y ( ) ducted containing components? ducts? duct system? system? system? component? Altered space - System 1 whole house 2100 Yes Yes Yes Yes No No conditioning System Registration Number: 316-A3026867A-M0119420A-0000 Registration Date/Time: 2016-06-16 22:44:52 (HERS Provider: USERA CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-06-16 22:45:32 Schema Version: 2013.1.007 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 2 of 7 ) C. Space Conditioning (SC) System Alterations Compliance Information I 01 02 03 04 05 06 07 08 09 10 11 12 13 Central Fan i Integrated Heating Cooling New or (CFQ System Altered Heating Minimum Altered Cooling Minimum Required Replaced New Ventilation Identification Heating Heating Efficiency Efficiency Cooling Cooling Efficiency Efficiency Thermostat Duct Duct System or Name System Type Component Type Value System Type Components Type Value Type Length Value Status All new All new System 1 Central gas heating AFUE 780 Central cooling SEER 14:000 Setback GT40Ft R6 Not a CH furnace componen split AC components system is D. Installed Heating Equipment information 01 02 03 04 05 06 07 System Identification or Name Heating Efficiency Type Heating Efficiency Value Heating Unit Manufacturer Heating Unit Model Number Heating Unit serial number Ratei I Heating Capacity, Output (STUN) System 1 AFUE .780 Lennox sl280df040v48-b- 5916d11442 69000 Notes: Registration Number: 316-AS026867A-M0119420A-0000 Registration Date/Time: 2016-06-16 22:44:52 Provider: USERA CA Building Energy Efficiency Standards- 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-06-16 22:45:32 Schema Version: 2013.1.007 CERTIFICATE OF INSTALLATION CF2R-NIGH=01-E Space Conditioning Systems, Ducts, and Fans (Page 3 of 7 ) E. Installed Coaling Equipment information 01 02 03 04 05 06 07 08 Condenser or Package Unit Condenser or Condenser or Condenser or System Rated Cooling Condenser Rated System Identification Cooling Efficiency Cooling Efficiency Package Unit Package Unit Package Unit Capacity at Design Nominal Capacity or Name Type Value Manufacturer Model Number Serial Number Conditions (BTUH) (ton) System 1 SEER 14.000 Lennox, xc16-048-230- 5816b16565 48000 4.0 04 Notes: - F. Extension of Existing Duct System, Greater Than 40 Feet This section does not apply to this project. G. installed Duct System information This section does not apply to this project. ` H. Installed Air Filter Device Information This section does not apply to this project. ' 1. Air Filter Device Requirements This section does not apply to this project. Registration Number: 316-A1026867A-M0119420A-0000 Registration Date/Time: 2016-06-16 22:44:52 HERS Provider: USERA CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated 2016-06-16 22:45:32 Schema Version: 2013.1.007 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (page 4 of 7 ) J. HERS Verification Requirements 01 02 03 04 05 06 07 08 09 10 MCH2O MCH21 MCH22 MCH23 MCH25 MCH28 Exemption from Minimum Exemption R-Value for AMU System SC System From Duct Duct Ducts In Ducts located AMU Fan Airflow Identification or Location or Area Leakage Leakage Conditioned In Cond Space Efficacy Rate Refrigerant Return Duct Design Name Served Requirements Test Space Verification (W/efm) (afm/ton) Charge Table 150.0-C or D Altered duct system has System-l__., whole house less than 40 ft No No No No No No No of duct in :Exemption unconditioned spaces Notes: Registration Number:316-A1026867A-M0119420A-0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Date/Time: 2016-06-16 22:44:52 Report Version:, 2013 Rev 1.007 Report Schema Version: 2013.1.007 Provider: USERA , 22:45:32 CERTIFICATE OF INSTALLATION I CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans I (Page 5 of 7 ) I K. Space Conditioning Systems, Ducts and Fans Mandatory Requirements and Additional Measures Note: Additionalmandatory requirements from Section150.0 that are not listed here maybeapplicable to some systems. .These requirements maybe applicable to only newly installed equipmer t or portions of the. system that are altered.. Existing equipment may be exempt from these requirements. Heating Equipment 01 Equipment Efficiency: All heating equipment must meet the minimum efficiency requirements of Section 110.1 and Section 110.2(a) and the Appliance Efficiency Regulations. 02 Controls: All unitary heating systems, including heat pumps, must be controlled by a setback thermostat.. These thermostats must be capable of allo ing the occupant to program the temperature set points for at least four different periods in 24 hours. See Sections 150.0(i),110.2(b). 03 Sizing: Heating load calculations must be done on portions of the building served by new heating systems to prevent inadvertent undersizing or oversizing. See sections 150.0(h)1 and 2). 04 Furnace Temperature Rise: Central forced -air heating furnace installations must be configured to operate at or below the furnace manufacturer's maximum inlet -to -outlet temperature rise specification. See Section 150.0(h)4. 05 Standby Losses and Pilot Lights: Fan -type central furnaces may not have a continuously burning pilot light. Section 110.5 and Section 1102(d). Cooling Equipment 06 Equipment Efficiency: All cooling equipment must meet the minimum efficiency requirements of Section 110.1 and Section 110.2(a) and the Appliance Efficiency Regulations. 07 Refrigerant Line Insulation: All refrigerant line insulation in split system air conditioners and heat pumps must meet the R-value and protection requirements of Section 150.0(j)2 and 3, and Section 150.0(m)9. 