B-2017-1765 • - CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1765
7955 SUNDERLAND DR CUPERTINO,CA 95014-4913(362 11 012) SANDIUM INC
SAN JOSE,CA 95134
OWNER'S NAME: KIRTLAND HENRY H AND ERIKA H TRUSTEE DATE ISSUED: 10/13/2017
OWNER'S PHONE:408-257-1372 PHONE NO:(408)894-9072
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-20 Lic.#888119
Contractor SANDIUM INC Date 12/31/2018 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:
REPLACE FURNACE-SAME LOCATION;INSTALL(N)AC UNIT-
I hereby affirm under penalty of perjury one of the following two declarations: SIDE YARD
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
1 Jt formance of the work for which this permit is issued.
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:$18000.00
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 362 11 012
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 regulati ,s*the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Slp 'a ure '...) Date 10/13/2017 Issued by:Abby Ayende
Date: 10/13/2017
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: 10/13/2017
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 tinder 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 5534.,'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 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 whicNemit,liazardous
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,S ctions 255 5,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Alio `n•r`or authorized agent: •
APPLICANT CERTIFICATION Ur Date: 10/13/2017 •
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY 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 mayaccrue 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.
Signature Date 10/13/2017 Licensed
Professional
}
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1765
7955 SUNDERLAND DR CUPERTINO,CA 95014-4913(362 11 012) SANDIUM INC
SAN JOSE,CA 95134
OWNER'S NAME: KIRTLAND HENRY H AND ERIKA H TRUSTEE DATE ISSUED: 10/13/2017
OWNER'S PHONE: PHONE NO:(408)894-9072
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRACTOR Lic.#888119
Contractor SANDIUM INC Date 12/31/2018 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:
REPLACE FURNACE-SAME LOCATION;INSTALL(N)AC UNIT-
I hereby affirm under penalty of perjury one of the following two declarations: SIDE YARD
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.
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:$18000.00
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 362 11 012
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 Issued by:Abby Ayende
Date: 10/13/2017
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:
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 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 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 agent:
APPLICANT CERTIFICATION Date:
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 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 Professional
CONSTRUCTION PERMIT APPLICATION _
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
\i",
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 ^ r1
-S (408) 777-3228 • buiiding@cupertino.org PEMIT#B- -
CUPERTINO REV/ DEF#
❑ NEW CONSTRUCTION ❑ADDITION ALTERATION ❑T.1. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA .
PROJECT ADDRESS 75 S5 J_ Ict ` 1 APN a '2.€i-
1
1 X012
OWNER NAME vik -V kk&A d PHONE /� p 27 J K l 7 1S) , E-MAIL hei, 1��d ,0/. M
STREET ADDRESS CITY,STATE,ZIP
CONTRACTOR NAME 0 OWNER-BUILDER COMPANY NAME I LICENSE NUMBER LICENSE TYPE
ISTREET ADDRESS ,1 eesddiCITY,STATE, ZIP J `14 n g`; c I
E-MAIL PHONE BUS.LIC I
' V'1n kc[te 6.9.,,,1&,„. ut.,, Itpt °11k 1q07
0 ARCHITECT 0 OWNER ❑OWNER AGENT 0 CONTRACTOR AGENT 0 ENGINEER 0 DEVELOPER❑TENANT
CONTACT NAME E-MAIL
I
STREET ADDRESS CITY,STATE,ZIP PHONE
DECRIPTON
Vq.CLL / ikc. 644
SINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL ❑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(5)
REMODEL REMODEL KITCHEN REMODELOTHR GARAGE ❑ATTACHED
BATHROOM SF SF SF SF 0 DETACHED
EXISING ' ❑YES EICHLER ❑YES SECOND STORY ADDITION ❑YES
FIRE SPRINKLERS 0 NO ❑ NO 0 NO
DWELLING SECOND DWELLING ❑YES 0 ATTACHED 0 DETACHED OTHER
rrUNITSI • , UNITADDITON: 0N SF
�POOLSI ❑1FIBERGLASS 0 VINYL-LINED ❑GUNITE 0 PREFABRICATED
POOL-SFi. ; SPA-SF I SPA ATTACHED❑YES 0 NO I TOTAL-SF
L'' I REC LVED BY: al. TO L VALUA ION:
Commercial of Midli-Family buildings with Public Swimming Pools renuires Department of Environmental Heath approval
GU p if 1 e 6 ism)`/�,�1 V VI'ES Va�OIX U 11
RE-ROOF EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES E WOOD SHAKES❑WOOD SHINGL ['TILE OTHER(SPECIFY)
i. I _.
