B-2016-2220 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2220
22211 QUINTERNO CT CUPERTINO,CA 95014-2749(357 09 07T R&B HEATING&AIR
CONDITIONING
NEW ALMADEN,CA
95042
OWNER'S NAME: CAMPBELL JEFFREY BAND NONOYAMAYUMI C DATE ISSUED:06/27/2016
OWNER'S PHONE:925-699-1562 PHONE NO:(408)977-1401
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class WARM-AIR HEATING VENTILATING AND AIR-CONDITIONING
Lic.#789287 X BLDG —ELECT -PLUMB
Contractor R&B HEATING&AIR CONDITIONING Date 2 28 X MECH X RESIDENTIAL_COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter) (commencing
with Section 7000)of Division 3 of the Business&Professions Cod,and that my JOB DESCRIPTION:
license is in full force and effect. REPLACE EXISTING A/C AND FURNACE
I hereby affirm under penalty of perjury one of the following two declarations:
m. I have and will maintain a certificate of consent to self-insu;e for Worker's
Compensation,as provided for by Section 3700 of the Labo�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 Sq.Ft Floor Area: Valuation:$15000.00
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 357 09 072
and state laws relating to building construction,and hereby authorize
representatives of this city to enter upon the above mentioned pr perty for
inspection purposes. (We)agree to save indemnify and keep ha�mless 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 Cuperti o Municipal Code,Section 9. 8.
Issued by:Abby Ayende
Signature Date 6 27 2 Date:06/27/2016
OWNER-BUILDER 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: I installed without first obtaining an inspection,I agree to remove all new materials for
m. I,as owner of the property,or my employees with wages as LIeir sole inspection.
compensation,will do the work,and the structure is not intehded or offered for
sale(Sec.7044,Business&Professions Code) Signature of Applicant:
2. I,as owner of the property,am exclusively contracting with icensed Date:6/271201
contractors to construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three eclarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
m. I have and will maintain a Certificate of Consent to self-ins a 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 ork 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 p=it 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,S s25505 5533,a 534.
exemption,I become subject to the Worker's Compensation provisions of the
Labor Code,I must forthwith comply with such provisions o�this permit shall Owner or authorized agent:
be deemed revoked. Date:6/2712016
APPLICANT CERTIFICATION ICONSTRUITION LENDING A Y
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 Istate 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 again I t liabilities, Lender's Address
judgments,costs,and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally,the appll6ant 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 6/27/2016
GENERAL PERMIT APPLICATION
MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE• UPERTINO, CA 95014-3255 MISC
CUPERTINO (408)777-3228• FAX(4081 777-3333•building(alcupertino.orp
I�?,oI(P- 2220
❑PLUMBING MECHANI AL ELECTRICAL ❑MISCELLANEOUS
PROJEC.• ADDRESS I 1r IAQPN#
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OWNERNAME PHONEE1-M,
AIL
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STREET ADDRESS CITY, STATE,ZIP FAX
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CONTACT NAME PHONE E-MAIL
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STREET ADDRESS CITY,STATE, ZIP FAX
10 OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CON'RACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAMEi r0 LICENSE NUMBER } LICENSE TYPE BUS.LIC#Rmn
1. ( r�I
COMPANY NAME E-MAIL FAX
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STREET ADDRESS CITY,STATE,ZIP PHONE
1-/041-177-14
ARCHITECT/ENGINEER NAME L CENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF Wr SFD or DUPLEX ❑ MULTI-FAMILY PROJECT RJ V ILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL URBAN INTE FACE AREA ® NO FLOOD ZONE 10 NO EICHLER HOME? ®NO
DESCRIPTION OF WORK n
AMC'k, Lflh I j r 61 ac Y Akc kausoc-0
TOTAL VALUATION: RECEIVED BY:
By my signature below,I certify to eac f e following: I am the property owner or authorized agent to act on the property owner's behalf I have read this
application and the information I hav vided is co •ect. I have rei d the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating t dding const ion._LAuthori c representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENT FORMAI REQUIREDOF '
. RICE USE ONLY.: ,
W ❑ OVERTHE'COUNTER
F`, ❑ EXPRESS
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MEPMiscApp_2011.doc remised 06/21/11
CERTIFICATE OF COMPLIANCE CFiR-ALT 02-E
Alterations to Space Conditioning Systems(formerly CF-1R-ALT-HVAC) (Page 1 of 3)
Project Name: jell campbell Date Prepared: 2016-06-27
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 CF111-ALT-02 document for each dwelling unit.
01 Project Name jell campbell 02 Date Prepared 2016-06-27
03 Project Location 22211 QUINTERNO CRT 04 Building Type Single family
05 CA City Cupertino 06 Dwelling Unit Name jell campbell
07 Zip Code 95014 08 Dwelling Unit Conditioned 2674
Eloor-Area_(ft2) .
