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B-2017-0834CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0834 21087 RED FIR CT CUPERTINO, CA 95014-4252 (359 05 027) WESTERN DESIGN BUILDERS NORTH HILLS, CA 91343 OWNER'S NAME: MANIAM NUNTHA KUMAR K AND BALASUBRAMANIAM DATE ISSUED: 06/27/2017 M OWNER'S PHONE: 949-545-3615 PHONE NO: (818) 334-7373 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO- License Class GENERAL BUILDING CONTRACTOR Lic. # 1jD473 Contractor WESTERN DESIGN BUILDERS Date 01/31/2018 X_ BLDG ELECT X_ PLUMB 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 license is in full force and effect. JOB DESCRIPTION 1 ST FLOOR BATHROOM ADDITION/REMODEL (50 S.F ); I hereby affirm under penalty of perjury one of the following two declarations: REMOVE/RELOCATE (I) FURNACE W/ A/C TO ATTIC WITH (N) 1. I have and will maintain a certificate of consent to self-insure for Worker's GAS LINE. Compensation, as provided for: by Section 3700 of the Labor Code, for the REV 41 -NEW 3/4" BLACK IRON GAS LINE - TANKLESS WATER eTformance of the work for which this permit is issued. HEATER (120000 BTU); (N) TANKLESS WATER HEATER, (N) have and will maintain Worker's Compensation Insurance, as provided for by eP,section CLOSET (34 S.F)- ISSUED 7/18/2017 3700 of the Labor Code, for the performance of the work for which this REV #2 - PROVIDE SUPPORT AND FRAMING FOR FURNACE - permit is issued. ISSUED 7/25/2017 APPLICANT CERTIFICATION Sq. Ft Floor Area: Valuation: $10000.00 1 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 representatives of this city to enter upon the above mentioned property for 359 05 027 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. PERMIT EXPIRES IF WORK IS NOT STARTED Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 7/25/2017 / Issued by' AbbyAyende OWNER-BUILDER DECLARATION Date: 06/27/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: RE-ROOFS: 1. I, as owner of the property, or my employees with wages as their sole All roofs shall be inspected prior to any roofing material being installed. If a roof is compensation, will do the work, and the structure is not intended or offered for installed without first obtaining an inspection, I agree to remove all new materials for sale (Sec.7044, Business & Professions Code) inspection. 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). Signature of Applicant: I hereby affirm under penalty of perjury one of the following three declarations: Date: 7/2$12.417 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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as provided for by MATERIALS DISCLOSURE Section 3700 of the Labor Code, for the performance of the work for which this _HAZARDOUS I have read the hazardous materials requirements under Chapter 6.95 of the permit is issued. California Health & Safety Code, Sections 25505, 25533, and 25534. I will s. I certify that in the performance of the work for which this permit is issued, I maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the shall not employ any person in any manner so as to become subject to the Health & Safety Code, Section 25532(a) should I store or handle hazardous Worker's Compensation laws of California. If, after making this certificate of material. Additionally, should I use equipment or devices which emit hazardous exemption, I become subject to the Worker's Compensation provisions of the air contaminants as defined by the Bay Area Air Quality Management District I Labor Code, I must forthwith comply with such provisions or this permit shall win maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. be deemed revoked. APPLICANT CERTIFICATION owner or authorized agent: I certify that I have read this application and state that the above information is .Date: 7/25/2017 correct. I agree to comply with all city and county ordinances and state laws CONSTRUCTION LENDING AGENCY relating to building construction, and hereby authorize representatives of this city I hereby affirm that there is a construction lending agency for the performance to enter upon the above mentioned property for inspection purposes. (We) agree of work's for which this permit is issued (Sec. 3097, Civ C.) to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Name judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands Lender's Address and will comply with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Signature Date 7/25/2017 31--toq q CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION.o� C , 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERT NO I louts) f/1-3228 • FAX (408)777-3333 • buildin cue ' o.or O NEW CONSTRUCTION O ADDITION O ALTERATION / TI REVISION / EFERRED ORIGINAL PERMIT # PROJECT ADDRESS �G L3e� ^ OWNER. NAME PHONE Gl (j f},Ir p���l E-MAIL L QP11 �Iwv s STREET ADDRESS o7'i i ('-� ` QR- i CITY, • ST TE, ZIP ��� FAX .n ,q CONTACT NAMEi It s-�C y�l, , [, n / y� Y ,__ �'V (�' J PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OXVNER-BUILDER. ❑ OWNER AGENT ❑. CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECTS ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONT ACTORNAME ` LICENSE NUMBER LICENSE TYPE. BUS. LIC # COMPANYNAME. E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME :" f V ck,� p `V \ A ` q_ %' tr'�/ LICENSE NUMBER BUS. LIC F COMPANY NAME E-MAIL. FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE - CONSTR. TYPE ## STORIES USE .TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA. AREA NET AREA. BATHROOM KITCHEN - OTHER - REMODEL. AREA REMODEL AREA REMODEL AREA , PORCH AREA DECK AREA. TOTAL DECK/PORCH ARE GARAGE AREADETACH _ ❑ATTACH I # DWELLING UNITS: IS ASECOND UNIT ❑YES SECOND STORY []YES BEING ADDED? []NO ADDITION? []NO PRE -APPLICATION El YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑YES CBiVED BY - TOTAL VAN: PLANNINGAPPL # ❑ No PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO By my signature below, I certify to each o£the following: I am the property owner or authorized agent toacton he property owner's behalf. 