REMOVE/REPLACE Ei NO IF NO PLYWOOD 01" ❑3/8" PLYWOOD TYPE: . PITCH: ROOF CLASS
y n OF LAYERS THICKNESS❑5/8' OTHER DOSS ❑CDX OTHER •12 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 uol 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 insp n purpos s. I acknowledge and authorize all information contained on this application form
to be made'available for public record. /I���
Signature'olf Applicant/Agent: /t-A_} t.t_ Date: IDA
3/1-1
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 Planriing 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
STATE OF CALIFORNIA
ALTERATIONS -HVAC
CEC-CFIR-ALT-03-E(Revised 03/15) CALIFORNIA ENERGY COMMISSION •
CERTIFICATE OF COMPLIANCE CF1R-ALT-03-E
Alterations-HVAC CZ 1,3 to 7 and 16(formerly CF-1R-ALT-HVAC) (Page 1 of 1)
Site Address: Enforcement Agency: Date Prepared: Permit#:
, C% - 0 ,0/11, t 15247-1745
Equipment Type Equipment Efficiency New:Deleting,Plenums,Lineset Conditioned Thermostat
/�
// Required R-value Floor Area(sq ft)
0 Packaged System 0 Evaporator Coil 46 AFUE COP . 0 R-6 (CZ 1,3-7)Ducts Served by system 'Setback
XI Split System 0 Condensing Unit 17 SEER R-8' (CZ16)Ducts `qoo sq ft Of not already
HSPF 0 R-6(all CZ's)Plenums present,must
d Furnace 0 Lineset EER 0 R-5 or R7.5 Lineset3 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.
0 1.HVAC Changeout/Repalr 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:MECH-01,MECH-20-HERS
Air Handler/Furnace CF3R:MECH-20-HERS
Installer Requirement:Duct leakage(<15%or,<10%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 0 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 )
❑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-MECH-01,MECH-20-HERS,MECH-22-HERS,MECH-(23 or 24)-HERS
CF3R-MECH-20-HERS,MECH-22-HERS,MECH-(23 or 24)-HERS2
Installer Requirement:Duct leakage<6%,Fan Efficacy(.58W/CFM),Air Flow z 350 CFM/ton(or Standards Table 150.0-C/D alternative)
03.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
Ducts2 and one or more of the following: CF2R-MECH-01,MECH-20-HERS,MECH-(23 or 24)-HERS
Condenser Unit,Evaporator Coil,Furnace CF3R-MECH-20-HERS,MECH-(23 or 24)-HERS
Installer Requirement:Duct leakage<6%,Air Flow 2 350 CFM/ton(or StandardsTable 150.0-C/D alternative)
❑Exempted from duct leakage testing I existing duct systems are constructed,insulated or sealed with asbestos.
❑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 Ducts2 CF2R:MECH-20-HERS
CF3R:MECH-20-HERS
Installer Required to:Duct.leakage(5_15%or,<10%to outside,or seal all accessible leaks)
❑ Exemptedfromduct leakage testing I existing duct systems are constructed,insulated or sealed with asbestos.
'All new ducting R-8 required when more than 40 ft installed and R-6 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 percent new duct material,and up to 25 percent may consist of reused
parts from the dwelling unit's existing duct system(e.g.,registers,grilles,boots,air handler,plenums,duct material.
3 R-5(1"thick insulation)for linesets 1"and less. R-7.5(1.5"thick insulation)for linesets over 1 inch. Most mfg will require Suction line Diameter
- with insulation as the following 1.5-21-2%",2,5-31-2%",3.5 to 4T-2V",5T-43i"
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 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
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: Responsible D signer Signet Date Signed: • License:
M 1---1/•(/ / � 10/14/11 g3 8 l 41
Company: Address: City/State/Zip: Phone:
(v N i0�'`ec . X161.0 CA 4118 Ell gel
For assistance or questions regarding the Energy Standards,contact the Energy Hotline at:1-800-772-3300
\rib;
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildinp(a cupertino.orq
PERMIT CANNOT BE FINALED UNTIL THIS CERTIFICATE HAS BEEN
COMPLETED,SIGNED,AND RETURNED TOTREBUILDING DIVISION
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, alarm(s)may be solely battery 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 Section R314 and CBC Sections 907.2.114 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 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
date signed below
Address: 14:i14:i5 s �2 Permit No. I-�- )Oi 2 ^ 1 -7 tr
Specify Number of Alarms. #Smoke Alarms I ¢ I #Carbon Monoxide Detectors Z- I
I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name:
E- D-1 l<l L-
_signature. . ... . . .. .Date:1 111 Oh
Contractor Name:
Signature Lic.# Date:
Smoke and COform.doc revised 01/10/2017