B-2017-1129CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1129
7545 DUMAS DR CUPERTINO, CA 95014-4310 (359 24 049)
AIR & PLUMBING
SYSTEMS INC
LOS GATOS, CA 95032
OWNER'S NAME: STEIN JAN AND SHERRI H TRUSTEE
DATE ISSUED: 07/13/2017
OWNER'S PHONE: 408-832-7219
PHONE NO: (408) 733-2000
i ICFNSFD CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C-20 Lic. #901246
Contractor AIR & PLUMBING SYSTEMS INC Date 07/31/2017
X BLDG _ ELECT _ 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:
REPLACE FURNACE (SAME LOCATION); RELOCATE AC UNIT
I hereby affirm under penalty of perjury one of the following two declarations:
(NEW LOCATION)
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
9Y performance of the work for which this permit is issued.
2. 1 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: $11000.00
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
59
359 24 049
3
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
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 Cupertin unicipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature -- Date 7/13/2017
Issued by: JASMINE ARCHBOLD
Date: 07/13/2017
OWN R- ER DECLARATION
I hereby affirm that I ant 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)
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: 7/13/2017
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
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued. i
1. I certify that 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 Arca Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with tite 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, 255�t1 25
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 7/13/2017
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
f()2iSTRUCTION LENDING AGENCY
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 7/13/2017
Professional
t GENERAL PERMIT APPLICATIONM, E:
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
• CUPERTINO, CA 95014-3255
10300 TORRE AVENUE
4 (408) 777-3228 • FAX (408) 777-3333 • buildinaC�cupertino.ora
CUPERT INN
❑PLUMBING ' tI ECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS
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CONTACT NAME f)f � L/ /
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CONTRACTOR NAME
LICENSE NUMBER�6m LICENSE TYPE
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ARCHITECT/ENGINEER NAI,4E
LICENSE NUMBER
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COMPANY NAME
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STREET ADDRESS
CITY, STATE, 'LIP
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USE OF ❑ SFD or DUPLEX PROJECT ZN w aDLP„ND ❑ -YES PROJECT A1' ❑ 1 -ES
BUII.DAG:❑ COA�A;ERCIAL URBAN ThTERFACE AREA ❑ NO FLOOD ZONE El NO
IS THE BLDG AN ❑ 1TS
EICIiLER HOME? El NO
DESCRIPTION OF WORK
C13 � C
TOT -4L VALUATION:
RECEIVED B
By my signature below, 1 certify to each of the following: lain the propea owner or authorized agent to act on the proper owner's behalf. I have read this
application and the information I have provided is correc rea the Descriptio f Work and veriA it is accurate. I agree to comp y witb all applicable local
ordinances and state laws relating to building cons thorese-tom gs eff pertTp Imo to enter the above-identifid prope for inspection purposes.
Signature of.ApplicanvAgent: Date: /
SUPPLEMENTAL IINTFORMATION REQUIRED
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OFFICE LSE ONLY � -
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MEPA1isc,4pp_2011.doc revised 05/21111
J I A I t Ur UALJr-UMN IA
ALTERATIONS - HVAC
Fal
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:
'— / n
Enforcement Agency:
Date Prepared:
Permit#:
< vG � Q p cc
Equipment Type
Equipment Efficiency
New: Ducting or Lineset
Required R -value
Conditioned Z
Floor Area (ft )
Thermostat
❑ Packaged SystemEvaporator
Coil
AFUE
COP
❑ R-6 (CZ 1-10,12&13) Ducts
Served by system
11Setback
ElSplit System;_0
Condensing Unit
SEER
($.R-8' (CZ 11,14-16) Ducts
ft
(If not already
-/
HSPF
El R-2.8 Lineset'
present, must
'Q/Furnace
Lineset
EER
be installed)
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this
form is 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,
CFIR-ALT-02-E
Condenser Unit, Evaporator Coil,
CF2R: MCH -01, MCH -20-H
Air Handler/Furnace
CF3R: MCH -20-H
Installer Requirement: Duct leakage (515% or, 510% to outside, or seal all accessible leaks)
Exempted from duct leakage testing if:
111. Duct system registered with HERS provider as previously sealed, or ❑ 2. There is less than 40 linear feet of duct in unconditioned
space, or ❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building_
2. New HVAC System Required Compliance Documents to be left on site for Final:
All new equipment and All New Ducts' 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)-H'
Installer Requirement: Duct leakage < 5%, Fan Efficacy (0.58W/CFM), Air Flow >_ 350 CFM/ton (or Standards Table 150.0-B / C alternative)
❑ 3. All New Ducts with Replacement
Required Compliance Documents to be left on site for Final:
Includes replacing or installing All New
CFIR-ALT-02-E
Ducts' 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 150.0-13 / 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 Ducts'
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.
' 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.
a 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 - d specifications submitted to the enforcement
agency for approval with this buil g pe mit application.
Responsible Designer Name: / � Al__
esponsible Designer Signature:
Date Signed���, /,,
Licensee/2 �A
v`
Company:
Address:
City/State/Zip:
Phone:
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300