B-2016-2106 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2106
1132 HUNTERSTON PL CUPERTINO,CA 95014-5069(362 22 027) ATKINSON
CLIMATROLLERS INC
SAN JOSE,CA 95112
OWNER'S NAME: ZALUSKY ROBERT AND MICHELINA TRUSTEE DATE ISSUED:06/10/2016
OWNER'S PHONE:408-255-3642 PHONE NO:(408)294-6290
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRACTOR LIC.#258540
Contractor ATKINSON CLIMATROLLERS INC Date 12/31/2016 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 Code and that my
license is in full force and effect. JOB DESCRIPTION:
REPLACE A/C-SAME LOCATION
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.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$5893.00
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 62 Number: Occupancy Type:
3
and state laws relating to building construction,and hereby authorize 362 22 027
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-paint
source reg Mtier a Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 6/10/2016 Issued by:Abby Avende
Date:06/10/2016
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RF.-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. 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)
2. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:6/10/2016
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
2. I have and will maintain Worker's Compensation Insurance,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
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. 1 certify that in the performance of the work for which this 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 become subject to the material. Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quatity Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupe tiro unicipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code, tions 5505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:6/10/2016
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,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Code,Section 9.18.
Licensed
Signature Date 6/10/2016 Professional
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 M '
C4DPERTdNO (408)777-3228• FAX(408)777-3333• build ingCcDcupertino.org
❑
PLUMBING ❑MECHANICAL [—]ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS �a® ��f APN#
OWNER NAME ts 1 PHONE l/�� ' [� E-MAIL
STREET ADDRESS CITY, STATE,ZIP J ( C FrA
CONTACT NAME PHONE E-MAIL Q
STREET ADDRESS -� � GZFAXLtD X ,� ,�,
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ''CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME ^ (� LICENSE NUMBER Zqg�LC D LICENSE TYPE epi BUS.LIC# r
COMPANY NAME �l 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
USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT 1N WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK771
TOTAL VALUATION: it ((f-0 RECEIVED BY x c �¢
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property ow er's beh f. I have read this
application and the information I ha v p ovid'd is correct. I have read the Description of Work and verify it is accurate. Ia ree to comply with all applicable local
ordinances and state laws relating to 'ldin construction. I authorize representatives of Cupertino to enter the abov=ide i/filed property for inspection purposes.
Signature of Applicant/Agent: Date: Cb `v
SUPPLEMENTAL INFORMATION REQUIRED
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p7 STAhIbARD
r
MEPMiscApp_2011.doc revised 06/21/11
COMMUNITY
DEVELOPM T DEPARTMENT
BUILDING DIVISION-CUPERTINO
APPR� ED
This set of plans and specificati ns MUST be kept at the
job site during construction. 1 is unlawful to make any
changes or alterations on ame,or to deviate
tl�ersfrom,without approval fro Ahe-a; l;�'ai lcla
The stamping of this plan and specifications SHALL NOZ-0..�j P LANS CH CKED e ',
be held to permit or to be an approval of the violatio ��—
o,any provisions of any City Ordinance or State Law. DATE
BY 0 _ zvw� PLANNING DEPT
DATE ,, 9 CUPERTINO
PERMIT NO.
CEC®P
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems(formerly CF-1R-ALT-HVAC) (Page 1 of 3)
Project Name: 2015-0800 Robert Zalusky Date Prepared: 2016-06-01
A. General Information
CF1R-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 2015-0800 Robert Zalusky 02 Date Prepared 2016-06-01
03 Project Location 1132 Hunterston PI 04 Building Type Single family
05 CA City Cupertino 06 Dwelling Unit Name 2015-0800 Robert Zalusky
07 Zip Code 95014 08 Dwelling Unit Conditioned 1966
Floor Area(ft2)
Number of space conditioning
09 Climate Zone 4
A", 10 (SC)systems in this dwelling 1
unit.
B.Space Conditioning(SC)System Information x
01 02 m 03 04 ty05 f 06 07 08 09 10
Is the SC Installing a p
SC System SC System CFA served �$ystem aF refrigerantInstalhng:.new SC Irjistalhng Installing- installing
i s w � :.
