B-2016-2593 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2593
940 ROSE BLOSSOM DR CUPERTINO,CA 95014-4216(359 06 027) NORTHWEST PACIFIC
VALLEJO,CA 94589
OWNER'S NAME: RAO PATNALA D AND VINUTHA D TRUSTEE BATE ISSUED:08/25/2016
OWNER'S PHONE:408-368-8579 PHONE NO:(707)746-7737
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C=20 Lic.#922380
Contractor NORTHWEST PACIFIC Date 09/30/2016 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:
I hereby affirm under penalty of perjury one of the following two declarations: REPLACE FURNACE AND A/C(SAME LOCATION)
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
/57' 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
permit is issued. Sq.Ft Floor Area: Valuation:$13500.00
APPLICANT CERTIFICATION
I 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 359 06 027
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-regulati ns per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 8/25/2016 Issued by:Abby Ayendg
Date:0815/2016
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(See.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: /28 5/2016
1 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 sclf-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
3. 1 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
shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous
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 /t �–
be deemed revoked. ,Owner or authorized agent: L., -
APPLICANT CERTIFICATION L Date:8/25/2016
I 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 DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 8/25/2016 Professional
z Z' i3
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE-AVENUE•CUPERTINO, CA 95014-3255 AIWA AM&
CUr ERTfN€ (408)777-3228•FAX(408)777-3333•buildinaCd)cupertino.org
❑ M I
PLUMBING CHANICAL []ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS... q,0 APN#
3,5q ob
ONVNERNAME PHOT E-KkIL
STREET ADDRESS_ CITY,STATE,ZIP FA a
toer CA
CONTACT NAME PHO 8 s E-M.AIL
STREET ADDRESS }I ® CITA �ZIPI i k i t IC
✓ FAQ
k le
13OP21.'ER ElwNs\,ER-BuiLDER 1301ANERAGEIT �❑ CONTRACTOR01`TRACTORAGITT 'T ❑ ARCHITECT ❑ENGLNEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER T%VLICENSE TYPE BUS.LIC T
COMPANY?\?AME yy
r �"� V.e c"'� ���J �t I� E-MAIL FAX
STREET ADDRESS CITY STATE,ZIP PHONE
ARCHITECT/ENGINEERNAME LICENSE NUMBER`'I BUS.LIC;
COI`4PANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ,;? SFD or Duplex ❑ Multi-Family PROJECT IN WILDI.AND I PROJECT IN
STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONT Cl Yes ❑ No
DESCRIPTION OF WORK
TOTAL VALUATION: J RECEIVED BY
J
By my signature below,I certify to each of the following: I am 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 have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to bu'ding construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: (/��If 16
S)PPLEMENTAL INFORMATION REQUIRED of icy DSE o Y,
r _
�� �� O�ER THE COUTTER
E' I❑ ESS
STAIi'DARD
U
LARGE
• � T�ZAJOIs ,, ,
G�(�, MEPA7isc pp__OI L doC 7evised 03116/11
STATE OF CALIFORNIA
ALTERATIONS - HVAC
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: qq Enforcement Agency: Date Prepared: Permit#:
Equipment TYPe Equipment EficiencY New:Ducting,Plenums,LinesetConditioned
Thermostat
Required R-value Floor Area(sq ft)
ackaged System El Evaporator Coil
AFUE COP ❑R-6 (CZ 1,3-7)Ducts Served by system ❑Setback
E3 Split System Condensing Unit SEER El R-S' (CZ 16)Ducts sq ft (If not already
HSPF ❑R-6(all CZ's)Plenums present,.must
J2rFurnate A Lirieset EER El or R7.5 Lineset3 be installed)
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this
form is allowed to be filled out by hand. For final inspection all forms.are to be registered(no hand filled forms allowed)and a copy left on site.
AC Changeout/Repair Required Compliance Documents to be left on site for Final:
Can4nciude new ducting
All Equipment, CFIR-ALT-02-E
Condenser Unit,Evaporator Coil, CF2R:MECH-01,MECH-20-HERS
Air Handler/Furnace CF3R:MECH-20-HERS.
Installer Requirement:Duct leakage(:S.15%or,<10%to outside,or seal all accessible leaks)
Exempted from duct leakage testing if:
❑1.Duct system registered with HERS provider as previously sealed,or Q 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 Ducts' CF1R-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)-HERS'
Installer Requirement:Duct leakage<6%,Fan Efficacy(.58W/CFM),Air Flow>_350 CFM/ton(or Standards Table 150.0-C/D alternative)
1:13.All New Ducts with Replacement Required Compliance Documents to be left on site for Final:
Includes replacing or installing All New CF111-ALT-02-E
Ducts'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;t 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 CF1R-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.
'A New Duct systemis 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.
s 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-2%",3.5 to 4T-2%8',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.
3. 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.
Re�p"pnsibblle Designer Name: Responsible D si er Signature: DaW
igned: l( License:
VUff�J 1I1U111�` 3.
//-V ,� f V I _Company: 1 Address: City/�tate/zip: e� Phone: 7
3-7
For assistance or questions regarding the Energy Standards,contact the Energy Hcklir(e at:1-$00-772-3300
a
SMOKE I CARBON,MONOXIDE ALARMSFILE
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION f
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228 FAX(408)777-3333.build!ng{akupertino.org
Permit No.
-°ZO1lti ^2 '3
Address 14 D kmw W-o s 4_�a'e"' 1�3-g #of Alarms Smoke: Carbon Monoxide:
PERMIT CANNaT BE FINALED ANDCC�MPLETEI?ENTIL'THIS CERTIFICATE
CHAS BEEN 7+ ,AND RT 11RNEDTO HE BfDILDING DTSIOI�I ?
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 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 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.
I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name: i y
� Liar. pQ Date: . .`9J..1..�.f.
,CA--, t> r �.�0 Signature......1......� _:.. ...... ..... ... ......
Contractor Name:
Signature...................................................................Lic.#......................................Date: ...................
Smoke and CO fonn.doc remised 03118114
i
MATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE � !f l
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
10300TORRE AVENUE- CUPERTINO, CA 95014-3255
CU.PERTINI 7
(408)777--3-3228(408)777-3333•buil'ding(a cupertino org
Owner Name P A-i 1V A i-- 8 4D 1 Permit TXT b 2
Address 9+ P_0> 8 L-c-3e, r.1 � A , L CA elS0r�-
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 forma
No Go to Question 3.
3. Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 110'1.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
,�?'No Go to Question 4.
z
4. Is your real property built and available for use or occupancy on or before January 1,4994?
El 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:
My propertyis.a single-family residential real property.,See Civil Code Section 1101.4.
Ori 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: 3 - Date: 31 i$
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit.
SB407 2015.doc revised 08126115
BUM-DMG P,!Vjlcrk
Pion-Compliant Water-Conserving Plumbing Fixture
Plumbing Fixturel (Fixture Complying with Current Code Applicable to New Construction)
Fixture Type Maximum Water Usage/Flow Rate
Water Usage 2013 CPC Ch.4 2013 CPC Ch.4 2013 CPC Ch. 4
/Flow mate2013 CALGreen Div.4.3 2013 CALGreen Div.4.3 2013 CALGreen Div. 53
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,
UrinaBs
average flush volume of two reduced flushes and one full flush
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 perminute @
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
maybe 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.doc revised 08126/15