B-2017-1783 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1783
10516 WHITNEY WAY CUPERTINO,CA 950144442(369 39 027) A-1 HEATING AND
COOLING INC
SAN JOSE,CA 95710 •
OWNER'S NAME: RIOPEL DAVID P TRUSTEE&ET AL DATE ISSUED: 10/17/2017
•
OWNER'S PHONE:408-255-1825 PHONE NO:(408)283-9915
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License•Class C-20 Lic.#966809
Contractor A-1 HEATING AND COOLING INC Date 07/31/2018 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 AC UNIT-SAME LOCATION
I hereby affirm under penalty of perjury one of the following twodeclarations:
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
-rformance of the work for which this permit is issued.
ave 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:$6900.00
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 369 39 027
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,th: .pplica understan.s and will comply with all non-point
source regul. to/s pe //e Cuperti . Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Sig / . '. �� Date 10/17/2017 Issued by:Abby Avende
Date: 10/17/2017
® re OWNER-BUILDER DECLARATION
I hereby affirm that I ant 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)
z. 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:10/17/2017
•
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 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
s. 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 Ba rea Air Quality Management District I
Worker's,Compensation laws of California. If,after making this certificate of will maintain compliance with the p•rtiunicipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Co:e, •c "s 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. et or authorized a4ent. /
APPLICANT CERTIFICATION10/17/2017
I certify that I have read this application and state that the above information is .L. I- I o i . ►t ► Y
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 10/17/2017 professional
13-z0A-- -. '))
\ ` ,/, GENERAL PERMIT APPLICATION M E P
•cf.--:,/ COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
4041.,,,,, 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 MI
CUPERTINO (408)777-3228•FAX(408)777-3333•building a(�.cupertino.orq SC
❑PLUMBING MECHANICAL ❑ELECTRICAL ®MISCELLANEOUS
PROJECT ADDRESS J®f% 47 //)ii W/ APN# z , -- 2G/O f`�
OWNER NAME Cu/t Ri ! •i * i �r''''l'i L/fa 1 f
STREET ADDRESS i Q57 0 ;u �/; �,r^ �,Q//Ato
y
CITY, STATE,ZI / Ck }jli� /CONTACT NAM � �j /v,�vJII'/ lLf!/,y .'•_.!' IL ........**-
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STREET ADDRESS /0,57
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XR 0 OWNER-BUILDER 0 OWNER AGE i 0 CONTRACTOR 0 CONTRA OR AGENT ❑ ARCHITECT 0 ENGINEERT 0 DEVELOPER 0 TENANT
CONT��C��f �I��T � r� LI i�:•:i`i:/% LICE TY BUS.LIC# 34/Lc--
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ARCHITECT/ENGINEER NAME I LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF 0 SFD or DUPLEX 0 MULTI-FAMILY PROJECT IN WILDLAND 0 YES PROJECT IN 0 YES IS THE BLDG AN 0 YES
BUILDING: 0 COMMERCIAL URBAN INTERFACE AREA 0 NO FLOOD ZONE 0 NO EICHLER HOME? 0 NO
DESCRIPTION OF WORK
A a
TOTAL VALUATION: A RECEIVED BY:
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property o�'s behal. I have read this
application and the information I have provi ed 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 buil [ruction. I authorize representatives of Cupertino to enter the above-identifiefiproperty for
inspectionpnspurposes.
Signature of Applicant/Agent: Date: 1O // './'
SUPPLEMENTAL INFORMATION REQUIRED ',,,e ! <`•OFFICE USE ONLY`' "
,w t, 0:OVER,THE COUNTER 1:„'*',
* F I® '0,EXPRESS ! }
7 +0. STANDARD s ro K, ',
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0„;LARGE •,, g'.
,EI'IVICA304 ry
MEPMiscApp_2011.doc revised 06/21/11
ALTERATIONS HVAC x
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: I r Enforcement Agency: Date Prepared: Permit#:
ilW
Equipment E ut ment Efficient( New:Ducting r Lineset Conditioned Thermostat
Type / ��/ q p y Required R-value Floor Area(ft2)
❑ Packaged System 0 Evaporator Coil AFUE COP 0 R-6 (CZ 1-10,12&13)Ducts Served by system 0 Setback
❑ Split System Condensing Unit SEER 0 R-8' (CZ 11,14-16)Ducts fta (If not already
HSPF 0>_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.
y1.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,5510%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 Ducts' 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:
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.
❑ 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.
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 the
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.
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 pprov.'With this building permit•licat,e .
Re n •le De ig Name: / Resp. si.e Dyfer 'g ature: Date Si/e,• / Lir• -* OP
`I ti - /1/1- 11. s u 4.q/ ( 7 / r /, G (44
C p y ç27 .
s / City/state/Zip: p
or assistance or qtistions regarding the Ehergy Standards,contact the Energy Hotline at:1-800-772-3300
F
SMOKE / CARBON MONOXIDE ALARMS6/991t3--
OWNER CERTIFICATE OF COMPLIANCE Lc6t
^r.aas
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO
(408)777-3228•FAX(408)777-3333•buildincl cupertino.orci
PERMIT CANNOT BkFINALEI3 UNTIL.THIS CERTIFICATE HAS BEEN
COMPLETED,SIGNED,AND RETURNED TO THE BUILDING 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.
alarm(s)maybe solelybatteryoperated.
Power Supply In dwelling units with no commercial powersupply,
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: 10510 W 1413G 41
:MY Permit No. I
Specify Number of Alarms. #Smoke Alarms I 1 #Carbon Monoxide Detectors I
I have read and agree to cot,pply with the terms and co ritions of this statement
Owner(or Owner Agent's)Name:
e
i/
Pi e R j a f 61-, Signature .. . - Date:to. .d. )O/7
Contractor Name: Ii
Signature Lic.# Date:
Smoke and CO form.doc revised 01/10/2017