B-2016-1860CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1860
18780 TILSON AVE CUPERTINO, CA 95014-3858 (375 17 036)
PAB CONSTRUCTION
INC
CUPERTINO, CA 95014
OWNER'S NAME: Uda Patel
DATE ISSUED: 08/2912016
OWNER'S PHONE: 408-504-1061
PHONE NO: (408) 499-6595
I ICFNSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class B Lic. #980537
Contractor PAB CONSTRUCTION INC Date 01/31/2017
X BLDG _ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
_ 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:
CONSTRUCT TWO STORY SFD (2,355 S.F.); ATTACHED GARAGE
I hereby affirm under enal ofperjury Mowing two declarations:
y penalty p ry one of the following
(420 S.F.); PORCHES/DECKS/BALCONIES (422 S.F.).
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.
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
Lj permit is issued.
Sq. Ft Floor Area: 2775
Valuation: $504000.00
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 to building construction, and hereby authorize
375 17 036
Deferred Submittal (R-3),R-3 (Custom),R-3 (Custom),U
representatives of this city to enter upon the above mentioned property for
(Private Gar / Ag Bldg),Deferred Submittal (R-
inspection purposes. (We) agree to save indemnify and keep harmless the
3),Deferred Submittal (R-3),Deferred Submittal (R-
City of Cupertino against liabilities, judgments, costs, and expenses which
3),Deferred Submittal (R-3),Deferred Submittal (R-
may accrue against said City in consequence of the granting of this permit.
3),Deferred Submittal (R-3),Deferrcd Submittal (R-
RAdditionally,
Additionally,the pplicant understands and will comply with all non-point
3),Deferred Submittal (R-3),U (Private Gar/Ag Bldg)
source regulati s p r the Cupertino Municipal Code, Section 9.18.
\ '
PERMIT EXPIRES IF WORK IS NOT STARTED
signature Date $/29/2016
WITHIN 180 DAYS OF PERMIT ISSUANCE OR ,
-
180 DAYS FROM LAST CALLED INSPECTION.
V
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
Issued by: Abby Aygnde
1. I, as owner of the property, or my employees with wages as their sole
Date: 08/29/2016
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business & Professions Code)
RE-ROOFS:
a. I, as owner of the property, am exclusively contracting with licensed
All roofs shall be inspected prior to any roofing material being installed. If a roof is
contractors to construct the project (Sec.7044, Business & Professions Code).
installed without first obtaining an inspection, I agree to remove all new materials for
I hereby affirm under penalty of perjury one of the following three declarations:
inspection.
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
Signature of Applicant:
performance of the work for which this permit is issued.
Date: 8/29/2016
2. 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
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
permit is issued.
3. I certify that in the performance of the work for which this permit is issued, I
HAZARDOUS MATERIALS DISCLOSURE
shall not employ any person in any manner so as to become subject to the
I have read the hazardous materials requirements under Chapter 6.95 of the
Worker's Compensation laws of California. If, after making this certificate of
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
exemption, I become subject to the Worker's Compensation provisions of the
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Labor Code, I must forthwith comply with such provisions or this permit shall
Health & Safety Code, Section 25532(a) should I store or handle hazardous
be deemed revoked.
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
APPLICANT CERTIFICATION
will maintain compliance with the Cope ' o unicipal Code, Chapter 9.12 and
I ceitify 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
the Health & Safety Code, S.s 25 O5, 2 33, and 25534.
I
relating to building construction, and hereby authorize representatives of this city
to enter upon the above mentioned property for inspection purposes. (We) agree i
Owner or authorized agent: 1
'112
to save indemnify and keep harmless the City of Cupertino against liabilities,
Date: 8/29/2016
judgments, costs, and expenses which may accrue against said City in
GENCY
I hereby affirm that there is a constru ti n lending agency for the performance
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal
of work's for which this permit is issued (Sec. 3097, Civ C.)
Code, Section 9.18.
Lender's Name
Lender's Address
Signature Date 8/29/2016
ARCHITECT'ARCIHTECTIS DECLARATION
I understand my plans shall be used as public records.
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228+ FAX (408)
77i-3333 bildingacunertina.orgCLPERSIN�t � /�c -
D/NEW
CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS ^
OWNERNAME Lk \ 5 -7PHCiNE E-MAIL _
STREETADDRESSQ i CITY, STATE, ZIP fFAX
(ijt?
CONTACT NAME f €. a gN`
'Y
PHONE —},I k E-MAIL
TREJiTADDRESSA6yr CITY, STATE`, ZIP G FAX
OWNER ❑ OWNER -BUILDER ❑ OWNERAU'HNT ❑. CONTRACTOR ❑ CONTRACTORAGENT 2 .ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC #
COMPANY NAME E-MAIL. FAX
STREET ADDRESS CITY, STATE, ZIP PHONE
CHITS lENGINEERNAME LICENSENUMEER BUS. LIC11
114m 9 410
COMPANYNAME P.MAIL FAX —
STRb'ETADDRESS CITY, STATE, ZIP PHONE
DESCRIPTION OF WORK_
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EXISTING USE PROFUSED USE CONSTR. TYPH I #:STOR]ES
_._._...._.,_....... _........ ..... ..::_:,:.: OFFICE.DSEdt�ISY __;.::'-:moi t:.:I->.-,:=::
.........
