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B-2016-2377 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2377 10175 CAROL LEE DR CUPERTINO,CA 95014-2301(316 23 075) CONTROLLED SYSTEMS OF CALIFORNIA INC SAN JOSE,CA 95160- 1039 OWNER'S NAME: JANICE CIMENELLO DATE ISSUED:07/25/2016 OWNER'S PHONE:408-257-8527 PHONE NO:(408)268-8675 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class WARM-AIR HEATING VENTILATING AND AIR-CONDITIONING tic.#7.18_162 X BLDG _ELECT _PLUMB Contractor CONTROLLED SYSTEMS OF CALIFORNIA INC Date 01/31/2018 X MECH X RESIDENTIAL_COMMERCIAL I 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. ADD(l)A/C IN SIDE YARD I hereby affirm under penalty of perjury one of the following two declarations: 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. z.(2 1 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'$7000.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application- nd state that the above APN Number: Occupancy Type: information is correct.I agree to c mply ith all city and county ordinances 316 23 075 and state laws relating to building ons uction,and hereby authorize representatives of this city to ant upo the above mentioned property for inspection purposes. (We)agree s e indemnify and keep harmless the PERMIT EXPIRES IF WORK IS NOT STARTED City of Cupertino aga st liabilitie ju ments,costs,and expenses which WITHIN 180 DAYS OF PERMIT ISSUANCE OR may accrue a ainsI d City in c uence of the granting of this permit. Additionally,t apnt under ds and will comply with all non-point 180 DAYS FROM LAST C INSPECTION. source regul ionshe Cup i o unicipal Code,Section 9.18. Issued by: A NAME Signat re A Date 07/25/2016 Date:07/25/2016 OWNE - DER 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 1. 1,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: 2. 1,as owner of the property,am exclusively contracting with licensed Date:07/25/2016 contractors to construct the project(See.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 Cha to 6.950f the z I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,2553 ,an 25 34. 1 will Section 3700 of the Labor Code,for the performance of the work for which this maintain compliance with the Cupertino Mu 'cipal Code CI ple 9.12 and the permit is issued. Health&Safety Code,Section 25532,a)sh uld I store _ h ndl hazardous s. I certify that in the performance of the work for which this permit is issued,I material. Additionally,should I us ipme t or devic w ch a 't hazardous shall not employ any person in any manner so as to become subject to the air contaminants as defined by t e Ba Area it Quali age ent District I will maintain compliance with e C ertin Municip o e,C apter 9.12 and Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code ectio 25505, 5 3,and 5534. 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 Owner or authorized agent be deemed revoked. Date:07/25/2016 APPLICANT CERTIFICATION N TI N LENDING AGENCY I certify that I have read this application and state that the above information is 1 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 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CU RTINO (408)777-3228•FAX(408)777-3333•building@cypertino.org misc PLUMBINGCHANICAL DELECTRICAL MISCELLANEOUS PROJECT ADDRESS 1017 ) A. APN# 3( (. — ( (. — 6 OWNERNAME PH ,� E NfP II e Al STREETADDRESS D —7 S CITY,STATE,ZIP FAX CONTACT NAME Q �D PHO 122-^2 EMAIL 48 L4-71 'DC S®C G(3"(D STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER Q.:OWNER-BUILDER ❑ OWNERAGENT 0T7NTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECTS ❑.ENGINEER, ❑. DEVELOPER ❑TENANT CONTZACTO N : b k`� V{` LICF�S$ I R 7 LICENSLTY BUS.LIC# CO B NI V v` l 6 I E-MAIL - A 0-6c\-60p), STREET ADDRESS CITY, T ZIP -. PH NE Q ➢ &5_ ARCHITECT/ENGINEERNAME LICENSE NUMBER ,. BUS.LIC# COMPANYNAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑sFDorDUPLEX ❑ MULTI-FAMILY PROJECTINWILDLAND 0 YES 7PROIECTIN ❑YES IS THE BLDG AN [3YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑NO DZONE [3 No EICIII.ERHOME? ❑NO DESCRIPTION OF WORK �e TOTAL VALUATION al 7 ®' RECD By my signature below,I certify to eac the f low' I am the property o er ora orized ag , act on the pro er's have read this application and the information I have o ided i con I have read the Des 'p ork and ve it is accurate m with all applicable local ordinances and state laws relating to b it ' co tru 'on. authorize represe ves o upertino to enter a above-id tifed p opi rty for' oses. Signature of Applicant/Agent: Date: SUPP EMENTAL INFORMATION REQUIRED iiC1 olv _ Cl �xeii�� C7.3�ANbAIi1J ItSAd�R MEPMiscApp_2011.doe revised 06121111 ✓1 f, v'I �1 PAA l tA All c9 r .e-e vii I r-- CC)' [- 6l 0, 0 I71 P PLANS HECKE® BY COMMUNITY DEVE,J;Ia ENT DcPAR TMIEENT BUILDING DIV I„ION CUPE s ,�R T 1NO DATIE i APS VIM PLANgING DEPT Thss set Of Plans and ��ke t a p ��y( / job Site during + � p p at l f' 9 nTI N 7 v ;d�� €t 3C� SE 4�SA II ' ' i 1.L�rul i<t�any Changes or i gra 3 tvxw ,a€ o deviate th r trc rl, '10L)t aPP,'*crt i frcrti thlo,,Bullding Ofticiai. Ccs !