B-2017-1257C
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1257
21507 RAINBOW DR CUPERTINO, CA 95014-4816 (356 23 023)
A R S AMERICAN
RESIDENTIAL
SERVICES OF
CALIFORNIA INC
MEMPHIS, TN 38120
OWNER'S NAME: MEYERS LEE A
DATE ISSUED: 08/01/2017
OWNER'S PHONE: 650-384-5086
PHONE NO: (408) 286-8931
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C-220 Lic. #742
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 AND A/C (SAME LOCATION)
I hereby affirm under penalty of perjury one of the following two declarations:
r. I have and will maintain a certificate of consent to self -insure for Worker's
pensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the LaborCode, for the performance of the work for which this
Sq. Ft Floor Area:
Valuation: $9775.00
permit is issued.
APPLICANT CERTIFICATION
I certify that 1 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
35623023
and state laws relating to building construction, and hereby authorize
representatives of this city to enter upon the above mentioned property for
inspection purposes. 1 (We) agree to save indemnify and keep harmless the
PERMIT EXPIRES IF WORK IS NOT STARTED
City of Cupertino against liabilities, judgments, costs, and expenses which
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
may accrue against s'aid'City inconsequence of the granting of this permit.
Additionally, the applicant understands and will comply with all non -point
180 DAYS FROM LAST CALLED INSPECTION.
source regul�f ns per tfie Cupertino Municipal Code, Section 9.18.
Issued by: Abby Ayende
Sign a ate 8/1/2017
Date: 08/01/2017
OWNER -BUILDER DECLARATION
RE -ROOFS':
I hereby affirm that lam 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
r. I, as owner of the property, or my employees with wages as their sole
inspection.
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business &•Professions Code)
Signature of Applicant:
2. I; as owner of the property, am' exclusively contracting with licensed
Date: 8/1/2017
contractors to construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of -perjury one of the followiug 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
HAZARDOUS MATERIALS DISCLOSURE
performance of jthe work foi which this permit is issued.
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. 1 will
Section 3700 of the Labor Code, for the performance of the work for which this
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued:
Health & Safety Code, Section 25532(a) should I store or handle hazardous
3. I certify that m the performance of the work for which this permit is issued, I
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupeunicipal Code, Chapter 9.12 and
Worker's Compensation laws of California. If,'after making this certificate of
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Cod ctions 5505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
Owner or authorized en• .
be deemed revoked.
Date: 8/1/2017
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
TRUCTION LENDING AGENCY
I hereby affirm 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 constFuction', and hereby authorize representatives of this city
Lender's Name
to enter upon the above mentioned' property for inspection purposes. (We) agree
to save indemnify and keep harmless the City of Cupertino against liabilities,
Lender's Address
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of, this permit. Additionally, the applicant understands
ARCHITECT'S DECLARATION
and will comply with all non -point source regulations per the Cupertino Municipal
I understand my plans shall be used as public records.
Code, Section 9.18.
Licensed
CUPERTINO
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE ^ CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(a,cupertino.ora MISC
L] PLUMBING LJ MECHANICAL UELECTRICAL
LJ MISCELLANEOUS
PROJECT ADDRESS M )CUfl J l� r ^
APN #
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OWNER NAM�E (,e
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CITY, STATE, ZIP(
FAX
CONTACT, NAME
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E-MAIL
STREET ADDRESS U-5
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER 13 DEVELOPER C] TENANT
CONTRACTOR NAME
LICENSE A�
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LI
SE TY EA 1
BUS. LIS'
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COMPANY NAME
E-MAIL
FAX
STREET ADDRESS/Gj C
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CITY, STA
PHONE,
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
'FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF SFDor DUPLEX ❑ MULTI -FAMILY
BUILDING: ❑ COMMERCIAL
PROJECT IN WILDLAND ❑YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN
FLOOD ZONE
❑ YES
❑ NO
IS THE BL• DG AN ❑ YES
£I6HLER'HOME7 ❑ NO
DESCRIPTION OF WORK
•
I
TOTAL VALUATION:
RECEIVED 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 behal . 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 Withlall applicable local
ordinances and state laws relating to buildin onstruction. I authorize entatives of CupertUto to enter the abov -' en ed r for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED
MEPMiscApp_2011.doc revised 06/21/11
STATE OF CALIFORNIA
ALTERATIONS - HVAC
CEC-CFIR-ALT-04-E Revised 03115 CALIFORNIA ENERGY COMMISSION —
CERTIFICATE OF COMPLIANCE CF1R-ALT-04-E
Alterations - HVAC CZ 2, and 8-15 (formerly CF-iR=ALT-HVAC) (Page 1 of 1)
Site Address: — f w�
Enforcement Agency:
Date Prepared:
Permit#:
Equipment Type
Equipment Efficiency
New Ducting, Plenums, Lineset:
Conditioned
Thermostat
Required R -value
Floor Area (sq ft)
❑ Packaged
CKvaporator Coil
FUE
COP
❑ R-6 (CZ2, 8-13) Ducting
Served by system
-wetback
Sy
C ndensing Unit
❑ R-8' (CZ 11, 14, 15) Ducting
�qft
(if not already
must
Split System
Compressor
EER
HSPF
❑ R-6 (all CZs) Plenums
present,
❑ Mini Split
ineset
EER
❑ R-5 or R7.5) Lineset°
be installed)
❑ Furnace
TXV
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this
form js.wed 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.