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AATION
EXIST FLOOR O - -' - -' - - -
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r �}•;��`�._c-::�.''E*�'=SEE?:"��''-c .: ':'_�•r%-:;E::`�'t
ARRA AREA Z.�f AREA �{ NET ARRA i7i/ .[/7.!...:. ; N:.'�
BATHROOM. ICTCH13N OTHER r _ ::.-:.:-:...a :•:>::::.,::_:-:_..;::-___,-=:,::.,.<::_.�::. .: _-:- .......,y _.-..:...
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DECK AREA
- ACH PORCH AREA TOTAL DECIP RCH AREA GARAGE ARE_ DT...
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QATTACH
RDWELLINGUNITS: ISA SECOND UNIT rl YZS SECONDSTORY ❑YES
BEINCADDED7 O -.1--10 .:. .......:... .. .. ..___. : a:
__ .: .,
PR E•APPACATION YES IF YES, PROVInF. C.OM'OPPLANNER'SNAMai -VALiiATION
PLANNINOAPPL6 E] NO PLAYNING APPROVAL LETTER
By my signature below, I certify to each of the following: f am the property owner or authorized agent to act on the properly 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 buildin construction. I authorize representatives of Cupertino to enter the above -identified properly for inspection purposes.
yy � `� t
SignatureofAplalicanUAgent: W,� f AA Date: I. ! #
TALINFORMATI.>,"
$UPP LEMEN ON REQUIRED
c =.;.•:"::.: _:--:.;r:_:-_:: -:,:::; _::::,::,.::::::-:=
U.. PLAN:CHECK:T;YPE3r :-'_ `� :
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-`_:-_z;-!;,';:_:.ROj3TING SLIP;::,; "==•-= ::.,_;.: �:
New SFD or Multifamily dwellings: Apply for demolition permit for
— Now
existing building(s). Demolition pennit is required prior to issuance Of building
_ ❑:,,OVER TILE-CQUATER
-
LDINGPLAh TtIiVIE1V
permit for new building.:..
_ Commercial Bldgs: Provide a Completed Hazardous Materials Disclosure
To—if any hazardous Materials are being used as part of this project
'
,- ..
sTAnDARD
-
❑ . iARGC
rLANNINGPL. RENIEYV
PUEI IC �NORks
FIRE DEPT
Copy of Planning Approval Letter or Meeting with Planning prior t0
subrnittal of Building Permit application.--
� `nq iJ4k
. S�ITARY SHIVER DISTRICT•
BldlgApp. 2011.doc revised 031161.11
'n -1N-1`7 C �r
CERTIFICATE OF VERIFICATION CF3R-MCH-20-H
Duct Leakage Diagnostic Test' —� ,�•-�"'� iP
Project Name: Patel Residdence
-
Enforcement Agency- City of
Cupertino
Permit Number- B-2016-1860
Dwelling Address: 18780 Tilson Ave.
City, Cupertino
Zip Code: 95014
A. System Information
01
Space Conditioning System Identification or Name
System 2
02
Space Conditioning System Location or Area Served
Location
03
Building Type from CF -111
Single family
04
Verified Low Leakage Ducts in Conditioned Space
(VLLDCS) Credit from CF1R?
No, credit is not taken
05
Verified Low Leakage,Air Handling Unit (VLLAHU) Credit
from CF1R?
No, credit is not taken
06
Duct System Compliance Category
New
MCH -20a - Completely New:Duc systen
B. Duct Leakage Diagnostic Test
01
Condenser Nominal Cooling Capacity (ton)
2
02
Heating Capacity (kBtu/h)
39
03
Conditioned Floor Area served by this HVAC system (ft2)
883
04
Duct Leakage Test Condition
Test final
05
Duct Leakage Test Method
Total leakage
06
Leakage Factor
0.06
07
Air Handling Unit Airflow (AHUAirflow) Determination
Method
Heating system method
08
Measured AHUAirflow
This field or section is not applicable
09
Calculated Target Allowable Duct Leakage (cfm)
51
10
Actual duct leakage rate from leakage test measurement
(cfm)
50
�El
Compliance Statement
System passes leakage test
Registration Number- 216-N0149098A-M2000003A-M20A Registration Date/Time, 2017-06-28 2041:31 HERS Provider- CalCERTS
CA Building Energy Efficiency Standards Report Version. 2013 Rev 1.008 Report Generated: 2017-06-28 20:40:58
2013 Residential Compliance Schema Version. 2013.1.007
CERTIFICATE OF VERIFICATION CF3R-MCH-20-H
Duct Leakage Diagnostic Test (Page 2 of 3 j
B: Duct Leakage Diagnostic Test
12 Notes
C. Additional Requirements for Compliance
01
System was tested in its normal operation condition. No temporary taping allowed.