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-idpentified property for inspection purposes. Signature of Applicant/Agent: dv(,�'�� Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECI�TYPE_ _ zr RO(J LING SLS ❑ COUNTER ❑ BTJIT DTNGPLAN REVJER — New SFD or Multifamily dwellings: Apply for demolition permit forffir existing building(s). Demolition permit is required prior to issuance of building _0NTRTHE permit for new building. ❑ ;Exr>i> s ❑ PiAiiraG Pi n 1161W Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STAlYDAR1l3 ❑ pusilctivolxs _ form if any Hazardous Materials are being used as part of this project. ©,Lrf32GE 0 FREPT _ Copy of Planning Approval Letter or Meeting with Planning prior to NO MAJOR ❑ sAITT &X S) W> R A3STRICT submittal of Building Permit application. ,. ox�L� " T Bldg-App_2011'.doc revised 06'21/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0834 21087 RED FIR CT CUPERTINO, CA 95014-4252 (359 05 027) WESTERN DESIGN BUILDERS NORTH HILLS, CA 91343 OWNER'S NAME: MANIAM NUNTIIA KUMAR K AND BALASUBRAMANIAM DATE ISSUED: 06/27/2017 M OWNER'S PHONE; 949-545-3616 PHONE NO: (818) 334-7373 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lia #610473 Contractor WESTERN DESIGN BUILDERS Date 01/31/2018 X BLDG _ELECT X 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: 1 ST FLOOR BATHROOM ADDITIONIREMODEL (50 S.F.); I hereby affirm under penalty of perjury one of the following two declarations: REMOVE/RELOCATE (1) FURNACE W/ A/C TO ATTIC WITH (N) 1. I have and will maintain a certificate of consent to self -insure for Worker's GAS LINE. Compensation, as provided for by Section 3700 of the Labor Code, for the REV #1 - NEW 3/4" BLACK IRON GAS LINE - TANKLESS WATER performance of the work for which this permit is issued. HEATER (120000 BTU); (I) TANKLESS WATER HEATER; (N) I have and will maintain Worker's Compensation Insurance, as provided for by CLOSET (34 S.F.) Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $10000.00 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 APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 359 05 027 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. i Signature Date 7/18/2017 Issued by: Abby Ayende - OWNER -BUILDER DECLARATION Date: 06/27/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: 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) 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: 7/18/2017 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 3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous 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 Coder Sectio s 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: 7/18/2017 1 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 relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) 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 and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records. Code, Section 9.18. Licensed Signature Date 7/18/2017 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 UFERTth[t I (408) 777-3228 • FAX (408) 777-3333 • building aC).cuoertina.ar ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TT/hzFVT.cT uuFr, nPTC'_1NTAT I)NDA TTN PROJECT ADDRESS 2 APN # OWNER NAME I/ JA / -36,6 E-MAIL�7j� STREET ADDRESS i CIT , STATE, ZIP FAX CONTACT NAME y,jAg V L� PHO E -MAI L D STREETA� DRESS CITY, STATE, ZIP n FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME ,Lg tA `���IZ 9` Zf� LICENSE NUMBER 04-73 LICENSE TYPE BUS. LIC # g r COMPANY NAME hG/— _` fY/Ic� I �(J MAIL p FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE q� p Q� DESCRIPTION OF WORK ice! �^ 1 Q� '�--•/r'N�q Il.� `tiA�\ • '� `-" e' - t VSO' o EXISTING USE W J ,, WO V P POSED USE CONSTR /i 9r -7v l(A / # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH ARE GARAGE AREA: DETACH []ATTACH I # D WELLING UNITS: IS A SECOND UNIT []YES SECOND STORY []YES BEING ADDED? ❑NO ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES ^ IVE BY: TOTAL VALUA ON: PLANNING APPL # []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO By my signature below, I certify to each of the following: I am the property owner or authorized agent to ct on thl property owner's behalf. 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 constructi authorize representatives of Cupertino to enter the above-idefie 1/property fo i��n purposes. Signature of Applicant/Agent: Date: SUPPLEMENT INFORMATION REQUIRED PLAN 'CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUILDINGPLAN REVIEW _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS- ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORK'S form if any Hazardous Materials are being used as part of this project. © LARCE ©_ FIRE.DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAyaa ❑ SANrrARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0834 21087 RED FIR CT CUPERTINO, CA 95014-4252 (359 05 027) WESTERN DESIGN BUILDERS NORTH HILLS, CA 91343 OWNER'S NAME: MANIAM NUNTHA KUMAR K AND BALASUBRAMANIAM DATE ISSUED: 06/27/2017 M OWNER'S PHONE: 949-545-3615 PHONE NO: (818) 334-7373 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #E1 QM Contractor WESTERN DESIGN BUILDERS Date 01/31/2018 X BLDG _ELECT —PLUMB X MECH X RESIDENTIAL COMMERCLAL 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. JOB DESCRIPTION: 1 ST FLOOR BATHROOM REMODEL (42 S.F.); (1) FURNACE AND I hereby affirm under penalty of perjury one of the following two declarations: A/C UNIT 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. z. I have and will maintain Worker's Compensation Insurance, as for by provided Section 3700 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: Valuation: $10000.00 permit is issued. 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 APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 359 05 027 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 6/27/2017 Issued by: Abby Ayende OWNER DECLARATION Date: 06/27/2017 -BUILDER 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: 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: 6/27/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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. HAZARDOUS MATERIALS DISCLOSURE z. 