® 7•tto stampinr of thisplan be s,;nns SHALL NOT I� idcrti'g c! p", of any _ �„ l c f the violation 1 or State Lao DATA 3 PLWyJT NO. L AL3 vc ' 6 t_ CERTIFICATE OF COMPLIANCE CFIR-ALT 02-E Alterations to Space Conditioning Systems(formerly CF-IR-ALT-HVAC) (Page 1 of 3 j Project Name: 10175 Carol Lee Drive Date Prepared: 2016-07-22 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 CF1R-ALT-02 document for each dwelling unit. 01 Project Name 10175 Carol Lee Drive 02 Date Prepared 2016-07-22 03 Project Location 10175 Carol Lee Drive 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name 10175 Carol Lee Drive 07 Zip Code 95014 08 Dwelling Unit Conditioned 1500 ?, 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 01 02 03 04 09 10 the SC ��to Ing aSC g Identification on or Location or Area b this ducted em SC System CIA served stem ' containigining ng �n asystem SC more than 40 entirely ne Installing y rely new entirely new Name Served System(ft2) system? component? components? feet of ducts? duct system? SC system? Alteration Type System 1 Location 1 1500 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-A0274123A-000000000-0000 Registration Date/Time: 2016-07-22 10:37:55 HERS Provider:CaICERTS CA Building Energy Efficiency Standards—2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-07-22 10;37:49 Schema Version:0.555SDD CERTIFICATE OF COMPLIANCE CF111-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 Beating 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 Central13 as No heating, This field or This field or Central split. All new This field or This field or System 1 AC component section is not section is not cooling SEER 14 Setback section is not section is not furnace altered applicable applicable components applicable applicable wired Documentation: CF211-MCH-01-E-Space Conditioning Systems Ducts and Fans -Duct insulation requirement for new plenums:R6. CF2R-MCH-20-H&CF3R-MCH-20-H-Duct Leakage testing required when heating or cooling components are installed in ducted systems,or when more than 40 ft of duct length is replaced. Leakage rate compliance;515%,or 510%leakage to outside,or seal all accessible leaks, CF211-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). CMCF311-MCH-23&CF3R-MCH-23 Air Flown 300 CFM/ton required When MCH-25 is required. Exceptions: Duct systems registered with HERS provider as previously sealed are exempt fromMCH 20 Duct Leakage Testing requirements -Heating-only systems and Air Handler/Furnace chan es do not require verificafii#ii`of Air Flow MCH 23,pr Refr`gg�ant Charge Mit H_ 25r? B yy $ „ It.� �; � Existing duc#systems constructed,insulated or sealed with asbesto ,ire exem from MCH-2t�Duct,L aka a Testi re uirelnent5. g 08, .q.' ,.. t.. y p p y Al e� q E.Entirely New or Complete Re lacement Duct� .,tem with or without Equhpment Changeout(Sections 15Q 2 b).�Diia 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) This section does not apply to this project, Registration Number:216-A0274123A-000000000-0000 Registration Date/Time: 2016-07-22 10:37:55 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-07-22 10:37:49 Schema Version:0.555SDD CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E Alterations to Space Conditioning Systems(formerly CF-111-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; (�CiU/G aL.JG�2E2> Doherty,John CrJnC Company; _ Signature Date: CONTROLLED SYSTEMS OF CALIFORNIA INC 2016-07-22 10:37:55 Address: CEA/HERS Certification Identification(if applicable); P O BOX 41039 718162 City/State/Zip: Phone: SAN JOSE CA 95160 408-268-8675 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. I am eligible under Division 3 ofthe Business and Professions Code to accept responsibility forthe 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 6ofthe California Code of Regulations ? 4, The building design features or system design features identified oep�this Certificate of Com'pliance are consistent Wlth;the Inform ttion provided ort$thef applicable cdirpliance documents,worksheets, calculations,plans and specifications submitted to the aft orcementogency fortrepproval`witfiathts building permit application. S. I will ensure that a registered copy of this Certificatko Cr-`mpliance shall=be,mape'iiiailable withth.e b�riiding permit(8)issuetl for°the bUilcii`hg,and"rnade availableto the°enforcement agency for all applicable inspections.I understand that a registered copy ofth s Ce lficate of Comp4anc$Is,required to b.e,jncluded with the ctocumentation the,bi Icer provides to,the building owner at occupancy. Responsible Designer Name: Res onsibl p g �, p e Desighe Signature. x nC Doherty,John Company: Date Signed: CONTROLLED SYSTEMS OF CALIFORNIA INC 2016-07-22 10:37:55 Address: License: P OBOX 41039 718162 City/State/Zip: Phone: SAN JOSE CA 95160 408-268-8675 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 