B-2017-1275Eli
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1275
7576 SHADOWHILL LN CUPERTINO, CA 95014-5052 (362 24 030)
ATKINSON
CLIMATROLLERS INC
SAN JOSE, CA 95112
OWNER'S NAME: SREEHARI NARASIMHAIAH AND SUKANYA
DATE ISSUED: 08/02/2017
OWNER'S PHONE: 408-529-3250
PHONE NO: (408) 294-6290
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C-20 Lic. #258540
Contractor ATKINSON CLIMATROLLERS INC Date 12/31/2018
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:
INSTALL (1) A/C UNIT
I hereby affirm under penalty of perjury one of the following two declarations:
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.
I have and will maintain Worker's Compensation Insurance, as provided for by 11
Section 3700'of the Libor Code, for the performance of the work for which this
Sq. Ft Floor Area:
Valuation: $6026.00
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 24 030
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.
Additional ly„the.applicant understands and will comply with all non -point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Sig `moi.%�CrilYFy�Tir�/ Date 8 2 2 1
Issued by: Jasmine Archbold
Date: 08/02/2017
I
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
RE -ROOFS:
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)
a. I, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct'the pr6jcct(Sec.7044, Business & Professions Code).
Date: 8/2/2017
I hereby affirm under penalty of lierjury one of the following three declarations:
"A”
1. I have and will maintain a Certificate of Consent to self -insure for Worker's
ALL ROOF COVERINGS TO BE CLASS OR BETTER
Compensation, as pro 'ded for by Section 3700 of the Labor Code, for the
performance of the wort for which this permit is issued.
HAZARDOUS MATERIALS DISCLOSURE
i. I have and will.mamtain'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
s. I certify that in the perpermit fformance of the work for which this peit is issued, I
Health &Safety Code, Section 25532(a) should I store or handle hazardous
I ;
shall not employ any pin any manner so as to become subject to the
material. Additionally, should I use equipment or devices which emit hazardous
1.erson
air contaminants as defined b the Ba Area Air QualityManagement District I
Worker's Compensatiop laws of California. If, after making this certificate of
exemption, I become subject to the Worker's Compensation of the
will maintain compliance with the Cupertino MunnicipaCode, Chapter 9.12 and
Health & Safety Code, Sections 25595,255333, 25534.
provisions
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked
the and
Owne,r orized agent:
APPLICANT CERTIFICATION
Dat
I certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
correct, l 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 ofthis 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 &4h s permit. Additionally, the applicant understands
and will comply with all non-poiit'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 8/2/2017
Professional
Alm
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 mi-sc
(408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.org
❑PLUMBING'
MECHANICAL ELECTRICAL a� [:]MISCELLANEOUS
PROJECT
PROJECT ADDRESS ,:,::�a ` , ' I AIN #
OWNER NAME /
�� I h �G, P EO � " , !�� � L,✓Q E-MAIL
STREET DD SS S 1 I I CITY, vATEZIP, p� - � FAX
CONTACT NAME I_ VO�1No,61
P� J %rj Qj O E-MAIL AA f_ [S `�` raj�Ir 1
STREET ADDRESS �1 V,, ` CITY S�TA� (3 /✓�(, ±FAX V I/
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR E _ \ � � LICENSE 11 BFR, n LICENSE TYPE_ I� BUS. LIC # O'n n
COMPANY NAME � �� V _ 1 J h E -MAI I✓� j �I _ { IL� FAX V �l/
STREET ADDRESS �J�� CITY, STATE, ZIP J b u PHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC #
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY, STATE, ZIP PHONE
USE OF PrSFD or DUPLEX ❑ MULTI -FAMILY I PROJECT IN WILDLAND ❑ YES 7PROIECTIN ❑ YES IS THE BLDG AN ❑ YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO D ZONE ❑ NO EICHLER HOME? ❑ NO
DESCRIPTION OF WORK -AT A r• r
r< t wo ktr--
TOTAL VALUATION: (o %� 10 �"3IVF�I3'�.B'.`...