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
AC Replacement Whole House 1966 Yes Yes Yes No No No Altered space
conditioning system
C. Extension of Existing Duct System,Greater Than 40 Feet(Section150.2(b)1Diib)
This section does not apply to this project.
�0LF"
Registration Number:216-A0202561A-000000000-0000 Registration Date/Time: 2016-06-01 15:50:23 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-06-01 15:49:47
Schema Version:0.5555DD
CERTIFICATE OF COMPLIANCE CF1R-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 Duct Length R-Value
No heating This field or This field or All new This field or This field or
AC
AC Replacement Central gas component section is not section is not Central split cooling SEER 14 Setback -section is not section is not
furnace altered applicable applicable components applicable applicable
Required Documentation:
CF213-MCH-01-E-Space Conditioning Systems Ducts and Faris:
-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:5 15%,or 510%leakage to outside,''o�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&CF3R-MCH-23 Air Flow,2 300 CFM/,ton r4 red when>MCH-25 is required
Exceptions:
Duct systems registered with HERS provider as prev(ously sealed are exemp4 from CH-20 Duct leakage Testing requrre rrepts ,
pir , '. -^. " a *- �.`"+
-Heating-only systems and Air Handler/Furnace changes do not require Venficat�q. of�A r Flow MCH 23 flrRefrigetant Charge MEGH Z5
Existing duct systems constructed,insulated or sealed with•as,hestosare exempt from MCi=Z�O)fJuctLekage Testg requiremetxt5. � ,
'Pk
E. Entirely_New_or-Complete.Replacement-Ducfi S, stem with or without E ui ment Changeout Se tion •150 2 b� 1Dua and-.-1-5O-2(b)1E-,F)--
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-A0202561A-000000000-0000 Registration Date/Time: 2016-06-01 15:50:23 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-06-01 15:49:47
Schema Version:0.555SDD
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems(formerly CF-1R-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: CY'UGG(i�
Faulkner,Cindy
Company: Signature Date:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING&ELECTRICAL 2016-06-01 15:50:22
Address: CEA/HERS Certification Identification(if applicable):
1171 NORTH 4TH STREET
City/State/Zip: Phone:
SAN JOSE CA 95112 408-294-6290
Responsible Person's Declaration statement-
I certify the following under penalty of perjury,under the lawsof,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 Busl ess'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 forthe building design or system design identified on this Certificate of Compliance conform to the
requirements of Title 24,Part 1 and Fa ,of the Cahforma Code of Regulations. " _ �1;
4. The building design features or system design features identified on Phis Certificate of Compliance are�ansistent witf he ih rmatabp.provided on"othpcapp])cab eCompliance documents,worksheets,
'w x � r
calculations,plans and specifications submittetl to the enforcement agency forapproval�aith this bwidfng permit appLcatiq. _ '
. ": ,: Yds` -s a
5. I will ensure that a registered copy of this Certificat pf Ct�ttipliance sh )I be,m24#e a all l le Wit--o buiming, rmrt(S}issued fori;he b6ild�ng and<made av�t2bI tot ''knforcement agency for all applicable
inspections.I understand that a registered copy of this CErtlficate of Compliance is-required to be.included with the documentation the.b5ilder provides to,Ye
-binding-owner-at occupancy.— ------- --
Responsible Designer Name: w� Responsible Designer Signature
Faulkner,Cindy
Company: Date Signed:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING&ELECTRICAL 2016-06-01 15:50:23
Address: License:
1171 NORTH 4TH STREET 258540
City/State/Zip: Phone:
SAN JOSE CA 95112 408-294-6290
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-A0202561A-000000000-0000 Registration Date/Time: 2016-06-01 15:50:23 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-06-01 15:49:47
Schema Version:0.555SDD
FIL
SMOKE / CARBON MONOXIDE E
E ALARMS �- , 710,i.
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPE TINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333• buildingCakupertino orq
Permit No.
Address 11 2X 140T-6-0 SG Gt� YI u6 #of Alarms Smoke: Carbon Monoxide:
P44
ERMIT CAINOT, E FIYALED AND COMPLETFD7NTII THIS CERTLFCATE
I N ,r �A D aI2E P iv z S�LDiN
s5 \ � �
.amu mn
�S BEE
PURPOSE
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
inspections are required.