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 3. I certify that in the performance of the work for which this permit is issued, I 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: . APPLICANT CERTIFICATION Date: 6/27/2017 1 certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) 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 and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 6/27/2017 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 77 -3333 • buildinoCa.cupertino.org CUPERTINO NEW CONSTRUCTION ❑ ADDITION ALTERATION / TI [:1REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS O ?)-7 TZF^` ��, # _?)'501-015-02-77 , �. v1 ' ©�� 'APN OWNER NAMEUN � T" �u� 'T�'V tri 1� 1 O Jif' " kJ L STREETADDRESS10 � D F1� G C GvTE ZIP FAX - L OAC- ^ A � w � ONE ^ 37 I O CONTACTNAMEtvq E • �� STREET ADDRESS�� L� �� N 1 14-W. CITY, STATE, ZIP `P a,, e_1VAa0� V0 F 2¢O ❑ OWNER ❑ OWNER-BUMDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR N Q Q� LICENSE IrEb 7FAX' LICENSE TYPE BUS. LIC #172) C ND��i Vt PV� E-MAIL(iON,nn S o iD a &Ve CI ra OC( ✓� �+A HONE d zo- 76 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE,,,]? PHONE # DWELLING UNITS: ISA SECOND UN r-, OYES SECOND STORY u YES BEING ADDED? NO ADDITION? NO PRE-APPLICATIGN ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN C] YES EIVED BY: TOTP� VAL® ATI_ ON: PLANNING APPL # NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO �Q,,'(+ j` l//}�1W( 7 1 By my signature below, I certify each of the follow' g: I am the property owner or authorized agent o act on the property owner's behalf. I have read this application and the information I have provided is c ect. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relatin to buildin ction I aulhorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/A t Date: e S SUPPLEMENTAL INFORMATION REQUIRED _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. —Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. BldgApp_2011.doc revised 06/21/11 A" DESCRIPTION OF WORK Q,V�T-14 A^Dt �Q,� , 1 � v LAI � - FT lQA c- --UOQ= `t AcuA EYUSTINd USE PROPOSED USE (yam � CONSTR. TYPE V I # STORIES i 1 USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG AREA 9 '.f � NEW FLIO_OOR/„ AREA DEMO AREA TOTAL NET AREA 72, q 1 a or BATHROOMKITCHEN REMODEL AREA REMODEL AREA OTTER REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA: DETACH M ATTACH # DWELLING UNITS: ISA SECOND UN r-, OYES SECOND STORY u YES BEING ADDED? NO ADDITION? NO PRE-APPLICATIGN ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN C] YES EIVED BY: TOTP� VAL® ATI_ ON: PLANNING APPL # NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO �Q,,'(+ j` l//}�1W( 7 1 By my signature below, I certify each of the follow' g: I am the property owner or authorized agent o act on the property owner's behalf. I have read this application and the information I have provided is c ect. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relatin to buildin ction I aulhorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/A t Date: e S SUPPLEMENTAL INFORMATION REQUIRED _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. —Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. BldgApp_2011.doc revised 06/21/11 A" CUPERTINO SANITARY DISTRICT 20863 Stevens Creek Blvd #100, Cupertino, CA 95014 Tel (408) 253-7071 • Fax (408) 253-5173 TT4411mgO'�" CUPERTINO SANITARY DISTRICT PERMIT LETTER Cupertino Sanitary District has adopted Resolution No. 1263. Building Permit Request (Over -the -Counter) Single Family Project ❑ Multi -Family Project ❑ Commercial Project Project Address: Permit Number: T -Ar C�k Scope of Work: 0Q11nvVW 1CVW e,1 ,%N,C,w Owner/Applicant Name: %.Av-4^& k�w�.r �r�c VW"��C,r^1Phone Addres Date: 1'' l� Prepared By: 1, as property owner or authorized agent, will be met and all r quired fees will be p� Date: Signature: _ C y Authorized Representative e ge all Cupertino Sanitary District requirements prior to the ap oval of final inspection for proposed project. moi....— Owner / Authorized Agent CUPERTINO SANITARY DISTRICT OFFICE USE ONLY j Pre -inspection Re uired ❑ Final Inspection Required Date Scheduled: ZIP 1� Date:5-25- 1-7 Conditional Approval By: - Authorized Re s tative Cupertino Sanitary District District will notify owner of the required fee within 5 days after Pre -Inspection has been completed and cc City of Cupertino. ❑ Inspection Fee Paid Date Paid: Inspection Fees: 0 $250/unit - Single Family Residential already connected, but new cleanout is required $150/unit - Single Family Residential already connected with existing cleanout in working order D $350 Minimum — Commercial and Retail Actual Amount: D $200/each — Disconnect and/or abandon lateral service Connection Permit Fees: $350/unit - Single Family Residential connecting to existing lateral $650/unit — Single Family Residential connecting with new lateral $100/unit — Multi, Hotel, Living Units, etc. Actual Amount: D $500/connection - Commercial and Retail Actual Amount: Connection Use Fees (See Attached Calculation Sheet): O Area and Frontage Fees Amount: Residential Excess Fees over 3.5 unit/acre Amount: D Commercial and Retail Connection Fees Amount: Commercial and Retail Change in Use Fees Amount: Date: Final Approval By: Authorized Representative Cupertino Sanitary District \': ' / WATER-CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE �raq� COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO r 1� (408)777-3228•FAX 408)777-3333•buildinq(a�cupertino.orq Owner Name hl�''�71/1a u' a/ �✓' S 1✓►a. ' / r1,avu, Permit No. �''2 vt 7 �° 3 y Address 2 0 D R��1 �`�r (''t� /"o (41- IT ° r� 1. Is your real property a:registered historical site? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. VNo 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. 47/No _. Go to Question 3: 3. Is water service permanently;disconnected for your building? ❑ Yes Civil Code Section's 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. �No Go to Question 4. 