B-2017-1137CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1137
7927 BELKNAP DR CUPERTINO, CA 95014-4973 (362 08 042)
RESCUE AIR SERVICE
INC
SAN JOSE, CA 95120
OWNER'S NAME: LIU SHUANG AND CHENG TAM
DATE ISSUED: 07/17/2017
OWNER'S PHONE: 408-725-0372
PHONE NO: (408) 655-9916
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class= Lic. #828201
Contractor RESCUE AIR SERVICE INC Date 11/30/2017
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);INSTALL (N) AC UNIT;
I hereby affirm under penalty of perjury one of the following two declarations:
t. f 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.
f� I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
Sq. Ft Floor Area:
Valuation: $6250.00
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
362 08 042
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 �r Date 7/17/2017
Issued by: Jasmine Archbold
OWNER -BUILDER DECLARATION
Date: 07/17/2017
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
t. 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: 7/17/2017
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
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
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 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: 7/17/2017
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 7/17/2017
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO I (408) 777-3228 • FAX (408) 777-3333 • building(LDcupertino.orq
❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION / TI ❑ REVISION/ DEFERRED ORIGINAL PERMIT #
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DESCRIPTION OF WORK
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EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
USE
TYPE
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SQ.FT.
VALUATION ($)
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NEW FLOOR
DEMO
TOTAL
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BATHROOM
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-------_----
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REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECKMORCH AREA
GAR, GF. AREA: DET4CH
ATTACH
I
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEING ADDED? ONO
ADDITION? ONO
PRE -APPLICATION [DYES IF YES. PROVIDE COP'' OF
IS THE BLDG ANYES
ECFfVED BY:
TOTAL VALUATION:
PLAMVING APPL # ❑ NO PLANNING APPROVAI. LETTER
ONO
F.ICHI,ER HOME:' ❑ NO
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 this
application and the information 1 have provided is correct. I have read the Description of Work and verity it is accurate. 1 agree to comply with all applicable local
ordinances and state laws relating to building col ruction. I authorize representatives of Cupertino to enter the above -identified property for inspection put -poses.
Signature of Applicant/Agent: CF�r �. Date: �/ `,' 0 ' _
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
❑
❑
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
OVER-THE-COUNTER
BUILDING PLAN REVIEW
permit for new building.
❑ EXPRESS
❑ PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑ LARGE
❑ FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑
submittal of Building Permit application.
SANITARY SEWER DISTRICT
❑ ENVIRONMENTAL HEALTH
BldgApp_201 Ldoc revised 06121/11
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CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 1 of 3)
Project Name: Taiyi Cheng Date Prepared: 2017-07-16
A. General Information
CF1R-ALT-02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented, use one
CF1R-ALT-02 document for each dwelling unit.
01
Project Name
Taiyi Cheng
02
Date Prepared
2017-07-16
03
Project Location
7927 Belknap Dr
04
Building Type
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
Taiyi Cheng
07
Zip Code
95014
08
Dwelling Unit Conditioned
1840
Installing
Installing
Installing
Floor Area (ft)
Location or Area
by this SC
ducted
containing
system
Number of Space
entirely new
09
Climate Zone
4
30
Conditioning (SC) Systems in
1
component?
components?
feet of ducts?
duct system?
this Dwelling Unit:
Alteration Type
B. Space Conditioning (SC) System Information
01
02
03
04
05
06
07
08
09
10
Is the SC
Installing a
SC System
SC System
CFA served
system a
refrigerant
Installing new SC
Installing
Installing
Installing
Identification or
Location or Area
by this SC
ducted
containing
system
more than 40
entirely new
entirely new
Name
Served
System (ftZ)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
System 1
Location 1
1840
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b)1Diib)
This section does not apply to this project
Registration Number: 217-A020241645A-000-000-0000000-0000 Registration Date/Time: 2017-07-16 19:11:14 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016 1.005 Report Generated: 2017-07-16 22:11:31
Schema Version: rev 10/16
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 2 of 3)
D. Altered Space Conditioning System (Sections 150.2(b)SE and F)
01
02
03
04
05
06
07
08
09
10
11
12
Heating
Cooling
System
Heating
Altered
Heating
Minimum
Altered
Cooling
Minimum
Required
New or
Identification
System
Heating
Efficiency
Efficiency
Cooling
Cooling
Efficiency
Efficiency
Thermostat
Replaced
New Duct
or Name
Type
Components
Type
Value
System Type
Components
Type
Value
Type
Duct Length
R -Value
Central gas
All new
Central split
All new
This field or
This field or
System 1
furnace
heating
AFUE
96
AC
cooling
SEER
14
Setback
section is not
section is not
components
components
applicable
applicable
Required Documentation:
CF214-MCH-01-E - Space Conditioning Systems
- Duct insulation requirement for the new portions of supply -air and return air ducts or plenunis R6 (CZ 1-10, 12 and 13) and R8 (CZ 11 and 14-16)
CF2R and MR -MCH -20-H - Duct Leakage Test required when heating or cooling components are installed in ducted systems, or when more than 40 ft of duct length is replaced
-Leakage rate compliance: — 15% or c 10% leakage to outside, or seal all accessible leaks.
