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B-2016-2992 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2992 22415 PALM AVE CUPERTINO,CA 95014-2711(357 03 029) DELUXE AIR WOODLAND,CA 95776 OWNER'S NAME: AGARWAL ANURAG AND GARG RITIKA DATE ISSUED:10/26/2016 OWNER'S PHONE:408431-8287 PHONE NO:(530)662-5008 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: ! License Class= Lic.#994539 Contractor DELUXE AIR Date 07/31/2018 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 j 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. 2. 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:$3325.00 I APPLICANT CERTIFICATION ' I certify that I have read this application and state that the above information is-correct.l agree to comply with all city and county ordinances APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 357 03 029 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 10/26/2016 Issued by Kim Dunbar Date: 10/26/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the RF=ROOF 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(Sec.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:10/26/2016 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. 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 j Health&Safety Code,Section 25532(a)should I store or handle hazardous s. I certify that in the performance the work for which this permit is issued,I 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,Sec' ns 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date:10/26/2016 LENDINGAGENCY certify that 1 have read this application and state that the above information is I 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, 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 ARCHITECT'S DECLARATION and will comply with all non-point source regulations per the Cupertino Municipal 1 understand my plans shall be used as public records. Code,Section 9.18. Licensed Signature Date 10/26/2016 Professional GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•building cu ertina _ MISIC C �'��T;INt� -E ❑.PLUMBING ECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS �1415 ©^1�n /q,v r APN# s 0 22 OWNER NAME }�.N V l�`-I a, 'r�'A '-lP^ R P, 'A PHONE 40 Lt 31 -O 2Q E-MAIL _„ STREET ADDRESS ((l1 W ITY STATE,ZIP FAX `l)5_ PFS LM AVC �k4i'lP o ep- a Fol -t CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FF ❑OWNER ❑ OwNER-BUHAER ❑ OWNER AGENT P(CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT 1:1 ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME t LICENSE NUMBERq LICENSETYPp[® BUS.LIC#j}-e� COMPANY NAMED e L •! A ,1� E-MAIL FAX STREET ADDRESS ' S� ff_ CITY,STATE,ZjP,.y ������ -976. PHONE s-30)W-soo ARCHITECT/ENGINEER NAME LICENSE NUMBER (J(/ [ BUS.LIC# (pa( COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF M&D or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS.THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE. ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK .e FUP CC �ggNoc c � v,E- Fd,2 L r �c C, SecAc Loci for l D✓o w c_ wv t K TOTAL VALUATION: By my signature below,I certify to each of the following; I am the property owner or authorized agent to act on&e property owner's behalf..I have read this application and the information I have provided" orrect. 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 buildin o crioh. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: I Date: ozi a f NTAL INFORMATION REQUIRED oFxc use cirri ` .. . 0 ()vER CITE COC7NTER , �* :Q EXPRESS c z i D STANDARD,,.'41, to f s " D TARGE F "74IA,JOR MEPMiscApp_201].doe revised 06121/11 STATE OF CALIFORNIA ALTERATIONS - HVAC CEC-CF1 R-ALT-03-E Revised 06/14 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE CF1R-ALT-03-E Alterations-HVAC CZ 1,3 to 7 and 16(formerly CF-IR-ALT-HVAC) (Page 1 of 1) Site Address: Enforcement Agency: Date Prepared: Permit#: 1- 1 S"^ f R LM P✓E 10496 /G New:Ducting,Plenums,Lineset Conditioned Equipment Type Equipment Efficiency Thermostat Required R-value Floor Area(sq ft) 11 Packaged System ❑Evaporator Coil oa AFUE COP R"R-6 (CZ1,3-7)Ducts Served by system Setback ❑Split System ❑Condensing Unit SEER ❑R-8' (CZ 16)Ducts sq ft (If not already HSPF 13R-6(all CZ's)Plenums present,must Furnace ❑Lineset o EER ❑R-5 or R7.5 Lineset' be installed) HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. Atpe-r--mit application_thist forrryis allowed`-to befilled-ou"t-by- and For final inspection all forms are to be registered(no hand filled forms allowed)and a copy left on site. M.HVAC thangeout/Repair Required Compliance Documents to be left on site for Final: Can-include new ducting All Equipment, CF111-ALT-02-E Condenser Unit,Evaporator Coil, CF2R:MECH-01,MECH-20-HERS Air Handler/Furnace CF3R:MECH-20-HERS Installer Requirement:Duct leakage(5_15%or,: 10%to outside,or seal all accessible leaks) Exempted from duct leakage testing if ❑1.Duct system registered with HERS provider as previously sealed,or❑2.There is less than 40 linear feet of duct in unconditioned space,or 0 3.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 DuctsZ CF1R-ALT-02-E CF2R-MECH-01,MECH-20-HERS,MECH-22-HERS,MECH-(23 or 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 2_350 CFM/ton(or Standards Table 150.0-C/D alternative) 3.All New Ducts with Replacement Required Compliance Documents to be left on site for Final: Includes replacing or installing All New CF1R-ALT-02-E DuctsZ 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 2_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. ❑4.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 for Duct leakage(<15%or,<10%to outside,or sealall 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. Z 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 handier,plenums,duct material. I 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%",2.5-3T-2%",3.5 to 4T-2%8",5T-4%" 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. B. 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 Designer Name: Responsi igner si natur Date Signed: License: Company: Addre City/State/Zip: q A Phone: JE E/ ff (12 0 As CV001)L96/0 (i Tf Csr,k 5-06 For assistance or questions regarding the Energy Standards,contact the Energy Hotline at:1-800-772-3300 WATER-CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION C U P ERTI N O 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228• FAX(408)777-3333•building(Mcupertino.org Owner Name k N t; G Ait ,•►A (_ f- f ! T ISA 6,A rt G Permit No. mob' 2° I - 2 9�j 2 Address ZZ41 S ?ALM AVG ,, COU 41TItJ12 , CA ICoi4- l.. Is your real property a registered historical site? 0 Yes Civil Code Sections 1.101.1 through 1101.8 do not apply. Skip the rest of the fonn and sign bottom of form. O'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. 11x1'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. EYNo 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. � /'J Yes My teal 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: LGA 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 1101.1 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 page. Owner or Owner Agent's Signature: Date: 1 /'201 Upon completing and signing this Certificate,please etum it to the Building Division in order to final your building permit. SB407 2015.doc revised 08126115 SMOKE ! CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 Cl)PERTINO (408)777-322.8•FAX(408)777-3333•build in cu Derti no.or FERNIIT CANNOT BE FINALED UNTIL THIS CERTIFICATE HAS BEEN COl'�IPLE 1TD,UQj';F.D,AND RF'I URNFD TO THE BUILDING DIVISION xa w vu ._ a.� .F..�, T..,.a.....-eo . 'uA..keu..� r�_k:r s...�., ral..+��•v +nw.>. ,..�... 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 X X the bedrooms) On every level of a dwelling unit including basements X _ X Within each sleeping room _— 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 42.0.6 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 specified below have been tested and are operational, as of the date signed below. Address: 2 L 4'1 S PALM AUG C u PC 0, C A 01 S 01 4 Permit No. 20 I Z`'3`l z Specify Number of Alarms: 3 # Smoke Alarms: 1 2— 1 # Carbon Monoxide Detectors: F-7--I 1 have read and agree to corn 1 with the terms and conditions of this statement Owner(or Owner Agent's)Name: Date: Signature. .................. .................... ........................................................... ...... ......... .......................................1..1.1.�.�..2v.t.[........ Contractor Name: Signature..................................................................Lic.# ......................................Date: Smoke and COform.doc revised 09/27116