B-2016-2834CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-2834
22330 HOMESTEAD RD APT 303 CUPERTINO, CA 95014-0137 (326 59 056)
ON-TIME AIR
CONDITIONING &
HEATING INC
PLEASANTON,CA
94588
OWNER'S NAME: WIGGLESWORTH DIANE C
DATE ISSUED: 09/29/2016
OWNER'S PHONE: 408-7725424
PHONE NO: (925) 444 4444
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class a-2,Q Lic. #817040
Contractor ON-TIME AIR CONDITIONING & HEATING INC Date 09/30/2017
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 affirmlunder penalty of perjury one of the following two declarations:
REPLACE HEAT PUMP (ROOF); REPLACE AIR HANDLER (CLOSET36K
BTU)
1. I ve and will maintain a certificate of consent to self-insure for Worker's
ompensafion, 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: $9637.00
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 59 056
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 046e granting of this permit.
Additionally, the applicant understands andAll comply with all non-point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per the Cupertino M . ci' ipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
4�)
Signature f Date 9-29-2016
Issued by: Kim Dunbar
1/1 J
OWNER-BUILDER DECLARATION
Date: 09/29/2016
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
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 (Scc.7044, Business & Professions Code)
z. 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: 9 29-2016
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1. 1 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
3. 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 h dle azardous
shall not employ any person in any manner so as to become subject to the
material. Additionally, should I use equipment or devices ch emit hazardous
it
air contaminants as defined by the Bay Area Air Qua ' Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the Cupertino M2#}99� Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Coder9gstions 2550 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: 9-29-2016
I certify that Ihave read this application and state that the above information is
correct. 1-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
ARCHITECT'S DECLARATION
Code, Section 9,18.
1 understand my plans shall be used as public records.
Licensed
Signature Date 9-29-2016
S
CUPER.TINO
GENERAL PEWIT APPLICATION
COMMUNITY DEVELOPI-01ENT DEPART10ENT • BUILDING DIVISION
110300 T ORRE AVENUE CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 • buildingaQcuoerino.ora
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By my si`nati� blow. I c airy to each of :he follo-wing: I amthee prop -t) o�vn= or zuthorizea 4oea to act . a the prop rr owners beaalr 1 have read this
application and the information I have e prow ided is co t. I ha read the De ti^ption of lYo 1, and ve if it is accw�te. I ag e io comply with all applicable local
and nzn es zad e ate 72 3 s relxtin_s to �uildina cons' a tion I an hor ze re _ en�rives of Lupe; ino to n r the above -id_ hne' op r inspection puoses.
Si_natureofApplicant', Rent: Date:
SUP PL_-tl \TAL PAF R� ATIO� REQUIRED
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CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
_
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 1 of 3 )
Project Name: MILES WIGGLESWORTH Date Prepared: 2016-09-27
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 MR -ALT -02 document for each dwelling unit.
01
Project Name
MILES WIGGLESWORTH
02
Date Prepared
2016-09-27
03
Project Location
22330 HOMESTEAD ROAD APT 303
04
Building Type
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
MILES WIGGLESWORTH
07
Zip Code
95014
08
Dwelling Unit Conditioned
1345
lnstallmg new SC
Irstallmg it
�nstallmg
Installing
Floor Area (ft2)
identification or
Location or Area
by this SC
ducted
containing
Number of space conditioning
more than 40
09
Climate Zone
4
10
(SC) systems in this dwelling
1
system?
component?
components?
feet of ducts?
unit.
SC system?
B. Space Conditioning (SC) System Information
01
02
06 t
07 ° ,
` 08
09
10
'I the SC±
)nstalling a
SC System
SC System
CFA served,
i}(Pk"+9
system a r
:
refrigerant
lnstallmg new SC
Irstallmg it
�nstallmg
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
Altered space
System 1
Location 1
1345
Yes
Yes
Yes
No
No
No
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)1D11ib)
This section does not apply to this project.
