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B-2017-1720 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1720 21132 PATRIOT WAY CUPERTINO,CA 95014-5708(326 53 004) HOMEOWNER BUILDER OWNER'S NAME: GOODRICH MARGARET K DATE ISSUED: 10/05/2017 OWNER'S PHONE:650-300-2433 PRONE NO: LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic.# Contractor HOMEOWNER BUILDER Date X BLDG _ELECT _PLUMB • I hereby affirm that I am licensed under the provisions of Chapter 9(commencing X MECH 7C RESIDENTIAL_COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: REPLACE FURNACE AND AC UNIT-SAME LOCATION I hereby affirm under penalty of perjury one of the following two declarations: i. 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 ' Section 3700 of the Labor Code,for the performance of the work for which this ' permit is issued. Sq.Ft Floor Area: Valuation:$7000.00 ' APPLICANT CERTI ICATION 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 53 004 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 Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. , Signature Date 10/5/2017 Issued by:Abby Ayende• • Date: 10/05/2017 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:10/5/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER , i. 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 permit is issued, California Health&Safety Code,Sections 25505,25533,and 25534. I will 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 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 District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the C .e Lino Municipal Code,Chapter 9.12 and • exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety C I d• Se. io o:r.5 0.,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall I�,k� // be deemed revoked. /''.0,/....„.` •/'//l / �j Owner or authorized'agent: , APPLICANT CERTIFICATION Date:10/5/2017 I certify that I have read this application and 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 complyAyn(ith all non-point source regulations per the Cupertino Municipal ARCHITECT'S_DDECLARATION Code,Section f.18. I understand my plans shall be used as public records. j! Licensed Signatur: g ,, 1 ; i�/� t Date 10/5/2017 Professional-- / CONSTRUCTION PERMIT APPLICATION \\�i �/ COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE G CUPERTINO,CA 95014-3255 /",s-r.19J � M s (408)777-3228 • building@cupertino.org PEMIT#B- ,,,_001R— - R (e. CUPERTINO ❑ NEW CONSTRUCTION Q ADDITION IJ ALTERATION❑T1. ❑MEP ❑RE-ROOF 0 SWIMMING POOL/SPA PROJECT ADDRESS 1 APN R 21132 Patriot Way .26 --�3--OO zt - OWNER NAME PHONE E-MAIL Margaret Goodrich 650 300-2433 mkgoodrich@gmail.com STREET ADDRESS CITY,STATE,ZIP P.O.Box 20402 Stanford,CA 94309 0 CONTRACTOR NAME ❑OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE Becks Heating&Air 833514 C20 STREET ADDRESS CITY,STATE, ZIP • P.O. Box 1311 Los Gatos, CA 95031 E-MAIL PHONE IBUS.LIC# (408)358-2172 0 ARCHITECT 0 OWNER ❑OWNER AGENT 0 CONTRACTOR AGENT ENGINEER'❑DEVELOPER 0 TENANT • CONTACT NAME E-MAIL Margaret Goodrich mkgoodrich@gmaii.com STREET ADDRESS QTY,STATE,ZIP PHONE P.O.Box 20402 Stanford,CA 94309 650 300-2433 DECRIETON Replacing central heating and air conditioning. No ductwork replaced. [SINGLE-FAMILY/DUPLEX ,❑MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL EXISTING USE EMS,e NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES tl TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($) " 'iU1' REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED BATHROOM SF SF SF SF 0 DETACHED EXISISPRINKLERS 0 NO EICHLER 0 YES SECOND STORY ADDITION 0 YES FIRE0 0 NO DWELLING SECOND DWELLING 0 YES ❑ATTACHED DETACHED OTHER UNITS I UNIT ADDITON: ❑NO S F POOLS' 0 FIBERGLASS 0 VINYL-LINED '❑GUNITE 0 PREFABRICATED POOL-SF SPA-SF I SPA ATTACHED ❑YES -' NO TOTAL-SF REC.