CF2R and CF3R-MCH-25-H Refrigerant Charge verification required when refrigerant containing components are Installed or altered (applicable in CZ 2, 8-15).
CUR and CF3R-MCH-23 Airflow Rate - 300 CFM per ton required when MCH -25 is required.
Exceptions:
- Duct systems registered with HERS provider as previously sealed are exempt from MCH -20 Duct Leakage Testing requirements.
- Heating -only systems and Air Handler Furnace changes do not require verification of Air Flow MCH -23, or Refrigerant Charge MCH -25.
-Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH -20 Duct Leakage Testing requirements.
E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)1Diia and 150.2(b)lE, F)
This section does not apply to this project.
F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)1C)
This section does not apply to this project.
Registration Number: 217-A020241645A-000-000-0000000-0000 Registration Date/Time: 2017-07-16 19:11:14 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-07-16 22:11:31
Schema Version: rev 10/16
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 3 of 3)
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature. n /m
Lee, Yonghyun
I�JG� 16 vw
Company:
Signature Date:
Bay HERS Rater
2017-07-16 22:11:14
Address:
CEA/ HERS Certification Identification (if applicable):
46961 Chemult Cmn
CC2016063
City/State/Zip:
Phone:
Fremont CA 94539
510-378-6632
Responsible Person's Declaration statement
I certify the following under penalty of perjury, under the laws of the State of California:
1. The information provided on this Certificate of Compliance is true and correct.
2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible designer).
3. 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 California Code of Regulations.
4. The building design features or system design features identified on. this Certificate of Compliance are consistent with the information provided on other applicable compliance documents, worksheets,
calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application.
5. 1 will ensure that a registered copy of this Certificate of Compliance shallbe made available with the building permits) Issued for the building, and made available to theenforcement agency for all applicable
inspections. I understand that a registered copy of this Certificate of Compliance is required to be Included with the documentation the builder provides to the building owner at occupancy.
Responsible Designer Name:
Responsible Designer Signature:
Kim, James
Company :
Date Signed:
RESCUE AIR SERVICE
2017-07-16 19:11:14
Address:
License:
6007 MAJORCA COURT
826201
City/State/Zip:
Phone:
SAN JOSE CA 95120
408-655-9916
Easy to Verify 0
at CaICERTS.com
L. .
Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document, and in noway implies Registration Provider responsibility /
the accuracy of the info rrpsh
Registration Number: 217-A020241645A-000-000-0000000-0000 Registration Date/Time: 2017-07-16 19:11:14 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017.07-16 22:11:31
Schema Version: rev 10/16
SMOKE / CARBON MONOXIDE ALARMS ;g
OWNER CERTIFICATE OF COMPLIANCE
,041,9 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333• buildino a cupertino.orq
PERMIT CANNOT'BE FINALED UNTIL THIS CERTIFICATE OAS BEEN
COMPLETED,SIGNED,AND RETURNED TO THE BUILDING DIVISION �'
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 R314 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 X X
the bedroom(s)
On every level of a dwelling unit including basements 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 9.07.2.11.4 and 420.612.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.
Address: 76 927 AS Drl Cifite4+71W) C 1 9 /(1 Permit No. _2o1 / 1f 3?
Specify Number of Alarms: 7 #Smoke Alarms: #Carbon Monoxide Detectors: I I
I have read and agree to comply with the,terms and conditions of this statement
Owner or Owner Agent's)Name: c
Signatures Date:
, Contractor Name.
Signature Lic.# Date:
Smoke and CO form.doc revised 09/27/16
08/01/17
B-2017-1137
Jasmine Archbold
Jasmine
Archbold08/01/17
Jasmine
Archbold08/01/17
Jasmine
Archbold08/01/17
Jasmine
Archbold08/01/17