Outside air (OA) duct connections to the central forced air duct system shall not be sealed/taped off during duct leakage
02
testing. OA ducts used for Central Fan Integrated (CFI) Indoor Air Quality ventilation systems, or Central Fan Ventilation
Cooling Systems, that utilize dampers that open only when OA is required and automatically close when OA is not required,
may configure the OA damper to the closed position during duct leakage testing.
03
All supply and return register boots were sealed to the drywall.
04
Building cavities were>not used as plenums or platform returns in lieu of ducts.
05
if cloth backed tape was used it was covered with Mastic and draw bands.
06
All connection., points between the air handler and the supply and return plenums are completely sealed.
Visual Inspection at Final Construction Stage (;applicable tf system wast stpd at rough 11
t..
After installing the interior finishing mall and verifying that the above rough m tests was ctmpleted, the followit� procedure must
be performed -- K
For al I supply and return reg isters`_verify that thespaces`between the register boot and theinterior finishing wall ar'e
07
properly sealed.
08
If the house rough -in duct leakage test was conducted without an air handler installed, inspect the connection points
between the air handler and the supply and return plenums to verify that the connection points are properly sealed.
09
Inspect all joints to ensure that no cloth backed rubber adhesive duct tape is used.
10
Verification Status
Pass
11
Correction Notes for this table
'The responsible persons signature on this compliance document affirms that all applicable requirements in this table have
been met unless otherwise noted in the Verification Status and the Corrections Notes in this table.
D. Determination of HERS Verification Compliance
All applicable sections of this document shall indicate compliance with the specified verification protocol requirements in order
for this Certificate of Verification as a whole to be determined to be in compliance.
101 1 Complies: All specified verification protocol requirements on this document are met.
Registration Number: 216-N0149098A-M2000003A-M20A Registration Date/Time: 2017-06-28 20:41:31 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.008 Report Generated: 2017-06-28 20:40:58
2013 Residential Compliance Schema Version: 2013.1.007
CERTIFICATE OF VERIFICATION CF311-MCH-20-1-11
Duct Leakage Diagnostic Test (Page 3 of 3 )
Documentation Author's Declaration Statement
1. i certify that this Certificate of Verification documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
Miles H Hancock-
✓"
Company:
Date Signed:
Energy Design Group
2017-06-28 20:41:31
Address:
CEA/ HERS Certification Identification (if applicable):
2149 Dartmouth St
CC2005088
City/State/Zip:
Phone
Palo Alto CA 94306
650-804-9063
Responsible Person's Declaration statement
I certifythe following under penalty[of perjury, under the laws of the State of California:
1, The information provided:on this Certificate of Verification is true and correct.
2. l am the certified HERS iiaterwho performed the verification identified and reported on this Certificate of Verification (responsible rater).
3. The installed features, materials, -components, manufactured devices, or system performance diagnostic results that require HERS verification
identified on:this Certificate of Veiification comply with the applicable requirements in Reference Appendices RA2, RA3, and the requirements
specified on the Certificate of Compliance for the building approved by the enforcement agency.
4. The information reported on applicable sectiosbthe Certificates} pf=Ehst#llattvri {CF2RS'-slgned artd Subrrrttttiilby the persons) responsible for the
construction or installationcorifo'ims to the t uirementwspecifedtrn the Certificate(sj f Compliaifee (Cr -1--R) approved by -,,-,the erifprcemept'llgency.
5. I will ensure that a registered cop}i of this Certificate of tertQatian s all be posted or mariefe vailable with 44 ilding peij it(s} issued ftiir the
building, and made available to tf,,;enforcement en �for� II applicable inspections 1 onderstandthat a registered copy 4thi` Certifcate of
Verification is required to beincluded with the documentation the build`e`"r provides to the building owner at occupancy.
Builder Or Installer Information AsShowon b111he"Certificate Of Installation
Company Name (Installing Subcontractor, General Contractor, or Builder/Owner):
NORTH CAL HEATING AND AIR
Responsible Builder or Installer Name;
CSLB License:
Slobodan Playsic
HERS Provider Data Registry Information
Sample Group Number (if applicable):
Dwelling Test Status in Sample Group (if applicable)
Tested
HERS Rater Information
HERS Rater Company Name:
Energy Design Group
Responsible Rater Name:
Responsible Rater Signature:
Miles H Hancock
Responsible Rater Certification Number w/this HERS Provider:
Date Signed:
CC2005088
2017-06-28 20:41:31
Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document, and innoway implies
Registration Provider responsibility for the accuracy of the information.
Registration Number: 216-N0149098A-M2000003A-M20A Registration Date/Time: 2017-06-28 20:41:31 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.008 Report Generated: 2017-06-28 20:40:58
2013 Residential Compliance Schema Version: 2013.1.007
-----------
CALGREEN SIGNATURE DECLARATION5 w
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Pfc-lect Name*
P -ect Address:
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