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the pioperty 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 con tructio . I thorize�presentatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: �(� �y/:/X Date: /
SUPPLEMENTAL INFORMATION REQUIRED
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MEPMiscApp_201 1. doc revised 06/21/11
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CERTIFICATE OF COMPLIANCE
CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 1 of 3)
Project Name: 2017- 0070 Narashin Sreehari Date Prepared: 2017-08-02
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
2017- 0070 Narashin Sreehari
02
Date Prepared
2017-08-02
03
Project Location
1576 Shadowhill Ln
04
Building Type
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
2017- 0070 Narashin Sreehari
`
Dwelling Unit Conditioned
07
Zip Code
_
95014
08
Floor Area (ft2)
1100
s the Sc"
f'nstallir g a
°`
V0
SC System
SC System
CFA served
Number of Space
refrigerant
.09
Climate Zone
s ; n
10
Conditioning( (SC) Systems in
1
Location or Area
by this SC
ducted
containing
this Dwelling Unit:
more than 40
d �.,a.
B. Space Conditioning (SC) System Information
�s'
4
Y
01
02
„
:? vry:TE
' 03
:xu,`&
�x -04
% }b1
05
06
off,'F
08
09
10
`
s the Sc"
f'nstallir g a
°`
V0
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 (ft2)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
Add AC
Whole House
1100
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=A020265078A-000-000-0000000-0000 Registration Date/Time: - 2017-08-02 10:32:12 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.006 Report Generated: 2017-08-02 10:32:21
Schema Version: rev 10/16
CERTIFICATE OF COMPLIANCE CF111-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF-iR-ALT HVAC) (Page 2 of 3)
D. Altered Space Conditioning System (Sections 150.2(b)1E 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
No heating
This field or
This field or
Central split
All new
This field or
This field or
Add AC
furnace
component
section is not
section is not
AC
cooling
SEER
14
Setback
section is not
section is not
altered
applicable
applicable
components
applicable
applicable
Required Documentation:
CF2R-MCH-01-E -Space Conditioning Systems
- Duct insulation requirement for the new portions of supply air and return -air ducts or plenums: R6 (CZ 1-10, 12 and 13) and R8 (CZ 11 and 14-16)
CF2R and CF3R,MCH-20-H - Duct Leakage Test required whe0eating or cooling components are installed in ducted systems, or when more than 40 ft of duct length is replaced
-Leakage rate compliance: <= 15% or <=10% leakage to oulsi Lor sea[ all accessible leaks.,
CF2R.and CBR -MCH -25-H Refrigerant Charge verification tequlred when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15).
CF213 and CF3R-MCH-23 Airflow Rate >=300CFM per,Al ":
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
GwCl,CyQCGCfi/l2P/t�
Faulkner, Cindy
�/
Company:
Signature Date:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL
2017-08-02 10:32:12
Address:
CEA/ HERS Certification Identification (if applicable):
1171 NORTH 4TH STREET
City/State/Zip:
Phone:
SAN JOSE CA 95112
408-294-6290
Responsible Person's Declaration statement
I certify the following under penalty of perjury, under the law's°af the State of California:
1. The information provided on::this Certificate of Compliance is true and correct.
2. I am eligible under Division 3`'`c f t%1 8usmess'and Professions Code to accept.r2sp`vhsibiliN for the building design or system design identified on this Certificate of Compliance (responsible designer).
3. That the energy features and perfottnarrce specifications, matenats components, and • anufactured deuces for the building design or system design identified on this Certificate of Compliance conform to the
Pait ..
requirements of Title 24, Part 1 and 63of the California Code of gulatrons
4. The building design features or system de3ign features identified on his Certificate of C in fiance are gris!,_ � �thA e q,prmat rowded ort ptl�ot-a�plicab o" pliance documents, worksheets,
calculations, plans and specifications sybmitted to the etlforcemeni'agency for 4pprova this bwli{ ng t appiicaticio
per
a N
5. I s�;titasie pert{M) for
will ensure that a registered copy ofrt�5ts Certifica pliance ayaille wi�kt;tltt? bt►itt issued the boilditwg andad available•tie.hforcement agency for all applicable
inspections. I understand that a regisceted copy of thi ificate of'Cgppltance Is requl d to be included with the�•docume anon the builder prpytdes to the buil, ng owner at occupancy.
