B-2016-2819CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-2819
21140 GRENOLA DR CUPERTINO, CA 95014-1626 (326 28 060)
SANDIUM INC
SAN JOSE, CA 95134
OWNER'S NAME: BANGA GAURAV AND GITAA TRUSTEE
DATE ISSUED: 09/28/2016
OWNER'S PHONE: 625-905-3879
PHONE NO: (408) 894-9072
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C=20 Lic. #BBB_M
Contractor SANDIUM INC Date 12/31/2016
X BLDG _ELECT _PLUMB
I hereby affirm that I am licensedunder 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 AND A/C UNIT (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
permit is issued.
Sq. Ft Floor Area:
Valuation: $13000.00
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
326 28 060
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 9/28/2016
Issued by: Abby A, ej
OWNER -BUILDER DECLARATION
Date: 09/28/2016.
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
t. 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. I, as owner of.the property, am exclusively contracting with licensed
Signature ofApplicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date:/29 8/2016
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
i. 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
win 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: s �' `"^�`
�
APPLICANT CERTIFICATION
Date: 9/28/2016
1 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
CONSTRUCTION LENDING AGENCY
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
ARCHINECT'S DECLARATION
1 understand my plans shall be used as public records:
Code, Section 9.18.
Licensed
Si
Signature Date 9/28/2016
9
Professional
GENERAL PERMIT APPLICATIONMEP
COMMUNITY DEVELOKIIENT DEPARTMENT - BUILDING DIVISION
110300 TORRE AVENUE - CUPERTINO, CA 95014-3255
CUP E RTI N O (408) 777-3228 , FAX (408) 777-3333 • buildinoha cuoerino.oro MISC
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B'LILDD:,G: ❑ CONENERCIAL URBAN. A?ERFACE AREA � NO FLOOD ZO?`'E �' NO
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DESCRIPTION OF PORI
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TOT..L VALUATION: ' SDD-S7 R=HIVED BY
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By my si=nature below. I cerily to each of [he follo-,ving: I zm the property owner or authorized agent to act on tl�e property owner's behalf. I have read this
application and $e information I h..ve pro.. ed is corect. I have read the Description of Work and venfj, it is accurate. I agree to comply with all applicable local
ordinances and smote laws relating to ` _udin construction. au Drize rept entztives of CuptJtino to enter the above -i Ptined pio efor inspection pu -poses.
SinatureofA•pphcau_� nL. Date: 6
StiPPLEI�IEAJTAL INTOR\iATION REQUIRED
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STATE OF CALIFORNIA
ALTERATIONS - HVAC
CEC-CF1R-ALT-03-E 1RPvicPr9 nstlri
CERTIFICATE OF COMPLIANCE
Alterations , HVAC CZ 1, 3 to 7 and 16 (formerly CF -1R -ALT -HVAC)
CF111-ALT-03-E
(Page 1 of 1)
Site Address' •, A �a
Enforcement Agency:
Date Prepared:
I Permit#:
Equipment TypeEquipment Efficiency New: Ducting, Plenums, Lineset Conditioned
Required R -value Floor Area (sq ft) Thermostat
11 Packaged system d Evaporator Coil AFUE COP ❑ R-6 (CZ 1,3-7) Ducts Served by system Setback
O Split System PLCondensing-Unit SEER JZR-81 (CZ 16) Ducts. Esq ft (If not already
Furnace Lineset HSPF 11R-6 (all CZ's) Plenums present must
EER
❑ R-5 or R7.5 Lineset3I 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 Changeout/Repair Required Compliance Documents to be left on site for Final:
Can include 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 (: 15% or, < 10% to outside, or seal all accessible leaks)
Exempted from duct leakage testing if:
1:11. Duct system registered with HERS provider as previously sealed, or ❑ 2. There is less than 40 linear feet of duct in unconditioned
space, or 113. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building 1
2. New HVAC System Required Compliance Documents to be left on site for Final:
All new equipment and All New Ducts'
CFIR-ALT-02-E
CF211-MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23or 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)
113. 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
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 >_ 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.
114. 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,:L10% 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 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.
3 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%8', 2.5-3T-2%", 3.5 to 4T-2%", 5T-4%8'
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.
Responsible Des' r-NamQe:
1” 1�CC�V✓�-
Responsible ' 'ner Signature:
Dat�lSi ed:
License:
L
y
n
Address:
City/State/Zip:
Phone:
ror assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300
CtjpI RTINQ
_ d ess_ —I I �-A 0
PURPOSE
SMOKE I CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 o FAX (408) 777-3333 • building d(� upertino.orq
loANOLA, PR I V I-
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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 CSC 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
bedroom(s)
X
X
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 iuaccordance with the r ranZcaCtlrer S instructions and in compliance with the L
allforiila Building
and California Residential Codes. The alarms have been tested and are operational, as of the date signed
below.
Smoke and CO forin.doc revised 03118114
11
CUPEI;TINO
Owner
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DMSION
10300 'TORRE AVENUE - CUPERTINO, CA 95014-325.5
777-3228 A FM OP 777-3333 « buiidina cur)ertino ora
;a-2 0I6 ZE l
Address 2- l I LAO CKNOLA_ V 1 V , CO C &411 IN 0 6isa I Ll
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.
L7 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.
"o Go to Question 3.
3. Is water service permanently disconnected for your building?
❑Ye 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. Iss your
real property built and available for use or occupancy on or before January 1, 1994?
011401 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.
wj es 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:
�.,❑ M Y prop ertYis a single-family residential real property. y.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 fixturesto 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).
❑ Myproperty is a commercial real properly. 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 110 1. 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 followina naize. i —1-10,_1
Owner or OwnerAg;ent's. Signature:
Upon. completing and signing this Ce ific , please return it to the Building Division in order to final your building p rmit.
SB407 2015.doc revised 08126115