B-2017-1634 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1634
10464 SCENIC CT CUPERTINO,CA 95014-2765(357 07 017) PELLE HEATING&
AIR INC
SAN JOSE,CA 95111
OWNER'S NAME: TSAI NEI-KWEI AND LI-HUA TRUSTEE DATE ISSUED:09/21/2017
OWNER'S PHONE:626-751-7757 PHONE NO:(408)978-7060
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-20 Lic.#809887
Contractor PELLE HEATING&AIR INC Date 10/31/2019 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:
(N)A/C UNIT
I hereby affirm under penalty of perjury one of the following two declarations:
1. I have and willmaintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
.erformance of the work for which this permit is issued.
y, 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
permit is issued. Sq.Ft Floor Area: Valuation:$5200.00
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 357 07 017
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. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands,and will comply with all non-point
source regulations per the pertinooMMunicipal Code,Section 9.18. 180 DAYS FROM LAST'CALLED INSPECTION.
Signature, '- —� _� Date 09-21-2017 Issued by:Kim Dunbar
Date:09/21/2017
OWNER-BUILDER DECLARATION
I hereby affirm that I ant exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: 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)
2. I,as owner of the property;am exclusively contracting with licensed Signature of Applicant:
• contractors to construci the project(Sec.7044,Business&Professions Code). Date:09-21-2017
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
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain 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
3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should 1 store or handle hazardous
shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized age
APPLICANT CERTIFICATION Date:09-21-2017
I certify that I have read this application and state that the above information is I k R T e► _i,tI i►
correct.I 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 of this 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 of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Licensed
Signature Date 09-21-2017 Professional
CONSTRUCTION PERMIT APPLICATION
\� COMMUNITY DEVELOPMENT DEPARTMENT • -
BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO,CA 95014-3255 2
` 'ss (408)777-3228 • building@cupertino.org PEMIT#B-4_11_1.. -,/ !/ 3 V
CUPERTINO REV# DEF#
❑ NEW CONSTRUCTION %.ADDITION 0 ALTERATION 0 T.I. ErMEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS to 1466,1 I n(eh 'c C4- APN#3 5 _ 0 .7___O
OWNER NAME ,j"--- �
I ` I PHONE(026-7s.7_773.7 E-MAIL —_
STREET ADDRESS (_ CITY,STATE,ZIP
lbqh4 „SC enc Cf Cuperrihv CA- SIS nlG
CONTRACTOR NAME 0 OWNER-BUILDER C MANY NAME LICENSE NUMBER LICENSE TYPE
feve -Pe I Ie die NeiF�by��"co i11`Hvr�n SIA re. C o
I STREET ADDRESS CITY,STATE,ZIP I
1 5i-D Chi(I-er ee r/ Cf' cn Zose, Ch f q 573
E-MAIL PHONEBUS.LIC It
Jessiw,,peirehiefsbc otii.riek yap 41 ' lobo 275...q3
0 ARCHITECT ❑OWNER ❑OWNER AGENT 0 CONTRACTOR AGENT ENGINEER 0 DEVELOPER 0 TENANT
CONTACT NAME E-MAIL '
STREET ADDRESS CITY,STATE,ZIP PHONE
DECRIPTON -A d I Pr"( P i /t filn cl Y In a Ce
I t/C &fon , I (oS&—L2
SINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 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 0 ATTACHED
BATHROOM SF SF SF SF 0 DETACHED
MUSING ❑YES EICHLER ❑YES SECOND STORY ADDITION 0 YES
FIRE SPRINKLERS 0 NO 0 NO 0 NO
DWELLING SECOND DWELLING ❑YES ❑ATTACHED❑DETACHED OTHER
urs# UNIT ADDITON: 0 NO S F
POOLS! 0 FIBERGLASS 0 VINYL-LINED ❑GUNITE 0 PREFABRICATED
POOL-SF SPA-SF I SPA ATTACHED OYES ❑NO [ TOTAL-SF
RE Y: tp,,,,,,J.:,,,,yeg,
Commercial or Multi-Fami1N Buildings with Public Swimming Pools requires Department of Environmental Heath approval
RE-ROOFI EXISTING ROOF TYPE: El BUILT-UP ROOF ID ASPHALT SHINGLES❑WOOD SHAKES 0 WOOD SHINGLES 0 TILE OTHER(SPECIFY)
REMOVE/REPLACE❑NO IF NO PLYWOOD 01"" ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
OYES #OF LAYERS THICKNESS❑5/8" OTHER ❑OSB 0 CDX OTHER •12 A
PROPOSED ROOF TYPE:OBUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES❑WOOD 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. Ihave 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 i ;y: pie.' •urposes. I acknow -dge and authorize all information contained on this application form
to be made available for public record
Signature'of Applicant/Agent: `. - .J —J2S Date: I /
SUPPLEMENTAL INFORMATION R e u ED r
*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
BldgApp_2017.doc revised 08/01/17
'<, ;CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems(formerly CF-1R-ALT-HVAC) (Page 1 of 3)
Project Name: Tasi J.K Date Prepared: 2017-09-12
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 Tasi J.K 02 Date Prepared 2017-09-12
03 Project Location 10464 Scenic Ct. 04 Building Type Single family
05 CA City Cupertino06. Dwelling Unit Name Tsai J.K
07 Zip Code 95014 a 08 Dwelling Uni ZConditioned 2110
Floor Area(ft )
4illi;:iirit:.'i Number of Space
09 Climate Zone 4 �' ' ' 10 Conditioning(SC)Systems in 1
this Dwelling Unit:
B.Space Conditioning(SC)System Informations ,
01 02 03 04 « ' l 05 I.. , 0S 07 08 09 10
Is the$C Jnstall�ng a y; r
SC System SC System CFA served systema'"'° ""refrigerant ' Installing new S'C 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
J.K Tasi Whole House 2110 Yes Yes Yes No No No Altered space
conditioning system
C. Extension of Existing Duct System,Greater Than 4,0 Feet(Section150.2(b)1Diib)
This section does not apply to this project.