4. Isyour real prop erty built and available for use or occupancy on or before January 1, 1994? ❑ No My real property ibuilt and available for use or occupancy after January 1, 1994.. • Civil Code Section 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. /Yes My real property isj 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.: i 5. Please check ONE of the foliowing: tgr My property is a single faiuily residential real property. See Civil Code Section 1101.4. On and after January 1, 201;4,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 fixt;tures shall be replaced with water-conserving plumbing fixtures (regardless of whether property undergoes+alterations or improvements). ❑ My property is a inultifanmly residential real property. See Civil Code Section 1101.5. On and after January 1 204,.specified building alterations or improvements shall require non-compliant plumbing fixtures to be replaced with water-conserving plumbing fixtures. On or before January 1,201)9,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 coinniercial 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, 12019, all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughoutthe 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 specifiedabove 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,andithat the water-conserving plumbing fixtures comply with the requirements as indicated in the table on the following.page Owner or Owner Agent's Signature: / �J Date: 0¶1207201 Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit. SB407 2015.doc revised 01/05/17 .-. t � Bi7�LD.TTPERM--�-I'"CNN„ OS�Tc ua FI MEDs"+AND000..VILETEDUom-NTIL_IT.-,H�IIS4 E _.. .. . f ' EISICCERTll,IC E SEEENSIGNETY- TURNED TOTH B pINI DT � T .� Non-Compliant Water-Conserving Plumbing Fixture •Plumbing Fixture (Fixture Complying with CurrentCode Applicableto'New Construction) Maximum,Water.Usage/Flow Rate • Fixture Type 2016 CPC Ch.4 2016 CPC Ch. 4 2016 CPC Ch. 4 Water Usage 2016 CALGreen Div.4.3 2016 CALGreen,Div:4.3 2016 CALGreen Div. 5.3 /Flow Rate Single-Family.r . ` 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-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. Faucets- Exceed 2.2 gallons Maximum 1.5 gallons per 1 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 @.6.0 psi. , , Faucets 7 Exceed 2.2 gallons • 1:.,§,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 .,Mayaemporarily up to 2.2 gallons per increase.up`to 2.2 minute;@ 60.psi, and must gallons,per,minute,@ default tomaximum 60 psi .and must 1.8 gallons per minute @ default to_maxi,m,um_, ' 60 psi 1.8 gallons per minute . Where faucets meeting, @ 60 psi the ab`ove' re unavailable" Where faucets'm'eeting aerators or other means the above:,are may be used to achieve 4unavailable aerators or - ' ' ° ' 4'reduction s,x other means may bi`e ` '� , used to achieve 4.` '':,, -. ! -. .'. ik :''x F. y'' t- ,,reduction s 1. If the existingplumbmg:fixture water usage/flow rate is equal to'or'lower than the figure;shown,itis1 not required to abe upgraded:= ea .fit tw c - ,. ), 'rid A, k� _ , _x°c r __ �,,+ ., -� " •r t'1 F+ff-,T : ') € 4.tVV ..)i,-1,iJ.4,frf . { F ,i.,t .` t hr I y � • i$ F '11. 0 7 ..xx,_. ..� r �, 7 y,f! i,,;:,,';4 :_r# .,, '?..',,`,.:i.,1;_ -,2;=;:'cr ,,r $ __ , A. - p ..;,r:,'. la ,E:: 4 .4 + +t ,1 _ ,.,. 1 to. . ., x.>."l ,Y ,. .; r `- • 4 .1:' t ) t§ '',, ,. SB407 2015.doc revised 01/05/17 SMOKE / CARBON MONOXIDE ALARMS ".10 OWNER CERTIFICATE OF COMPLIANCE yr n� COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228•FAX (408)777-3333•buildinq(a cupertino.orq PRI IIVC�0T,4 EitINA EDT NTth,THIS�CERTIFICAT,E �S BEES * "''dCi*tEnTED,SIGNED.ANJ)R1T DDTO THEEBUItI D1I J604 IONF c x� PURPOSE This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2016 CRC Section R314,R315,2016 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 $1000.00, CRC Section R314,R315, and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations: AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the X X bedroom(s)—(Smoke alarms shall not be located within 3 feet of bathroom door) On every level of a dwelling unit including basements and habitable attics X X Within each sleeping room X Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall'comply with CBC Section 420.6 and shall:be approved by the Office of the State Fire Marshal. Power Supply: In dwelling units with no commercial power supply,alarm(s) may be solely battery operated. In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic,basement or crawl space.Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for alarms which must be connected to the building wiring. As owner of the above-referenced property,I hereby certify that the alarm(s) referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes. The alarms specified below have been tested and are operational, as of the date signed below. f Address: 2 1 0 8 9"/Zed �� 6- ClA pe-✓ ,,1D ( 1 d I Permit No.6--, q�/��03 y Specify Number of Alarms: #Smoke Alarms: �►� #Carbon Monoxide Detectors: 12 1 /have read and agree to comply with the terms and conditions of this statement Owner,�, p (of.Owner•Agent''Js)Name: �,n- /2V-2014—l`l�! "'�✓I�✓r$ ` ' 1fa4'gignature / Date: ! Contractor Name: Signature Lic.# Date: Smoke and CO form.doc revised 01/10/2017 0,4%Nsrraar4 ! CUPERTINO SANITARY DISTRICTS sl 20863 Stevens Creek Blvd#100, Cupertino, CA 95014 Tel (408)253-7071 • Fax(408)253-5173 fi%'49arsxso x.`446 CUPERTINO SANITARY DISTRICT PERMIT LETTER Cupertino Sanitary District has adopted Resolution No. 1263. Building Permit Request (Over-the-Counter) Single Family Project ❑ Multi-Family Project n Commercial Project Project Address: .,—Wit " '"` . -- Al: ' Permit Number rs f t510 Scope of Work: bCt tvOOW ot&ooteI _ Av�rc‘VVI Owner/Applicant Name: - - Ac. Kw -r c�vl',�JPhone: E C! 5 S _>�I S Address: n c_Date11-C �� Prepared By: CUOI r C y Authorized Representative I, as property owner or authorized agent, ac edge all Cupertino Sanitary District requirements will be met and all r quired fees will be pa•d prior to the.ap ,oval of final inspection for proposed project. Date: �j1 7-7 17 Signature: . 