B-2016-2916CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-2916
11218 STAUFFER IN CUPERTINO, CA 95014-5150 (366 09 046)
ATKINSON
CLIMATROLLERS INC
SAN JOSE, CA 95112
OWNER'S NAME: BHATTACHARYAPARTHAAND SRABONI
DATE ISSUED: 10/13/2016
OWNER'S PHONE: 408-366-0171
PHONE NO: (408) 294-6290
LICENSED CONTRACT D RATION
BUILDING PERMIT INFO:
License Class C=20 Lic. #258540
Contractor ATKINSON CLIMATROLLERS INC Date 12/3172016
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 farce and effect.
JOB DESCRIPTION:
REPLACE FURNACE (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. '
_r
,2. .-I have and will maintain Worker's Compensation Insurance, as provided for by.
IQhi
/ Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Sq. Ft Floor Area:
Valuation: $6277.00
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
366 09 046
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 CupertinoMunicipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Vu t ��/
Signature Date 10/13/2016
Issued by: AbbyAyende
-'
OWNER DECLARATION
Date: 10/13/2016
-BUILDER
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RF -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
1. I, as owner of the property, or my employees with wages as their sole
installed without first obtaining an inspection, Iagree 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 (Sec.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
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
s. I certify that in the performance.of the work for which this permit is issued, h
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
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: U
APPLICANT CERTIFICATION
Date: 10113/201.6
I certify that I have read this application and state that the above information is
t"ON TR TION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
.
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,
Lender's Address
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
ARCHITECT'S DECLARATION
and will comply with all non -point source regulations per the Cupertino Municipal
I understand my plans shall be used as public records.
Code, Section 9.18.
Licensed
Signature Date 10/13/2016
professional
GENERAL PERMIT APPLICATION 7 �o —q o o
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildingft-cupertino.org
PROJECT ADDRESStUl
Q�
APN #
_ bye 044(.;
OWNERNAME6pA j D
6hpa" H I/J� } JfI
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PHONE4*.�jtr_ . 0 1�
E-MAIL
STREET ADDRESSI 2 /
CITY, ST�TE, ZIP .
FAX
CONTACT NAME
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Y
HONE gy e
-70'�
EMAIL
-
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STREETllSS
ADD
CI6, STATE, Z
CA 4 1117
FAX
❑ OWNER ❑ OWNER BUILDER
❑ OWNER AGENT X CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER
11 TENANT
CONT CT N E -
0� V, b .
LICENSE NUMBI ®
LICENSE TYPE _
-
o
BUS. LIC #
C
'V
jc
v i
VOW,
�E-MAIL ° 4
-
FAX
STREET ADDRESS 0
y�
CITY, STATE, ZIP �II�J� 6
PHOT[oe
I
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD m DUPLEX
BUILDING: In COMMERCIAL
❑ MULTI -FAMILY
PROJECT IN WILDLAND ❑ YES
URBAN INTERFACE AREA 0 NO
PROJECT IN ❑. YES
FLOOD: ZONE ❑. NO
IS THE BLDG AN
EICHLER HOME?
❑ YES
❑ NO
DESCRIPTION OF WORK YI A 11) IA rJ /. A U %n A I h r n.. n e%. s4"
MEPMiscApp_2011.doc revised 06/21111
CERTIFICATE OF COMPLIANCE
CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 1 of 3 )
Project Name: 2016- 0232 Sraboni Bhattacharya Date Prepared: 2016-10-12
A. General Information
CRR -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- 0232 Sraboni Bhattacharya
02
Date Prepared
2016-10-12
03
Project Location
11218 Stauffer Ln
04
Building Type.
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
2016-0232 Sraboni Bhattacharya
07
Zip Code
95014
08
Dwelling Unit Conditioned
3000
Floor Area (ft2)
SC System
SC System
CFA served
system a
frigera t
Number of space conditioning
Irsta Vg
09
Climate Zone
4
10
(SC) systems in this dwelling
1
ducted
containing
system
more thn 40�
unit.
entirely new
B. Space Conditioning (SC) System InformatioPow t; tw ,= i
01
0203
04'05
a
10
11s the SC
Instalhng a
SC System
SC System
CFA served
system a
frigera t
•Installing}new£SC
Irsta Vg
lnstalhC�g
nstalling
Identification or
Location or Area
by this SC
ducted
containing
system
more thn 40�
entirely new
entirely new
Name
Served
System (ft2)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
Furnace
Whole House
3000
Yes
No
Yes
No
No
No
Altered space
Replacement
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)1Diib)
This section does not apply to this project.
