B-2017-1678 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1678
22408 BALUSTROL CT CUPERTINO,CA 95014-3948(356 03 019) ON-TIME AIR
CONDITIONING&
HEATING INC
PLEASANTON,CA
94588
OWNER'S NAME: KINNEY EDWARD E JR AND KAY B TRUSTEE DATE ISSUED:09/27/2017
OWNER'S PHONE:408-252-1956 PHONE NO:(925)872-7326
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-20 Lic.#817040
Contractor ON-TIME AIR CONDITIONING&HEATING INC Date 09/30/2019 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 : the Business&Professions Code and that my
license is in full force and of ct. JOB DESCRIPTION:
REPLACE FURNACE(SAME LOCATION);REPLACE AC UNIT
I hereby affirm under.enalty.of perjury one of the following two declarations: (SAME LOCATION);REPLACE COIL SAME LOCATION
1. 1 have a .will maintain a certificate of consent to self-insure for Worker's
Comp;nation,as provided for by Section 3700 of the Labor Code,for the
pe '.rmance of the work for which this permit is issued.
ave and will maintain Worker's Compensation Insurance,as provided for by
ection 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$18144.00
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 356 03 019
representatives of this city to enter upon the above mentioned .rrperty for
inspection purposes. (We)agree to save indemnify and .--. harmless the
City of Cupertino against liabilities,judgments,cos ., nd expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence. :• he granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands .'."will comply with all non-point
'source regulations per the Cupertin.. unicipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signatur- 2111V Date 09-27-2017 Issued by:Kim Dunbar
Date:09/27/2017
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:09-27-2017
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 Quality Management Di ict I
Worker's Compensation laws of California. If,after making this certificate of 'will maintain compliance with the'Cupertino Municipal Code,Cha. • '.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code, :ct' 5505,25533,: : 534.
Labor Code,I must,forthwith comply with such provisions or this permit shall . �s
be deemed revoked. Owner or authorized agent; !'
APPLICANT CERTIFICATION Date:09-27-2017
I certify that(have read this applicationand state that the above information is CONSTRUCTION LENDING AGENCY
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 09-27-2017
CONSTRUCTION PERMIT APPLICATION
.\y"�,,/ COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
( .,
10300 TORRE AVENUE • CUPERTINO,CA 95014-3255 q
.,-1.4.4. (408) 777-3228 • building@cupertino.org •PEMIT#B- 20 l - / 0.- 0
CUPERTINO • REV# DEF#
❑ NEW
�CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS
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OWNS, PHONE E-MAIL
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STREET ADDRESS CITY, STATE,ZIP • '
kjCONTRACTORNAME ❑OWNER-BUILDER COMPANY NAME `� LICEN� O LICENSE
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EFAMILY/DUPLEX ❑MULTI-FAMILY 0 INDUSTRIAL ❑COMMERCIAL I
EXISTING USE EXISTING SF f'NEW'FLOOR SF PORCH SF DECK SF DEMO SF STORIES,# TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
REMODEL REMODEL,KITCHEN REMODELOTHR GARAGE ❑ATTACHED
BATHROOM SF SFSF SF ' ❑DETACHED
EXIS!SPRINKLERS 0 NO EICHLER 0 No SECOND STORY ADDITION 0
YES
FIRENO
DWELLING SECOND DWELLING ❑YES 0 ATTACHED❑DETACHED OTHER
UNC# UNIT ADDITON: ❑NO , S F
POOLS! ❑.FIBERGLASS ❑VINYL-LINED, ❑GUNITE ❑PREFABRICATED
POOL-SF SPA-SF. I SPA ATTACHED❑YES 0 NO TOTAL-SF
REC itt/TO l IN:
Commercial or Multi-Family Buildings with Public Swimming Pools requires Department o/'Environmental Heath approval
RE-ROOF!EXISTING ROOF TYPE:' ❑BUILT-UP ROOF E ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY)
REMOVE/REPLACE❑NO, IF NO' , PLYWOOD E I" ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
0 YES i I #OF LAYERS THICKNESS❑5/8" OTHER ❑OSB E CDX OTHER .12 A
PROPOSED ROOF TYPE:❑BUILT-UP.ROO$I❑ASPHALT SHINGLES ❑WOOD SHAKES❑WOOD SHINGLES ❑OTHER
*Provide a signed copy:of the'C uperiino'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 e read the Description of Work and verify it is accurate. I agree
to comply with all applicable local"ordinances and state laws-relatin• . building construction. I authorize representatives of Cupertino to
enter the above-identified property for inspection sur.,: I a .wledge and authorize all information con fined on :s application form
to be made availablefor public record.
