B-2016-2222 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2222
10765 PENINSULAR AVE CUPERTINO,CA 95014-0121(326 03 024) MONTEROS HEATING
&AIR CONDITIONING
MOUNTAIN VIEW,CA
94040
OWNER'S NAME: LAMPKIN SUSAN E TRUSTEE DATE ISSUED:06/28/2016
OWNER'S PHONE:408-568-8304 PHONE NO:(650)964-4030
L.IMSED CONTRACTOR'S DECLARATION ARATION BUILDING PERMIT INFO:
License Class C-20 Lic.#989002
Contractor MONTEROS HEATING&AIR CONDITIONING Date 12/31/2017 X BLDG —ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing X MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
REPLACE FURNACE(SAME LOCATION)AND A R CONDITIONER
I hereby affirm under penalty of perjury one of the following two declarations: (BACKYARD)
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.
J z./ I have and will maintain Worker's Compensation Insurance,as provided for by
lam/ Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$10500.00
APPLICANT CERTIFICATION
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 326 03 024
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 N T 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-point
source regulati s per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 6/28/2016 Issued by:Abby Ayende
Date:06/28/2016
OWNER-BUILDER DER D RATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material bei ng installed.If a roof is
1. I,as owner of the property,or my employees with wages as theft'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., I,as owner of the property,am exclusively contracting with licensed Signature ofApplicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date: 26/ 8/2016
I hereby affirm under penalty of perjury one of the following three declarations: AL ROOF COVERINGS TO BE CLASS"A" R BETTER
i, 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 and r 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 25505,25513,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Cod(,Chapter 9.12 and the
s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store r handle hazardous
shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or device which emit hazardous
air contaminants as defined by the Bay Area Air Quality anagement District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code ections 25505,2553 3,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall 601 L
be deemed revoked. /-0r or authorized agent: (/!�
APPLICANT CERTIFICATION
Date:6/28/2016
I certify that I have read this application and state that the above information is CN TR TION LENDING
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agen y 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 DEL TI
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 6/28/2016 Professional
GENERAL PERMIT APPLICATION EP
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
10300 TORRE AVENUE CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333 building(afcupertino.orgCUPERTINO
Isc
❑PLumBING Q MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS �y
OWNER NAME
5 � c4me k1`11090 e.
STREET ADDRESS PSN f„y � � •_ CITY, STATE,ZIP 'r rA 140 FAX
l (Pr2 l'�✓�'
CONTACT NAME p�P yp� PHONE qo j_t'�!b E-MAIL
STREET ADDRESS. (� ,1 CITY,STATE,ZIP V
FAX
❑OWNER ❑ OwNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑. DEVELC PER ❑TENANT
CONTRACTOR NAMEe e, r �9 LICENSE NUMBERf*yP,,, LICENSETYPP BUS.LIC#
COMPANY NAME1C14,E-MAIL P FAX
STREET ADDRESS' j CITY,STATE,ZIP P ONE p
�� C.
rAl,
ARCHITECT/ENGINEER NAME __7LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ SFD Or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ NO FLOOD ZONE ❑ Yes ❑ NO
DESCRIPTION OF WORK 9
TOTAL VALUATION: �`� RECEI�EDBY
666
By my signature below,I certify to each of the f wing: I am the property owner or authorized agent to act on the property owner's behalf. 'I have re id this
application and the information I have provi is o ect. 1,have read the Description of Work and verify it is accurate. I agree to comply with all app icable local
ordinances and state laws relating to build' cqn crio . I a nze reprqsontatives of Cupertino to enter the above entifief property for inspectior purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE Nig
CO" {>YER TIEa OUNTER
E D EXPRESS
W.. [I
"STANDARD,
L1 1,ARCI '
q' MAJOR
MEPMscApp 2011.doc re ised 03/16111
MONTEROS HEATLNG &A!R
Heating,Air Conditioning, Date
w
Refrigeration -j U's L AMpk1d ,
650-964-4030Job Name: Phone #:
'
Address;.
` 7 T Map Code: Representative:
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NOTE:Show location of Condensing Unit(CU), Furmc (F),Drain(D),Electrical Panel(EP), 4
Relocated Thermostat(T),and any New S�pply(S)and/or Return(R)Grilles. 0 Squares per Inch
f r_e�
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems(formerly CF-IR-ALT-HVAC) (Page 1 of 3)
Project Name: Lampkin Date Prepared: 2016-06-25
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 CF111-ALT-02 document for each dwelling unit.
01 Project Name Lampkin 02 Date Prepared- 2016-06-25
03 Project Location 10765 Peninsular Ave. 04 Building Type Single family
05 CA City Cupertino 06 Dwelling Unit Name Lampkin
Dwelling Unit Conditioned -
07 Zip Code 95014 08 1800
Floor Area(M)
Number of space conditioning
09 Climate Zone 4 10 (SC)systems in this dwelling I
unit.
