B-2016-2672 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2672
1143 YORKSHIRE DR CUPERTINO,CA 95014-4953(362 07 020) D G HEATING AND
AIR CONDITIONING
SAN JOSE,CA 95112
OWNER'S NAME: VITTAL CHIRADEEP AND MRiNALINI NARENDRA DATE ISSUED:09/07/2016
OWNER'S PHONE:408-685-8455 PHONE NO:(408)201-9411
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C=20 Lic.#928315
Contractor D G HEATING AND AIR CONDITIONING Date 02/28/2017 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;REPLACE A/C;SAME LOCATIONS
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
p tis issued. Sq.Ft Floor Area: Valuation:$7940.00
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 362 07 020
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 agairr}}ss' aid City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,thesap,licant understands and will comply with all non-point
source regulation per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signatur Date 09/07/2016 Issued by:
Date:09/07/2016y .
OWNERLUILDER DECLARATION
I here y 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 aloof is
1. L 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.7644,Business&Professions Code)
a 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:09/07/2016
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 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(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 Cup e Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code, ctio 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:09/07/2016 C',!
certify that I have read this application and state that the above information is E
NCY
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`^cork'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. I understand my plans shall be used as public records.
Licensed
Signature Date 09/07/2016 Professional
GENERAL PERMIT APPLICATION MEP
,- COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333•buiiding(aDcupertino.arq ' c
�_� r �16 .-
❑PLUMBING ,U-UECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS APN# `
OWNERNAIy1E P Woo 3 l✓o if9 1 �/fp PHONE (� �1 E-MAIL
STREETADDRESS
ayR � FAX
CONTACT NAME
PHONE..� ��"''ys� �} � fJ �C�l°.J'6�P f'la°,�... E-MAIL
STREET ADDRESS }��® V py �"
CITY,t9 T P�f J as�L 1 -3 FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONPRACTORAGENT ❑ ARCHITECT ❑.ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME < LIC S BER- LICENSE T BUS.LIC#
COMPANY NAME j _J - E-MAIL _ -.. - FAX
STREET ADDRESS / CITY,STATE,ZIP PHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE„ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑YES PROJECT IN ❑YES IS THE BLDG AN ❑YES -
BUILDING COMMERCIAL URBAN DTIERFACE AREA ❑ NO FLOOD ZONE El NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK
sFur.ae—e—
Lf
TOTAL VALUATION: 6 "''
By my signature below,I certi to each of the following: I am the property owner or authorized agent to act on property owner's behalf, I have read this
application and the information I have provided rrect. 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 building c ns' ction. I autl} rize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: s1f Date:
SUPPLE NTAL INFORMATION REQUIRED �
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MEPMiscApp_2011.doc revised 06121111
STATE OF CALIFORNIA
ALTERATIONS HVAC
CEC-CFI R-ALT-03-E Revised 06/14 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CFIR-ALT-03-E
Alterations-HVAC CZ 1,3t 7 and 16(formerly CF-IR-ALT-HVAC) (Page 1 of 1)
Site Address: Enforcement Agency: Date Prepared: Permit#:
l 1
Jo,rtP5 )b
New:.Ducting,Plenums,Lineset Conditioned
Equipment Type Equipment.Efficiency Thermostat
Required R-value Floor Area(sq ft)
❑ Packaged System ❑Evaporator Coil '760 AFUE COP ❑R-6 (CZ1,3-7)Ducts Served by system ❑Setback
JVU
iit'System n ondensing Unit 13 SEER ❑R-8' (CZ 16)Ducts sq ft (If not already
HSPF ❑R-6(all CZs)Plenums present,must
rn,ace Lineset EER 13R-5 or R7.5 Lineseta 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.
1.HVAC Cfangeout/Repair Required Compliance Documents to be left on site for Final:
Can-include new ducting
All Equipment, CF111-ALT 02-E
Condenser Unit,Evaporator Coil, CF2R:MECH-01,MECH-20-HERS
Air Handier/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❑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 l
❑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)
❑3.All New Ducts with Replacement Required Compliance Documents to be left on site for Final:
Includes replacing or installing All New CF1R-ALT-02-E
Ducts2 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:Ductleakage<6%,Air Flow>_350 CFM/ton(or Standards Table 150.0-C/D alternative)
El 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 H-2
space,but less than All New'Ducts' CF2R:MEC -20 HERS
CF3R:MECH-20-HERS
Installer Required to:Duct leakage(<15%or,<10%to outside,or seal all accessible leaks)
11 Exempted fromi 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 wails,between floors etc.
'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.
I 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%",5T-4%"
Contractor(Documentation Author's/Responsible Designer's Declaration Statement)
fy g p y perjury,under the laws of the State of California:
1 certify the following under enalt of
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.
Responsible Designer Name: Responsible DesignerSignatur Date Signed: License
Company: Address: ✓ 'r'C+Q City/State/Zip: Phone:
For assistance or questions regarding the Energy Standards,contact the Energy Hotline at:1- 00-772-3300
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERT.INO 10300 TORRE AVENUE CUPERTINO,CA 95014-3255
(408j 777-3228•FAX(408)777-3333•buildingcuoertino org
OwnerName
Ca�11 Permit N o_ 2-0�.�''
Address
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.
o 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.
0��o 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..
o Go 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.
Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.,
V Yes My real property is built and available for use or occupancy on or before January 1, 1994.
Civil Code Sections 110 1.1 through 1101.8 apply. Check one of the three following statements and sign
bottom of form..
5. Prle check ONE of the following:
Ff VMy 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):
1,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 followin page.
Owner or Owner Agent's Signature Daft: f Dj
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit.
SB4072015.doe revised 08126115
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
CtJPERTINO 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255
(408)777-.3228 FAX(408)777-3333•building(Wcupertino.org
dress �' #ofANrms -Sm-o--e: Carbon Mono cle
PERMIT CANNOT BE FrWA LED AND COMPLETED UNTIL TffiS CERTLFICATE LL
HAS BEEN,sig=AND 2 Ti0 THE P,UILDING;DIVISION
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 i,ncluding 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
CSC 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.
Iii 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 wiui flie manufacturers ms 1L uC loris and in compliance with the Califon-da 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 A
gents)_Name:'-
V l t"" si nafiur....J�...... ..:. . ............... ............. Date............,.....
5o'ntra5o,Natn.e:
Sinature :'........ .........................................:,.Lic#_ ...................................{Date ..................
Smoke and CO for ns.doe revised 03/18/14