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B-2017-1615 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1615 20740 VALLEY GREEN DR CUPERTINO,CA 95014-1704(326 10 047) S C BUILDERS INC SUNNYVALE,CA 94085 OWNER'S NAME: SI 30 LLC DATE ISSUED:09/20/2017 OWNER'S PHONE:408-921-6077 PHONE NO:(408)328-0688 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic.#767196 Contractor S C BUILDERS INC Date 08/31/2019 X BLDG _ELECT _PLUMB X I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH_RESIDENTIAL X COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: APPLE- 1ST FLOOR;T.I-UPGRADE(E)2 TON SPLIT SYSTEM TO 4 I hereby affirm under penalty of perjury one of the following two declarations: TON SPLIT SYSTEM-MDF ROOM;UPGRADE ELECTRICAL TO 1. I have and will maintain a certificate of consent to self-insure for Worker's ACCOMMODATE NEW UNIT Compensation,as provided for by Section 3700 of the Labor Code,for the rformance of the work for which this permit is issued. 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:$24000.00 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 326 10 047 A(Tenant Improvements) 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 t -rtino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. a tidonature a ,� Date 9/20/2017 Issued by:Abby Ayende �� Date:04/20/2017 OWNER-BUILDER DECLARATION I hereby affirm that I am 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 construct the project(Sec.7044,Business&Professions Code). Date:9/20/2017 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. 1 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 a. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I 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 •uality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cuperti .Au unici.. Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,S' io iir,25 3,an. 25534. Labor Code,I must forthwith comply with such provisions or this permit shall `���,�` be deemed revoked. ��` er or authorized agent: ♦)t;,*.___:;11b. APPLICANT CERTIFICATION Date:9/20/2017 �U I certify that I have read this application and state that the above information is I 1, I 0` ``P ri.l. ` correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction leri.ing -.- .r 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. l understand my plans shall be used as public records. Licensed Signature _ _Date 9/20/2017 'Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION \\I"/ 10300 TORRE AVENUE • CUPERTINO,CA 95014-3255 �,,-t9QJ+ 17�/{� Rs tS (408)777-3228 • building@cupertino.org PEMIT#B- CUPERTINO REV# DEF# ❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. ' MEP ❑RE-ROOF ❑SWIMMING POOL/SPA PROJECT ADDRESS `f ,` ,1 r.�, APN S Y GI O �W C� Y 11LL�\041. �.Die- 6' - lam)— ocf� OWNER�E v PHONE E-MAIL -!'—2. Lv,l.Q Lbe> - `l. \ i tt,n-1-7 CI+ET'Et1.‘.)1+VM F18)-Puz.Go y STREET ADDRESS X14 0 Y&11 &rte pr crrY STATE,ZIP c4A. 91 So 14 ❑CONTRACTOR NAME 0 OWNER-BUILDER MPANY NAME LICENSE NUMBER CAN LICENSE TYPE E bola- Sc wt cLt.YS lkonvot 13 SSTREE ADDR CITY,STA ZIP I (1l o 'Ince ? L . �ArlYIAI V C- 94-o$s E-MAILV u.'?/la 4)�(ld (4HONC A� s -3 --�e t BUS.LIC It 0 ARCHITECT 0 OWNER ❑OWNER AGENT 0 CONTRACTOR AGENT 0 ENGINEER 0 DEVELOPER❑TENANT CONTACT NAME E-MAIL STREET ADDRESS C11 Y,STATE,ZIP PHONE DECRIPTON UrS\ z Vfi t i IP Li caro) SA_\�• S ✓1 -ro L4-m4 Six-r 4,417) f_en . 0‘3‘ C.'SQ.s(GAL.