Registration Number: 216-AO35626OA-000000000-0000
Registration Date/Time: 2016-09-27 14:44:57
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-09=27 14:44:57
Schema Version: 0.555SDD
M
CERTIFICATE OF COMPLIANCE CF111-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF-lR-ALT-HVAC) (Page 2 of 9
D. Altered Space Conditioning System (Sections 150.2(b)IE 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
All new
raP
Centl split
All new
Less than or
System I
Electric
heating
I
AFUE
80
H
cooling
SEER
14
Setback
equal to 40
R-6
components
components
feet
Required Documentation:
CUR -MCH -01-E- Space Conditioning Systems Ducts and Fans,
-Duct insulation requirement for new plenums: R6.
CF2R-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: 515%, 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 & CF313-MCH-23 Air Flow z 300 CFM/ton requiredwhenMCH-25 is required.
Exceptions:
-Duct systems registered with HERS provider as�prdviously sealed are exempt rfrom ,MCH 720 Duct Leakage Testing requirements—
e verificatibn"of"Air Fl 13, f ECH125
-Heating-only systems and Air Handler/Furnace changes do not.re'�uir qw,�IC Xor'Re Refrigerant arge MI
�Lea equir rnen,ts.
-Existing duct systems constructed, insulated or sealed� with asibest " °are exemptifrom MCH -20 Pu' 6ge Testino,',jr re
E. Entirely New or Complete Replacement Duct System, with or without -,Equipment Changeout (Sections,150.2(-b)lDiiaand150.2(b)1E, F)
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-AO35626OA-000000000-0000
CA Building Energy Efficiency Standards - 2013 Residential Compliance
Registration Date/Time: 2016-09-27 14:44:57
Report Version: 2013 Rev 1.008
Schema Version: 0.555SDD
HERS Provider: CaICERTS
Report Generated: 2016-09-27 14:44:57
CERTIFICATE OF COMPLIANCE CF1R-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: 96w
Queen, Drew
` ueew
Company:
Signature Date:
i PERMIT E RATERS
2016-09-27 14:44:57
Address:
CEA/ HERS Certification Identification (if applicable):
31225 La Baya Drive #213
City/State/Zip:
Phone:
West Lake Village CA 91362
818-735-7876
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. I 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 building design.or system design identified on this Certificate of Compliance conform to the
requirements of Title 24, Part1 and Part 6 of the California Code of Regulations. "" s
4. The building design features or system design features identified on this Certificate of Compliance are consisteht 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. i
a 1 a
5. 1 will ensure that a registered copy of this Certificate of Compliance 's' hall be matle availaile witYl„tile bui,ldiggkpermtttsfissued for Che,buildgg, and rade available to,tlte,enforcement agency for all applicable
inspections. I understand that a registered copy of this Certificate of Coampliance ig,requireyd to be"included with the documeptation,the,builder provides tp,oe building owner at occupancy.
Responsible Designer Name: �
Res onsbDesigg ver Signature:
Queen, Drew
Company:
Date Signed:
ON-TIME AIR CONDITIONING & HEATING INC dba SERVICE CHAMPIONS
2016-09-27 14:44:57
Address:
license:
7020 COMMERCE DR
817040
City/State/Zip:
Phone:
PLEASANTON CA 94588
925-598-1911
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-AO35626OA-000000000-0000 Registration Date/Time: 2016-09-2714:44:57 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-09-27 14:44:57
Schema Version: 0.5555DD
CUPERTINO
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(a.cupertino.org
Permit No. 8-24-293Y'
Address 22-33t 46LftgM &14?3 c j22'i-/ # of Alarms Smoke: !v Carbon Monoxide:
R5cl
PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE
HAS BEEN SIGNED AND RETURNED TO THE BUILDING 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
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 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.
1 have read and agree to comply with tl3o terms and conditions of this statement
Ower (or Owner Agent.s) Name:
In t Ht
...................................................
Signature ........ .. ........ .... ............................ Date: q.1.l..1�.
Contractor Name:
Signature................................................................... Licl...................................... Date: ...................
Smoke and CO farm.doe revised 03/18/14
CUPERTINO
Owner Name
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10340 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - buildinnCa)-cuoertino.ong
•• rNOWMEWIMINN11111 u
w
A
, .11T 1.
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.
N' No Go to Question 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.
g"No 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.
R—No 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.
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..
Please check ONE of the following:
($' 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 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).
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 following image. 0 /
Owner or Owner Agent's Signature: Z / -- Date-
Upon completing and signing this Certificate, please'retu 't to the Building Division in order to final your building permit.
SB407 2015.doc revised 08/26/15