B-2017-0995CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0995
21865 ALMADEN AVE CUPERTINO, CA 95014-2803 (357 15 018)
A R S AMERICAN
RESIDENTIAL
SERVICES OF
CALIFORNIA INC
MEMPHIS, TN 38120
OWNER'S NAME: CHAN WALTER AND WINNIE S TRUSTEE
DATE ISSUED: 06/23/2017
OWNER'S PHONE: 408-605-8929
PHONE NO: (408) 286-8931
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class= Lic. #742039
Contractor A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC
X BLDG —ELECT —PLUMB
Date 10/31/2017
X MECH X RESIDENTIAL _ COMMERCIAL
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 AC UNIT LIKE FOR LIKE - 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.
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
Sq. Ft Floor Area:
Valuation: $7361.00
permit is issued.
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
357 15 018
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
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
may accrue against said City in consequence of the granting of this permit.
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.
Issued by: SEAN HATCH
Signature Date 06-23-2017
Date: 06/23/2017
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
r. I, as owner of the property, or my employees with wages as their sole
inspection.
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business & Professions Code)
Signature of Applicant:
2. I, as owner of the property, am exclusively contracting with licensed
Date: 06-23-2017
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
1. 1 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
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
i. 1 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 Municipal 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
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
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
Worker's Compensation laws of California. If, after making this certificate of
the Health & Safety Code, tions 25505, 25533, and 25534
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
Owner or authorized agent:
be deemed revoked.
Date: 06-23-2017
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I 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
Lender's Name
to enter upon the above mentioned 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
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
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
MEP
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 MISC
CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • buildingcWcupertino.org
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USE OF D or DUPLEX ❑ MULTI -FAMILY
BUILDING: ❑ COMMERCIAL
PROJECT IN WILDLAND ❑ YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORKkc
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TOTAL VALUATION:
RECEIV
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By my signature below, I certify to each of the following: I am the property owner or authorized agent to At on e property owner's behalf. I have read this
application and the information I have prov�correct.la Description ofWork and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to bu' inpresentatives of Cupertino to enter the above` enyf d ert f section purposes.
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Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
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MEPMiscApp 2011. doe revised 06/21/11
J I H I C Vt UTALWUMNIH
ALTERATIONS - HVAC
CEC-CFIR-ALT-03-E (Revised 01/16) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ALT-03-E
Alterations - HVAC CZ 1, 3 to 7 and 16 (Page 1 of 1)
Site Address: G n / C6-5 C/
4 G�2�LC
Enforcement Agency:
Date Prepared:
Permit#:
Equipment Type
Equipment Efficiency
New: Ducting or Lineset
Required R -value
Conditioned
Floor Area (ftZ)
Thermostat
❑ Packaged System
evaporator Coil
AFUE
COP
❑ R-6 (CZ 1-10,12&13) Ducts
❑ R-8'
Sery y sys m
etback
(If not already
Split System
J ondensing Unit
7E4ER
(CZ 11,14-16) Ducts
L�
❑ Furnace
j
ineset
EER
HSPF
1:12: R-2.8 Lineset3
present, must
be installed)
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this
for ' allowed to be filled out by hand. For final inspection all forms are to be registered (no hand filled forms allowed) and a copy left on site.
1. HVAC Changeout/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: MCH -01, MCH -20-H
Air Handler/Furnace
CF3R: MCH -20-H
Installer Requirement: Duct leakage (< 15% or, 5510% 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 113. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building1
❑ 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-MCH-01-E, MCH -20-H, MCH -22-H, MCH -(23 or 24)-H
CF3R-MCH-20-H, MCH -22-H, MCH -(23 or 24)-H2
Installer Requirement: Duct leakage < 5%, Fan Efficacy (0.58W/CFM), Air Flow >_ 350 CFM/ton (or Standards Table 150.0-13 / C 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-MCH-01-E, MCH -20-H, MCH -(23 or 24)-H
Condenser Unit, Evaporator Coil, Furnace
CF3R-MCH-20-H, MCH -(23 or 24)-H
Installer Requirement: Duct leakage < 5%, Air Flow >_ 350 CFM/ton (or Standards Table 150.0-B / C alternative)
❑ Exempted from duct leakage testing if 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
CF1R-ALT-02-E
space but less than All New DuctsZ
CF2R-MCH-20-H
CF3R-MCH-20-H
Installer Required to: Duct leakage (< 15% or, < 10% to outside, or seal all accessible leaks)
❑ Exempted from duct leakage testing if existing duct systems are constructed, insulated or sealed with asbestos.
' All new ducting requires R-8 insulationwhen more than 40 ft installed in CZs 11 & 14-16 and R-6 in CZs 1-10, 12 & 13, and R-6 insulation 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 %new duct material, and up to 25%may consist of reused parts from the
dwelling unit's existing duct system (e.g., registers, grilles, boots, air handler, plenums, duct material.
3 R-2.8 (1" thick insulation) for linesets 1" and less.
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.
3. 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:
Responsible Designer Signature• Da Signe
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For assistance or questions regardffig the Energy Standards, contact the Energy Hotline at: 1-800-772-3300