-ct, p.Gc,0"4,1 op-A-% 1Jti Li V a\Z ❑SINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL XCOMMERCIAL1 EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES It TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($) REMODEL REMODEL KiTCHEN REMODEL OTHR GARAGE ❑ATTACHED $ n , BATHROOM SF SF SF SF 0 DETACHED dy ©CZ) EXISING ❑YES EICHLER 0 YES SECOND STORY ADDITION ❑YES FIRE SPRINKLERS 0 NO 0 NO ❑NO DWELLING SECOND DWELLING ❑YES 0 ATTACHED 0 DETACHED OTHER UNITS# UNIT ADDITON: ❑NO S F POOLS' ❑FIBERGLASS ❑VINYL-LINED 0 GUNITE 0 PREFABRICATED POOL-SF SPA-SF I SPA ATTACHED❑YES 0 NO TOTAL-SF RE LVED BY T TAL VALUATION: Commercial or Multi-Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval I._ a�`T ry/� I 1:1 BUILT-UP S GLES TILE OTHER(SPECIFY) RE-ROOF EXISTING ROOF TYPE: BUILT-UP ROOF ASPHALT SHINGLESE WOOD SHAKES REMOVE/REPLACE❑NO IF NO PLYWOOD ❑1„ ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS ❑YES I #OF LAYERS _ THICKNESS❑5/8" OTHER ❑OSB ❑CDX OTHER •12 A PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES 0 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 applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection p a.' I acknowledge and authorize all information contained on this application form to be made available for public record. �� �' Signature of Applicant/Agent: r �i Date: o t'1 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 BldgApp_2017.doc revised 08/01/17 Building Department �� City Of Cupertino 0300 Torre Avenue 4.1 Ips\ Cupertino.CA 95014-3255 CUPERTINO Telephone:408-777-3228 Fax:408-777-3333 CONTRACTOR/SUBCONTRACTOR LIST JOB ADDRESS 20740 Valley Green Dr PERMIT# B-2017-1615 OWNER'S NAME:Apple Computer PHONE#650.280.5188 ClieS GENERAL CONTRACTOR:SC Builders Inc BUSINESS LICENSE#24074 ADDRESS:910 Thompson Place CITY/ZIPCODE:94085 "Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE# Cabinets&Millwork Cement Finishing Electrical Sprig Elec 21974 to 0 (� Excavation Fencing Flooring/Carpeting Linoleum I Wood.. .. . . .... Glass/Glazing Heating Insulation Landscaping Lathing Masonry - Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Western Allied Mechanical L-DOO Sheet Rock Tile Air • „. e 10.27. 17 Owner/ '.ontractor Signature Date CONSTANT VOLUME, SINGLE ZONE, UNITARY: PACKAGED-AND SPLIT) " ri "` al-- AIR CONDITIONER AND HEAT PUMP SYSTEMS -3011-1b�5 'c( is 3r -_ .' CEC-NRCA-MCH-03-A(Revised 17115) ' CALIFORNIA ENE69M�f • CiERTFFICATE OF ACCEPTANCE: NRCA MCH-03-A 'Constant Volume,Single Zone, Unitary Packs ed and Split).Air Conditioner and Heat Pum Systems .: (Page 3 of 3) " = Project Na e: ,' - Enforcement Agency: '" Permit Nuumber:" ProjectM e : - city: : - -Zip 201'1.6. �- Com_ el - c � : . . System Name or dennficaton/r : ': System Location Ar e - ' . DOCUMENTATION AUTHOR'S DECLARATION STATEMENT .1: I certify"that this Certificate ofAcceptance documentation'is accurate and complete. Documentetio uthor Name ': i l DOCui eent8ti.on Author S Do um ntatio Aan a : Date Signed: d r s Ati ATT Certification entificatio If applicable): .. : TPhone:City to/Z ; r� .. .. • • FIELD,TECHNICIAN'SDECLARATIOFTATEMENT . I••:certify the following under.penalty.of perjury,under the laws of the State of California: " 1• I Therinformation provided on this.CertificateofAcceptance is true and correct 2. I am the person,who performed the acceptance verification reported on this.Certificate"of Acceptance(Field Technician). '3. The construction or installation identified on this Certificate of Ac•ceptance complies with`the applicable acceptance'requirements - a t inthe plansand specifications approved by the enforcement agency;:and conforms to the applicable acceptance ." indicated requirements:and procedures.specified in Reference Nonresidential.Appendiix NA7.. 4. I have confirmed that the Certificate(s):of Installation for the construction or installation_identified on this Certificate'of Acceptance has been completed and signed by the responsible builder/installer and:has been posted or made:available with the building permit(s) Issued for the building. FieldTechnicia• ame: iA, Field TechniciaiiSignature: Field echnciant ms nyiNafie •Position mpany(Titlej iegt ."vis Ea ` A Identification(if applicab Addr s TTcertifjcation • , I! O.: 4,-S Py vt, 41‘.1:: :: :: .: :. • " • ' Cit tate/Zi ,� .k. • Phon Datesigned, ;rhe✓ ! faaT °� �z - 2 �. l RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury,under the laws of the State of California: 4. lam theec FieldTThnician,or the Field Technician is acting on,my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance: ' i system des �n,•construction or""installation offeatures-materialsde In;the;applicable classificatlonao accept responsibility for""the. 2, I am eligib a under Division 3 of-the Business and Professions-Co g ,components,or manufactured devices far the scope of work identified or this Certificate of Acceptance and attest to.the.declarations in this statement,(responsible acceptance;person): • 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this -certificate:0f Acceptance complies with•the acceptance requirements indicated in the'plans and specifications approved by the enforcement agency,and conforms to the applicable:acceptance.requirements"and procedures specified in Reference'Nonresi:dential T ; Appendix NA7. •• .: 4. llhave confirmed that the Certificate(s)`of Installation for the construction or installation:identified on this Certificate,of Acceptance has been completed and,is posted or made available with the building•permit(s)issued for the:building, '' . I will ensurethat a completed;signed copy of this Certificate of Acceptance shall:be posted,or made available with the building: pertnit(s)issued for the building,and made available to;the enforcement agency for all inspections stand thata: g py. s Certificate of Acceptance is required to be included signed co ofthl with the document ''n the bu'd , provides:to ""the building ' . owner at occupancy.: .: Responsibi Acceptance Person Narn / Responsible Ac ` •e P gn er Respo sible cce lnc•e'Pers m1.• any ame �� _ Position with company itl ) ' .Addei, ltenv . -.CSLB license: . • y/State/•Zi': • 1 .. frk ,tl ,.0104,s- SJ l PJon? " �Q Date Signed:.r�G>✓ CA Building Energy Efficiency Standards-,2013,Nonresidential Compliance December 2015' CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS : . . CEQ-NRCA-MCH-03-A(Revised 12/15) • CALIFORNIA ENERGY COMMISSION - CERTIFICATE OF ACCEPTANCE NRCA-MCH-03-A Constant Volume,Single Zone,Unitary(Packaged and Split)Air Conditioner and Heat:P ump Systems 1 - (Page 1 of 3) Project Name: : . Enforcement Agency: Permit Number: .Project A ess:' .. .- .. .. .- .. .. . City: : . ./ .. - - 7p Cod . Kms: System Name or Id ntif a' /Tag•; a - - - System Lace` or Area Served: - Note: Submit onecertificate of Acceptance for each system that mu_st Enforcement Agency:Use: Checked by/Date. demonstrate compliance. : . . A. Construction Inspection :. 1. Supporting documentation needed to perform test includes,but not limited to: a. 2013 Building Energy Efficiency Standards Nonresidential Compliance Manual(NA7.5:2 Constant Volume,Single-zone, Unitary,Air Conditioner and Heat Pumps Systems Acceptance At=A-Glance). fib. 2013 Building Energy EfficiencyStandardsManual., 2. instrumentatiOn to perform test includes,but not limited;to a. Temperature Meter ..: : b. Amp Meter- 3. Installation(check if applies): Thermostat is located within the°space-conditioning zone that is served by.the-HVAC system. L.1-,: Pr gramming(check.all those that a l ' Thermostatmeetsthetgmperature adJustment and dead band reqwrements of 2013 Building Energy'ff.ficienc y:Standards Manual section 120.2(b) r Minimum heating setpoints ,`Maximum tooling'. setpoint ?', °F Deadhand: °F: Occupied,unoccupied;and holidayy schedules have been programmed per the facility's,schedule 0 Pre-occupancy Pur e_has beenprogrammed:to meet there uirements'of2013 Buildingy Ener Efficiency Standards Manual 'section 120.1(c)2. : 1.. Chec ,`ethod used to determine pre-occupancy purge: Lesser of:conditioned floor area times ventilation:rate from 2013 Building Energy Efficiency Standards TABLE 120:1-A or 15cfm perpersontirnes the expected numberof occupants. : .. . .. . 0 3 complete airchanges.. . . Notes: : : CA Building Energy Efficiency Standards -2013:Nonresidential Compliance' December•2015, CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) „..... AIR CONDITIONER AND HEAT PUMP SYSTEMS CEC-NRCA-MCH-03-A(Revised 12/15) CALIFORNIA ENERGY COMMISSION RT I FICATE OF ACCEPTANCE NRCA-MCH-03-A Constant Volume,Single Zone, Unitary'.