Registration Number:417-A020115770A-000-000-0000000-0000 Registration Date/Time:2017-09-12 15:39:02 HERS Provider:CHEERS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2016.1.006 Report Generated:2017-09-12 15:39:04
Schema Version:rev 10/16
'::- CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems(formerly CF-1R-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
No heating This field or This field or All new This field or This field or
J.K Tasi Central gas component section is not section is not Central split cooling SEER 16 Setback section is not section is not
furnace altered applicable applicable AC 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 r61CZ 1 10 12 and 13)and R8(CZ 11 and 14-16)
CF2R and CF3R-MCH-20-H-Duct Leakage Test required when heating or cooling components are mstel#e0n du ted systems,or when more than 40-ft of duct length is replaced
-Leakage rate compliance:<=15%or<=10%leakage to outside,or seal all accessible leaks �x i '
�
CF2R and CF3R-MCH-25-H Refrigerant Charge verification required when refrigerant containing compgiiO pyrer installed or altered(applicable in CZ 2,8-15).
CF2R and CF3R-MCH-23 Airflow Rate>=300 CFM per ton required when MCH-25 is required
Exceptions: ,
-Duct systems registered with HERS provider as previously sealed are exempt from MCH-20 Duct LeakageTesting requirements.
-Heating-only systems and Air Handler Furnace changes do not require verification of Air Flow MCH-23,or Refrigerant Charge MCH-25.
-Existing duct systems constructed,insulated or sealed with asbestos are exempt from MCH-20 Duct Leakage Testing requirements.
E. Entirely New or Complete Replacement Duct System,with or withOut Equipment ChangedUt(Sections 150.2(b)1Diia and 150.2(b)1E, F)
,,a.,, �.kict..W r
eva fr k .+'els`',
"'L i This..,section does not apply to this-"project.
F.Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)1C) •
This section does not apply to this project.
Registration Number:417-A020115770A-000-000-0000000-0000 Registration Date/Time:2017-09-12 15:39:02 HERS Provider:CHEERS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2016.1.006 Report Generated:2017-09-12 15:39:04
Schema Version:rev 10/16
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems(formerly CF-1R-ALT-HVAC) (Page 3 of 3)
Documentation Author's D.eclaration.5tatement . .
1. I certify that this Certificate of Compliance documentation is_accurateand complete.
Documentation Author Name: - Documentation Author Signature:
Jessica Valencia Jesgca.Valenrta.
Company: Signature Date:
Pelle Heating and Air,Inc. 2017-09-12
Address: CEA/HERS Certification Identification(if applicable):
3751-D Charter Park Court
City/State/Zip: Phone:
San Jose CA 95136 408 978-7060
Responsible Person'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 Business and Professions Code to accept responsibility forthe t)ding design or system design identified on this Certificate of Compliance(responsible designer).
3. That the energy features and performance specifications,materials,components,and manufactti 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 California Code of Regulations.
4. 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 appl(ieetion.
5. I will ensure that a registered copy of this Certificate of Compliance shall be made available�ivith th budding.'permit(s)'rissued for the building,and made available to the enforcement agency for all applicable
inspections.I understand that a registered copy of this Certificate of Compliance is'required o be included with"the doctimentation the builder provides to the building owner at occupancy.
Responsible Designer Name: (g - � Responsible Desigp r Signature:
Jessica Valencia at filL ;J f,teoi ricta
Company: Date Signed:
Pelle Heating and Air,Inc. 2017-09-12
Address: License:
3751-D Charter Park Court 809887
City/State/Zip: Phone:
San Jose CA 95136 408-978-7060
Digitally signed by CHEERSTM. This digital signature is provided in order to secure the content of this registered
document,and in no way implies Registration Provider responsibility for the accuracy of the information.
Registration Number:417-A020115770A-000-000-0000000-0000 Registration Date/Time:2017-09-12 15:39:02 HERS Provider:CHEERS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2016.1.006 -- Report Generated:2017-09-12 15:39:04
Schema Version:rev 10/16
i/ SMOKE 1 CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
%,,s/ COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
s
- 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPRTINO (408)777-3228•FAX(408)777-3333•buiidincaouaertino.orq
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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 Emits exceeds
$1000.00, CRC Section 8314,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 ALARM - CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the X X
bedroom(s)—(Sthoke alarms shall not.be located within 3 feet of bathroom door)
On every level of a dwelling unit including basements and habitable attics X I X
Within each sleepionroom X 1
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.coiortply with
CBC Section 420.6 and shall be approved by the Office of the State Fixe Marshal.
Power Supply:In dwelling units with no commercial power supply, alarrn(s)may be solely,bafery 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 ISecti,on 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. ''I
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
; I •
date signed below.
I,',r' c i,
Address: (D'1 (0q ' vCev IC ( CtEVkH G lO 9C01( Permit No.6^ 2011- I b q
Specify Number of Alarms; #Smoke Alarms: I Li I #Carbon Monoxide Detctors: I I
I have read and agree to comply with the terms and conditions of this statement ;
Owner(or Owner Agent's)Name:
signatureA Date:
Contractor Name: (�
��/e �eIIe Slgnatur .,...... .... . ....... .. ...�
Llc.#.g/0 8'?-1 •� ate: 43/i.7
Smoke and COform:doc revised 01/10/2017