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B-2016-3141CITY OF CUPERTINO BUILDING PERMIT r BUILDING ADDRESS: I CONTRACTOR: PERMIT NO:B .2016-3141 21623 CASTLETON ST CUPERTINO, CA 95014-4712 (356 18 062) A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC MEMPHIS, TN 38120 OWNER'S NAME: HIGASHIUCHI JON AND DORCAS TRUSTEE DATE ISSUED: 11/17/2016 OWNER'S PHONE: 408-255-9940 PHONE NO: (408) 286-8931 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-20 Lie. #742039 Contractor R S AMERICAN RESIDENTIAL RVI OF CALIFORNIA INC X BLDG _ELECT _PLUMB X MECH X RESIDENTIAL _ COM1 4ERCILAL Date 10/31/2017 I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business & Professions Code and that my JOB DESCRIPTION: license is in full force and effect. REPLACE FURNACE AND A/C (S LOCATION) I hereby affirm under penalty of perjury one of the following two declarations: t. 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 U` Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $15000.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type; information is correct. I agree to comply with all city and county ordinances 35618 062 and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the PERMIT EXPIRES IF WORK IS NOT STARTED City of Cupertino against liabilities, judgments, costs, and expenses which 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 180 DAYS FROM LAST CALLED INSPECTION. source regulations per the Cupertino Municipal Code; Section 9.18. sp / J 1 w Issued by: AbbyAyende Signature Date 11/17/2016 Date: 11/17/2016 ON VNERAWILDERD RATION •�// I I hereby affirm that I am exempt from the Contractor's License Law for one of the following RE -ROOFS: All roofs shall be inspected prior to any roofing installed without first obtaining an inspection, material being installed. If a roof is I agree to remove all new for two reasons: materials 1. I, as owner of the property, or my employees with wages as their sole inspecfibn. compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant: 2. L as owner of the property, am exclusively contracting with licensed bate: 11/17/2016 contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations; ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER is I have and will maintain a Certificate of Consent to self -insure for Worker's I� Compensation, as provided for by Section 3700 of the Labor Code, for the HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the 2. I have and will maintain Worker's Compensation Insurance, as provided for by California Health & Safety Code, Sections 25505, 25533, and 25534. I will Section 3700 of the Labor Code, for the performance of the work for which this maintain compliance with the Cupertino 1�Iunicipal Code, Chapter 9.12 and the permit is issued. Health & Safety Code, Section 25532(a) (should I store or handle hazardous 3. I certify that in the performance of the work for which this permit is issued, I material. Additionally, should I use equipment or devices which emit hazardous aircontaminants as defined by the Bay Arepa Air Quality Management District I shall not employ any person in any manner so as to become subject to the will maintain compliance with the Cuperliho Municipal Code, Chapter 9.12 and Worker's Compensation laws of California. If, after making this certificate of the Health & Safety Code, Sections 25505, 25533, and 25534. exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I forthwith this Cil must comply with such provisions or permit shall Owner or authorized agent: _ be deemed revoked. Date: 11/17/2016 APPLICANT CERTIFICATION certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY 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 Lender's Name to enter upon theabovementioned property for inspection purposes. (We) agree 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 I understand my plans shall be used as p blit records. and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Licensed CUPERTINt Pj-20) c, -31q, GENERAL 'PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION MEP 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 o building a2cupertino.org misc L�JPLUMBING LjMECHANICAL _ ❑ELECTRICAL ❑MISCELLANEOUS / PROJECT ADDRESS �1 6 � � &s (eW, ` svpd �N " Q _OU?- 0 WNER NAMEI i c�31 cS t Z f fir �l PHONE(/ / ( STREET ADDRESS y ) f G 5 J CITY, STATE, ZIP _7 FAX CONTACT NAMEPo C4,: ` / t J (� PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP F ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR. ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER` ❑ TENANT - CONTRACTOR N AME ( LICENSE NUMBE ., l� J �-'20 3LICENSE PE 1 (J BUS. LIC # f COMPANY NAME EMAIL FAX STREET ADDRESS %L�O�r /�i / ( ( CITE S TATE> r� G Y PHONE U ( ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC COMPANTY NAME E-MAIL, FAX STREET ADDRESS CITY, STATE, ZIP PHONE. USE OF ❑ SFD 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? El NO DESCRIPTION OF WORK L. (,Z,/4 A-- 4% G/ + C/A C, tet( at4al- ��V,Q/' 6 1 I y TOTAL VALUATION: RECEIVED BY._ 5`l , By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner' behalfl I have read this application and'the information I have provided is correct. 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 building construction. I authorize representatives of Cupertino to enter the above -identified prop rty for inspection purposes. Signature of Applicant/Agent: A Gf Date: (I ! 