B-2016-2334 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2334
10790 PENINSULAR AVE CUPERTINO,CA 95014-0100(326.03 049) ON-TIME AIR
CONDITIONING&
HEATING INC
PLEASANTON,CA
94588
OWNER'S NAME: BROWN THOMAS AND JAYME DATE ISSUED:07/18/2016
OWNER'S PHONE:408-730-8307 PHONE NO:(925)444-4444
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class INSULATION AND ACOUSTICAL Lic.# 1$ 7040
Contractor ON-TIME AIR CONDITIONING&HEATING INC Date 09/30/2017 X BLDG =ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing X MECH X RESIDENTIAL_COMIVIERCL&L
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and eff JOB DESCRIPTION:
REPLACE A/C REAR YARD WITH ASSOCIATED DUCT WORK
I hereby affirm under nalty of perjury one of the following two'declarations:
i. I have an ill maintain a certificate of consent to self-insure for Worker's
Comp sation,as provided for by Section 3700 of the Labor Code,for the
pe rmance of the work for which this permit is issued.
ave 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:$14661.00
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 tobuildingconstruction,and hereby authorize 326 03 049
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save Inde y and keep harmless the
City of Cupertino against liabilities,judgm s,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in conse ence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understa and will comply with all non-point
source regulations the Cupe ' o Municipal Code,Section 9.18. 180 DAYS FROM LAST - LED INSPECTION.
Signature Date 07/18/2016, Issued by:
Date:07/18/2016
OWNER-BUILDER DECLARATION
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 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)
z. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:07/18/2016
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
s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(x)should I store or handle hazardous
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 Quali anagement District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cuertino Munlel Code Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety CodZZ5505 553 ,an 5
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:07/18/2016
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 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 used
DECLARATION
Code,Section 9.18. I understand my plans shall be sed as public records.
Licensed
Signature Date 07/18/2016
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildingCcDcupertino.org MISC
CUPE£�TIIntO
❑PLUMBING MECHANICAL []ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS l 0 ® APN# r Q i
OWNER NAME P O E L
3-0 07
STREET ADDRESS f �e CITY„STATE,ZIP
CONTACT NAME6N�-/ ��S ''�d ��Z-C✓�f E�'(V
STREET ADDRESS CI ,STATE,ZIP " + FAX
/ C'
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT K-11;�ACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME e d LICENSE NUMBER(7 /1n) LICENSE TYPE/3 BUS.LI, j
LGA �J I 7 V C �» /)19 7
COMPANY NAM2,,i f( � � &MAI FES
STREET ADDRESS CITY,STA �zIF
c -����cc� e' e
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF D or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE: ❑ Commercial / URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ NO
DESCRIPTION OF WORK A /
TOTAL VALUATION:
"* By my signature below,I certify to each of the following: I a
the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I ve read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buil ' g n ction. authorize representatives of Cupertino to enter the above-identifi rope f/o�r inspection purposes.
Signature of Applicant/Agent: Date: �� 1=J
S. PLEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
1M THE COUNTER"
' � 0 `EXPI2ES5
STANDARD
e'C3
a LARGE`
MAJOR•'
MEPMiscApp 2011.doc Devised 03/16/11
CERTIFICATE OF COMPLIANCE CFIR-ALT 02-E
Alterations to Space Conditioning Systems(formerly CF-IR-ALT-HVAC) (Page 1 of 3
Project Name: TOM BROWN Date Prepared: 2016-07-06
A.General Information
CFIR-ALT-02 is applicable to multiple space conditioning systems contained within a single dwelling unit.When multiple dwelling units must be documented,
use one CFIR-ALT-02 document for each dwelling unit.
01 Project Name TOM BROWN 02 Date Prepared 2016-07-06
03 Project Location 10790 PENINSULAR AVENUE 04 Building Type Single family
05 CA City Cupertino 06 Dwelling Unit Name TOM BROWN
07 Zip Code 95014 08 Dwelling Unit Conditioned 1993
Floor Area(ft2)
Number of space conditioning
09 Climate Zone 4 10 (SC)systems in this dwelling 1
unit.
