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B-2017-1198CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1198 10100 PHAR LAP DR CUPERTINO, CA 95014-1176 (326 18 041) A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC MEMPHIS, TN 38120 OWNER'S NAME: MILLER CAROLYN L TRUSTEE DATE ISSUED: 07/24/2017 OWNER'S PHONE: 408-206-0889 PHONE NO: (408) 286-8931 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class CC220 Lic. # 47 2039 Contractor A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC X BLDG —ELECT —PLUMB X MECH X RESIDENTIAL — COMMERCIAL Date 10/31/2017 I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my JOB DESCRIPTION: license is in full force and effect. REPLACE FURNACE (SAME LOCATION -ATTIC); REPLACE A/C (SAME LOCATION IN BACKYARD) I hereby affirm under penalty of perjury one of the following two declarations: t. 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 erformance of the work for which this permit is issued. 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: $16311.00 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 326 18 041 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 ;agai'nst 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' Municip d Section 9.18. I � Issued by: Jasmine Archbold SigP4e, Date 7/24/017 Date: 07/24/2017 OWNER -BUILDER DECLARATION RF ROOFS: I hereby 9fflrm that I am exempt from the Contractor's License Law for one of the 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 1. I, is owner of the property; oimy 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:27/ 4/017 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 t. I have and will maintain a: Certificate of Consent to self -insure for Worker's Compensation,las provided for by Section 3700 of the Labor Code, for the ork HAZARDOUS MATERIALS DISCLOSURE fo peifor which this permit is issued. imance.o "' w I have read the hazardous materials requirements under Chapter 6.95 of the 2. I have and will maintain Worker's Compensation Insurance, as provided for by California Health & Safety Code, Sections 25505, 25533, and 25534. I will Section 3700 of the Labor Code, for the performance of the work for which this maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the permit is issued. Health & Safety Code, Section 25532(a) should I store or handle hazardous the performance of the work for which this permit is issued, I a. I certify that mr material. Additionally, should I use equipment or devices which emit hazardous p 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 ctions 25505, 25533, and 25534. exemption,Lbecome subject i6the Worker's Compensation provisions of the Labor. Code I'must forthwith'comply with such provisions or this permit shall Ow r authorized agent: be deemed,revoked: 1i 7/24/017 LENDING A ENCY j Jr APPLICANT, CERTIFICATIONCONSTRUCTION certify that I have readjthis 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;Imentioned property for inspection purposes. (Vile) agree to save indemnify acid keep harmless the City of Cupertino against liabilities, Lender's Address judgments, costs, and e' kpenses 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,alljnon-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 M Em P 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUC�EFdT l E3 (408) 777-3228 • FAX (408) 777-3333 • building(�cunertino.orgMISC ❑ PLUMBING MECHANICAL r❑ ELECTRICAL ❑ MISCELLANEO,US PROJECT ADDRESS O /y W APN # (a _. t } OWNER NAME 2 PH © E-MAIL ' STREET ADDRESS C STT IT'S 6/ FAX CONTACT NAME PH NE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT Or CONTRACTOR ONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAMEff CA F 1. LICENS 1 EN T T BUS. # 3'� COMPANY NAME — % E-MAIL FAX STREET ADDRESS 1p CI7 TAf£iZ% / ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFDor DUPLEX ❑ MULTI-FAMTLY PROJECT TN WiLDLAND ❑ YES PROJECT IN ❑ YES IS THE BLDG AN ❑ YES BUILDING: ❑ COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO EICHLER HOME? ❑ NO DESCRIPTION OF WORK A—C I i i � i aTOTAL VALUATION: n. RECENED BY� By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read t is application and the information I have prod ed is correct. I h ve read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buil construction. authorize representatives of Cupertino to enter the abve-id ttified prop r,for inspection purposes. Signature of Applicant/Agent: Date: l' SUPPLEMENTAL INFORMATION REQUI.RED oFFcE usE oi\�Y ❑ OVER THE -COU VIER i' a ' ❑ ERTRESS ca ❑ STANDARD •. C ` ❑ LARGE F a ❑ MAJOR MEPMiscAPP_2011.doc revised 06/21/11 STATE OF CALIFORNIA ALTERATIONS - HVAC CEG-CF1 R -ALT -04-E Revised 03/15 CALIFORNIA ENERGY COMMISSION -- CERTIFICATE CERTIFICATE OF COMPLIANCE CF111-ALT-04-E Alterations - HVAC CZ 2, and 8-15 (formerly CF -IR -ALT -HVAC) (Page 1 of 1) n Site Address: ,^ Enforcement Agency: _,Mr 7 • Permit#: Equipment Type Equipment Efficiency New Ducting, Plenums, Lineset: Conditioned Thermostat U'� Required R -value Floor Area (sq ft) ❑ Packaged PVEvaporator Coil AFUE COP ❑ R-6 (CZ2, 8-13) Ducting Ser`ved b system RSetback System P'Split System Condensing Unit Compressor SEER HS ❑ R-8' (CZ 11, 14,15) Ducting lJ' sgft (If not already present, must ❑ R-6 (all CZs) Plenums ❑ Mini Split i�l Lam' jset EER El R-5 or R7.5) Lineset' be installed) ❑ Furnace 9AV 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. JIME HVAC Changeout/Repair Required Compliance Documents to be left on site for Final: All Equipment, CF111-ALT-02-E Condenser Unit, Evaporator Coil, CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24)2 -HERS, MECH-25-HERS2 Compressor, TXV, Lineset, CF3R: MECH-20-HERS, MECH-(23 or 24)-HERS2, MECH-25-HERS2 Air Handler/Furnace' (Can include new ducting) Installer Requirement: Duct leakage (:5_15%, or < 10% to outside, or seal all accessible leaks), Air Flow Z 300 CFM/ton, Refrigerant Charge. 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 ❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building 1 ❑ 2. New HVAC System Required Compliance Documents to be left on site for Final: All new equipment and All New Ducts3 CF111-ALT-02-E Including Mini Split CF2R: MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24)-HERS2, MECH-25-HERS' CF3R: MECH40-HERS, MECH-22-HERS, MECH-(23 or 24)-HERS2, MECH-25-HERS2' Mini Splits require CF111-ALT-02-E, CF2R-MECH-01, and (CF2R-CF3R) MECH-25-HERS Installer Requirement: Duct leakage < 6%, Fan Efficacy (.58W/CFM), Air Flow 2 350 CFM/ton (or alternative), Refrigerant Charge ❑ 3. All New Ducts with Replacement Required Compliance Documents to be left on site for Final: All New Ducts3 and one or more of the following CF111-ALT-02-E replaced: Condenser Unit, Evaporator Coil, CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS Compressor, TXV, Lineset, Furnace2 CF3R: MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS Installer Requirement: Duct leakage < 6%, Air Flow 2 350 CFM/ton (or alternative), Refrigerant Charge Exempted from duct leakage testing if: ❑ 1. 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: New,ducting but less than All New Ducts3 CF1R-ALT-02-E,:CF2R: MECH-20-HERS, CF3R: MECH-20-HERS Installer Required to: Duct leakage (<_15% or, < 10% to outside or; or seal all accessible leaks) ❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos. ' All new ducting R-8 required when more than 40 ft installed and R-6 when less than 40 ft installed. This includes in walls, between -floors etc. 2 Heating only systems and Air Handler/Furnace changes do not. require Air Flow MECH-(23 or 24), or Refrigerant Charge verification MECH-25 3 All New Ducts is when at least 75 percent of the duct system is new.duct material, and up to 25 percent may consist of reused parts from the dwelling unit's existing duct system (e.g., registers, grilles, boots, air handler, coil, plenums, duct material) 4 R-5 (1" thick insulation) for linesets 1" and less. R-7.5 (1.5" thickinsulation) for linesets over 1 inch. Most mfg will require Suction line Diameter with insulation as the following 1.5-2T-2Ya", 2.5-3T-2%", 3.5 to 4T-2%", 5T-4%" 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 Codejof 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 s ner Signature: DatQJ&ne /� Lij , Company:: > /State/' For assistance or questions regarding the Energy �%ndards, contact the Energy Hotline at: 1400472-3300 f. SMOKE / CARBON MONOXIDE ALARMS Paa— , a OWNER CERTIFICATE OF COMPLIANCE 5t.t9 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUPERTINO10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333• building cupertino.orq PERMIT CANNOT BE FINALED UNTIL THIS CERTIFICATE HAS COMPLETED,`SIGNEWANROETURNED,TO THE BUILDING DIVISION ,11 PURPOSE This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314,2013 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 R14 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: i AREA SMOKE ALARM CO ALARM Outside'of each separate asleeping area in the immediate vicinity of X X the bedroom(s) On every level of a dwelling unit including basements X X Within each sleeping room, X i • 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,sliall'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 dwellingunits, alarms are permitted to be solely battery operated where repairs ori 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 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 helnse' '' Address: 101CD T AR )-PI Permit NO.1 Specify Number of Alarms: #Smoke Alarms: MIE #Carbon Monoxide Detectors: �I /have read and agree to comply with the terms and conditions of thi statement Owner(or Q er Agent'srs Signature..:.62:4,7" ?' Date:,a2/Jn/( Contractor Na e:. 'Signature Lic.# Date: Smoke and CO fa m.doc revised 09/27/16 I i