-ED BY: / TO VALUATION: Commercial or Multi-Fantiht Buildings with Public Swimming Pools requires Department of Environmental Heath approval .9� (fid`t l " I D 00 RE-ROOF!EXISTING ROOF TYPE: ElBUILT-UPROOF❑ASPHALT SHINGLES EI WOOD SHAKES ET WOOD SHINGLES❑LLL TILE{ OTHERT(SPECIFY) J REMOVE/REPLACED NO IF NO PLYWOOD CI 1/2" CI 3/8" PLYWOOD TYPE: PTTCH: ROOF CLASS 0 YES I F OF LAYERS THICKNESS❑5/8" OTHER ❑OSB ❑CDX OTHER :121 A PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 OTHER *Provide a signed copy of the Cupertino's Tear-Off Policy SF ;tot 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 :ve provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinan d s e laws r ating to building construction. I authorize representatives of Cupertino to enter the above-identified property fo .n ,L a `� owledge and authorize all information contained on this application form to be made available for public record. `�/�j / ,/ /! /�fAtii.Aim. ,— Date: /� 3" / SUPPLEMENTAL INFORMATION RE I UIRED *New SFD/Second Dwelling Uriits/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_201 7.doc revised 08/01/1 7 STATE OF CALIFORNIA ALTERATIONS - HVAC CEC-CFIR-ALT-03-E(Revised 01116) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE CFIR-ALT-03-E Alterations-HVAC CZ 1,3 to 7 and 16 (Page 1 of 1) Site Address: - Enforcement Agency: _ Date Prepared: Permit#: ,aan 'PaJYio 1 New:Ducting or Lineset ConditionedEquipment Type Equipment Efficiency Thermostat Required R-value . Floor Area(ft) ❑Packaged System 0 Evaporator Coil (35 AFUE 0I COP 0 R-6 (CZ 1-10,128e13)Duds Serv-.,' system .Setback ❑R-81 (CZ 11,14-16)Ducts ` I 2 Of not already Split System 0 Condensing Unit iq SEER ) [ ft HSPF 0 Z R-2.8 Lineset3 present,must ❑Furnace , 0 Lineset 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. -X1.HVAC Changeout/Repair Required Compliance Documents to be left on site for Final: (Can include new ducting) All Equipment, daggetRIMIM . Condenser Unit,Evaporator Coil, CF2R:MCH-01,MCH-20-H , Air Handler/Furnace CF3R:MCH-20-H Installer Requirement:Duct leakage(s 15%or,s10%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 I ❑2.New HVAC System Required Compliance Documents to be left on site for Final: [, All new equipment and All New Ducts2 CF1R-ALT-02-E ' CF2R-MCH-01-E,MCH-20-H,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) ❑3.All New Ducts with Replacement Required Compliance Documents to be left on site for Final: 1; Includes replacing or installing All New CF1R-ALT-02-E 'I Ducts2 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:Duet leakage<5%,Air Flow 2 350 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. ❑4.New Ducting over 40,feet I Required Compliance Documents to be left on site for Final: 1,11 Adding or replacing ducts in unconditioned CFIR ALT 03 E space but less than All New Ducts2 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 withiasbestos. 1 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. 2 A 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 theI dwelling unit's existing duct system(e.g.,registers,grilles,boots,air handler,plenums,duct material.. 3 R-2.8(1"thick insulation)for linesets 1"and less. I , 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. I 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 prov`•ed on other applicable compliance documents,worksheets,calculations,plans and specifications submitted to the enforcement rr e .y for:For. . with this building permit application. Res0 . is �,^a, • Responsible Designer Signature: Date i ed: Ii. License: / /' 4077 Lamp. y: I Address: City/State/Zip: Phone: I II For assistance or questions regarding the Energy Standards,contact the Energy Hotline at:1-800-772-3300 i ,wiOWNER-BUILDER DISCLOSURE FORM . COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION • .- 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333•buildinq( cuoertino.orq CUPERTINO • Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: ,- SITE ADDRESS/`�� ��6 ©e� /66 AP - b -01/ BP# -�n _i�� OW{ M OWNER ADD �j �J� l D(��iY7 / • , vV g, ill C.�l� iF/, 0,'l.JS( A�4� I -/f- t i I 7G`f DESCRIPTION OF WORK: /20eafri et71--- rkv-rLa.e_ __/ ig-d,_- _ We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (D1' ONS:Please read and initial each statement below to signify you understand or verify this information.) I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- - er"building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not • provide coverage for those injuries. I am willfully acting as an•Owner-Builder and am aware of the limits of my it ance coverage for injuries to workers on my property. 16.. I understand building permits are•not required to be signed by property owners unless they are responsible for t"ta` •nstruction and are not hiring a licensed Contractor to assume this responsibility. driq , Av. I understand as an "Owner-Builder" I am the responsible party of record on the permit.I understand that I may pro ect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her e instead of my own. C . r.ers k 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license on permits and contracts. 