B-2016-2596CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-2596
19479 ROSEMARIE PL APT 4 CUPERTINO, CA 95014-3452 (375 0l 007)
CALIFORNIA DELTA
MECHANICAL INC
6056 E BASELINE RD
MESA AZ 85206
OWNER'S NAME: COHEN DAVID N ET AL
DATE ISSUED: 08/25/2016
OWNER'S PHONE: 650-766-9160
PHONE NO: 888-828-0707
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class CC -20 Lic. # 18 1114
Contractor CALIFORNIA DELTA MECHANICAL INC Date 8/31/2018
X BLDG —ELECT —PLUMB
X MECH X RESIDENTIAL COMMERCIAL
I hereby affirm. that I am licensed under the provisions of Chapter 2 (commencing.
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
UNIT 4 - REPLACE A/C (SAME LOCATION
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
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: $9488.00
permit is issued.
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
375 01 007
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 NOT 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 regulations per the upertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 8/25/2016
Issued by: AbbyAyende
Date: 08/25/2016
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. 1, 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)
2. 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: 9/25/2016
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
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
a. 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 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 Quality Management 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, Sections 25505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent: w--'--`�
APPLICANT CERTIFICATION
Date: 8/25/2016
I certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
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
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 DECLARATION
Code, Section 9.18.
1 understand my plans shall be used as public records.
Licensed
Signature Date 8/25/2016
Professional
s
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(@cupertino.org
so
MEPMiscApp_2011.doc revised 06121/11
ALTERATIONS - MVAC
CEC-CF1 R -ALT -03-E Revised 06/14 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ALT-03-E
Alterations -HVAC CZ 1, 3 to 7 and 16 (formerly CF -IR -ALT -HVAC), (Page 1 of 1)
Site Address:
Enforcement Agency:
Date Prepared:
Permit#:
�� � �t-•OjCI''�� �C _ _
'r's
New: Ducting, Plenums, Lineset
Conditioned
Thermostat
Equipment Type Equipment Efficiency
Required R -value
Floor Area (sq ft)
❑ Packaged System
❑ Evaporator Coil
_ AFUE
COP
❑ R-6 (CZ 1,3-7) Ducts
Served by system
0 Setback
Split System
❑ Condensing Unit
SEER
11R -8t (CZ 16) Ducts
sq ft
(if not already
El Furnace
❑ Lineset
EER
HSPF
13R-6 (all CZ's) Plenums
present must
❑ R-5 or R7.5 Lineset'
be installed)
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this
form isal oVved to'be<filled ouf`by hand: For final inspection all forms are to be registered (no hand filled forms allowed) and a copy left on site.
1. HVAC CFiangeout/Repair
Required Compliance Documents to be left on site for Final:
Caninciude new ducting
All Equipment,
CF1R-ALT-02-E
Condenser Unit, Evaporator Coil,
CF2R: MECH-01, MECH-20-HERS
Air Handler/Furnace
CF3R: MECH-20-HERS
Installer Requirement: Duct leakage Lc 15% or, <10% to outside, or seal all accessible leaks)
Exempted from duct leakage testing if:
111. Duct system registered with HERS provider as previously sealed, or ❑ 2. There is less than 40 linear feet of duct in unconditioned
space, or ❑ 3. Existing duct systems are constructed; insulated or sealed with asbestos (list manufacture date of building_
❑ 2. New HVAC System Required Compliance Documents to be left on site for Final:
All new equipment and All New Ductsz CFIR-ALT-02-E
CF2R-MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS
CF3R-MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24)-HERS2
Installer Requirement: Duct leakage < 6%, Fan Efficacy (.58W/CFM), Air Flow >: 350 CFM/ton (or Standards Table 150.0-C / D alternative)
❑ 3. All New Ducts with Replacement Required Compliance Documents to be left on site for Final:
Includes replacing or installing All New CFIR-ALT-02-E
DuctsZ and one or more of the following: CF2R-MECH-01, MECH-20-HERS, MECH-(23 or 24) -HERS
Condenser Unit, Evaporator Coil, Furnace CF3R-MECH-20-HERS, MECH-(23 or 24) -HERS
installer Requirement: Duct leakage < 6%, Air Flow_ 350 CFM/ton (or Standards Table 150.0-C / D alternative)
❑ Exempted from duct leakage testing I existing duct systems are constructed, insulated or sealed with asbestos.
❑ 4. New Ducting over 40 feet
Required Compliance Documents to be left on site for Final:
Adding or replacing ducts in unconditioned
CFIR-ALT-02-E
space but less than All New Ducts'
CF2R: MECH-20-HERS
CF3R: MECH-20-HERS
Installer Required to: Duct leakage (< 15% or, < 10% to outside, or seal all accessible leaks)
Exempted from duct leakage testing I existing duct systems are constructed, insulated or sealed with asbestos.
' All new ducting R-8 required when more than 40 ft installed and R-6 when less than 40 ft installed. This includes in walls, between floors etc.
z A New Duct system is when the duct system, is constructed of at least 75 percent 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, plenums, duct material
a R-5 (1" thick insulation) for linesets 1" and less. R-7.5 (1.5" thick insulation) for linesets over 1 inch. Most mfg will require Suction line Diameter
with insulation as the following 1.5-2T-2%", 2.5 -3T -2Y4", 3.5 to 4T -2%s", 5T-4%"
Contractor (Documentation Author's /Responsible Designer'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. 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the information on this document.
I. That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24, Parts 1 and 6 of the California Code of Regulations (CCR).
4. 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 CCR.
5. The building design features or system design features identified on this Certificate of Compliance are consistent with the information
provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement
agency for approval with this building permit application.
Responsible Designer Name:
Responsible Designe at r
Date signed:
License:
J
Company: -
Address:
Ciitr_y.//State/Zip:
Phone:
//
22
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