4'",'"---+--- "' ` Owner/Authorized Agent ' (-----.1 1 CUPERTINO SANITARY DISTRICT OFFICE USE ONLY !! Pre-inspection Rewired ❑ Final Inspection Required! Date Scheduled: '.21B- t7 Date: -2 - t--1Conditional Approval By: ' ` ceAc"-- I ' I Authorized Re s tative Cupertino Sanitary ;strict District will notify owner of the required fee within 5 days after Pre-Inspection has been completed and cc City of Cupe,•° o., 1 ., Inspection Fee Paid Date Paid: 9- f 1 - (7 Inspection Fees: i' ' lrl $250/unit-Single Family Residential already connected, but new cleanout is required $150/unif-Single Family Residential already connected with existing cleanout in working order I= $350 Minimum—Commercial and Retail Actual Amiount: J. = $200/each —Disconnect and/or abandon lateral service Connection Permit Fees: $350/unit-Single Family Residential connecting to existing lateral D $650/unit—Single Family Residential connecting with,new lateral D $100/unit—Multi, Hotel, Living Units, etc. Actual Amount; D $500/connection -Commercial and Retail Actual',Amount; Connection Use Fees(See Attached Calculation Sheet): ' , D Area and Frontage Fees. ' ' Amount: D, Residential Excess Fees,over 3.5 unit/acre Amount: 0 Commercial and Retail Connection Fees Amount: , 0 Commercial and Retail Change in Use Fees Amount: ' d Date: 7--3-O- 1`7 Final Approval By: rrr% :%7 Authorized Representative Cupertino Sanitary District CERTIFICATE OF VERIFICATION • CF3R-MCH-22-H Space Conditioning System Fan Efficacy (Page 1 of 3) Project Name: Nuntha Kumar Enforcement Agency: City of Permit Number: .,8 2017-0834." Cupertino Dwelling Address: 24O87 R•uiA' 1 City: Cupertino Zip Code: 95014 A. Ducted Cooling System Information • • 01 System Identification or Name 21087 Red Fir Ct. 02 System Location or Area Served Entire Home .;; ;::. , 03 System Installation Type New 04 Nominal Coaling Capacity(tons)of Condenser 2 ' ,'' i,;; 05 Condenser Speed Type- , Multi-speed. , 06 Cooling System Zonal control Type Not Zonal 07 Central Fan-Integrated(CFI)Veritilation System;Status— Not a CFI system 08 System Bypass D�u.Ft Status .;' ` 4 .. r 1 . No Bypass Duct ;�- �` - =, , i' Y f ,L A. r�{ k -yJ5 1 E 5!T 09 Date of SystemrAlrflow Rate Measurement. h .2017.09 15 z`5 4 I 10 Airflow Rate Protocol utilized �'; ,x- , I . RA3 3 procedures for air low rrate measurement `�? q t 6_r, r . S a +.' ': .�..o's` r , 4,,,.,r 4.,. Ni; I. 1 B. Fan Watt Measurement Apparatus and Procedure Information ii: Instrument Specifications are given in RA3.3.1,and system fan watt measurement apparatus information is given in RA3.3.2.2. 01 Fan Watt Verification Device Used. Analog Utility Revenue Meter(spinning wheel type) . Ii 11 I I,' MCH-22a Forced Air System Fan Efficacy Measurement-Newly Installed Non-Zoned Systems or Zoned Multi-Speed ;: Compressor ;;I 1, ; G i 1 I 1'; C. Forced Air System Fan Efficacy Measurement j The procedureVor System Fan Watt Verification are specified in Reference Residential Appendix RA3.3. 01 Actual Tested Watts 325 2 Actual Tested Ai 0rflow from MCH-23(cfm) 959 i III1 ii ' 03 Required Fan 'Efficacy(watts/cfm) 0.58 1 04 Actual Fan ffficacy(watts/cfm) 0.34 I III11 li. 05 Compliance Ii Sttement: System fan efficacy complies - 11I i . Registration Number: ' Registration Date/Time: 2017-09-15 11:02:10 HERS Provider:CaICERTS 217-A020315697A-000-001-M22001A-M22A I'; f ' CA Building Energy Efficiency Standards Report Version:2016.1.006 Report Generated:2017-09-15 11:02:02 • 2016 Residential Compliance Schema Version:rev 2013-09-11 I!; , CERTIFICATE OF VERIFICATION CF3R-MCH-22-H Space Conditioning System Fan Efficacy (Page 2 of 3) D.Additional Requirements 01 All registers were fully open during the diagnostic test. 02 System fan was set at maximum speed during the diagnostic test. 03 If fresh air duct is part of the HVAC system it was not closed during the diagnostic test. 04 Airflow rate and fan watt draw shall be simultaneous measurements when used to calculate the Fan Efficacy tested value. Multi-speed compressor space cooling systems or variable speed compressor systems shall verify air flow(cfm/ton)and fan 05 efficacy.(Watt/cfm)with system operating in cooling mode at the maximum compressor speed and the maximum air; handler fan speed. 06 Zoned cooling air distribution systems with'single speed compressors'shall meet both the airflow(cfm/ton)and fan efficacy (Watt/cfm)criteria in every zonal control mode. • 07 Verification Status kic,144, Pass-all applicable requirements are met 08 Correction#Notes The responsible p rsons,signature on this compliance document affirms that all applicablekrequirements in this table have been met unless''othervi ise notain the Verification Status and the Corrections Notes in thistable. Y : a ftp,. z y, moi. Y .., fi ..��. � `�� y-.� lr� 3±t:. ,6arr Corrections �.-.-'%�. ,:t'. � a€s.: :..f: fia s�:, :-.,... E. Determination of HERS Verification Compliance. t sYri�yL �• t S_x.1, F_ All applicable sections of this documentvshall indicate compliance with the specified"verification protocol requirements in order for this Certificate of Verification as a whole to be determined to be in compliance. ' ; 01 Complies:All:specified verification;protocol requirements on this document are met. I I I ,I Registration Number: Registration Date/Time: 2017-09-1511:02:10 HERS Provider:CaICERTS 217-A020315697A-000-001-M 22001A-M 22A CA Building Energy Efficiency Standards Report Version:20161.006 Report Generated:2017-09-15 11:02:02 2016 Residential:Compliance Schema Version:rev 2013-09-11 a CERTIFICATE OF VERIFICATION CF3R-MCH-22-H • Space Conditioning System Fan Efficacy (Page 3 of 3) Documentation Author's Declaration Statement - ' 1. I certify that this Certificate of Verification documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: - Stacie Bagnasco : i 4,..iiv "-e°" .`: Company:; Date Signed: 831 Conserve dba Central Coast Energy Services - 2017-09-15 11:02:10 Address: CEA/HERS Certification Identification(if applicable): PO Box 2707' CC2006315 ; City/State/Zip: i Phone: ' Watsonville CA 95077 831-726-4018 , Responsible Person's Declaration statement , I certifythe following under ena � , g p lty ofperjury,under the laws of the State of California: 1. The information provid ` on'this Certificate of Verification is true and correct 2. I am the certified HERS Ratar-who performed the verification identified and reported on this Certificate of Verification(responsible rater). 04 3. The installed features,materials components,manufactured devices,or system performance diagnostic results that require HERS verification identifiedon this Certificate'ofVenfication complywith,the applicable requirements in Reference.Appendices RA2,RA3,and the requirements specified on the Certificate of Compliance for the build g approved by the enforcement agency. 