Registratiop Number: 216-AO38270OA-000000000-0000
CA Building Energy Efficiency Standards - 2013 Residential Compliance
Registration Date/Time: 2016-10-12 13:34:10
Report Version: 2013 Rev 1.008
Schema Version: 0.555SDD
HERS Provider: CalCERTS
Report Generated: 2016-10-12 13:34:32
CERTIFICATE OF COMPLIANCE CFIR-ALT02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 2 of 3
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
Furnace
Central gas
All new
Central split
No cooling
This field or
This field or
This field or
This field or
Replacement
furnace
heating
AFUE
96
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 Fa#t,
-Duct insulation requirement for new plenums: R6.
CF211-MCH-20-H & CF3R-MCH-20-H - Duct Leakage testing . t.,epired 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 15%, or!5 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).
1 !. 1:
r �
CF2RCF3R-MCH-23&CF3R-MCH-23Aie-,'F1'ow„-�',.00.�Cr,M/ibneq�i hgn�MQH25 i! 5 required.
Exceptions:
-Duct systems registered with HERS provider as'prtviously sealed are exempt frcim 20 Duct Le kage _g
d Air Flow WWWa
-Heating-only systems and Air Handler/Furnace changes onotr6quireverifica
,M
M 'M - Iff
LINS, I I'll �111V
with as i�� re exem, rom u age Test "';X'#q . 11 , eN:1 ::
k
-Existing duct systems constructed, insulated or sea re exem, r
C”' uIr
, ft
'
4�tmt- "tr 4r,'t', 4M,77174
W
E. Entirely New or Complete Replacement Duct 5 stem, with or without Equipment Changeout (Sectiio,nsc��1'59.2 Tb),fiia,andA 0.2(b)IE, 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-AO38270OA-000000000-0000 Registration Date/Time: 2016-10-12 13:34:10 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-10-12 13:34:32
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: (?�%YGLGGCfi/%LPJli
zdy
Faulkner, Cindy
Company:
Signature Date:
ATKINSON CLIMATROLLERS INC dba VALLEY. HEATING,COOLING & ELECTRICAL
2016-10-12 13:34:10
Address:
CEA/ HERS Certification Identification (if applicable):
1171 NORTH 4TH STREET
City/State/Zip:
Phone:
SAN JOSE CA 95112 y:
408-294-6290
Responsible Person's Declaration statemel
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 gusmess'and Prdfessions Code to accept responshitityfor the building design or system design identified on this Certificate of Compliance (responsible designer).
3. That the energy features and perforiYtance specifications, materrals,`conlpanents, and anufac. u ed devices for tpe budding design or system design identified on this Certificate of Compliance conform to the
Part 1 Part 6nf the California Code Reg tla�ons� I) 7 3
requirements of Title 24, and of
�.
.
Ilk C rtiftcat f fiance are a stste -w the i firm rovided o : othera ?Ica fiance documents worksheets
4. The building design features or system tlesign features identified on t is e e orfrrrp c n K h�, ion p n p
calculations, plans and specifications siib'mitted xo the enfarcement,agency fgrajigrovavf1 this builtding perrrtit ap icati,. a
wr
S. 1 will ensure that a registered copy of This Certificat&f mpliance shajl a brad atiai[ Ile {t buildt k ,pe mit(,, issu l for ite ld g an - ace avallablb t�3;t le,, nforcement agency for all applicable
inspections. I understand that a regist red copy of this; 'y,'I lcate of Compliance is regyued to be; ncluded vlth th„- cumen>�tion,,the '��Icpr prQuides tc�,t ie building owner at occupancy.
PRes
Responsible DesignerlVame: ---
p Ug�
onsible Dei er5r natlare:-;-.' 'j7p�J
Faulkner, Cindy
Company:
Date Signed:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL
2016-10-12 13:34:10
Address:
License:
1171 NORTH 4TH STREET
258540
City/State/Zip:
Phone:
SANJOSE CA 95112
408-294-6290
Digitally signed by Ca10ERTS. 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-AO38270OA-000000000-0000 Registration Date/Time: 2016-10-12 13:34:10 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-10-12 13:34:32
Schema Version: 0,555SDD
PURPOSE
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 oo)cupertino.org
This affidavit is a self -certification for the installation of all required Smoke and Carbon
compliance with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 where
inspections are required.