RI- HVAC Changeout/Repair
Required Compliance Documents to be left on site for Final:
All Equipment,
CF1R-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/Furnace2 (Can include new ducting)
Installer Requirement: Duct leakage (5.15%', or < 30% to outside, or seal all accessible leaks), Air Flow 2 300 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 a
❑ 2. New HVAC System
Required Compliance Documents to be left on site for Final:
All new equipment and All New Ducts3
CF1R-ALT-02-E
including Mini Split
CF2R: MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24)-HERS2, MECH-25-HERS,
CF3R: MECH-20-HERS,.MECH-22-HERS, MECH-(23 or 24)-HERS2, MECH-25-HERS2
Mini Splits require CF1R-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
113. All New Ducts with Replacement
Required Compliance Documents to be lefton site for final.
All New Ducts' 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
I
Compressor, TXV, Lineset, Furnace'
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 Ducts' CF111-ALT-02-E, CF2R: MECH-20-HERS, CF3R: MECH-20-HERS
Installer Required to: Duct leakage (S.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 mayconsist of reused parts from the
dwelling unit's existing duct system (e.g., registers, grilles, boots, air handler; coil, plenums, duct material)
° R-541" thick insulation) for linesets 1" and less. R-7.5 (1.5" thick insulation) for linesets over 1 inch. Most mfg will require Suction line Diameter
with insulation as the following 1.5-2T-2%", 2:5-3T-2%", 3.5 to 4T -2%a", 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 &of the California Code of Regulations (CCR).
4. That the energy features and performance specifications, materials, components, and manufactured devices fog 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 approvalwith this building permit application.
Responsible Designer Name:
Responsible Desjgfa Signature:
Date SSned: �'
Licf e:
Company:
O to :sv) -. (-
Ph %4gO J
For assistance or questions regarding the EnepytStandards, contact the Energy Hotline at: i-So0-772-3300 /
r.
\\ // SMOKE / CARBON MONOXIDE ALARMS °"'.;, 6k
VOWNER CERTIFICATE OF COMPLIANCE
4,5t,,� COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildinq(c�cupertino.orq
1 PERMIT CANNOT BE FINALED UNTIL THIS CERTIFICATE HAS BEEN i
1 '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 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 ALARMCO ALARM
Outside of each separate sleeping area in the immediate vicinity of the X X
bedroom(s)7(Smoke alarms shalt 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 morn ' X i '
Carbon Monoxide alarms'are not required in dwellings which do not contain fuel-burning appliances and that'i , •
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. i i
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 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
r
date signed belo . ' 13-20H-1257
Address:. -- 15-0-7-7 . l(A l�100 I J 1 . 6,1' YO Permit No.
I
Specify Number of Alarms: #Smoke Alarms:I S— ( #Carbon Monoxide Detectors: F57
' and conditions of this statement! i'
Owner(or Owner Agent's)Name , 'have read and to comp/with the;terms.4i1 _ - I
pC SeL - Signature " Date:10111201 .
Contractor Warne: '
Signature Lic# ' ''Date:
i Smoke and COform:doc revised 01/10/.2017