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B-2016-2804 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2.016-2804 10541 N BLANEY AVE CUPERTINO,CA 95014-2454(316 34 029) PELLE HEATING& AIR INC SAN JOSE,CA 95111 OWNER'S NAME: LIN HONGPING AND DING PING DATE ISSUED:09/26/2016 OWNER'S PHONE:408-6790931 PHONE NO:(408)978-7060 LICENSE )R'S DECLARATION BUILDING PERMIT INFO: License Class C-20 Lic.#809887 Contractor PELLE HEATING&AIR INC Date 10/31/2017 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: REPLACE FURNACE(SAME LOCATION);INSTALL(N)AC UNIT I hereby affirm under penalty of perjury one of the following two declarations: r. 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 permit is issued. Sq.Ft Floor Area: Valuation:$5000.06 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 316 34 029 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 Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature- =^ Date 9-26-2016 Issued by:Kim Dunbar Date:09/26/2016 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 r. 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(Sec.7044,Business&Professions Code) 2. 1,as:owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(See.7044,Business&Professions Code). Date:9-26-2016 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. 1 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. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(x)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 be deemed revoked. c�Owner or authorized agent �. APPLICANT CERTIFICATION Date:9-26-2016 certify that I have read this application and state that the above information is CO STRUCTIO"E 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 9-26-2016 Professional GENERAL PERMIT APPLICATION MEP s. COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION i 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333 building—cupertino.orggU R lO MISC �-701 r� F. —'2F6� Ej PLUMBING MECHANICAL ]ELECTRICAL []MISCELLANEOUS y. PROJECT ADDRESS APN# / OWNER NAME E-MAIL 'Pty Dv� V-7 - 073 STREET ADDRESS CSI Y, STATE,Z1P FAX CONTACT NAME ONE E-MAIL # . >d 1 STREET ADDRESS CITY,STAT6E,ZIP f3 FAX p1 _ y vet N OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT PKCONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME {.(CENSE NUMBER LICENSE TYPE BUS.LIC !��✓ Ips C1y`.�7 I COMPANY NAME E-MAIL STREET ADDRESS ((��@@� CITY STATE,ZIP PONE 9 513LP O + ARCIUrECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS. CITY,STATE,ZIP_ - PHONE USE OFSFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES ;4_1;t BUILDING ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO .. DESCRIPTION OF WORK f d '1 P A. !AI ( 6. 3. TOTAL VALUATION: RECEI 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 eqneq 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 ing consfructigh. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: - Date: SUPPLEMEN INFORMATION REQUIRED o�rci�sl•;o�aLY ,. "u f ,#� � OVERT73�COUN"TER . a ©77, ' LAItZ:E NTATOR ,{J MEPMiscApp_2011.doc revised 06/21/11 a%ry, ;a CERTIFICATE OF COMPLIANCE CF111-ALT 02-E Alterations to Space Conditioning Systems(formerly CF-IR-ALT HVAC) (Page 1 of 3) Project Name Ding,Ping Date Prepared: 2016-09-16 A.General Information CF1R-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 Ding,Ping 02 Date Prepared 2016-09-16 03 Project Location 10541 N.Blaney Ave 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name Ding,Ping 07 Zip Code 95014 08 Dwelling Unit Conditioned 2092 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 u ., ,,, •, , y� ,�< � fix, w. 7 t, 01 02 03 04• OS, 06 w 0 1 . ;'� 0 09 10 �. .g ti SC` installing a SC System SC System CFA served ystem a r, frigerant �'-Instal iq nevi S Ir stahin"g Installing, ;Installing Identification or Location or Area by this SC ducted containing system more than 40 entirely new entirely new Name Served System(ft2) system? component? components? feet of ducts? duct system? SC system? Alteration Type Ding,Ping Whole house 2092 Yes Yes Yes No No No Altered space conditioning system "!� T C.Extension of Existing Duct System,Greater Than 40 Feet(Section 150.2(b)1Diib) This section does not apply to this project. Registration Number:216-A0342347A-000000000-0000 RegistrationDate/Timer 2016-09-16 09:39:47 HERS Provider:CalCERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.008 Report Generated:2016-09-16 09:40:28 Schema Version:0.555Snr) x. CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E Alterations to Space Conditioning Systems(formerly CF-1R-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 Heating 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 Central gas All new Central split All new This field or This field or Ding,Ping furnace heating AFUE 92 AC cooling SEER 14 Setback section is not section is not components components applicable applicable Reouired Documentation: CF2R-MCH-01-E-Space Conditioning Systems Ducts and Fans -Duct insulation requirement for new plenums:R6. CF211-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:<_15%,or<_10%leakage to outside,or seal all accessible leaks. CF2R-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). CF2RCF3R-MCH-23&CF3R-MCH-23 