B-2016-2302 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2302
19742 BIXBY DR CUPERTINO,CA 95014-3325(369 09 018) PELLE HEATING&
AIR INC
SAN JOSE,CA 95111
OWNER'S NAME: THOMPSON CHARLES T AND MARGARET M DATE ISSUED:07/12/2016
OWNER'S PHONE:408-257-0177 PHONE NO:(408)978-7060
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class WARM-AIR HEATING VENTILATING AND AIR-CONDITIONING
Lia#8098$7 X BLDG _ELECT —PLUMB
Contractor PELLE HEATING&AIR INC Date'10/31/2017 X MECH X RESIDENTIAL_COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my JOB DESCRIPTION:
license is in full force and effect. REPLACE FURNACE(CLOSET)AND ADD(I)A/C(REAR YARD)
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
r performance of the work for which this permit is issued,
z.' 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:$5000.00
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 andcounty ordinances
369 09 018
and state laws relating to building construction,and hereby authorize
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save indemnify and keep harmless the PERMIT EXPIRES IF WORK IS NOT STARTED
City of Cupertino against liabilities,judgments,costs,and expenses which WITHIN 180 DAYS OF PERMIT ISSUANCE OR
may accrue against said City in consequence of the granting of this permit.
Additionally,the applicant understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION.
source regulations per the Cupertino �icipal Code,Section 9.18.
-� Issued by:MELISS
Signa Date 07/12/2016 Date:07/12/2016
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: installed without first obtaining an inspection,I,agree to remove all new materials for
t: I;as owner of the property,or my employees with wages as their sole inspection.
compensation,will do the work,and the structure is not intended or offered for
sale(Sec.7044,Business&Professions Code) Signature of Applicant:
z. 1,as owner of the property,am exclusively contracting with licensed Date:07/12/2016
contractors to construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:. ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
z. 1 have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will
Section 3700 of the Labor Code,for the performance of the work for which this maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued: Health&Safety Code,Section 25532(a)should I store or handle hazardous
3. 1 certify that in the performance of the work for which this permit is issued,I material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code,Sections 25505;25533,and 25534.
exemption,I become subject to the Worker's Compensation provisions of the
Labor Code,I must forthwith comply with such provisions or this permit shall ``�Y
be deemed revoked. Owner or authorized agent:
Date:07/12/2016
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that 1 have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance
correct.I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued(Sec.3097,Civ C.)
relating to building construction,and hereby authorize representatives of this city Lender's Name
to enter upon the above mentioned property for inspection purposes. (We)agree
to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address
judgments,costs,and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally,the applicant understands ARCHITECT'S DECLARATION
and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records.
Code,Section 9.18.
Licensed
Professional
Signature Date 07/12/2016
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE CUPERTINO,CA 95014-3255
CUPER.� (408)777-3228•FAX(408)777-3333•buildinINOq,Ca7cuPertino.org MI
SC
(�- "ZOO 270
El PLUMBING R<IECHANICAL .ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS V)LIOV
APN#
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OWNER NAME - . PHO(At4 i... E-MAIL _.
Ir
STREET ADDRESS CTI Y, STA ZIP _ FAX
CONTACT NAME -
PHO &MAO
STREET ADDRESS` TY,STATE,ZIP '/ ® `
Ea > °T
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT X CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑:TENANT
CONTRACTOR N LICENSE NUMBER LICENSE TYPE BUS.LIC# n
59
COMPANYNAME �-- - E-MAIL 6J FAX !/
STREET ADDRESS 1-0 :C Y,STATE,ZIP HONE
a
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF Dor DUPLEX ❑ MULTI-FAMILY PROJECT IN WBALAND ❑ YES 7FD
ECT IN ❑YES IS THE BLDG AN El YES
BUII,DIIIG: COMMERCIAL URBAN IlVTERFACE AREA ❑ NO ZONE ❑NO EICHLER HOME? - ❑NO
DESCRIPTION OF WORK9��
33 a_
® 1 ,
TOTAL VALUATION: R
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the pr owner's beha . I have read this
application and the information I have pr vided is correct., ve read the Description of Work and verify it is accurate. I agree to co with all applicable local
ordinances and state laws relating to buil ng co truc'&,Yajphorize representatives of Cupertino to enter the above-identified rty for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENT INFORMATION REQUIRED
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CERTIFICATE OF COMPLIANCE CFIR-ALT 02-E
Alterations to Space Conditioning Systems(formerly CF-1R-ALT-HVAC) (Page 1 of 3)
Project Name: Thompson,Chuc�Date epared: 2016-07-01
A.General Information
CFI11-ALT-02 is applicable to multiple space conditioning systems contained within a single dwelling unit.When multiple dwelling units must be documented,
use one CFI11-ALT-02 document for each dwelling unit.