_ "^nPs.'' S 4,& 'tin f a 1'�5! _
B.Space Conditioning(SC)System Information410 t21 -10
's .. � s
or M
61
01 02 31 04% 07 09 10
Is the SC k"> Installing a ,< rell
SC System SC System CFA served � stem a refriger t g nstallh ev0'SC r staffer g �►n"ILP 1 stall mg � install ng
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 1993 Yes Yes Yes Yes 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-A0250764A-000000000-0000 Registration Date/Time: 2016-07-06 17:26:34 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-07-06 17:26:42
Schema Version:0.555SDD
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems(formerly CF-IR-ALT-HVAC) (Page 2 of 3
D.Altered Space Conditioning System(Sections 150.2(b)1E and F)'
01 02 03 04 05 06 07 08 09 10 11 12
Heating Cooling
System Heating Altered Heating Minimum Altered Cooling Minimum Required New or
Identification System Heating Efficiency Efficiency Cooling Cooling Efficiency Efficiency Thermostat 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
Central gas Central split Greater than
System 1 AC component section is not section is not cooling SEER 14 Setback R-6
furnace altered applicable applicable components 40 feet
Required Documentation:
CF2R-MCH-01-E-Space Conditioning Systems Ducts and Fans
-Duct insulation requirement for new plenums:R6.
CF211-MCH-20-11&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:<_15916,or 510%leakage to outside,or sear 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 required when MCH-25 is required..
Exceotions:
-Duct systems registered with HERS provider as previously sealed are exempt from il!1
1-20 Duct Leakage Te t ng r kqu rrement „ fi
-Heating-only systems and Air Handler/Furnace changes do not require verificatk of Air Flow MC,,23 ar RefrIge nt ha ge ME 2
s�
1ds m
-Existing duct systems constructed,insulated or sealed with asbesto re exempfrom MCi 20Du,Leakage Testi"'yrequirrf
.,,.
�°�,' -��r. �+�+�� s7e.�;a> ..,-� r.u�� +�• w�;y,. r�r s::: sr�x=k,�' k'„� a rb=p. ✓,� ^'yik,� :�
E.Entirely New or Complete Replacement DuC tem,wi h 11thout, qutpment Changequt SeCtiQns 15 .2(bjl Diia and 50.2(b)1E,Fj
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-A0250764A-000000000-0000 Registration bate/Time: 2016-07-06 17:26:34 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-07-06 17:26:42
Schema Version:0.555SDD
CERTIFICATE OF COMPLIANCE CFIR-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: CJS
Queen,Drew �`'
Company: Signature Date:
i PERMIT E RATERS 2016-07-06 17:26:34
Address: CEA/HERS Certification Identification(if applicable):
31225 La Baya Drive#213
City/State/Zip: Phone:
West Lake Village CA 91362 818-735-7876
Responsible Person's Declaration statement
I 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. !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 manufactu ed devices for the building design,ortsystem design identified on this Certificate of Compliance conform to the
requirements of Title 24,Part 1 and Part 6 of the California Code of R urattns e y4 , I'
4. The building design features or system design features identified o"this Certificate Rf mi�-lance arect� s:ster#ty�th the i orm'10n,,>,provided omother�apptica�t cd npliance documents,worksheets,
calculations,plans and specifications submitted to the erg orcement agency fo�i plOvaliwithahis build ng per it ap I:catioti. gi,
t t v
5. 1 will ensure that a registered copy of this Certificat�4f�Ccirgpliance s a!( p made, ailbie�iii k'tjae biJildiflp„ermit(s}issued forhe olid;prig,andzrnadg available t the phforcement agency for all applicable
inspections.t understand that a registered copy of thisG�er�icate of Coinplances required to bgncluded,ikh thedAocumeationthebilder pp_ es tithe building owner at occupancy.
” R,.; 'S.111-1,
��,� r.b�e ii n
41
Responsible Designer Name: � ij �,fi.�,. Responsible Designer Signature. h t, ��a�a�� "�
Queen,Drew
Company: Date Signed:
ON-TIME AIR CONDITIONING&HEATING INC dba SERVICE CHAMPIONS 2016-07-06 17:26:34
Address: License:
7020 COMMERCE DR 817040
City/State/Zip: Phone:
PLEASANTON CA 94588 925-598-1911
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-A0250764A-000000000-0000 Registration Date/Time: 20'16-07-0617:26:34 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Deport Generated:2016-07-06 17:26:42
Schema Version:0.555SDD
�- WE KE � CARBO. '; N D)O DE ALARM
qn3
COMMUNITY REVEL RMENT DEPARTMENT►BUILDING DIVISION
10300 TORRE AVENUE••CUPERTINO,CA 95014-3255
(408)777-3228. FAX`(408)777-3333►building(acupertino.org
k
s
PURPOSP
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 907.2.11.2 where no interior access.for
inspections are required.