Number of space conditioning
09 Climate Zone 4 10 (SC)systems in this dwelling 1
unit.
B.Space Conditioning(SC)System Informatio x, rF
Ol 02 . 06 07 08 09 10
t 'FIs theSC Installing ate`
SC System SC System CFA served s stem a'--y refrigerant Installing nevuSC � 'Installing k Installing, � 'Installing
, :�_. w.n G�
Identification or Location or Area by this SC duct6d 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
Entirely new or
System 1 Location 1 2674 Yes Yes Yes Yes Yes Yes complete
replacement space
conditioning system
C. Extension of Existing Duct System,Greater Than 40 Feet(Section 150.2(b)1Diib)
This section does not apply to this project.
Registration Number:216-AO23758OA-000000000-0000 Registration Date/Time: 2016-06-27 12:33:04 HERS Provider:CalCERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-06-27 12:32:57
Schema Version:0.555SDD
CERTIFICATE OF COMPLIANCE CFIR-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)
This section does not apply to this project.
E. Entirely New or Complete Replacement Duct System,with or without Equipment Changeout(Sections 150.2(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 150.2(b)1C)
01 02 03 04 05 06 07 08 09 10 11—
Heating Cooling
System Heating Minimum Cooling Minimum Required
Identification or Heating System Altered Heating Efficiency Efficiency Cooling Altered Cooling Efficiency Efficiency Thermostat New Duct
Name Type Component Type Value System Type Component Type Value Type R-Value
Central gas All new heating Central Y rAll;n'ew cooling SetbackTher
System 1 AFUE 80 f FN SEER 14 R-6
furnace components s packaged AC components . f mostat
T,` w
Required Documentation: f l
CF2R-MCH-01-E-Space Conditioning Systems Ducts and Fans
-Duct insulation requirement for new plenums:R6. f ;
CF2R&CF3R-MCH-20-H Duct Leakage Verification required. 'a
-Leakage rate compliance:5 6%.
CF2R&CF3R-MCH-22 Fan Efficacy Verification
CF2R&CF3R-MCH-23 System Air Flow Rate Verification
-Compliance:Fan Efficacy:5 0.58 W/cfm and System Airflow z 350 cfm/ton.
-Alternative Compliance:CF2R&CF3R-MCH-28 Return Duct Design Verification is an alternative to MCH-22 and MCH-23 verification.
CF2R&CF3R-MCH-25-H Refrigerant Charge Verification required when refrigerant containing components are installed or altered(applicable in CZ 2,8-15).
Exceptions:
Heating-only systems are exempt from the 0.58 W/cfm and 350 cfm/ton requirements.
Note:
An"entirely new or replacement duct system"means at least 75 percent of the duct system is 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,coil,plenums,duct material)if the reused parts are accessible and can be sealed to prevent leakage
Registration Number:216-AO23758OA-000000000-0000 Registration Date/Time: 2016-06-27 12:33:04 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-06-27 12:32:57
Schema Version:0.555SDD
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: G^C�fLfhd'�P�GjLt�J1
Bejinez,Ramiro
Company: Signature Date:
R&B HEATING&AIR CONDITIONING 2016-06-27 12:33:04
Address: CEA/HERS Certification Identification(if applicable):
P 0 BOX 270
City/State/Zip: Phone:
NEW ALMADEN CA 95042 _408-9.7_7401
Responsible Person's Declaration statement
I certify the following under penalty of perjury,under the jaws 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(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
requirements of Title 24,Part 1 and Part 6 of the California Code of Regulations
4. The building design features or system design features identified on`'this Certificate of C`o`mpliance are consistent withthe information.prowded on other applicable compliance documents,worksheets,
calculations,plans and specifications submitted to the enforcement agency for approval with this building permit application.
5. I will ensure that a registered copy of this Certificate of Compliance shalLbe,mad.e available wlth;the building permit(s),issued forthe:building,and made available.to-the_enforcement agency for all applicable
inspections.I understand that a registered copy of this Certificate of Compliance-Is required to be included with the documentation the builder provides to the building owner at occupancy.
Responsible Designer Name: <i Responsible Designer Signature. /�=��--�
Bejinez, Ramiro i^ lLrhd'0P$v"C"
Company: Date Signed:
R&B HEATING&AIR CONDITIONING 2016-06-27 12:33:04
Address: License:
P 0 BOX 270 789287
City/State/Zip: Phone:
NEW ALMADEN CA 95042 408-977-1401
Digitally signed by Ca10ERTS. 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-AO23758OA-000000000-0000 Registration Date/Time: 2016-06-27 12:33:04 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-06-27 12:32:57
Schema Version:0.555SDD
Unirrs/ZUan 11:05 rar CUUl
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
CVPERTINO 10300 TORRE AVENUE-CUPERTiNO,CA 95014-3255
(408) 77-3228-FAX(408)777-3333, ilr�dinaPa cupsrtino.ora
Owner Name Permit No. Q 1 10
Address - 11 1�1 t t't-�-r C �'►c y
1, Is your real property a registered historical site?'
1] Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the fonri and sign bottom of fo-in.
Nr 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 it
plumbing,installation of water-conserving plumbing fixtures is not technically feasible?
El Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
O The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
Oto Go to Question 3.
3, Is water service permanently disconnected for your building?
0 Yes Civil Codc Sections 1101.1 through 1101.8 do riot apply. Skip the rest of the form and sign bottom of fo in.
1�sl0 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. Skil,the rest of the form and sign bottom of f yn.
Yes My real property is built and available for use or occupancy on or befplg Jarutary 1, 1994.
Civil Code Scctions 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:
r7 Myproperty is a sinKlc fancily residential real property. Sec Civil Code Section 1101.4.
On and atter,lanuary 1, 2014, building alterations of improvements shall require all non-compliant plumbing f xtures
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 Nether
property undergoes alterations or improvements).
❑ My property is a rn.ultifantiiy residential real property. See Civil Code Section 1101.5.
On and after January 1,2014,specified building alterration%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 Januaiy 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- cone, ing
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 peiyury that non-compliant plumbing fixtures will be
replaced prior to date specified above with water-conserving pliunbing fixtures in accordance with Civil Code S ecti ons 1101.1
through 110 1.8,the current California Plumbing Code and California Green Building Standards Code,and rnanufa turer's
installation requirements,and that the at -conserving pbing fixtures comply with the requirements as indicated in the
table on the followinga'ee.
Owner or Owner Agent's Signature,k :7Date:
lJpon completing and signing this Certific te,please return it to he uildi ,Division in order to final your building permit.
S3407 2015.daa re,ised 08126115
Vol cal cvin 11;00 ri8-1 C. UUz
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION.
GUPERT{NO 10300TORPE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228-FAX(408)777-3333-bui1dino(ZDcupertt2:orp
Permit o.
Address 'r L L I I .: ci A-r -Y it of Alarms Smoke: c s Carbon Monox AL. c a
PERMIT CANNOT BE FINALED ANI?COMPLETED UNTIL THIS CERTIFICATE
HAS BEEN j p A>\l .� Ti1R1VFD TO:'T .,G
tc t ;.a•
E. -DIVISION.-
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PURPOSE
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide AI arms for
compliance with 2013 CRC Section 8314,2013 C13C Sections 420.6 and 907.2.11.2 where no interior ac Less for
inspections are required.
GENERAL INFORMATION
Existing single-family and multi-family dwellings shall be provided with Smoke Alarms and Carbo
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 I LLARM
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 slee in 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 hi dwelling units with no conunereial power supply,alarm(s)may be solely battery operated.
In existing dwelling units, alarms are perrnilted 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,basemen or crawl
space.Refcr 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 ave been
installed in accordance with the inanufacturcr'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 si ncd
below.
1 have reed and agree to co=fy with the terms and conditions of this statement
owner(or Owner Agent's)Name:
Si natuf ...•..........D te: ...............
Go actor Name: _ f
SI nature. ti r, .LIc.# r :�l
Smoke and CDform.doe r vised 03118114
SMOKE / CARBON MONOXIDE ALARM
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
10300 TORRE AVENUE- CUPERTINO, CA 95014-3255
CUPERTINO
(408)777-3228•FAX(408)777-3333•building aacuoertino. rq
Permit No. -2220
Address 1' #of Alarms Sntoke: Carbon Monoxide, es
PERMIT CANNOT BE TINALED AND COMPLETED UNTIL THIS CERTIFICATE
HAS BEEN SIGNED AND RETURNED TO THE BUILDING DIVISION
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 907.2.1.1.2 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 907.2.11.3 and 420.6 require that Smoke Alarms anal/or Carbon
Monoxide Alarms be installed in the following locations:
AREA SMOKI,ALARM CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the X X
bedroom(s)
Un every level of a dwellixig 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)m y 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 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.
As owner of the above-referenced property,I hereby certify that the alarm(s) re erenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms have been tested and are operational,as of the date signed
below.
I have read and a ree to c ly with the ter, s.and conditions of this statement
or�Vy)
Z_ ��
SI nature.
1 ............11 ........Date..._ ,
ntractor Name: �7GQ Q
Si nature_..., ... LI .......Date: .,f.?. i. '
Smnke and COJoem.doc 1-(,,vi.5�d 03/18114
T0001 XVd TZ:OT 9TOZ/LT/80