B-2017-0386CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0386
21403 SHANNON CT CUPERTINO, CA 9501411970 (362 01001) ON-TIME AIR
CONDITIONING &
HEATING INC
PLEASANTON,CA
94588
OWNER'S NAME: SHERIDAN JESSE AND BEHARRY SAVITRI E I I DATE ISSUED: 03/09/2017 I
OWNER'S PHONE: 603 -369* -8774 1 1 PHONE NO: (925) 444-4444
LICENSED CONTRACTOR'S DECLARATION
License Class C=20 Lic. # 18 7040
Contractor ON-TIME AIR CONDITIONING & HEATING INC Date 09/30/2017
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
license is in full force and effect.
hereby affirm under penalty of perjury one of the following two declarations:
1. 1 have and will maintain a certificate of consent to self -insure for Worker's
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.
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.
and state laws relating to building construction, and hereby authorize
representatives of this city to enter upon the above men ' ned property for
inspection purposes. (We) agree to save indemni nd keep harmless the
City of Cupertino against liabilities, judgment osts, and expenses which
may accrue against said City in conseque a of the granting of this permit.
Additionally, the applicant understand nd will comply with all non -point
source regulations pe;ie Cuperti Municipal Code, Section 9.18.
Sig
Date 03/9/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. 1, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am, exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three 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.
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.
3. I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the
Worker's Compensation laws of California. If, after making this certificate of
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall.
be deemed revoked.
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 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 City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
Date 0319/2017
BUILDING PERMIT INFO:
X BLDG ELECT PLUMB
X MECH X RESIDENTIAL _ COMMERCIAL
DESCRIPTION:
,ACE DUCTS SUPPLY 1 RETURN
Ft Floor Area: l Valuation: $6918.00
APN Number: Occupancy Type:
362 01 001
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
by: Kim Dunbar
RF -ROOF
All roofs shall be inspected prior to any roofmg material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant:
Date: 03/9/2017
ALL ROOF COVERINGS TO BE CLASS "A" OR
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipmenV5505,25,and25534. emu hazardous
air contaminants as defined by the Bay Area e ent District I
will maintain compliance with the Cupertino h4 t.
9.12 and
the Health & Safety Code, Se on 5534.
Owner or authorized agent
Date:. 03/9/2017
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building&cupertino.org misc
MEPMiscApp_2011.doc revised 06/21/11
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page I of 3)
Project Nam JESSE SHERIDAN Date Prepared: 2017-03-08
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
CF1R-ALT-02 document for each dwelling unit,
01
Project Name
JESSE SHERIDAN
02
Date Prepared
2017-03-08
03
Project Location
21403 SHANNON COURT
04
Building Type
Single family
05
CA City
CUPERTINO
06
Dwelling Unit Name
HOUSE
SC System
SC System
CFA served
Dwelling Unit Conditioned
refn
07
Zip Code
95014
08:
Fl oor Area (ft7)
2054
Location or Area
by this SC
ducted
containing
Number of Space
more than 40
09
Climate Zone
4
10
Conditioning (SC) Systems in
I
system?
component?
components?
feet of ducts?
this Dwelling Unit:
SC system?
B. Space Conditioning (SC) System Information
01
01
02
03
04
05
R-6
07
08
09
10
Is the $C-,.
,Installing -a -
SC System
SC System
CFA served
system a
refn
Installing, new'SC
In stalling
Installing
Installing
Identification or
Location or Area
by this SC
ducted
containing
system
more than 40
entirely new.
entirely new
Name
Served
System (ft)
system?
component?
components?
feet of ducts?
duct system,?-
SC system?
Alteration Type
Extension of existing
SYSTEM I
LOCATION 1
2 1 054
Yes
No.
No
Yes
No
No
duct system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section1.50.2(b)1Diib)
01
02
System Identification or
Name
New Duct R -Value
SYSTEM I
R-6
Registration Number: 417-A020056663A-000-000-0000000-0000 Registration Date/Time: 2017-03-08 16:115:15 KERS Provider- CHEERS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-03-08 16:15:17
Schema Version; rev 10/16
CERTIFICATE OF COMPLIANCE CUR -ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 3 of 3)
Documentation Author's Declaration Statement
1.1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
April Rodriguez
AprillRcdrCq'ek
Company:
Signature Date:
I Permit E Raters
2017-03-08
Address:
CEA/ HERS Certification Identification (if applicable):
31225 La Baya Drive
City/State/Zip:
Phone:
Westlake Village CA 93291
81$,735-7886
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. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility.forthe building design or system design identified on this Certificate of Compliance (responsible designer).
3. That the energyfeatures 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 California Code of Regulations.
4. 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 forapproval with this building permit application.
S. I will ensure that a registered copy of this Certificate of Compliance shall be made available with the building`permit(s) issued for the building, and made available to the enforcement agency for all applicable
inspections. I understand that a registered copy of this Certificate of Compliance is required to be included with `the documentation the builder provides to the building owner at occupancy,
Responsible Designer Name: „
Responsible Designer Signature:
L
Lyndy Rose
Yom'
Company:
Date Signed:
On -Time Air Conditioning & Heating Inc dba Service Champions
2017-03-08
Address:
License:
7020 Commerce Drive
817040
City/State/Zip:
Phone:
Pleasanton CA 94588
925-444-4444
Registration Number: 417-A020056663A-000-000-0000000-0000
Digitally signed by CHEERS"". This digital signature is provided in order
to secure the content of this registered document, and in no way implies
Registration Provider responsibility for the accuracy of the information.
Registration Date/Time: 2017-0308 16:15:15
HERS Provider: CHEERS
CA Building Energy Efficiency Standards 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-03-08 16:15:17
SchernaVersion: rev 10/16