GENF-RAt IN VORMATION
Basting smgle=family and multi-family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the variation of additions, alterations, or repairs to existing dwelling units exceeds
$10001.00,CRC Section 8,314 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 ANLARM
Outside of each separate sleeping area in the immediate vicinity of the X
bedroom(s)
O'n ever level of a dwellin .unit fficlucli .nbasemenfs X
t
Within each see in room X
Carbon NSonoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that
do not leave an ai<tad-ed garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 429.1 and shall be approved by the Office of the State Fire Marshal.
h Dower Supply:I dwelling units with no,commercial power supply,alarm(s)may be solely buttery operated.
In existing,dwelling units, alarims.are permzteed to be solely battery operated where repairs or alterations do,
not r,e su(11 in,the femoval of wall and ceiling finishes or, there is ii to access by means of attic,basement or crawl
space.Refer to CkC Section R31'4 and CBC Sections 9'0'7.2.11.4 and 4201.6.2. An electrical per rirt is-required.for
alarms which must be connected tor,the building wiring.
As owner of the above-referenced pi aperty,I hereby certify that the alarixi(s)referenced above has/have been
installed i1 acco dance with the-manufacturer's instructions and in compliance with the CaliforruaBuildiilg
and Califon a Residential,Codes.The alarrnshave been tested and are operational,as of the date sighed
b elow.
!havar adf anct a ree to com,f,;:wth the terms and conditions.of flits statemant
......... .................................................. flate :,
. ...
Sf'natU7e,,..: .. Ltc.
Date
WATER-CONSERVING PLUMBING FIXTURES FILE
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•`BUILDING DIVISION ° J'
CUPERTI O 10300 TORRE AVENUE CUPERTINO,CA 95014-3255
(408)777- 228-E-AX(4 8)777-33 • buildin u ertino.or _
Ownerr.Nt e r .6�.4 cF t�l�(C I Permit N o 13- 2-:64 2'3-`f
Address lQ l0 /HCl 1A)0
1. Is your real property a registered historical site?
❑ Yom' Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
No o 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 Ovil Code Sections 1101.1 through 1101.8 do not apply.
LJ The licensed pluinber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
No o to Question 3.
3. Is water service permanently disconnected for your building?
❑ Ye
Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
No o 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.
9vil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
if es My real property is built and available for use or occupancy on or before January 1, 1994.
C�ivil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign
bottom of form..
5. PleUpcheck ONE of the following:
I IkMy 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 repl}�ced 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 prop'rty 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 beore 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
unprovements).
El Myproparty is a commercial real property. See Civil Code Section 1101.5.
On and anter 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 owns r 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 110 1.1
through 1101.8,the current California Plumbing Code and California Green Building Standards Code,and manufacturer's
installation m quirements,and that the water-conserving plumbing fixtures comply with the requirements as indicated in the
table on the following page.
Owner or Own',er Agent's Signature: / Date: "Alar-1110
Upon corr pleting and signing this Certificate,please return it to the Building Division in order to final your b lding ermit.
S$4072015.doe revised 08126115
BTJILDING PERMIT CANNOT BE+ FII�AL�D AND COMPLETED.UNTI"L THIS=
ERTIFICATE HAS BEEN I NED AND RETURNED TO THE BUILDING DIVI7-7,97
SION
I;
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
/Flow Rate 2013 CALGreen Div.4.3 2013 CALGreen Div. 4.3 2013 CALGreen Div. 5.3
Single-Family Multi-Family Commercial
Residential Residential
Water Closets Exceed 1.6 Single flush toilets: 1.28 gallons/flush
(Toilets) Gallons/flush Dual flush toilets: 1.28 gallons/flush effective flush volume(the 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 onIV one shower outlet to be in operation at a time.
l 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
is 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.
SB407 2015.doe revised 08/26/15