B-2017-1691 - CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1691
10094 RANDY LN CUPERTINO,CA 95014-2343(316 23 067) A R S AMERICAN.
RESIDENTIAL .
SERVICESOF
CALIFORNIA INC
MEMPHIS,TN 38120
OWNER'S NAME: TAN HEOW M AND ANNE E TRUSTEE DATE ISSUED:09/29/2017
OWNER'S PHONE:508-932-5830 PHONE NO:(408)283-9536
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
c .
License Class C-20 Lic.#742039 •
Contractor A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC X BLDG _ELECT _PLUMB
Date 10/31/2019 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 FURNACE AND AC UNIT AND DUCT WORK-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
,
+erformance of the work for which this permit is issued.111
„ Of
^ I have and will maintain Worker's Compensation Insurance,as provided for by
I. Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: •
Valuation:$26200.00
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.I agree to comply with all city and county ordinances 316 23 067
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 regulation the Cupertino Municipal Code,Section 9.18.
Issued by:AbbyAyende
gnature Date 9/29/2017 Date:09/29/2017
OWNER-BUILDER DECLARATION RE-ROOFS:
I hereby affirm that I 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,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:
•
z. I,as owner of the property,am exclusively contracting with licensed Date:9/29/2017
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
t. 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. 1 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 mit hazardous
shall not employ any person in any manner so as to become subject to the air contaminants as defined by t...lay Area,Air Quality Matta!•ment District I
will maintain compliance wit' he C.pertino Municipal Code ' hapter 9.12 and
Worker's Compensation laws of California. If,after making this certificate of the Health&Safe, Code,.ectiohs 25505,25533 ,nd 25534.
exemption,I become subject to the Worker's Compensation provisions of the 1
Labor Code,I must forthwith comply with such provisions or this permit shall yorrer or authorized agent:
be deemed revoked. ' ate:9/29/2017 i
•
I 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 construbtion;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 i
to enter upon the above mentioned property for inspection purposes. (We)agree '
to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address
judgments,costs,and ekpenses,which may accrue against said City in ..
consequence ofthe granting of this permit. Additionally,the applicant understands ARCHITECT'S DECLARATION
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
41/ . B
10300 TORRE AVENUE • CUPERTINO,CA 95014-3255
gl,tas 1
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(408) 777-3228 • building@cupertino.org PEMIT#B- °C`I - 6 I _
CUPERTINO REV# DEF#
❑ NEW CONSTRUCTION ❑ADDITION ALTERATION ❑T.I. 1=1 MEP ❑RE-ROOF 111 SWIMMING POOL/SPA
PROJECT ADDRESS I 60q61 APN F I/__42,5^ coil._
OWNER NAME 142,o i PH IE �j 2–L D� E-MAIL//��STREET ADDRESS (0 O }e /UT'\/`— CITY ATE,ZIP 7n ) '� / 5 .0/67/'–/
❑CONTRA/ OR NAME ❑OWNER-BUILDER C A • ' 1ICENSEER 6 LICENSEI 'TYPE
IsTP i' SS / CPTY,ST ,Z / /16 I
es)
paz."74„,
(/V v GLCfi�J�n (�
E-MAIL � PH•� X� BUS.LIC#
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❑ARCHITECT 0 OWNER 0 OWNER AGENT 0 CONTRACTOR AGENT 0 ENGINEER 0 DEVELOPER❑TENANT
CONTACT NAME E-MAIL
STREET ADDRESS CITY,STATE,ZIP PHONE
DECRIPTON
/e 0 i AI' r---cA/71.6.6_6/7/--(_____/ -z- --a-
, .:
❑SINGLE-FAMILY/DUPLEX ❑MULTI-FAMILY ❑INDUSTRIAL 0 COMMERCIAL
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES I TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE 0 ATTACHED
BATHROOM SF SF SF SF 0 DETACHED
EXISING 0 YES
EICHLER 0 YES SECOND STORY ADDITION ❑YES
FIRE SPRINKLERS.D NO 0 NO 0 NO
DWELLING SECOND DWELLING ❑YES ❑ATTACHED❑DETACHED OTHER
UNITS# UNIT ADDITON: 0 NO S F
POOLSI 0 FIBERGLASS ❑VINYL-LINED ❑GUNITE 0 PREFABRICATED
POOL-SF SPA-SF I SPA ATTACHED❑YES 0 NO I TOTAL-"SF •
REC D Y: n TA UA N:
Commercial or Multi-Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval `//J`/A\/A11
RE-ROOF'EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGL S❑TILE OTHER(SPECIFY)
REMOVE/REPLACE❑NO IF NO PLYWOOD ❑1" ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
El yESI #OF LAYERS THICKNESS❑5/8" OTHER ❑OSB ❑CDX OTHER :12 A
PROPOSED ROOF TYPE:❑BUILT-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 informa s.. 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 or.:. antes . d state laws relatin to building construction. I authorize representatives of Cupertino to
enter the above-identified property •.r inspectir,n purposes. I a ledge and authorize all information ained on this application form
to be made available for public reco d. C, . / ^^7
Signature of Applicant/Agent: Date: J
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
ALTERATIONS - HVAC
". .