B.Space Conditioning(SC)System Information '
a
01 02 03 04 � �0S O6 07�: 08 a 09 10
",Is the SCS": Installing a _ h
5C System SC System CFA served u-system a; refrigerant `Installing new SC Installing ilnstalling wlnstalling
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 Location 1 1800 Yes Yes Yes No No No Altered space
conditioning system
C.Extension of Existing Duct System,Greater Than 40 Feet(Section1S03(b)1Diib)
This section does not apply to this project,
Registration Number:216-A0236153A-000000000-0000 Registration Date/Time: 2016-06-25 08:55:29 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-06-25 08:55:24
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)
01 02 03 04 0S 06 07 08 09 10 11 12
Heating Cooling
System Heating Altered Heating Minimum Altered Cooing 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
Central gas
All new Central split All new This field or This field or
System 1 furnace heating AFUE 80 AC Cooling SEER 14 Setback section is not section is not
components components applicable applicable
Required Documentation: -
CF2R-MCH-01-E-Space Conditioning Systems Ducts and Fans
-Duct insulation requirement for new plenums:R6.
CFZR-MCH-20-H&CF3R-MCH-20-H—Duct Leakage testing,required when heating or cooling components are installed in ducted systems,orwhen 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&CF311-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 t 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 Handl,er(Furnace changes do not require verification of Air Flow MCF)23,or RefngeCanfi'Chaige MESH 25 `
Existing duct systems constructed,insulated or sealed with asbestos are exempt from MCH 2ODuM'leakage Test(ng regwremer)t5
.. , ...
M
,
E.Entirely New or Complete Replacement Dud'$s��em,with
R �o�
r�wtthout Eque�p�ment Changecut(Sections.150 2(b�1Da and�150.2
(b)1EF)
�
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.
r
Registration Number:216-A0236153A-000000000-0000 Registration Date/Tme: 2016-06-25 08:55:29 HERS Provider:CaiCERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-06-25 08:55:24
CERTIFICATE OF COMPLIANCE CF1R-ALT02-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:
'Monteros,Claudio
Company Signature Date:
MONTEROS HEATING&AIR CONDITIONING 2016-06-25 08:65:29
Address: CEA/HERS Certification identification(if applicable):
809 CUESTA DRIVE#B198 989002
City/State/Zip: Phone:
MOUNTAIN VIEW CA 94040 408-813-3356
'Responsible Person's Declaration statement
1 certify the following under penalty of perjury,under the laws of the State of California:
1. The information provided on this Certificate of Compliance is true and correct.
2. 1 am eligible under Division 3 of the 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 Compliance are consistent with the information provided on othe"applicable compliance documents,worksheets;
calculations,plans and specifications submitted to the enforcement'agency foulapproval with this building permit application. s •
S. I will ensure that a registered copy of this,Certificate of,Compliance shall,be dade.available with the building permits)issued for>the<bui(ding,and,made avaliabiiko the enforcement agency for all applicable
l
Inspections.I understand that a registered copy of this Certificate of Compliance is required to be included with the,documentatioR,theebuilder provides to the building owner at occupancy.
Responsible Designer Name: Responsible Designer Signature.IN,
Monteros,Claudio
'Company: Date Signed:
MONTEROS HEATING&AIR CONDITIONING 2016-06-25 08:55:29
Address: License:;
809 CUESTA DRIVE#13198 1,989002
City/State/Zip: Phone:
MOUNTAIN VIEW CA 94040 408-813-3356
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-A0236153A-000000000-0000 Registration Date/Time: 2016-06-25 08:55:29 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-06-25 08:55:24
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CVPI-RT I t40 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildina?D-cupertino.org
07 , Permit No. � -ZD t 6 -,?Z-
Address
ZZ ZZ
Address f �' ,._ i 'rr 9 s �Y of Alarms Smoke: Carbon Monoxide: ,
a�PERMIT�CANN;>oT BE�INALEDANI�GO,IS�PIETED UNTIL T�III�CERTIFICATE
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 CSC 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.
1 have read and agree to ply with the terms and conditions of this statement
Owner(or Owner Agent's)Name:�
6! .5&, 1 �,. L�6 K 1 v1 Signature... . ......................Date:
Contractor Name:
k %. ice 1 Signature.// .........Lrc.#....... .. '... � .Date:
r
Smoke and CO form.doc revised 03118114
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CU>'IyRT 40 10300 TORRE AVENUE CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333 building(akupertino.org
Owner Name to S 6_1. \ , —L t.i -� y j 1r r In Permit No,
J
Address I U 7 V1 1 V1 J_t.t:.1 Gzy- -Ave , (2" e'``�I yt 6 A t J`_C� I
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 form.
No Go to Question 2.
2. Does your real property have a licensed plumber certifying that,due to the age or configuration of the property or its
plumbing,installation of water-conserving plumbing fixtures is not technically feasible?
El Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
❑ The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
No Go to Question 3.
3. Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
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..
5. _Please check ONE of the following:
rCj 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).
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- 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 plumbing fixtures comply with the requirements as indicated in the
table on the following page.
Owner or Owner Agent's Signature: Date:
Upon completing and signing this Certificate,please return it to the Buildin ivision in order to final your building permit.
SB40 7 2015.doc revised 08/26115
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Non-Compliant Water-Conserving Plumbing Fixture
Plumbing Fixturel (Fixture Complying with Current Code Applicable to New Construction)
Maximum Water Usage/Flow gate
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
Gallons/flush 0.5 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. H 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.doc revised 08126/15