GENERAL INFORMATION
Existing single-family and multi -family dwellings shall be provided with Smoke Alarrr
_
Monoxide arms. W-ien.the valuation of additions, alterations, or repairs to existing d
$1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke)
Monoxide Alarms be installed in the following locations:
Alarms for
interior access for
and Carbon
fling units exceeds
ins and/or Carbon
AREA
SMOKE ALARIk1
CO ALARM
Outside of each separate sleeping area in the immediate vicinity of
X
Contractor Name'.
�p
X
the_Uedroom(s)
Jl�B lJ dEn
......... .................. ................. .......
-�
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-
do
uerdo not have an attached garage. Carbon monoxide alarms combined with smoke
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
'ower Supply: In dwelling units with no commercial power supply, alarm(s) may be sc
In existing dwelling units, alarms are permitted to be solely battery operated where rep
not result in the removal. of wall and ceiling finishes or there is no access by means of ai
space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical
alarms which must be connected to the building wiring.
As owner of the above -referenced property, I hereby certify that the alarm(s) referencec
appliances and that
shall comply with
battery operated..
or alterations do
basement or crawl
mit is :required for
above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
a
and California Residential Codes. The alarms specified below have been tested and are pperational, as of the
date signed below.
Address: 11218 S7A J r F-EIZ. L-A W L �1�.
PerTit 0 ,
Specify Number of Alarms:
Alarms:
Carbon Mon6xide
1 have read and agree to comply with the terms and conditions of this sta
Owner (or Owner Agent's) Name:
Signature ............................
........ 11]
Date:
Contractor Name'.
�p
SignatureY Lica
.".......Date:
Jl�B lJ dEn
......... .................. ................. .......
i
Swope an CO fo aizcloc rei-iseci09,'271'16
'7
IHN
Owner Name I
Address t 1 2
WATER -CONSERVING PLUMBING FIXTURES
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 `,
4 o A SRAGOW) 8k4rr--AC_A44(Z%p• Permit No_ 2
STAyFrek LiV Ca 400-(Z r KI0
9 S-ot
1. Is your real propertya registered historical site?
El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and si bottom of form.
X No Go to Question 2. 1
2. Does your real properly have a licensed plumber certifying that, due to the age or configuration of l e propertyor 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.
El No Go to Question, 3. --
3. Is water service permanently disconnected for your building? j
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sigm 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?
XNo 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 si 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-compli t plumbing fixtures
to be replaced with water -conserving plumbing fixtures throughout the building.On or before Jar. nary 1, 2017, all non-
compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless of whether
property undergoes alterations or improvements).
El My property is a multifamily residential real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specifiedbuilding alterations or improvements shall require non- c mpliant
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 r improvements).
1, as the owner or owner's agent of this property, certify under penalty of perjury that non-compliant
lumbing fixtures will be
replaced prior to date specified above with water -conserving plumbing fixtures in accordance with C
ivil Code Sections 110 1. 1
through 1101.8, the current California Plumbing Code and California Green Building Standards Cod,-,
and manufacturer's
installation requirements, and that the water -conserving plumbing fixtures comply with the requirem
nts as indicated in the
table on the following page.
Owner or Owner Agent's Signature: 22 Gate:
Upon completing and signing this Certificate, please return it to the Building Division in order to finals your building`permit.
i
S+072015.doc revised 08126115
1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shown, it is no� required to be upgraded.
7 2015.doc revised 08/26/15
Non -Compliant
Water -Conserving Plumbing Fixture
Plumbing Fixturel
(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/fl
sh
(Toilets)
Gallons/flush
Dual flush toilets: 1.28 gallons/flush effective flush volume
(the composite,
average flush volume of two reduced flushes arid
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 pe rf
rmance ;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.
II
Faucets —
Exceed 2.2 gallons
Maximum 1.5 gallons per
Within units:
0.5
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,-
si;20
20psi
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 psi
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
p
i
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 be
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 no� required to be upgraded.
7 2015.doc revised 08/26/15