Responsible Designer Name:
ponsibleDesigFSErSig �.--'
Res natiure: �p
Faulkner, Cindy
c��CL�l2PJti
Company:
Date Signed:
ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL
2017-08-02 10:32:12
Address:
License:
1171 NORTH 4TH STREET
258540
City/State/Zip:
Phone:
SAN JOSE CA 95112
408-294-6290
Easy to Verify
,0 �'
at CaICERTS.com
Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered document, and in noway implies Registration Provider responsibility fc
r the accuracy of the inform
Registration Number: 217-A020265078A-000-000-0000000-0000
Registration Date/Time:
2017-08-02 10:32:12
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.006 Report Generated: 2017-08-02 10:32:21
Schema Version: rev 10/16
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SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
e".1,94.4, COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPI+RTit7 10300 TORRE AVENUE• CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildino a(�cupertino.orq
PERMIT GANNQT BE INALEI)UNTIL THIS:CERTIFICATE"HAS BEEN
COM LETED,SIGNED,-SND ETU I3'TO THE BI TIDING 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 R314,2016 CBC Sections 420 6 and 907.2.11.2 where no interior access
for inspections are required.
GENERAL INFORMATION
Existing single-family arid 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 CSC 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 907.2.11 4 and 420.6.2.An electrical permit is required for
1 —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 belowpilGO
et Address. `3 7f ' V K � 11-0 L Permit No. Y' I��
Specify Number of Alarms: #Smoke Alarms. J r I #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:
Signature . 1d.L. f17Iat :7
Contractor Name: r
Signature. M . ..`.. . +� c.# Date:
Smoke and CO fonn.doc revised 12/15/16
I I
I ?ad ' 4-,- -4_
WATER-CONSERVING PLUMBING FIXTURES LOS 6 13-
OWNER CERTIFICATE OF COMPLIANCE
-r. COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTL O �oz,
408)7 78•`FAX(408)777-3333• buildinq •(a�cupertino_orq 0,
Owner Name IP
°, t%1- - Permit No.
Address '7 1) /6 ( Doo>4 H LL u � j-(i JC) t 9 501 Lf
1. .. Is your real property a registered historical site?
1 ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
i 11711 No 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.
kw.---..,No--- `Go fo Question 3.
3. Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
X,No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
❑ No My real property is built and available for use or occupancy after January 1, 1994.
Civil Code Sections 1101.1,through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
IYes My real property is 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..
5. Please check ONE of the following:
My property is a single:family residential real property. See Civil Code Section 1101.4.
On and after January 1,2014,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 fixtures shall be replaced with water-conserving plumbing fixtures (regardless of whether
property undergoes alterations or improvements).
❑, My property is a multifamily residential 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 p1u nbing fixtures:` — =
On or before January 1,2019,all non-compliant plumbing fixtures shall be replaced with water-
conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or
improvements).
117 My property is a commercial 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, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving
plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvements).
I,as the owner or owner's agent of this property,certify under penalty of peijury that non-compliant plumbing fixtures will be
replaced prior to date specified above 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, and that the water-conserving plumbing fixtures comply with the requirements as indicated in the
table on the following page.
1 Owner or Owner Agent's Signature: 1,��►�l l Date: '�
Upon completing and signing this Certi .te` ease" return it to the Building Division in order to final your building p- nit.
SB407 2015.doc revised 01/05/17
Jasmine
Archbold
08/07/17
08/07/17
B-2017-1275
Jasmine Archbold
Jasmine
Archbold
08/07/17
Jasmine
Archbold
08/07/17
Jasmine
Archbold
08/07/17
08/07/17
B-2017-1275
Jasmine Archbold