B-2017-1624 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: •PERMIT NO:B-2017-1624
21430 COLUMBUS AVE CUPERTINO,CA 95014-4971(362 05 004) A R S AMERICAN
RESIDENTIAL
SERVICES OF
CALIFORNIA INC
MEMPHIS,TN 38120
•
OWNER'S NAME: SKEELS SALLYATRUSTEE .DATE ISSUED:09/20/2017
OWNER'S PHONE:408-691-0133 PHONE NO:(408)286-8931
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-20 Lic.#742039
Contractor A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC X BLDG _ELECT _PLUMB •
Date 10/31/2017 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 JOB DESCRIPTION:
license is in full force and effect., REPLACE AC AT 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
go
Section 3700 of the Labor,Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$9000.00
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above APN Number: Occupancy Type:
information is'correctagree to comply with all city and county ordinances 362 05 004
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 er the Cupertino Municipal Code,Section 9.18.
Issued by:Phuong Devries
,ISignature „....<<: 9 2”v / 2 Date:09/20/2017
OWNER-BUILDER'DECLARATION RE-ROOFS:
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I hereby affirm thatd'am 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,1 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. ,.as owner'of the property,am exclusively contracting with licensed Date:
contractors to construct the project'(Sec.7044,Business&Professions Code).
I hereby affirm underipenalty,of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
i. I have andwill maintain'a Certificate of Consent to self-insure for Worker's
•Compensation,asiprovided for'byiSection 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. 1 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
peirnit 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
shall not employ any person in any manner so as to become subject to the will maintain compliance with the Cupertino Municipal Code;Chapter 9.12 and
Worker's Compensation'laws of California. lf,after making this certificate of the Health&Safety C ,Sections 25505,255 3,and 25534.
exemption I become subject to the.Worker's Compensation provisions of the
Labor Code,1 must forthwith comply with such provisions or this permit shall Owner7` authorized ager
be deemed revoked. Da 2,, /� . —
APPLICANT'CERTIFICATION { NSTRUCTION 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 theCity 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 with1all non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records.
Code,Section 9.18.,' ,
1 Licensed
CONSTRUCTION PERMIT APPLICATION
~ COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION , B
10300 TORRE AVENUE • CUPERTINO,CA 95014-3255
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(408) 777-3228 • building@cupertino.org PEMIT#B- ?,(J j1— - I& `.Z
CUPERTINO REV# DEF#
❑ NEW CONSTRUCTION ❑ADDITION El ALTERATION El T.I. El MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS 2...1L/� o Co(piri r 'C 17,6,-----
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OWNER NAME C ( keje,
j PHONE/a...4‘"`/ 0 /3, E-MAIL
STREET ADDRE$Fr> ��S v ^ /0 iv, �� CI�4 A ZIAylso C��
• El CON '..TOR NAME ❑OWNER--BB/VUILLDDER COMPANY NAME (v"✓ LICENSE NUMBER `•// LICENSE PE
/ IX ri 7 03/
/4 / ,
STREEITRESS(q6 ATEIP 46' Lc,- C q
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E-MAIL PHO BUS.LIC#
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1
0 ARCHITECT El OWNER ❑OWNER AGENT ❑CONTRACTOR AGENT ENGINEER❑DEVELOPER El TENANT
CONTACT NAME ' , E-MAIL
STREET ADDRESS CITY,STATE,ZIP PHONE
DECRIPTON ,
• 1 ziir-'(-- itC"------.
•
9.890 ::' ; .
,'INGLE-FAIILY/DUPLEX 1 ❑MULTI-FAMILY ❑INDUSTRIAL El COMMERCIAL I
EXISTING USE. EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES# TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
:
REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED 1
BATHROOM SF SF I SF SF El DETACHED
EXISING El YES EICHLER El YES SECOND STORY ADDITION YES
FIRE SPRINKLERS 0 NO , 0 NO
DWELLING SECOND DWELLING a YES El ATTACHED El DETACHED OTHER
UNITS.# UNIT ADDITON: , I❑'NO,, SF
.
