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B-2017-1341CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1341 10173 PARISH PL CUPERTINO, CA 95014-2216 (316 44 016) A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC MEMPHIS, TN 38120 OWNER'S NAME: LOPEZ VICTORIA R TRUSTEE DATE ISSUED: 08/14/2017 OWNER'S PHONE: 408-973-9125 PHONE NO: (408) 286-8931 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-20 Lic. #242039 Contractor R S AMERICAN' RESIDENTIAL SERVICES OF CALIFORNIA INC X BLDG —ELECT _PLUMB X MECH X RESIDENTIAL _ COMMERCIAL Date 10/3112017 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); REPLACE AC UNIT (SAME LOCATION); 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. 2. 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: $12000.00 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..) agree to comply with all city and county ordinances 316 44 016 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 may accrue against said City inconsequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the applicant understands and will comp) with all non-point 180 DAYS FROM LAST CALLED INSPECTION. source regulations per the Cupertino Municipal Co , Section 9.18. Issued by: Jasmine Archbold S' Date 8/14/2017 Date: 08/14/2017 OWNER-BUILDER DECLARATION I hereby affirm that I 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: 2. I, as owner of the property, am exclusively contracting with licensed Date: 8/14/2017 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 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 3. 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 Mana meat District I shall not employ any person in any manner so as to become subject to the will maintain compliance with the Cupertino Municipal Code, hapter 9.12 and Worker's Compensation laws of California. If, after making this certificate of the Health & Safety Cod , tions 25505, 25533, d 25534. 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 be deemed revoked. Owner or au gent: Date: 8 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 charmless the City of Cupertino against liabilities, Lender's Address judgments, costs, and expenses which may accrue against said City in AR HIT . T' 'D .0 . RATION consequence of the granting of this permit. Additionally, the applicant understan&. 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 1#1 (408) 777-3228 • building@cupertino.org PEMIT #B - t3 — ZO l - l ?2u( I ❑NEW CONSTRUCTION ❑ ADDTIION VALTERATION ❑ T.I. ❑ MEP ❑ RE -ROOF ❑ SWIMMING POOL/SPA PROJECTADDRESS APN# sb � q_, ^r © � OWNER NAME Z,I �^ Q / E-MAIL STREET ADDRESS / D / 7 3 n/ Ml L % n l C STATE, ZIP - C -01 Ll CONCTO AME ❑ OWNER -BUILDER COMPAA[Y N� LICENSE NUM13FR LICE TYPE STREET ADDRESS ` ` F/ C TACE, ZIP E-MAIL PHON1 / BUS. C�#� ❑ ARCHITECT ❑ OWNER ❑ OWNER AGENT ❑ CONTRACTOR AGENT ❑ ENGINNJEER ❑ DEVELOPER ❑ TENANT i CONTACT NAME E-MAIL STREET ADDRESS CITY, STATE, ZIP PHONE DECRIPTON 1 h_2 NGLE-FAMILY) DUPLEX [IMULTI-FAMILY [IINDUSTRIAL ElCOMMERCIAL USE TYPE OCC SQ.FT. VALUATIONODEL ING USE rREM EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES # TOTAL NET SF BATHROOM SF REMODEL KITCHEN SF REMODEL OTHR GARAGE SF SF ❑ ATTACHED ❑ DETACHED FIRENG [I YES SPRINKLERS❑ NO EICHLER El No YES SECOND STORY ADDI'T'ION 0 NO DWELLING ISECONDDWELLING ❑ YES'[] ATTACHED[] DETACHED OTHER UNITS # UNIT ADDITON: ❑ NO S F POOLS ❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNITE E] PREFABRICATED POOL - SF SPA -SF SPA ATTACHED ❑ YES ❑ NO TOTAL - SF Commercial or Multi-Fainil u Buildings with Public' Swimming Pools requires Department of Enviromngdal Heath approval IVED BY: TOTAL VALUATION: f� V RE -ROOF EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ TILE OTHER (SPECIFY) REMOVE /REPLACE ❑ NO ❑ YES IF NO I # OF LAYERS PLYWOOD ❑ h" ❑ 3/8" THICKNESS F15/8" OTHER PLYWOOD TYPE: ❑ OSB ❑ CDX OTHER PITCH: .12 ROOF CLASS I A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF,' ❑ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER *Provide a signed copy of the Cupertino's Tear -Off Policy SF #of SQUARES 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 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 construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. I acknowledge and authorize all information contained on this application form to be made available for public record. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED *New SFD/Second Dwelling Units/Multifamily Dwellings: A Demolition permit is required prior to issuance of a building permit for all new construction. *Commercial Buildings: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. *Copy of Planning Approval Letter or. Meeting with Planning prior to submittal of Building Permit application. *HOA -Provide a letter of approval from the Home Owner's Association B1dgApp_2017.doc revised 08101/17 STATE OF CALIFORNIA A n 9'=!]M A-rWNao42 _ A 11A.f' ML. I t=uory o nd021a%0 - ... -- CALIFORNIA ENERGY COMMISSION ' SEC-CFIR-ALT-04E Revised 03/15 CF1R-ALT- CERTIFICATE OF COMPLIANCE of 1 Alterations - HVAC CZ 2, and 8-15 (formerly CF-1R'ALT-HVAC) (Page 1 of 1) Site Address: , Enforcement Agency: Date Prepared: Permit#: EquipmentType V� Equipment ment Efficiency New Ducting, Plenums, Lineset. Required R -value Conditioned Floor Area (sq ft) Thermostat ❑ Packaged Evaporator Coil AFUE CO ❑ R-6 (CZ2, 8-13) Ducting a s/ys�tem Setback (If not already S em f� Condensing Unit _/ ❑ R-8 (CZ 11, 14, 15) Ducting q ft present must . d❑'Split System Compressor SEER HSPF ❑ R-6 (all CZ's) Plenums be installed) [3 Mini Split ❑ Furnace Lineset �-y�� "'^V EER ❑ R-5 or R7.5) Lineset" h 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. 1. HVAC Changeout/Repair Required Compliance Documents to be left on site for Final: All Equipment, CFIR-ALT-02-E Condenser Unit, Evaporator Coil, CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24)Z -HERS, MECH-25-HERS Compressor, TXV, Lineset, CF3R: MECH-20-HERS, MECH-(23 or 24)-HERSZ, MECH-25-HERSZ Air Handler/FLlrnace2 (Can include new ducting) Installer Requirement: Duct leakage (:S_15%, or < 10% to outside, or seal all accessible leaks), Air Flow 2300 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 ❑ 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 CF2R: MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS, MECH-25-HERSZ including Mini Split CF3R: MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24)-HERSZ, MECH-25-HERS7. Mini Splits require CFIR-ALT-02-E, CF2R-MECH-01, and (CF211-CF3R) MECH-25-HERS Installer Requirement: -Duct leakage < 6%, Fan Efficacy (.58W/CFM), Air Flow >- 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 Ducts' and one or more of the following CFIR-ALT-02-E MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS replaced: Condenser Unit, Evaporator Coil, CF2R: MECH-01, Compressor, TXV, Lineset, FurnaceZ CF3R: MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS Installer Requirement: Duct leakage < 6%, Air Flow >- 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 I Required Compliance Documents to be left on site for Final: New ducting but less than All New Ducts3 I CFIR-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 may consist of reused parts from the dwelling unit's existing duct system (e.g., registers, grilles, boots, air handler, coil, plenums, duct material) ` R-5 (1" 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 -25/e", 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 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 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 on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement provided agency for approval with this building permit application. Responsible Designer Name: Responsible Designer Signature- Date Sig Llcens Company: /� /State/Zip�j}� / hon 0/4 / 0/ For assistance or questions regarding lisle rnJianoarob, cuniaL• U.. 11-57 ••�•••••'- W-• - - -. -- ---- V CUPERTINO SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinq(d)cupertino org PERMIT CANNOT BE'- $"AaO UNM Ti -I S CERTIFICATE HAS BET COWLETEID; � I I7I�NT T).��i T,BUIE��T(� DIVII�N 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 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 $1000 00, CRC Section R314 and CBC Sections 907.2.11.5 and 420 6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations. AREA Outside of each separate sleeping area in the immediate vicinity of the bedroom(s) On ever_ y level of a dwelling unit including basements Within each sleepm5z room SMOKE ALARM CO ALARM X X X X X —I Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply In dwelling units with no commercial power supply, alarm(s) may be solely battery operated. In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl space Refer to CRC Section R314 and CBC Sections 907.2.114 and 420 6.2. An electrical permit is required for alarms which must be connected to the building wiring As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes The alarms specified below have been tested and are operational, as of the date signed below Address- 1 0) 33 FA94SH QLA-GE Cv f�i"L7�� � Sa ! � 7� Permit No ��01 % j37 Specify Number of Alarms: 4 Smoke Alarms. = # Carbon Monoxide Detectors. l have read and agree to comply with the terms and conditions of this statement Owner (or Owner Agent's) Name: A l7-i.($Signature .. oo�f we"... .......... Date: '7-1,7-11 Contractor Name: Signature Lic.# Date: Smoke and CO fornn.doc revised 12/15/16