4. The information reported on'applicable''sections of:the Certificate(s).of Installation(CF2R)signed'andjsubmitted,lbythe persons)responsible for the construction or installation-conforms to the requirementsspecifiedson the Certificates)of Compliance(CFMapproved byt ie enforcement agency. 5. I will ensure that a,registered copy,of this Certificate ofNerification shall be posted or made availablewith theebruilding permits)issued for the building,and made availableltto th4e�,enforcement agency for all applicable inspections I°understand that a,registeredtcopy of this,�Certificatte,of, a. Verification is required to be included;with the documentation the builder provides to the budding owner at occupancy `'- Builder Or Installer Information As Shown On The"Certificate"Of Installation ' ' Company Name(Installing Subcontractor General'Contractor,or Builder/Owner): , COMFORT,ZONE HEATING&AIR'CONDITIONING CO Responsible'Builder or,Installer Name: ' SLB License: Raymond Lui 898653 HERS Provider Data Registry Information Sample Group Numberj(if applicable): ' Dwelling Test Status in Sample Group(if applicable) Tested HERS Rater'Information ' HERS Rater Company Name: 831 Conserve dba Central Coast Energy Services Responsible Rater Name:'' Responsible Rater Signature: - Stacie Bagnasco � acv `� Responsible Rater Certification Number w/this HERS Provider: Date Signed: CC2006315 ; ', 2017-09-15 11:02:10 , l Digitally signed by CaICERTS. 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 Number: Registration Date/Time: 2017-09-15 11:02:10 HERS Provider:CaICERTS 217-A020315697A-000-001-M22001A-M22A CA Building Energy Efficiency Standards Report Version:2016.1.006 Report Generated:2017-09-15 11:02:02 2016 Residential Compliance `Schema Version:rev 2013-09-11 CERTIFICATE OF VERIFICATION CF3R-MCH-20-H Duct Leakage Diagnostic Test (Page 1 of 3) Project NameMinnie;Kumar of Permit Number: lam" 1r �.. Cupertino Dwelling Address: 081;1w it m.. • City: Cupertino Zip Code: 95014 A.System isliormatlen 01 Space Conditioning System Identification or Name 21087 Red Fir Ct. 02 Space Conditioning System Location or Area Served Entire Home 03 Building Type from CF-1R Single family Verified Low Leakage Ducts in Conditioned Space(VLLDCS) 1 No,credit is not taken 04 Credit from CF1R? Verified Low Leakage Air Handling Unit(VLLAHU)Credit No,credit is not taken 05 from CF1R? *4. VI 06 Duct Systen Compliance Category t�,r New MCH-20a-Completely New tiuctystern e €- >. ur e,- 4;^ '. ,. - irk r le.r.. ,-_,?e4 i'j x ,, :. � - .:: ti .4�'`t• 3 ., ,�, ;.,.,; B.Duct Leakage'Diagriostic Test ' .a ' 01 Condenser Nominal Cooling Capacity`(ton) 2 02 Heating Capacity;(kBtu/h) 42 03 Conditioned Floor Area served by this HVAC system(ft2) 914 04 ` Duct Leakage Test Conditions Test final 05 Duct Leakage Test Method Total leakage 06 Leakage Factor 0.05 Air Handlin 07 g UnitAirflovv'°(AHIJAirFlow)Determination Heating system method Method 08 Measured AHUAir low This field or section is not applicable 09 `, Calculated TirgetAlinwaille Dui ° ( ) {46 10 Actual Duct'Leakage Rate from Leakage Test 31 Measurement(cfm) 11 Compliance Statement System passes leakage test i , Registration Number: 1' Registration Date/Time: 2017-09-15 11:02:10 HERS Provider:CaICERTS 217-A020315697A-000-001-M20001A-M20A CA Building Energy Efficiency Standards Report Version:2016.1.006 Report Generated:2017-09-15 11:01:02 2016 Residential Compliance Schema Version:rev 03/16 I ' CERTIFICATE OF VERIFICATION CF3R-MCH-20-H Duct Leakage Diagnostic Test (Page 2 of 3) R.Duct Leakage Diagnostic Test 12 Notes: C.Additional Requirements for.Compliance 01 System was tested in its normal operation condition.No temporary taping allowed. Outside air(OA)duct connections to the central forced air duct system shall not be sealed/taped off during duct leakage 02 testing:OA ductsused for Central Fan Integrated(CFI)Indoor Air Quality ventilation;systems,or Central Fan Ventilation Cooling Systems,that utilize dampers that open only when OA is required and automatically close when OA is not required, may configure the OA damper to the closed position during duct leakage testing. 03 All supply and return'register boots were sealed to the drywall. �yR 04 Building cavities:werejnot used as plenums or platform returns in lieu of ducts. ' 1tS m 05 If cloth;backed tapejwras used it was covered with Mastic and draw bands, 06 All'connection points between the airhandlers and the supply and return plenums are completely sealed. Visual Inspection at Final Construction'Stage(applicable if system was tested at rough in) t AV;-1 After444- installing the interior finishingrwall and verifying that the above rough in testswas completed,the following procedure must be performed JA4P-" A ? ..qf }s $ 3 r-.,sw 4 � Ss it, t i r- 07 o For,allsupply and'return registeit.verify that thexspaces`between the register boot and the interior finishing'wall are properly sealed. ' 08 If the house rough-in duct leakage test was conducted without an air handler installed,inspect the connection points between the air handler and the supply and return plenums to verify that the connection points are properly sealed. 09 Inspect ailljoints toiensure that no cloth backed rubber adhesive duct tape is used. 10 Verification Status: Pass 11 Correction'Notes: The responsible person's signature on this compliance document affirms that all applicable requirements inthis table have been met unless otherwise;noted in the Verif'i'cation Status and the Corrections Notes in this table. D. Determination of HERS Verification Compliance Al!applicable*pops'of this document shall indicate compliance with the specified verification protocol requirements in,order for this Certificate of Verification as a whole to be determined to be in compliance. 01 Complies All specified verification protocol requirements on this document are met. Registration Number: Registration Date/Time: 2017-09-15 11:02:10 HERS Provider:CaICERTS 217-A020315697A-000-0014A20001A-M20A CA Building EnergyiEfficiencyStandards Report Version:2016.1:006 Report Generated:2017-09-15 11:01:02 2016 Residential Compliance Schema Version:rev 03/16 is ,; • r CERTIFICATE OF VERIFICATION CF3R-MCW20-H Duct Leakage Diagnostic Test (Page 3 Of 3) Documentation Author's Declaration Statement , 1. I certify that this Certificate of Verification documentation is accurate and complete. ., Documentation Author Name:' Documentation Author Signature: (,A _ Stacie Bagnasco .7�r Y"'a4i� . Company: Date Signed: 831 Conserve dba Central.Coast Energy Services 2017-09-15 11:02:10 • Address: . CEA/HERS Certification Identification(if applicable): PO Box 2707, . CC2006315 . ' City/state/Zip: Phone: Watsonville CA 95077 ' . 