Signature of Applicant/Agen ,.'_'_ •. .1›-._11 .& k_ 'Ta - ; ,'.mr• .:..
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'approyal 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: ED KINNEY Date Prepared: 2017-09-26
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 ED KINNEY 02 Date Prepared 2017-09-26-
03 ProjectLocation22408 BALUSTROL COURT 04 Building Type Single family
05 CA City Cupertino ,a., :;06 Dwelling Unit Name HOUSE
,,-'ti .
' °.V,PW r Dwelling Unit Conditioned
07 Zip Code 95014 },..:,;,),'\.=_kl:'.-;';'',:'•",‘'. ',-.--'08J, Floor Area(ft2) 1680
f
;, 44 'i Number of Space
09 Climate Zone 4 = 10 Conditioning(SC)Systems in 1
' ,
this Dwelling Unit:
B.Space Conditioning(SC)System Information
01 02 03 04 ` ' 1205 °u €€w':= 06 t-u' 07 08 09 10
Is the S45/1.-1 1InstaHing a_Vi wP COint r tt
SC System SC System CFA served system a refrigerant Installing new SC'" 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
SYSTEM 1 LOCATION 1 1680 Yes Yes - Yes No No No Altered space
conditioning system
C.Extension of Existing Duct System,Greater Than 40 Feet(Section150.2(b)1Diib)
This section does not apply to this project.
Registration Number:417-A020118438A-000-000-0000000-0000 Registration Date/Time:2017-09-26 07:43:39 HERS Provider:CHEERS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2016.1.006 Report Generated:2017-09-26 07:43:40
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 Declaration Statement
1.I certify that this Certificate of Compliance documentation is accurate and complete. -
Documentation Author Name: Documentation Author Signature:
April Rodriguez Ap-a RocirigtAe''
Company: Signature Date:
I Permit E Raters 2017-09-26
Address: CEA/HERS Certification Identification(if applicable):
31225 La Baya Drive
City/State/Zip: Phone
Westlake Village CA 91362 !r;:;:,•<\;\.tai ;'818-735-7876
Responsible Person's Declaration statement
I certify the following under penalty of perjury,under the laws of the State of California: 4v 17-1111
1. The information provided on this Certificate of Compliance is true and correct. h v
2. I am eligible under Division 3 of the Business and Professions Code to accept responsibility for the yijjaing design or system design identified on this Certificate of Compliance(responsible designer).
3. 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 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 agen_cyfor,;approval with this building permit application.
5. I will ensure that a registered copy of this Certificate of Compliance shall be made availab °fi
lelwith thewlding5permit(s)issued for the building,and made available to the enforcement agency for all applicable
inspections.I understand that a registered copy of this Certificate of C&npliance is required fo be included lkittithe documentation the builder provides to the building owner at occupancy.
Responsible Designer Name: tib e„y atc o car 1.`_ Respons ible#,Design Signature:
Lyndy Rose Lyvidy Rose L °
Company: Date Signed:
On-Time Air Conditioning&Heating Inc dba Service Champions 2017-09-26
Address: License:
7020 Commerce Drive 817040
•
City/State/Zip: Phone:
Pleasanton CA 94588 925-444-4444
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-A020118438A-000-000-0000000-0000 Registration Date/Time:2017-09-26 07:43:39 HERS Provider:CHEERS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2016.1.006 Report Generated:2017-09-26 07:43:40
Schema Version:rev 10/16