B-2017-1315C
F"
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1315
10436 N BLANEY AVE CUPERTINO, CA 95014-2334 (316 30 144)
A R S AMERICAN
RESIDENTIAL
SERVICES OF
CALIFORNIA INC
MEMPHIS, TN 38120
OWNER'S NAME: MOSHTAGH FARHAD AND JOY
DATE ISSUED: 08/10/2017
OWNER'S PHONE: 408-242-7070PHONE
NO: (408) 286-8931
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class CC -20 Lic. #742039
Contractor 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 (2) FURNACE AND(2) A/C - SAME LOCATION
I hereby affirm under penalty of perjury one of the following two declarations:
1. I have and will maintains 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 fof which this permit is issued.
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: $20000.00.
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
16
316 30 144
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
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 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 Municipal Code, Section 9.18.
Issued by: Abby Ayende
a 8 20
ture Date 10 1
Date: 08/10/2017
OWNER -BUILDER DECLARATION
I hereby affirm that am 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:
installed without first obtaining an inspection, I agree to remove all new materials for
1. ,' 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:
z. I, as owner of the property,' am exclusively contracting with licensed
i
Date: 8/10/2017
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
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
HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued.
I have read the hazardous materials requirements under Chapter 6.95 of the
z. 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 25$32(a) should I store or handle hazardous
a: I certify that in the performance of the work for which this permit is issued, I
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay,Area Air Quality Management strict I
shall not employ any person in any manner so as to become subject to the
Worker's Compensation' law6 of California. If, after making this certificate of
g
t.
will maintain compliance with the Cupertino Municipal Code Chat 9.IZ and
P P P Chap
the Health &Safety Code a tions 25505, 25533, and 25.4.
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
mer or authorized agent:
be deemed revoked. 400
Date: 8/10/2017
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
I certify that I have read this 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 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'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
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(a)mpertino.org
❑ PLUMBINGMECHANICAL ELECTRICAL' ❑ MISCELLANEOUS
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT
CONTRACTOR 11 -CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
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USE OF V FD.or DUPLEX ❑ MULTI -FAMILY
BUILDING: ❑ COMMERCIAL
PROJECT IN WJLDLAND ❑ YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
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TOTAL VALUATION:
RECEIVED.B .
By my signature below, I certiry.to each f 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 1have 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 relarin�to building coition. I authorize re entatives of Cupertino to enter the abo a -i enured erty for'n A tion purposes.
Signature of Applicant/Agent: [/ Date:
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE 1j5E ofvLY
❑ OVER THE COUNTER
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EXTRESS
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❑ STANDARD
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❑ LARGE
- ❑ MAJOR
MEPMiscApp_2011.doc revised 06/21/11
STATE OF CALIFORNIA
ALTERATIONS - HVAC
CEC-CFIR-ALT-04E Revised 03/15 CALIFORNIA ENERGY COMMISSION " -
CERTIFICATE OF COMPLIANCE CF1R-ALT-04-E
Alterations - HVAC CZ 2, and 8-15 (formerly CF-lR-ALT-HVAC) (Page 1 of 1)
Site Address:
Enforcement Agency:
Date Prepared:
Permit#:
Equipment Type
Equip t Efficiency
New Ducting, Plenums, Lineset:
Conditioned
Thermostat
Required R -value
Floor Area (sq ft)
❑ Packaged
gEvaporator Coil
COP
13R-6 (CZ 2, 8-13) Ducting
Sery d by system
Setback
Systgm
Condensing Unit
❑ R-8' (CZ 11, 14, 15) Ducting
/�Cgft
(If not already
JWSplit System
Compressor
SEER
HSPF
❑ R-6 (all CZ's) Plenums
T7
present, must
❑ Mini Split
Lineset
EER
❑ R-5 or R7.5) Lineset'
be installed)
❑ Furnace
TXT/
HERS VER FICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this
fo 1>41lowed to be filled out by hand. For final inspection all forms are to be registered (nohand filled forms allowed) and a copy left on site.
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)' -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 < 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 dud 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 DuctO'
CF1R-ALT-02-E
including Mini Split
CF2R: MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS', MECH-25-HERS2
CF3R: MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24)-HERS2, MECH-25-HERS'
Mini Splits require CF1R-ALT-02-E, CF2R-MECH-01, and (CF2R-CF3R) MECH-25-HERS
Installer Requirement: Dud leakage < 6%, Fan Efficacy (.58W/CFM), Air Flow 2:350 CFM/ton (o(alternative), Refrigerant Charge
❑ 3. All New Duds with Replacement �
Required Compliance Documents to be left on site for Final:
All New Ducts' and one or more of the following
CFSR-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: Dud leakage < 6%, Air F16w2 350 CFM/ton (or alternative); Refrigerant Charge•
Exempted.from dud leakage testing if -,O 1. Existing dud 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
CFiR-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)
a R-5'(1" thick insulation) for linesets 1" � and- I,ess..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%", 5T-4%"
Contractor (Documentation Author,'s /Responsible'Designer's Declaration Statement)
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 tle; California Business and Professions Codeto accept responsibility for the information on this document.
3. thatthe energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
a'46requirements of Title 24, Parts 1 a6 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 land Part 6 of the CCR.
S. 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:RespoiisibleDesigner5ign
re: Da igne : r�
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For assistance or questions regarding the Energy$Andards, contact the Energy Hotline at: 1-800-772-3300