POOLS' ❑FIBERGLASS ❑VINYL-LINED ❑GUNITE El PREFABRICATED
POOL-SF SPA-SF I 'SPA ATTACHED❑YES 0 NO I TOTAL-SF •
1 , ,I 1 RECEIV j B': TOTAL VALUATION:
Commercial or Multi-Family Buildings with'Public.Swimming Pools requires Department of Environmental Heath approval •,7 00 0
RE-ROOF'EXISTING ROOF TI PE:1 BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES WOOD, ❑TILE OTHER(SPECIFY) _
REMOVE/REPLACE❑NOI IF NO;, ❑'iEl' PLYWOOD " 3/8" . PLYWOOD TYPE: PITCH: ROOF CLASS
❑YES #1OFLAYERS THICKNESS E 5/8" OTHER I ❑OSB El CDX OTHER 12 A
PROPOSED ROOF TYPE:❑BUILT-UP+ROOFI ❑ASPHALT SHINGLES❑WOOD SHAKES OWOOD SHINGLES 0 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 applicableJoca'l ordinances and state laws relating to building construction. I authorize representatives of Cupertino to
enter the above-identified property for'inspec' n urposes. I ackn wledge and authorize all information contained on this application form ,
to be made available for publie record. �7
Signature of Applicant/Agent:' " .1 Date: 1 /
SUPPLEMENTAL INFORMATION REQUIRED •
*New SFD/Second Dwelling UtS/Mu
mltifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings: Providea 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 froin the Home Owner's Association
BldgApp_2017.doc revised 08/01/17
STATE OF CALIFORNIA
ALTERATIONS - HVAC . -=--. _..-'
CEC-CF1R-ALT-04-E(Revised 03/15) CALIFORNIA ENERGY COMMISSION '-
CERTIFICATE OF COMPLIANCE - CF1R-ALT-04-E
Alterations-HVAC CZ 2,and 8-15(formerly CF-1R-ALT-HVAC) (Page 1 of 1)
Site Address) / r co(ciyitLi? Enforcement Agency: Date Prepared: Permit#:
r ` / r
Equipment New Ducting,Plenums,Lineset: Conditioned Thermostat
Equipment Type �/ �/J"� Efficiency Required R-value Floor Area(sq ft)
❑Packaged Evaporator Coil Coil COP 0 R-6 (CZ2,8-13)Ducting Served by system � etback
Sys m ondensing Unit AFUE ❑R-8' (CZ 11,14,15)Ducting /$ qft (If not already
E Split System ompressor / EER HSPF 0 R-6(all.CZ's)Plenums present,must
❑Mini Split inesetbe installed)
/ EER 0 R-5 or R7.5)Lineset4
❑Furnace TXV
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.
ANA.HVAC Changeout/Repair Required Compliance Documents to be left onsite 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/Fyrnace2(Can include new ducting)
Installer Requirement:Duct leakage( 15%,or<10%to outside,or seal all accessible leaks),Air Flow>_300 CFM/ton,Refrigerant Charge.
Exempted fromduct leakage testing if:
0 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
0 3.,Existing duct systems are constructed,insulated or sealed with asbestos(list manufacture date of building 1
❑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-HERS2
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>_350 CFM/ton(or alternative),Refrigerant Charge
❑3.1All New Ducts with Replacement Required Compliance Documents to be left on site for Final:
All New Ducts3 and one or more of the following CF1R-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,Furnace' 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:0 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 Ducts3 CF1R-ALT-02-E,CF2R: MECH-20-HERS,CF3R: MECH-20-HERS
InstallerRequired to:Duct leakage(<15%or,<10%to outside or,or seal all accessible leaks)
0"EXCEPTION:Existing duct systems constructed,insulated or sealed with asbestos.
t 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.
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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)
4 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-2%",2.5-3T-2''A",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. I 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
Provided on other applicable compliance documents,worksheets,calculations,plans and specifications submitted to the enforcement
agency for approval with this building permit application. ,
Responsible Designer Name: el, Responsible Designer Signature. Date Si a Lice
1.
Company: ii.... J fires n /`N /Ste%�r6— ?-)!C(.-72r2-33f44C- C
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