1U/A SUPPLEMENTAL INFORMATION REQUIRED MEPMiscAl p_2011.doc revised 06121111 CERTIFICATE OF COMPLIANCE CFIR-ALT 02-E Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 1 of 3 Project Name: Jon Higashiuchi Date Prepared: 2016-11-16 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 MR -ALT -02 document for each dwelling unit. 01 Project Name Jon Higashiuchi 02 Date Prepared 2016-11-16 03 Project Location 21623 Castleton Street 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name Jon Higashiuchi 07 Zip Code 95014 08 Dwelling Unit Conditioned Floor Area (ft2). 1500 09 Climate Zone 4 10 Number of space conditioning (SC) systems in this dwelling unit. 1 B. Space Conditioning (SC) System Information $A2; yx 01 02 03 04 06""" 07 0$ ! 09 10 Is the SC �5ystem Installing a SC System SC System CFA served a .R. refuge a'tInstalhngvfiew SC Irlstal(mgnstialh g .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 System 1- Indoor -1 Location 1 15'00 Yes Yes. Yes No No No Altered space 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-A0426131A-000000000-0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Date/Time: 2016-11-16 15:52:07 Report Version:.2013 Rev 1.008 Schema Version: 0.555SDD HERS Provider: CalCERTS Report Generated: 2016-11-16 15:51:58 CERTIFICATE OF COMPLIANCE CF1R-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 fleating Cooling System— —Heating-- —Altered— —Heating— —Minimum— Altered---Coolim —Minim-um— —Re—quire—d— —Ne%r-oY--- 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 System 1- I Central gas All new Central split All new Less than or Indoor -1 furnace heating AFUE 80 AC cooling SEER 16 Setback equal to 40 R-6 components components feet Required Documentation: CF2R-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: :5 15%, 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 & CF3R-MCH-23 Air Flow z 300 CFM/,ton required when MCH -25 is required. Exceptions: -Duct systems registered with HERS provider as previously sealed are exempt from MCFJ-20 Duct Leakage Testing requiremeptsi, -Heating-only systems and Air Handler/Furnace changes do not require verificatid'A"of "Ar Flow MCW'23�W , Re n e r�art . ge WCH-251.,2 "' pnt h r , I A 't Existing duct systems constructed, insulated or sealed with asbestc�',"f'are exem JromMCH", u(�ql.kage Test! �equir m 0 `" ' 4t' 4tmt 44 i2 E. Entirely New or Complete Replacement Duct Sy tem, with or without Equipment Changeout (Sections 150.2(b)1Diia, and,450.2(b)1E, F) 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-AO426131A-000000000-0000 Registration Date/Time: 2016-11-1615:52:07 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-11-16 15:51:58 Schema Version: 0.555SDD CERTIFICATE OF COMPLIANCE CFIR-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: Docu:mentation-Author-Signature: '.Hawkins, Stephanie ��7LGfL4' Company: Signature Date: A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC 2016-11-16 15:52:07 Address: CEA/ HERS Certification Identification (if applicable): 965 RIDGE LAKE BLVD STE 201 742039 City/State/Zip: Phone: MEMPHIS TN 38120 408-286-8931 X123 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, com onents, 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 ii'of the California Code of Rgu+ations. 4. The building design features or system design features identified or%'this Certificate of Garrf ance are cpri terit with the informJlon on,othef ap ca,kJ.e compliance documents, worksheets, provided calculations, plans and specifications submitted to the enforcement agency for;approvaP4w f this building permit application, E I 5. I will ensure that a registered copy of this Certificat pf Compliance shall,beWade,�ailable vuithAbp buIld,irrg p_mit("s� issued for be,buildjng, and trade av',, able to,tha,ehforcement agency for all applicable inspections. l understand that a registered copy of this Cerfificate of Compllanceas required to be included with the, documentationche bdllder provides to the building owner at occupancy. Responsible Designer Name: , r"%', Hawkins Stephanie Responsible Designer Signature. `:il�JLGP/i�GlLy Company: Date Signed: A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC 2016-11-16 15:52:07 Address: License: 965 RIDGE LAKE BLVD STE 201 742039 City/State/Zip: Phone: MEMPHIS TN 38120 408-286-8931 X123 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-A0426131A-000000000-0000 Registration Date/Time: 2016-11-16 15:52:07 HERS Provider: CaICERTS CA Building Energy Efficiency Standards -2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-11-16 15:51:58 Schema Version: 0.555SDD CUPERT'IN© SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVE GENERAL INFORMATION Existing single-family and multi -family d• Monoxide alarms. When the valuation of $1000.00, CRC Section R314 and CBC Sect Monoxide Alarms be installed in the follo Hation of all required Smoke and Carbon Monoxide Alarms for CBC Sections 420.6 and 907.2.11.2 where no interior access for Ings shall be provided with Smoke Alarms and Carbon itions, alterations, or repairs to existing dwelling units exceeds 907.2.11.5 and .420.6 require that Smoke Alarms and/or Carbon locations: AREA Signat e ........ ............................................................................................................................ SMOKE ALARM CO ALARM Outside of each separate sleeping area int the bedroom(s) e immediate vicinity of X X On every level of a dwelling unit including basements X X Within each sleel2ing 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.1 he Office of the State Fire Marshal. Power Supply: In dwelling units with no co ercial power supply, alarm(s)•may be solely battery operated. h -t 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 build ng wiring. As owner of the above -referenced property, installed in accordance with the manufactur and California Residential Codes. The alarir date signed below. Address: 21 t&2 Specify Number. of Alarms: hereby certify that the alarm(s) referenced above has/have been -'s instructions and in compliance with the California Building . specified below have been tested and are operational, as of the # $moke Alarms: r q9tj y s l # Carbon Monoxide Detectors: I have read and agree Ito comniv with the terms and conditions of this statement Owner (or Owner Agent's) Name: �"�0A/���t,��l�j Wt �J r - ` 'L'(1 Signat e ........ ............................................................................................................................ ....... Date: Contractor Name: Signature................................................................. Lic.# ......................................Date: Smoke and COfo»n.doc revised 09/27/16 CUPERTINO Owner Name Address WATER -CONS RVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPS ENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE it CUPERTINO, CA 95014-3255 777-3228 • FAX (4 8) 777-3333 • buildingp_cugertino.org'5':�C(e7r / Permit No. 1. Is your real property a registered historical site? ❑ Yes Civil Code Sections 1101.1 through 1'1 1.8 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, c plumbing, installation of water -conserving plumbi ❑ Yes Civil Code Sections 1101.1 through 11 ❑ The licensed plumber's certificatior Skip the rest of the form and sign botto No Go to Question 3. 3. Is water service permanently disconnected for you ❑ Yes Civil Code Sections 1101.1 through 11, ,LK No Go to Question 4. 4. Is your real property built and available for use or ;rtifying that, due to the age or configuration of the property or its ig fixtures is not technically feasible? 11.8 do not apply. has been provided to the Building Division. n of form. building? L8 do not apply. Skip the rest of the forn and sign bottom of form. on or before January 1, 1994? ❑ No My real property is built and available f Dr 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. Y. Yes My real property is built and available i or 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 On and after January 1, 2014, building alterai to be replaced with water -conserving plumbin, compliant plumbing fixtures shall be repla property undergoes alterations or improvemen ❑ My property is a multifamily residential real p On and after January 1, 2014, specified builds plumbing fixtures to be replaced with water -c( On or before January 1, 2019, all non-complia conserving plumbing fixtures throughout the Y improvements). ❑ My property is a commercial real property. Sf On and after January 1, 2014, specified buildii plumbing fixtures to be replaced with water-ci On or before January 1, 2019, all non -torr. plumbing fixtures throughout the building (re€ erty. See Civil Code Section 1101.4. or improvements shall require all non-compliant plumbing fixtures Lures throughout the building. On or before January 1, 2017, all non - with water -conserving plumbing fixtures (regardless of whether ?erty. See Civil Code Section 1101.5. alterations or improvements shall require non- compliant >erving plumbing fixtures, plumbing fixtures shall be replaced with water - Wing (regardless of whether property undergoes alterations or Civil Code Section 1101.5. alterations or improvements shall require non- compliant serving plumbing fixtures. iant plumbing fixtures shall be replaced with water- conserving dless of whether property undergoes alterations or improvements). 1, as the owner or owner's agent of this property, c rtify under penalty of perjury that non-compliant plumbing fixtures will be replaced prior to date specified above with water -c onserving plumbing fixtures in accordance with Civil Code Sections 1101.1 through 1101.8, the current California Plumbing de 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: 2 t Upon completing and signing this Cel i tate, p se etum it to the Building Division in order to final your building permit. SB407 2015.doc revised 08./26115 1. If the existing plumbing fixture water is equal to or lower than the figure shown, it is not required to be upgraded. SB407 201 5.doc revised 08126115 Non -Compliant Water -Conserving Plumbing Fixture Plumbing Fixture1 (Fi ture Complying with Current Code Applicable to New Construction) Fixture Type Maximum Water Usage/Flow Rate 20;1 CPC Ch. 4 2013 CPC Ch. 4 2013 CPC Ch. 4 Wafer Usage /Flow Rafe 2013 C LGreen 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; eld shower is considered a showerhead.) For multi le showerheads serving one shower, the combined flow rate of all showerh ads 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: 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; 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 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 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 gallo s per minute @ default to maximum 60 psi 1.8 gallons per minute Where faticets 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 is equal to or lower than the figure shown, it is not required to be upgraded. SB407 201 5.doc revised 08126115