01 Project Name Thompson,Chuck 02 Date Prepared 2016-07-01
03 Project Location 19742 Bixby Drive 04 Building Type Single family
05 CA City Cupertino 06 Dwelling Unit Name Thompson,Chuck
07 Zip Code 95014 OB
Dwelling Unit Conditioned 2002
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 , _� vm
� . N
11
01 02 03 04fl5� ^ X06 "' 07 [�$ 09 10
. ` z 2rt u; r✓ w ,*.,. r 'NX, u "r,a' r _y r�Fs 'ray J+
; is the SC I stalling a
SC System SC System CFA served s,,ystem a #rige ant ,Installing new SC Flnsta)l ri'g nstalhr g `}Installing
Identification or Location or Area by this SC ducted containing system more than 40 entirely new entirely new
Name ServedSystem(ft2) system? component? components? feet of ducts? duct system? SC system? Alteration Type
Chuck Thompson Whole house 2002 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.
Registration Number:216-A0246747A-000000000-0000 Registration Date/Time: 2016-07-01 15:50:48 HERS Provider:CalCERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-07-01 13:50:35
Schema Version:0.555SDD
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
All new All new This field or This field or
Chuck Central gas Central split
heating AFUE 92 AC cooling SEER 16 Setback section is not section is not
Thompson furnace components components applicable applicable
Required Documentation:
CF2R-MCH-01-E-Space Conditioning Systems Ducts and Fans
-Duct insulation requirement for new plenums:R6.
CF2R-MCH-20-H&MR-MCH-20 H—Duct Leakage testingrequired when heating or cooling components are installed inducted systems,or when more than 40 ft of duct length is replaced.
-Leakage rate compliance:<_15%,or 5 10%leakage to outs de;:or seal all accessible leaks.
CF2R-MCH-25-H&CF3R-MCH-25-H Refrigerant Charge Verificaiipp required when refrigerant containing components are installed or altered(applicable in CZ 2,8-15).
CF2RCF3R-MCH-23&CF3R-MCH-23 Air Flow>-30,O,CFM/ton required,whe INCH-25 is required.
Exceptions:
Duct systems registered with HERS provider as"previously sealed are exempt from M20 Duct Lekage e Ping requirementsq � r ,
Heating only systems and Air Handler/Furnace changes do not require verificaticlt of Air Flow MCFi�23;U'Refrig�" nt Charge Ivl u., �r
9 f n, � gid.
-Existing duct systems constructed,insulated or sealed with asbestos re exempfrom MCH 2Ouct Leakage Testi g� gu�rames. u
u
g-.
.... +�1,F%✓, g.. '"�.�r�/</'� �N°k/vyre<:,,: rye 'fir,�,:r�� .� eet �a� ihmt ✓� -% art
E.Entirely New or Complete Replacement Duc Stem,with or vyithout Equipment Changeout(Sections 1�0 2( )1Dua,and 150.2(b)1E,F)
,, rr ai ,
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-A0246747A-000000000-0000. Registration Date/Time: 2016-07-01 15:50:48 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-07-01 15:50:35
Schema Version:0.555SDD
CERTIFICATE OF COMPLIANCE CKR-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: GAG E �fLG
Sanchez,Rafael
Company: Signature Date:
PELLE HEATING&AIR INC 2016-07-01 15:50:48
Address: CEA/HERS Certification Identification(if applicable):
179 SAN RAMON DRIVE
City/State/Zip: Phone:
SAN JOSE CA 95111 408-978-7060
Responsible Person's Declaration statement;;,
I certify the following under penalty of perjury,under thealaws;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 ofahe Busihessand Pro fessiohs 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 com onents,and manufac ured devices for building de ign or system design identified on this Certificate of Compliance conform to the
requirements of Title 24,Part 1 and Part 6-,of the Califor6iaf66'de of Iteg�alaY ns. �y
4. The building design features or system design feature's id, ntified o �his Certrficatef Cm�tliance are4 onsistehlt wit he iriformattb�nl rovided orr the appl cableirnpliance documents,worksheets,
calculations,plans and specifications submitted tb the eforcementaenc y fo a ovalrwlf this bwing per,, a icati ^
93,/�l ,„.,s Y-, ,r '%�. !pr of AN
5. J will ensure that a registered copy of this Certiftcateaof Ctirtipliance shalltelmade a�ailble vtth,,tlie bnildng Pmit(sf issuad forJjt <tiUildl g,and$tnatl ava1�abl Yo„thednforcement agency for all applicable
, Gam.
inspections.l understand that a registered copy of thisfYtjicate of Compliance) requited to be,„included wi>h the raocumentationtheb�lilder provides to tt�e bual,�ing owner at occupancy.