ofihe information. Registration Number:216-A0274123A-000000000-0000 Registration Date/Time: 2016-07-22 10:37:55 HERS Provider CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-07-22 10:37:49 Schema Version:0.555SDD SMOKE I-GA BON i 0,NDMD,,E A, M F I L i€ GO`MMUNITY D,EVELO'PMENT'.DEPrARTMENT w BUILDING DIVISfON I NNIF 10300TORREADEN=U E-tCUPBRTINO•,!CA35.014-3255 (408)777-3223-,FAX+(408)777-3333►rbuildrrt4.0 cut utitao,org —Z07 FiJPOSt 'Flus affidavit is a self-certification for the znstaIlatiOil of all required Smoke and Carbon Monoxide Alarms for - compltarce with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access.for inspections are required. l Xisting;s ngl94arriily and Multi-farrrily dwellings shall be provided with Smoke Alarms and Carbon Mono dde alatms When the valuation of additions,alterations,or repairs to existing dwelling units exceeds $ZO©OS',CRC Section 8314 and CDC Sections 907.2.11.5 and 420.6 require that Smoke Alar Mus a.ind./o'r Cartcn, Monoxide Alar m be installed in the following locations AU-8A SNORE ALARM CO`A�Al Ouftsfcte of,each separate sleeping area in the immecliate v>cinEy of the 0�+��re'r level©f a dweller unit irrcludrt .baserr>;erris- � X WIthin,each}%lee8 n rood Carbon Mien de alarms are not reggired in dwellings which do not containf++eI brzr ng appliances and:that don-al<1'Ra�e an attached garage. Cairbon monoxide alarms,combin i with snncrke alarms shall comlply witi, C°BSC Seche 429.6 and%Niall be approved by the Office of the State lsire � �arshal. Power Sulp,p :;Tnk well`urtg;>iinrnts with no cointx ercial power surppl ,,alar ,(s)) nay ;'e s.alely bainery operated.. 1n.,exitstift,dwel'l'ing m,tits, alarnrcs are perrnxtted to be solely,battery opera+le+d where,r, amrs or a;lte�'atzo-%ps,doi ii©t res>al�t mi the removal o,f wa and eeilriZg frnrslles or tNnere is r�o-acce%s by rne. }sof atticp basem enr,o=+crawTl. space..Refer to CRC Secfi-on R3=14 aid CB-C Sections 907.2.311.4 and 420.6>.2.An,elec,tical pe t=?=t is re t aired;foxy aila,mn&w1l dichtmust be coruitiected.to the but l'ding wkd!Lrtg. As,.owmer,of tfie above-referenced pz operly,I Hereby certify that fhe ala ain(s);s refer:meed above mast',ave be.e, nstafled in accordmLce with the rm:aivufiaclurer's instrueHon&and IR,cum-plrance with,..the Cahiforniar B;u ldInzg and Callforni a Residential Codes,The alairms lkave been;tested and are operat oizial,as,&fthe date s g ted b elow., _ A #have r=ead and a .ree fo om;i'r; rCtr>th ,f.'ermss aadc.o • i6 s;of Phis;stafemen DOW { f ...� I 4� Si naf[tre. ,.. UL Date WATER-CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 - J _(408)777-3228•FAr–,Lon 8)777-3333 b 'ldin cu ertino.or _ r — lvi c© C-) F Permit No. 'CQ j t��ilress -a V-0 L C.(t, VL 0 Q, C4-50I Ll 1. Is your real property a registered historical site? El 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? ❑ 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. IV- 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. (� l ] Yes My real property is built and available for use or occupancy on or before January 1, 1994. L—' 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: )(3KMy property is a single-family residential real property._ See Civil Code Section 1101.4. On and after January 1,2014, building alterations or improvements shall require all non-compliant plumbing fixtures to be replaced with water-conserving plumbing fixtures throughout the building.On or before January 1,2017,all non- compliant plumbing fixtures shall be replaced with water-conserving plumbing fixtures (regardless of whether property undergoes alterations or improvements). ❑' My property is a multifamily residential real property. See Civil Code Section 1101.5. On and after January 1,2014,specified building alterations or improvements shall require non compliant plumbing:fixtures to be replaced with water-conserving plumbing fixtures. On or before January 1,2019,all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvements). ❑ My property is a commercial real property. See Civil Code Section 1101.5. On and after January 1,2014,specified building alterations or improvements shall require non-compliant plumbing fixtures to be replaced with water-conserving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvements). I,as the owner or owner's agent of this property,certify under penalty of perjury that non-compliant plumbing fixtures will be replaced prior to date specified above with water-conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 through 1101.8,the current California Plumb' Code and California G n Building Standards Code,and manufacturer's installation requirements,and that the w r-con erving plumbing f res omply with the requirements as indicated in the table on the followingage. to � Owner or Owner Agent's Signat 44VDafe: 1 Upon completing and signixg this Certif ate,please return it to the Building Division in order to final your bur ing p it r SB407 2015.doe revised 08126115