CEC-CF1R-ALT-03-E(Revised 01/16) CALIFORNIA ENERGY COMMISSION .
CERTIFICATE OF COMPLIANCE • CF1R-ALT-03-E
Alterations-HVAC CZ 1,3 to 7 and 16 (Page 1 of 1)
Site Address: Enforcement Agency: Date Prepared: Permit#:
d0q e-04/1
L/ (•A"1/13/".
Equipment Type F ,� / Ipment Efficiency New:Ducting or Lineset Conditioned Z Thermostat
"v Required R-value Floor Area(ft )
IDPackaged System l2 E �ivaporator Coil �(,2AFUE COP 0 R-6 (CZ 1-10,12&13)Ducts Serfig.d by systenetback
) lit System condensing Unit /L/SEER
E3 R-8' (CZ 11,14-16)Ducts t ) ) ftz (If not already
HSPF ( >R-2.8 Linesee present,must'
Furnar_eineset EER be.installed)
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.
71.HVAC Changeout/Repair Required Compliance Documents to be left on site for,Final:
(Can include new ducting)
All Equipment, CF1R-ALT-02-E
Condenser Unit,Evaporator Coil, CF2R:MCH-01,MCH-20-H •
Air Handler/Furnace CF3R:MCH-20-H •
Installer Requirement:Duct leakage(515%or,510%to outside,or seal all accessible leaks)
Exempted from duct 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
0 2.New HVAC System Required Compliance Documents to be left on site for Final:
All new equipment and All New Ducts' CF1R-ALT-02-E
CF2R-MCH-01-E,MCH-20-1-I,MCH-22-H,MCH-(23 or 24)-H
CF3R-MCH-20-H,MCH-22-H,MCH-(23 or 24)-H2
Installer Requirement:Duct leakage<5%,Fan Efficacy(0.58W/CFM),Air Flow>_350 CFM/ton(or Standards Table 150.0-B/C alternative)
0 3.All New Ducts with Replacement Required Compliance Documents to be left on site for Final:
Includes replacing or installing All New CF1R-ALT-02-E
Ducts'and one or-more of the following: CF2R-MCH-01-E,MCH-20-H,MCH-(23 or 24)-H
Condenser Unit,Evaporator Coil,Furnace CF3R-MCH-20-H,MCH-(23 or 24)-H
Installer Requirement:Duct leakage<5%,Air Flow>_350 CFM/ton(or Standards Table 150.0-B/C alternative)
❑Exempted from duct leakage testing if existing duct systems are constructed,insulated or sealed with asbestos.
0 4.New Ducting over 40 feet • Required Compliance Documents to be left on site for Final:
Adding or replacing ducts in unconditioned CF1R ALT 02 E
space but less than All New Ducts' CF2R MCH 20 H
CF3R-MCH-20-H
Installer Required to:Duct leakage(<15%or,<10%to outside,or seal all accessible leaks)
❑ Exempted from duct leakage testing if existing duct systems are constructed,insulated or sealed with asbestos.
'All new ducting requires R-8 insulationwhen more than 40 ft installed in CZs 11&14-16 and R-6 in CZs 1-10,12&13,and R-6 insulation when less
than 40 ft installed.This includes in walls,between floors etc.
2A New Duct system is when the.duct system is constructed of at least 75%new duct material,and up to 25%may consist of reused parts from the
dwelling unit's existing duct system(e.g.,registers,grilles,boots,air handler,plenums,duct material.
R-2.8(1"thick insulation)for linesets 1"and less.
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 Pi-ofessions 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: /AL ResGppons�ible Designer Signature: \C1 Date Signe..�'
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Company:A26
55 P f/�cg�s D
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For assistance or questions regardi the Energy Standards,contact the Energy Hotline at:1-800-772-3300