Responsible Designer Name: y A. ”
t �� ResponsibleDesignerSiigrnatUre. �lLf
Sanchez, Rafael
Company: Date Signed:
PELLE HEATING&AIR INC 2016-07-01 15:50:48
Address: License:
179 SAN RAMON DRIVE 809887
City/State/Zip: Phone:
SAN JOSE CA 95111 408-978-7060
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-A0246747A-000000000-0000 Registration Date/Time: 2016-07-01 15:50:48 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-07-01 15:50:35
Schema Version:0.555SDD
;I
}
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SMOKE / CARBON MONOXIDE_ ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUP TING 90300 TORRE AVENUE,CUPERTINO, CA 95014-3255
(408)777-3228 FAX(408)777-3333 a buildin cugertino.orcl
Permit No. o .0 l fV•-Z 3
Address /5747- 8 i x 6 b r i a— #of Alarms Smoke: a Carbon Monoxide: 3
PF I ?IiT AIVC)I.T3 I�IlVAl1ED A1I} g11!IPLETED TJl�T1Z THIS CRRTTI+,II ;ATR
HAS I3E7ilI'�r � D�1+tTCTI�N1�l}TO rHE BUII:,DING DN1SIOl�Ii ��
} 777-
PURPOSE
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance w th 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
L__
inspections ar required.
�_: __ -
GENERAL INFORMATION
Existing singl�-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,CRd Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon
Monoxide A+ms be installed in the following locations:
SMOKE-ALARM CO ALARM -
Outside:o.,each sel?.arate sleeping area in the immediate vicinity of the X X
bedroom( )A
On ever evel of a dwelling unit includingbasements X X
Within ea h sleeping room X
4
Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that
do not have aa 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 Suppl�b: In dwelling units with no commercial power supply, alarm(s)may be solely battery operated.
In existing d-_
telling 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. _
I have read and a ree to comply with the terms and conditions of this statement µ -
e pwr ,erRor,Owner Agent'sj Name:
�,� /n.dA44,;' d-V ow
Contractor Nam
Sign atu Lic.# ... .� ............Date: ..
Smoke and CO form.doc revised 03118114
C
i
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
CUPER' TI 10300 TORRE AVENUE®CUPERTINO, CA 95014-3255
(408)777-3228=FAX(408)777-3333 buildingacupertino.org
Owner Name v I� �- S Permit N a. `' I 0
Address 11 7Z- 6 14 ,b r I v Cu l ('� g yo f
1. Is your real property a registered historical site?
Yes Civ 1 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,;inst Nation of water-conserving plumbing fixtures is not technically feasible?
{ ❑ 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.
No Go to Question 3.
3. Is water servic permanently disconnected for your building?
11 Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
1, No Go o Question 4.
4
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
El No My -eal property is built and available for use or occupancy after January 1, 1994..
Civ 1 Code Sections 110 1,1 through I101.8 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.
Civ 1 Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign
bot om of form..
5. Please check ONE of the following::
54 My propert 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.
r On and aftJanuary 1,2014,specified building alterations or improvements shall require non- compliant
plumbing xtures to be replaced with water-conserving plumbing fixtures_
On or befoe 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 propert is a commercial real property. See Civil Code Section 1101.5.
On and aftc r January 1,2014,specified building alterations or improvements shall require non-compliant
plumbing f xtures to be replaced with water-conserving plumbing fixtures.
On or'bef re 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 ownei 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 1101.3,the current.California Plumbing Code and California Green Building Standards Code,and manufacturer's
installation requirements,uirements,and that the water-conserving plumbing fixtures comply with the requirements as indicated in the
l
table on the fc1lowing page. ot
Owner or Owner Agent's Signature: ccz.Qco Date:
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit.
` SB4072015.doc revised 08126115
I
i
I
BUILDING PERMIT CANNOT BE FINALED AND COMPLETED UNTIL:THIS
ERTIFICA
TE-HA S BREN I NED AND�2ETURNED TO THE BUILDING DLVISION ;
1
Non-Compliant Water-Conserving Plumbing Fixture
Plumbing Fixturel (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
I 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
I per minute @ 20 psi
In common and public
use areas: 0.5 gallons
per minute @ 60 psi
1.8 gallons per minute
60 psi
f 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.
1
1
SB407 2015.doe revised 08126115