B-2016-2918CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-2918
11892 PLACER SPRING CT CUPERTINO, CA 95014-5102 (366 55 007)
ATKINSON
CLIMATROLLERS INC
SAN JOSE, CA 95112
OWNER'S NAME: SUBRAMANIAM RAM AND GOMATHI TRUSTEE
DATE ISSUED: 10/13/2016
OWNER'S PHONE: 408-204-8424
PHONE NO: (408) 294-6290
LICENSED CONTRACTOR'S AR TION
BUILDING PERMIT INFO:
License Class C=20 Lic. #258540
Contractor ATKINSON CLIMATROLLERS INC Date 12/31/2016
XBLDG _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)
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.
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
permit is issued.
Sq. Ft Floor Area:
Valuation: $4072.00
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
366 55 007
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.
Additionally, the applicant understands and will comply with all non -point
WITffiN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
i"""
Signature � .Date 10/13/2016.
Issued by: Abby Avende
OWNER -BUILDER DECLARATION
Date: 10/13/2016
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. 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.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
Signature of -Applicant:
contractors to construct the project (Sce.7044, Business & Professions Code).
Date: 10/13/2016
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. 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 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.
Owner or authorized agent: i`—
APPLICANT CERTIFICATION
Date: 10/13/2016
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
Lenders 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 10/13/2016
Professional
Feg
COMMUNITY DEVELOPMENT DEPARTMENT * BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(c�cupertino org'
MEPMiscApp_2011.doc revised 06/21/11
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC)
Project Name:
2016-0235 Ram Subramanium I Date Prepared:
(Page 1 of 3 )
2016-10-12
A. General Information
MR -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
2016- 0235 Ram Subramanium
02
Date Prepared
2016-10-12
03
Project Location
11892 Placer Spring Ct
04
Building Type
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
2016- 0235 Ram Subramanium
07
Zip Code
95014
08
Dwelling Unit Conditioned
2300
duct system?
SC system?
Alteration Type
Furnace
Floor Area (ft2)
2300
Yes
No
s
No
Number of space conditioning
No
09
Climate Zone
410
(SC) systems in this dwelling
1
unit.
B. Space Conditioning (SC) System"Information �hF°F° =`
4,� %
01 02 o3 04 0
09 10
the
a
SCS stem
System
SCS stem r=
y
' CFA served
y, °
stem a
s
re#rigerat
nstallingevSC
g
Insiialling
nstalling
entirely
Identification or
Location or Area
by this SC
ducted '
containing
system
slnstalli'g
more than 40
entirely n w
new
Name
Served
System (ft2)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
Furnace
Whole House
2300
Yes
No
Yes
No
No
No
Altered space
Replacement
conditioning system
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-A0382681A-000000000-0000 Registration Date/Time: 2016-10-12 13:26:57 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-10-12 13:27:25
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CFlR-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
Keating
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
Furnace
Centra . I gas
All new
Central split
No cooling
This field or
This field or
This field or
This field or
Replacement
furnace
heating
AFUE
80
AC
component
section is not
section is not
Setback
section is not.
section is not
components
altered
applicable
applicable
applicable
applicable
Required Documentation:
CF2R-MCH-01-E - Space Conditioning Systems Ducts and Faris,
-Duct insulation requirement for new plenums: R6.
CF2R-MCH-20-H & MR -MCH -20-1-1 — 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, '.,.' r 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).
CF2 RCF3 R -M CH -23 & CF3 R -MCH -23 Air 166 , on requ r.. qMhepWCH25 is required.
Exceptions:
-Duct systems registered with HERS provider as'?prlayiously sealed are., x r zN Duct Leakage Peq'WT� menu...
rf,
Fl _t!
Heating -only systems and Air Handler/Furnace changes do not require ri i a 661�# Tta e
Tu
-Existing duct systems constructed, insulated or sealed with "besto re ex C a
'2 k
L
6 g
Al
2k
4m, �44: 44,
INN
E. Entirely New or Complete Replatibment Duct
Stem, with -or vy-ithoqui
V
pment ngeout fSectionstl .2(b),JDiia,and 450.2(b)1E, F)
4Wr m-
A—-
This section does not apply to this project.
F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)IC)
This section does not apply to this project.
Registration Number: 216-AO382681A-000000000-0000
Registration Date/Time: 2016-10-12 13:26:57
HERS Provider: CalCERTS
CA Building Energy Efficiency Standards -.2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-10-12 13:27:25
Schema Version: 0.555SDD -
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -1R -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:
GGt ii�%2�/!i
Faulkner, Cindy
CT�t e
Company:
Signature Date:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL
2016-10-12 13:26:57
Address:
CEA/ HERS Certification Identification (if applicable):
1171 NORTH 4TH STREET
City/State/Zip:
Phone:
SAN JOSE CA 95112 -?,
408-294-6290
Responsible Person's Declaration statement
I certify the fallowing under penalty of perjury, under the lawsclfthe State of California:
1. The information provided on this Certificate of Cotn�lta ipq is true and, correct,
2. I am eligible under Division 3" of the gl sIridgs'and Professions Code to accept Y sponsib'ility for the building design or system design identified on this Certificate of Compliance (responsible designer).