(Packaged and Split)Air Conditioner and Heat Pump Systems : 1 (Page 2 of 3) : ProjectEnforcement Agency: Permit Number: Project A/ ee: /6..... ' , in. City: lour c.,:,,,,44, . Zip Codk7 czili.1./ System Nan:patio/10., System Locatio r Azaa.Soacy:• / • B. Functional Testing Requirements. Operating Modes Step/Disable economizer control and demand-controlled ventilation(if applicable)to prevent unexpected interactions Occupied Mode Step 2:Heating-load during occupied condition Step Bi No-load during occupied condition Step 4:Cooling load during occupied condition Unoccupied Mode . i Step 5:No load during unoccupied condition Step 6: Heating load during unoccupied condition • . Step 7.; Cooling load during unoccupied condition . . . : Step B::Manual override . . _ . 8 .1 6 5 4 3.._ ?-.. Step 2-8:Check and verify the following for each simulation mode required Vii 01 t31-gd'MI WI r-1 a. 1 Supply fan pperatesCOntinually . to,•4411 . . : b. Supply far!turns off Mt RE Id FA Ei il c. Supply far):tYleS:on.and off ' ' " - ' • Cf!'''" i '?41 EU=:s.4 El BB d. : :System reverts to"occupied"mode to satisfy any condition ' - En Pill flA 501,11A 1.4 . - : - '-'44.',,,' va va..tlt... NV -"- •,. e. System turns off when manual override time period expires i: : - . iffej gai'i'19 Wdl Ill El . . f. Gas-firectfutnace,heat pump,or electric heater stages on g. ::No heating is providedby the.unit Siric:440C-: (...-_,,4. Aiti . .z.-t-is ci : elh, . . •. .5.1Mm tr5P, - ' Mi h. No cooling is provided by the unit . 1. Compressor'stages on 'td )c,:,*liblii y:_l.d.A r.tiw J. . 'Outside air damper is open to minimum position I- REirITIF :I - i . . k. Outside air damper closes completely f 1::?:: - a ilk Step 9:System returned to initial operating conditions after all tests have been completed: Yes 3 No 0 . . . : C.Testing Results 7 6- 5 4 .3 2.: .. . Indicate if Passed(P),Failed(F),or N/A1X),fill inappropriateletter las 11 AK 14 ,1- .._ , .-Evaluation k , .., : .PASS:All Construction Inspection responses are complete and'all.applicable Testing Results responses are''Pass' (P) CA Building EnergVIffitiency Standards-2013 Nonresidential Compliance December 2015- Form 0.00 DUCTLESS SPLIT Test Report 8-9011.NI tC W. _ — WESTERN ALLIED MECHANICAL,INCi 1 `"• ; . MECHANICAL CONTRACTORS Ea e _ .+ State Contractors License Number: 826782 1180 O'Brien Drive,Menlo Park,CA 94025 4d—ib,31 ill — — Phone: 650-326-0750 Fax:650-321-4946 Job Information Job Name: Apple VP03 Job Number: 1017152 Job Site Address: 20740 Valley Green.Cupertino,CA Technician: Adam D. Lessler Date: 10/30/2017 Indoor Unit Info Outdoor Unit Info Unit Designation: . FC-18 Unit Designation: CU-18 System Served: IT Room Location Unit Installed: Roof Location Unit Installed: IT Room Manufacturer: DAIKIN Manufacturer: DAIKIN Oudoor Model#: RXTQ48TAVJU Indoor Model#: FXMQ48PBVJU Serial Number: F001003 Serial Number: E000578 Airside AP(temp): 23° mom*:.^., m rr__ r,._: . °.. _ _._. . _, " y .x " .1, Indoor Unit Info Outdoor Unit Info Unit Designation:'. Unit Designation: System Served: Location Unit Installed: Location Unit Installed: Manufacturer: Manufacturer: Oudoor Model#:_ Indoor Model#: Serial Number: Serial:Number: Airside AP(temp): — Indoor Unit Info: Outdoor Unit Info Unit Designation: Unit Designation: . . System Served: Location Unit Installed: Location Unit Installed: Manufacturer: Manufacturer: Oudoor Model#: Indoor Model#: Serial Number: Serial Number: Airside AP(temp): L .7", ,^7'o7477,-",,7"", •a __ _ ...�. _.. -'-- " „- ... ,0"_: ff".7..'"- .-. .: "^ a"_": A:Lt. r' `d;„” FC-18 Filter Size(2)@ 11.38 X 26.88 X 3.75 Compressor Rated Voltage:208 Actual Voltage:205 Remarks: Compressor Rated Amperage:29.1.Actual Amperage:6.4,6.3,6.5. Average Amperage:6.4 FC-18 Condensate Pump Wired For Safety Shutdown. Total System Charge: 11.8Ibs Test Report By: Date: r I I r I r i Page of I I I i I Date and Revision Number:08/04/2013 Rev 1