GENERAL INFORMATION
Existing single-family and multi-family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions,alterations,or repairs to existing dwelling units exceeds
$1000.00,CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon
Monoxide Alarms be installed in the following locations:
AREA SMOKE ALARM CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the 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 and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply:In dwelling units with no commercial power supply, alarm(s)may be solely battery operated.
In existing dwelling units,alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic,basement or crawl
space.Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2.An electrical permit is required for
alarms which must be connected to the building wiring.
As owner of the above-referenced property,I hereby certify that the alarm(s)referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms have been tested and are operational, as of the date signed
below.
have read and agree to comply wittj4e terms and conlitions his statement
Owner(or Owner Agent's)Name: f JjlJ
Signature........ .......Date:-74 /.2rs i6
Contractor Name:
Sinature...................................................................Lic.#......................................Date ...................
Smoke and CO form.doc revised 03/18/14
I
WATER—CONSERVING PLUMBING FIXTURES G'
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTllNO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255.
(408)777-3228•FAX(408)777-3333• buildingCcDcupertino.ora
Owner Name Ro @c.0 Tr ?ALu k_� I Permit No. Q
Address 11'32 o/4 rc—t, STS
1. Is your real property a registered historical site?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of forin.
# No Go to Question 2.
2. Does your real property have a licensed plumber certifying that,due to the age or configuration of the property or its
plumbing,installation of water-conserving plumbing fixtures is not technically feasible?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
❑ 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?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
N 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.
A Yes My real property is built and available for use or occupancy on or before January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign
bottom of form..
5. Please check ONE of the following:
A My property is a single-family residential real property. See Civil Code Section 1101.4.
On and after January 1, 2014,building alterations or improvements shall require all non-compliant plumbing fixtures
to be replaced with water-conserving plumbing fixtures throughout the building.On or before January 1,2017,all non-
compliant plumbing fixtures shall be replaced with water-conserving plumbing fixtures (regardless of whether
property undergoes alterations or improvements).
❑ My property is a multifamily residential real property. See Civil Code Section 1101.5.
On and after January 1,2014,specified building alterations or improvements shall require non-compliant
plumbing fixtures to be replaced with water-conserving plumbing fixtures. '
On or before January 1,2019,all non-compliant plumbing fixtures shall be replaced with water-
conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or
improvements).
❑ My property is a commercial real property. See Civil Code Section 1101.5,
On and after January 1,2014,specified building alterations or improvements shall require non-compliant
plumbing fixtures to be replaced with water-conserving plumbing fixtures.
On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving
plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvements).
I,as the owner or owner's agent of this property,certify under penalty of perjury that non-compliant plumbing fixtures will be
replaced prior to date specified above with water-conserving plumbing fixtures in accordance with Civil Code Sections 1101.1
through 110 1.8,the current California Plumbing Code and California Green Building Standards Code,and manufacturer's
installation requirements,and that the water-con ' g plumbing fixtures comply with the requirements as indicated in the
table on the following age. 1_2
Owner or Owner Agent's Signature: Date: -7 3(
4 Z4
Upon completing and signing this Certificate,please return it the Building Division in order to final your building permit.
SB40 7 2015.doc revised 08/26/15
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0
Non-Compliant Water-Conserving Plumbing Fixture
Plumbing Fixture 1 (Fixture Complying with Current Code Applicable to New Construction)
Maximum Water Usage/Flow Rate
Fixture Type 2013 CPC Ch. 4 2013 CPC Ch.4 2013 CPC Ch.4
Water Usage 2013 CALGreen Div.4.3 2013 CALGreen Div. 4.3 2013 CALGreen Div. 5.3
/Flow Rate 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 composite,
average flush volume of two reduced flushes and one full flush
Urinals Exceed 1.0 0.5 gallons/flush
Gallons/flush
Showerheads Exceed 2.5 2.0 gallons per minute @ 80 psi. Also certified to the performance criteria 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 shall 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 minute @ 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 minute @ 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 figure shown,it is not required to be upgraded.
SB4072015.doe revised 08/26/15