831-726-4018 • Responsible Person's Declaration statement I certify the following under penaltof-perjury,under the laws of the State of California: ' 1. The information provided do this Certificate of Verification is true and correct. • 2. I am;the certified HERS Rater who performed the verification identified and reported on this Certificate of Verification(responsible rater). ' 3. The installed featuresmaterials components,manufactured devices,or system performance diagnostic results that require.HERS verification ntife on ideitis Cer,htificateof Verificat on complywithµthe,applicable requirements in Reference Appendices RA2,RA3,and the requirements specifiedlin the Certificate of Compliance for the`building approved by the enforcement agency. 4. The information.reported on applicable-sections of the Certificate(s),of Installation(CF2R)signedsandsubmitted'bythe pers n(s)responsible for the construction dr installation conforms'to the requirementsspecified on the Certificate(s)of Compliance(CF1R�)approved by the enforcementlagency. t� �_ ,� 4 �`=: x�„�.k" .,� air h v. 1� }`'' 5. 1 will ensure thata registered copy%of this Certificate of Verification shall be posted or made available.with the building permits)issued for the building,andima'de available to the agency,for all applicablejnspectionss 1'understand that a registered,copy of+this Certificate of4 I Verification i srequired to be;included with the documentation the builder pto rovides the building owner at occupancy '' . ,; E ,,. . s :w; 4--,g4v Y .0,,,,,,:, ,. .s bio. ,-0,7-,,,' „ j.. Via} , a r'.� + 1s'.:' '' .` { ' >i, ^("n i t_' t,,i4 d-�r.: 1 ti, Builder Or Installer Inforthation As Shown On The Certificate''Of Installation Company hire(Installir ,g,Subcontractor,General Contractor,or Builder/Owner): COMFORT ZONE HEATINGi!&FAIR CONDITIONING CO ' • Responsible Builder or Installer N ,•fi•. ame: CSLB License: Raymond,Lui' i'l" : 898653 ' HERS ProviderData Registry Information V I n !'I • ' Sample Group Number(ifapplicable) Dwelling Test Status in Sample Group(if applicable) ' ' it' , l+ Tested HERS Rater!Information , • 1 HERS Rater Company Name: , • 831 Conserve'dba Central Cdast Energy Services Responsible Rater Name! . ' Responsible Rater Signature: Stacie Bagnasco!' ' l ' _ Responsible Rater'Certification Number w/this HERS Provider: pate Signed: , 'H '`' ,CC2006315° + , . 2017-09-15 11:02:10 I. L' • Digitally signed by Ca10ERTS This'digital signature is provided in order to secure the content of this registered document,and in no way implies i ' ' ,1 Registration Provider responsibility for the accuracy of the information: Registration Number: i: ,` Registration Date/Time: •2017-09-15 11:02:10 HERS Provider:Ca10ERTS 217-A020315697A-000-001-M 20001A-M20A , CA Building Energy Efficiency Standards. Report Version:2016.1.006 ' Report Generated:2017-09-15 11:01:02 2016 Residential Compliance ; Schema Version:rev 03/16 CERTIFICATE OF VERIFICATION CF3R-MCH-23-H Space Conditioning System Airflow Rate (Page.1 of 4) Project Name: Nuntha Kumar Enforcement Agency: City of Permit Number: •.2 e 3f?083, Cupertino Dwelling Address: =1087.( 1 City: Cupertino Zip Code: 95014 A:Ducted Cooling System information 01 System Identification or Name 21087 Red Fir Ct. 02 System Location or Area Served Entire Home 03 System Installation Type,, New 04 Nominal Cooling Capacity(tons)of Condenser 2 05 Condenser,Speed Type its Multi-speed 06 Cooling System Zonal Control Type Not Zonal 07 Central fan Integrated(CFI)Ventilation System Status-"-` Not CFI system ! . " "nw 08 System Bypass Duet NoBypasDuct 4 �& S s uY i e+ 3 �7 n A iti 09 Date of SystemrAirflow Rate Measurement k �� 2017 09-15 �# IgE: t '.,x ',1010,01,,,,- x,.., x ; nn-.': y r} �, .. a. , w a of a: r: �+Aq..tO I 'I ' �, S �. y .w.A qy" $., k i its. xvrl'x'. ... 10 Airflow Rate I?rotocol Utilized : ? RA3 3 procedures for airflow ratexmeasi cement w. Y B. Hole,for;the_placement of a Static Pressure Probe(HSPP),and Permanently Installed Static Pressure.Probe(PSPP) in the Supply Plenum.•; ; Procedures''for';installin`g HSPP or PSPP are specified in RA3.3.1:1. 01 Method Used to Demonstrate Compliance with the. HSPP/PSPP are not applicable to this system HSPP/PSPP I Requirement' ; C.Airflow Rate Measurement Apparatus and Procedure Information Instrument Specificatidns!aregiven in RA3.3.1.1, and system airflow rate measurement apparatus information is given in RA3.3.2. • 01 Airflow Rate Measurement Type used for this airflow rate Traditional Flow Capture Hood according to procedure in verification'. . RA3.3.3.1.4 • 02 Manufacturer of Airflow Measurement Apparatus Kanomax • 03 Model number of Airflow Measurement Apparatus 6710 Certification Status of the Airflow Measurement Apparatus Certified by Manufacturer and listed on CEC Website at 04 Accuracy http://www.energy.ca.gov/title24/equipment_cert/ama_fas , /index.html. Registration Number,: Registration Date/Time: 2017-09-15 11:02:10 HERS Provider:CaICERTS 217-A020315697A-000-001-M 23001A-M 23A CA Building Energy Efficiency Standards Report Version:2016.1.006 Report Generated:2017-09-15 11:01:38 2016•Residential Compliance Schema Version:rev 10/16 CERTIFICATE OF VERIFICATION CF3R-MCH-23-H Space Conditioning System Airflow Rate (Page 2 of 4) • MCH-23a Forced Air System Airflow Rate Measurement-Newly Installed Non-Zoned Systems or Zoned Multi-Speed , Compressor D.Forced.Air System Airflow Rate Measurement The procedures.for System Airflow Rate Verification are specified in Reference Residential Appendix RA3.3. 01 Required Minimum System Airflow Rate(cfm/ton) 350 02 Required Minimum System Airflow Target(cfm) 700 03 Actual System Airflow Rate Measurement(cfm) 959 • 04 Compliance Statement: ' System airflow rate complies E.Additional Requirements. 