08 Condensing Unit Location: Condensing units shall not be placed within five (5) feet of a dryer vent -outlet; See Section 150.0(h)3A. 09 Sizing: Cooling load calculations must be done on portions of the building served by new cooling systems to prevent inadvertent undersizing or overszing. See Section 150.0(h)1 and 2. Air Distribution System Ducts, Plenums and Fans SD Insulation: in all cases, unless ducts are enclosed entirely in directly conditioned space, the minimum duct insulation value is R-6. Note that higher va ues may be required by the prescriptive or performance requirements. See Section 150.0(m)1. Registration Number: 316-A1026867A-M0119420A-0000 Registration Date/Time: 2016-06-16 22:44:52 } ERS Provider: USERA CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 016-06-16 22:45:32 Schema Version: 2013.1.007 CERTIFICATE OF INSTALLATION GF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 6 of 7 ) K. Space Conditioning Systems, Ducts and Fans Mandatory Requirements and Additional Measures t Note: Additional mandatory requirements from Section 150.0thatare not listed here maybe applicable to -some systems.. These requirements maybe applicable to only newly installed equipmer system thatarealtered. Existing. equipment .may be exemptfrom these requirements. t or portions of the 11 Connections and Closures: All installed air -distribution system ducts and plenums must be, sealed and insulated to meet the requirements of CIVIC Sections 602.0, 603.0, 604.0, 605.0 and ANSI/SMACNA-006-2006s Supply -air and return -air ducts and plenums must be insulated to a minimum installed level enclosed. entirely in directly conditioned space as confirmed through field verification and diagnostic testing in accordance with the requirements of Residential Appendix RA3.1.4.3.8. 601.0, of R-6.0 or eference Heat Pump Thermostat 12 A thermostat shall be installed that meets the requirements of Section 110.2(b) and Section 110.2(c). 13 The thermostat shall be installed in accordance with the manufacturers published installation specifications 14 First stage of heating shall be assigned to heat pump heating. IS Second stage backup heating shall beset to come on only when the indoor set temperature cannot be met. The responsible person signature on this compliance document affirms that all applicable requirements in this table have been met. Registration Number:316-A1026867A-M0119420A-0000 Registration Date/Time: 2016-06-16 22:44:52. Provider: USERA CA Building Energy Efficiency Standards- 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-06-16 22:45:32 Schema Version: 2013.1.007 I CERTIFICATE OF INSTALLATION I CF2R-MCH-01-E I Space Conditioning Systems, Ducts, and Fans I (Page 7 of 7) ,I Documentation Author's Declaration Statement 1. l certify that this Certificate of Installation documentation is accurate and complete. Documentation Author Name; - - Documentation Author Signature: Joe Novelo Signature Date: Company: - California Air Duct Testers 2016-06-16` Address: - - CW HERS Certification Identification (if applicable): 1630 Oakland Rd; Suite A205-3 - 410231432 City/State/Zip:. - _. -... Phone: San Jose CA 95131 408-824-0740 Responsible Person's Declaration statement I certify the following under penalty of perjury, underthe laws of the State of California: 1. The. information provided on this Certificate of Installation is true and correct. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction; or installation of feature , materials, components, or manufactured devices: for the scope of work identified on this Certificate of Installation, and attest to the declarations in this statement (responsible builder/installer), therwise I am an. authorized representative of the responsible builder/installer. _ 3. The constructed or installed features, materials, components or manufactured devices (the installation) identified on this Certificate of Installation conforms to all applicable codes anc regulations, and the installation conforms to the requirements given on the plans and specifications approved by the enforcement agency. 4.. 1 reviewed a copy ofthe Certificate of Compliance approved by the enforcement agency that Identifies the specific requirements for the scope of construction or installation identified on this Certificate of Installation, and I have ensured that the requirements that applyto the construction:or installation have been met. S. I will ensure that a registered copy of this Certificate of Installation shall be posted, or made available with the building permit(s) issued for the building, and made available to the enf )rcement agency for all applicable inspections. I. understand that aregistered copy of this Certificate of Installation is required to be included with the documentation the builder provides to the building own r at occupancy. Responsible Builder/InstallerName: - "'. Responsible Builder/installer Signature:- - Giovanni Piazza - CompanyNamei(InstallingSubcontractor or General tontmctororBuilder/Owner) - - Position With Company (Title): loom Piam Global Heating And Cooling Services Address: - ._�:::. - ; . __ ! CSLB License:. _.- 3153 Mount Oso Dr c-20# 1014692 City/State/Zip: - - Phones.- - Date Signed: -- SanJose CA 95148 408-896-3744 2016-06-16 i } .,s digital signature is prividoil in orac-r to secure the content of this registered document, andih no way Implies Registration Frutdderresoonsib,'Ptyfor tho accuracy oltho iniomiation.' Registration Number: 316-A1026867A-M0119420A-0000 Registration Date/Timer 2016-06-16 22:44:52 iERS Provider: USERA CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 016-06-16 22:45:32 Schema Version: 2013.1.007