3. That the energy features and performance specifications ,materiOlS corppnnents, and manufactured devices for the 'building ; design q�system design identified on this Certificate of Compliance conform to the
Parti i ,.�,P° � ,�
requirements of Title 24, Part 1 and 6'of the Cal[fornla lode of Regulations 5
4. The building design features or system ddsign featules i entified orr this Certif[ a f m fiance ares rts)stentkvttl the [nformatio ora othefappltcabfe cofnpliance documents, worksheets,
provided
calculations, plans and specifications sbbmittddre the a forcemen['agencyfgr pp va wit . this buil;"[ng per 3t app{icath i
�-
"ild
5. [will ensure that a registered copy of Yh[s,,Certificd pliance sltall triad gftaiP,, le wl kfe It i i pelmitis),issu for j5, g, and'mat e ava abl�fo ti7� nforcement agency for all applicable
inspections. I understand that a regis red copy of ticate of Compliance is,„required to bye Included wjth th ., ocume �tat[onthe�pili1fler p ttvides to.the bu' ing,owner at occupancy.
Responsible Designer Name: ... • :.
Responsible De gner Signature.
Faulkner, Cindy
Company:
Date Signed;
ATKINSONCLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL
2016-10-12 13:26:57
Address:
License:
1171 NORTH 4TH STREET
258540
City/State/Zip:
Phone:
SAN JOSE CA 95112
408-294-6290
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-A0382681A-000000000-0000 Registration Date/Time: 2016-10-12 13:26:57 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards- 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-10-12 13:27:25
Schema Version: 0.555SDD
CUPERTINO
PURPO
SMOKE i CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 9501.4-3255
(408) 777-3228 • FAx (408) 777-3333 • buildina5cunertino.orn
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 mule -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 file irrunediate vicinity of
X
J
�
the_bedroom(s)
Lic.# Date:4i
.�..Signature
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 -burring appliances a id 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..
hz 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 specified below have been tested and are operational, as of the
date signed below.
Address: ri O 92- fl_- r E p 67 C. P& k
specify Number of Alarms: # Smoke Alarms: q-^ , #
rJ0 Permit No.
Lrbon Monoxide Detectors: 1 1
I have read and agree to comply with the terms aW_conditions of this
Owner (or Owner Agent's) Name:..
A.:........
�......... ....:.....:.. Date:
Signature.........
.
Contractor Name:
p �a
1 l 3
Lic.# Date:4i
.�..Signature
Smoke clad COform.doc revised 09127116
,
WATER -CONSERVING PLUMBING FIXTURES i
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
p (408) 777-3228 • FAX (408) 777-3333 • buildingCa)cupertino.org
Owner Name we R A M/A 1v tf�A pl Permit No
Address 'I `� 2 '1Q L� G0 l d-, CZA
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.
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.
INo 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.
W, 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.
5. 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 of4whether
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-compliantplumbing 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-complianfplumbing fixtures will be
replaced prior to datespecified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101.1
through 1101.8, the current California Plumbing Code and California Greeni Building Standards Code, and manufacturer's
installation requirements, and that the water -conserving plumbing fixtures comply with the requireiYents as indicated in the
table on the following nage. n
Owner or Owner Agent's Signature:%� t\ 4. �-= —� Date: i
Upon completing and signing this Certificate, please return it to the Building Division in order to final your building permit.
SB4072015.doc revised 08126115
1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shown,
it is not required to be upgraded.
SB4072015.doc revised 08126115'
Non -Compliant
Water -Conserving Plumbing Fixture
Plumbing Fixture
(Fixture Complying with Current Code Applicable to New Construction)
Fixture Type
Maximum Water Usage/Flow Rate
2013 CPC Ch. 4
2013 CPC Ch. 4
2013 CPC Ch. 4
Water Usage
/Flow Rate
2013 CALGreen Div. 4.3
2013 CALGreen Div. 4.3
2013 CALGreen Div. 5.3
Single -Family
Multi -Family
Commercial
Residential
Residential
Water Closets
Exceed 1.6
Single flush toilets: 1.28 gallons/flush
(Toilets)
Gallons/flush
Dual flush toilets: 1.28 gallons/flush effective flush volume (the composite,
average flush volume of two reduced flushes and one full flush
Urinals
Exceed 1.0
Gallons/flush
0.5 gallons/flush
Showerheads
Exceed 2.5
2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of
gallons per minute
U.S. EPA WaterSense Specification for Showerheads
(A hand-held shower is considered a showerhead'.)
For multiple showerheads serving one shower, the combined flow.rate of all
showerheads and/or other shower outlets controlled by a single valve shall not
exceed 2.0,gallons per minute @ 80 psi, or the shower shall be designed to
allow only one shower outlet to be in operation at a time.
Faucets —
Exceed 2.2 gallons
Maximum 1.5 gallons per
Within units:
05 gallons per minute @ 60
Lavatory
per minute
minute @ 60 psi; minimum
Maximum 1.5 gallons
psi
Faucets
0.8 gallons per minute @
per minute @ 60 psi;
20 psi
minimum 0.8 gallons
per minute @ 20 psi
In common and public
use areas: 0.5 gallons
per minute @ 60 psi
1.8 gallons per minute
60 Dsi
Faucets —
Exceed 2.2 gallons
1.8 gallons per minute @
1.8 gallons per minute
1.8 .gallons per minute @ 60
Kitchen
per minute
60 psi
@ 60 psi
psi
Faucets
May temporarily increase
May temporarily
up to 2.2 gallons per
increase up to 2.2
minute @ 60 psi, and must,
gallons per minute @
default to maximum
60 psi, and must
1.8 gallons per minute @
default to maximum
60 psi'
1.8 gallons per minute
Where faucets meeting
@ 60 psi
the above are unavailable,
Where faucets meeting
aerators or other means
the above are
may be used to achieve
unavailable, aerators or
reduction.
other means may
used to achieve
reduction.
1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shown,
it is not required to be upgraded.
SB4072015.doc revised 08126115'