3; 01 Air filters,th`aj meet the applicablezrequirements of Standards Section 150.0(m)12 or 150.0(m)13 were properly installed in the systemsduring system air flow rate measurement identified on this Certificate of Verification. ' <�. :Y _,.':`.3 - ;, _ r ., %'rn ..� fit- wr. • The airflow rate measurement apparatus used toperfornphe airflowirate measurement identified on hls Certificate of 02. Verification was calibrated inlaccordance with the`apparatus manufacturer's specifications and'conforms to the �ra''`rr ifu i c r. f1. +..8� '' s"$:. �*•, �` e €.F„'s f.. !N� IP; instrumentation specificationsgiyen in RA3 3 1 • A visual inspection shall confirm that bypass ducts-that deliver conditioned supply airYdirectly to the space conditioning 03 system return duct airflow'are not used on newly constructed zonally controlled systems unless the Performance Certificate of Compliance,:indicates an allowance for use of a bypass duct.When a bypass duct is accounted for on the Performance Certificate of Compliance,the airflow rate shall conform to the specifications listed on the Certificate of Compliance.. 04 All registers were'fully open during the diagnostic test. 05 System fan was set at;maximum speed during the diagnostic test. 06 If fresh air duct is part of;the HVAC system it was not closed during the diagnostic test. 07 Airflow rate and fan watt draw shall be simultaneous measurements when used to calculate the'Fan Efficacy tested value. Multi-speed comp'ressor'space cooling systems or variable speed compressor systems shall verify air flow(cfm/ton)and fan 08 efficacy(Watt/,cfm)with system operating in cooling mode at the maximum compressor speed and the maximum air handler fan speed.' 09 Verification Status: Pass-all applicable requirements are met 10 Correction,Notes: The responsible person's signature on this compliance document affirms that all applicable requirements in this table have. been met unless:otheryrise noted in the Verification Status and the Corrections Notes in this table • Registration Number: Registration Date/Time: 2017-09-15 11:02:10 HERS Provider:CaICERTS 217-A020315697A-000-001-M23001A-M23A CA Building Energy EfficiencyStandards Report Version:2016.1.006 Report Generated:2017-09-15 11:01:38 2016 Residential,Compliance, Schema Version:rev 10/16 CERTIFICATE OF VERIFICATION CF3R-MCH-23-H Space Conditioning System Airflow Rate (Page 3 of 4) F. Determination of HERS Verification Compliance H All applicable sections of this document shall indicate compliance with the specified verification protocol requirements in order for this Certificate of Verification as a whole to be determined to be in compliance. 01 Complies:All specified verification protocol requirements on this document are met. 3 ..} ;E `s'E•fi'" i� r��.ah a v'� F1 n ef I 1yf t i r7 P T� i 1 { f,yap . y .. �r� c is t lo„ J i.: S �, �' ��.', �,s-.... • 4F fl:/ f 4... • '� .,ms •. Y u F6 rr.,� I.Cy I . I I Registration Number: i Registration Date/Time: 2017-09-15 11:02:10 HERS Provider:CaICERTS 217-A020315697A-000-001-M23001A-M23A I I ' CA Building Energy Efficiency Standards Report Version:2016.1.006 Report Generated:2017-09-15 11:01:38 2016 Residential Compliance Schema Version:rev 10/16 V CERTIFICATE OF VERIFICATION CF3R-MCH-23-H Space Conditioning System Airflow Rate (Page 4 of 4) Documentation Author's Declaration Statement 1. I certify that this Certificate of Verification documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: n� Stacie Bagnasco Company: Date Signed: 831 Conserve dba Central Coast Energy Services 2017-09-15 11:02:10 ' Address: CEA/HERS Certification Identification(if applicable): PO Box 2707 CC2006315 City/State/Zip: Phone: • Watsonville CA 95077 831-726-4018 Responsible Person's Declaration statement I certify the following under penaltyjofiperjury,under the laws of the State of California: 1. The information provided.on this Certificate of Verification is true and correct. 2. I am the certified HERSkRaierwho performed the verification identified and reported on this Certificate of•Verification(responsible rater). 3. The installed feetures`materials components,manufactured devices,or system performance diagnostic results that require HERS verification identified on this Certificate of Verification comply with the.applicable requirements in Reference Appendices RA2,RA3,and the requirements specified-on-the Certificate of Compliance for the`building approved by the enforcement agency. 4. The information reported on applicable sections of.the Certificate(s)lof Installation(CF2R)signedand submittedby the person(s)responsible for the construction or installation.canfor s to the,requirementstspecifiedson the Certificate(s)i,bf Compliance(CF1R)approved by theenforcement agency: 5.• ; I will ensure that's registered copy of this Certificate of•Ver;ification shall be posted,6r made,available with thebuilding permit(s)issued for the building,and made'available;to the^enforcemnt eagency for all applicable inspections I understand that a4registered copy of,;ahis�Certrficate of • Verification is regwred to be`'included with the documentation the builder`prowdesto the building owner if occupancy. . rel ..f .c „ t'1'".iS; i<x' wi4'Nm .-.vaut?,:.. %'+.`y. 'i4- -5l/ { ,. `C+:.';. 1,A0T •.�t:_<.. Builder:Or Installer Information As Shown On The"Certificate Of Installation Company Name(Installing Subcontractor,General Contractor,or Builder/Owner): • COMFORT ZONE HEATING,&AIR CONDITIONING CO Responsible Builder or Installer Name: SLB License: Raymond Lui 898653 HERS Provider Data Registry Information Sample Group Number(if applicable): Dwelling Test Status in Sample Group(if applicable) Tested i HERS Rater Information, • HERS Rater Company Name: 831 Conserve dba Central•Coast'Energy Services Responsible Rater Name: Responsible Rater Signature: Stacie Bagnasco g Responsible Rater Certification Number w/this HERS Provider: Date Signed: CC2006315 2017-09-15 11:02:10 ' I Digitally signed by Ca10ERTS..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 Number: Registration Date/Time: 2017-09-15 11:02:10 HERS Provider:CaICERTS 217-A020315697A-000-001-M 23001A-M 23A CA Building Energy.Efficiency Standards Report Version:2016.1.006 Report Generated:2017-09-15 11:01:38 2016 Residential Compliance Schema Version:rev 10/16 Arnold Hom 07/25/17