Air Flow>_300 CFM/ton required when MCH-25 is required. Exceptions: Y g p previously p M 20 Duct Leakage Testing requiremerats1 r Duct systems registered with HERS provider as reviousl sealed are exempt from CH- Heating-only systems and Air Handler/Furnace changes do not require verification of Air FlotN,w MGH,23 itr Refi igeranfC�ia�ge nh R 25 � -Existing duct systems constructed,insulated or sealed with asoestos are exempt;from MCH=20 putt L age Testittg:requir"fi. �r E. Entirely New or Complete Replacement Duc 'item,with or without Eqqjpment Ghangeout(Sections 1S0 2(b)1Dna.and 150.2(b)1E,F) J 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-A0342347A-000000000-0000 Registration Date/Time: 2016-09-16 09:39:47 HERS Provider:CalCERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.008 Report Generated:2016-09-16 09:40:28 Schema Varcion;0.555Snn 4 E CERTIFICATE OF COMPLIANCE CFIR-ALT 02-E Alterations to Space Conditioning Systems(formerly CF-IR-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: Q / _"' 00/-C Sanchez,Rafael �I�jA Company: Signature Date: PELLE HEATING&AIR INC 2016-09-16 09:39:47 Address: CEA/HERS Certification Identification(if applicable): 179 SAN RAMON DRIVE City/State/Zip: Phone: SAN JOSE CA 95111 408-978.7060 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. l am eligible under Division 3 of the Business and Professions Code to accept responsibility for the 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 bu Iding design or system design identified on this Certificate of Compliance conform to the requirements of Title 24,Part 1 and Part 6 of the California Code of Regulatfbns. ' , 4. The building design features or system design features identified on4his Certificate of�bmpliance are conststenty ter-the informatton provided o otherapplicaple'compliance documents,worksheets, i, 1i„ . 411 calculations;plans and specifications submitted to the eriforcement.agency for approv�l with this buildrng permit ap)lication. �i 5. J will ensure that a registered copy of this Certificate of.Coinpliance shal);,be made available witii„tl��buildiri»pgrmit(si issue6 for the buildjng,and.made aval ble,t hforcement agency for all applicable inspections.I understand that a registered copy of this-Gei{icate of Complianc, �$required to be included ]#h the documentation the builder provides tonne building owner at occupancy. Responsible Designer Name: Resp ons)ble Desig ner Signature: Sanchez,Rafael Company: Date Signed: PELLE HEATING&AIR INC 2016-09-16 09:39:47 Address: License: 179 SAN RAMON DRIVE 809887 City/State/Zip: Phone: SAN JOSE CA 95111 408-978-7060 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 of the information. Registration Number:216-A0342347A-000000000-0000 Registration Date/Time: 2016-09-16 09:39:47 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.008 Report Generated:2016-09-16 09:40:28 Schema Version:0.555SDD WAFER-CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE F �1,�77 COMMUNITY DEVELOPMENT BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE m CUPERTINO,CA 95014-3255 O (408)777- 228-FAX(408)777-3333 building cupertino.org Owner Nam , t PermtNo Address Ud is 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? 0 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. 4. Is your real property built and available for use or occupancy on or before January 1, 1994? 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. 1 K 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.. c 5. Please check ONE of the following: LJ My 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 orbefore 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,). ❑ holy 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 plumbingfixtures to be replaced with water-conserving plumbing fixtures. On or before January 1, 26191 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.'g 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 11018,the current California Plumbing Code and California Green Building Standards Code,and manufacturer's installation requireiaaents,and that the water-conserving plumbing fixtures comply with the requirements as indicated in the table on the following page.. Owner or Owner Agents Signature:; } / Date; toy Upon completing and signing this;Ceitificate,please return it to the Building Division in order to final your building permit. 04072015.doc revised 08/26/15 SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE M E COMMUNITY DEVELOPMENT'DEPARTMENT•BUILDING DIVISION L i CI dPETl`lC 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333• building(6cupertino.org Permit No. 1 1�- Address J� / eAll" . #of Alarms Smoker Carbon Monoxide: ._. 610" IT CANNQT BE FINALEDXAND COMPLETED UNTIL THIS CERTIFICATE 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 CSC Sections 907.2.1.1,4 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. l have read and a ree to comply with the terms and conditions of this statement Owner(or Owner Agents)Name: Signature r .............Date: Contractor Name: Sinature...................................................................Lic.#......................................Dater ................... Smoke and CO form.doc revised 03118114