1 5. I understand if I employ to or otherwise engage persons, other thanCalifornia licensed r p yany r I n ed Contractors, and the - value of my construction is at least five hundred dollars ($500), including labor and materials, I may be , •,sidered an "employer"under state and federal law. J. 6. I understand if I am considered an "employer" under state and federal law, I must register with the state and =Aral government,withhold payroll taxes, provide workers' compensation disability insurance, and contribute to nemployment compensation for each "employee." I also understand my failure to abide by these laws may subject • 'k to serious financial risk. ,/ . I understand under California Contractors' State License Law, an Owner-Builder who builds single-family r- dential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. ,fj� 8. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for 14"!"rfinancial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. OwnerBuildeiForm 2010.doc revised 04/14/10 11 9. I understand I may obtain more information regarding my obligations as an "employer"from the Internal enue Service, the United States Small Business Administration,the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State • Lic-nse Board (CSLB) at 1-800-321-CSLB (2752)or www.cslb.ca.gov for more information about licensed c• actors. ak .Ja � t. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I - e party legally and financially responsible for proposed construction activity at the site address listed above. 4. -yem 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide N- ba applicable laws and requirements that govern Owner-Builders as well as employers. -'12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the in • mation I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors,you will be responsible for verifying whether or not . .those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY . . (DIRECTIONS:Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued,this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note:A copy of the property owner's driver's license, form notarization, or other verifi ation =cc-pt- • - to t e city maybe required to be presented when the permit is issued to verify the property owner's s snilfij;;. �/ _ `� fie p_erit:.yfOwnar`s- ig:al : %,%7,0f___., lire ,44 • Cafe: /O--,� -. / gm (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner,the execution of which I understand is my personal responsibility, I hereby authorize the following person(s)to act as my agent(s)to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project(or Description of Work): Project Location or Address: Name of Authorized Agent: Tel No • Address of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwnerBuilderForm 2010.doc revised 04/14/10 _ _, ,--- „ t-7„-,, -----j F I t.ti 1 9LI SMOKE / CARBON MONOXIDE ALARMS 010 p • OWNER CERTIFICATE OF COMPLIANCE 40-.4.04..., COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO,CA 95014-3255 CUPERTtN€� (408)777-3228•FAX(408)777-3333•buildinoc cuoertino.orq PERNIIT`CANNOT S,E,FINALED UNTIL:THIS CERTIFICATE HAS BEEN COMPLETED,;SIGNED,AISTD RETURNED TO THE BI;TIGDINGDIVISION 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 units exceeds $1000 00, CRC Section R314,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)—(Smoke alarms shall not be located within 3 feet of bathroom door) On every level of a dwelling unit including basements and habitable attics X X Within each sleeping room X 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 comply with CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply In dwelling units with no commercial power supply, alarni(s)may be solely battery operated. In existing dwelling units,alarms are permitted to be solely battery operated whererepairs 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 Section 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. As owner of the above-referenced property,I hereby certify that the alaini(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 date signed below Address* 6l vc� J4 )6W/rla) 0J Permit No.6-,..9.07,-/7;),e2 Specify Number of Alarms #Smoke Alarms. I 5 I #Carbon Monoxide Detectors I I I have read and agreq to comply with the terms and conditions of this statement Owner(or wnne`rAgent's)Name: - I of kP liA i a -- Signature '4//., " 424 '0 ,...16..4--.1 Contractor Name: Signature Lic.# Date: Smoke and COforrn.doc revised 01/10/2017