B-2017-1882 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1882
10861 MAXINE AVE CUPERTINO,CA 95014-0119(326 02 015) RANDO AAA HVAC
INC
SAN JOSE,CA 95125
OWNER'S NAME: VAVAK FRANKLIN J AND LOIS J TRUSTEE DATE ISSUED: 11/01/2017
OWNER'S PHONE:408-245-1909 PHONE NO:(408)293-4717
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-43:C-20 Lic.#768871
Contractor RANDO MA HVAC INC Date 09/30/2019 X BLDG _'ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X 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 WALL FURNACE-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.
3 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:$2200.00 -
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 326 02 015
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 regu-• • •- the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
„., -ur=
d Date 11/1/2017 Issued by:AbbyAyende
r . Nov Date: 11/01/2017
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.
' j sale(Sec.7044,Business&Professions Code) S
' 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:11/1/2017
I herebyaffrm 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 peiformance 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 definedby 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 Co e 'ins 25505,255 3,'and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall ,� /
1,40�
be deemed revoked. . _•r authorized agent.
APPLICANT CERTIFICATION Date:11/1/2017
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 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 11/1/2017 Professional •
CONSTRUCTION'PERIVIIT.APPLICATION
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'°' ° 10300 TORRE AVENUE CTJPERTINOf,CA,9,5.014:$255
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RE-ROOF EXISTING ROOF TYPE: `❑BUILT=UP ROOF`[]ASPHALT SHINGLES Q,WOOD SHAKES fl WOOD SHING ES'O. E OTHEii(SPECIFY)
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YNFOS I IF NO PLYWOOD ❑'� OM' PLY NOOD TYPE: TITCH .„ 12 RQOF CLASS
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rov ide a si ed copy of the C
*Pupertino s Tear-Off Policy = • ^ '' • sF #of SQUARES
B 'my signature below I certify to"each;of the follow ng,t I'am�the property owner'or authorized agent to act on.,,,,the property owner s-behalf I
' dive read=this application'andrthe information I have providedis'c'orrect,=I have read the DeS'Cription"of Work and-verify itis accurate.'I agree..
'' to=Comply'ivith:all applicable;;local,ordinances and state laws relating;'to building construction I`authorize representatives'of Cupertino to '
enter the,above-identified°'property forL .section purposes 'I acknowledge'and aiuthorize-'all'.inform`ation contained-on this,"application form,,.
to 'be made'available for public record ,
Sigriatureof Applicant/Agent; `SAA VP Date: to 'L' .
i, SUPPLEMENTAL,INFORMATION RE6,IREI7' , ' , - ° ,
' " ',° *New SFD/Second'Duelling Units/Multifan'I -Dwellings:A Demolition permit is required'prior to'issuanceof a building permit fol-all]tew construction.
°Commercial:Buildings: Provide:a corripleted Hazardous Materials Disclosure form if any Hazardous Material s'are being used as;part of this project.
*° , Planning Approval Letter,or Meeting'sith Planning prior to'submittal of Building Permit application, °
Copyof Pla
"`',.1,,r-; "HOA Provide a letter of approval from;tlie Horne'Owner's,•Association' ° '
1dgApp 201�'doc.revi ed 08!01%1T
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems(formerly CF-1R-ALT-HVAC) (Page 1 of 3)
Project Name: RICK VAVAK Date Prepared: 2017-10-25
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 RICK VAVAK 02 Date Prepared 2017-10-25
03 Project Location 10861 MAXINE AVE 04 Building Type Single family
05 CA City Cupertino 06 Dwelling Unit Name RICK VAVAK
iS
07 Zip Code 95014 08 Dwelling Unit Conditioned 1071
ren_ Floor Area(ftZ)
Number of Space ...
09 Climate Zone 4 l � 10 Conditioning(SC)Systems in 1
'_ this Dwelling Unit:
B.Space Conditioning(SC)System Information k
01 02 �.,' 03 1 t-t. 04 05 6
� r;. 07 : E 08 09 10
`Is the SC Installing.a _ " " v ' �.:e,
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
WILLIAMS WHOLE HOUSE 1071 No - No = =No - - -- -No =- - --No== - -- - - No = -= -No alteration
performed
C. Extension of Existing Duct System,Greater Than 40 Feet(Section15O.2(b)1Diib) -= -- - - -- - - - -
This section does not apply to this project.
Registration Number:217-A020370031A-000-000-0000000-0000 Registration Date/Time: 2017-10-25 12:03:41 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2016.1.006 - Report Generated:2017-10-25 15:03:30
Schema Version:rev 10/16 - - - --
CERTIFICATE OF COMPLIANCE CE1R-ALT 02-E
Alterations to Space Conditioning Systems(formerly CF-1R-ALT-HVAC) - - (Page 2 of 3)
D.Altered Space Conditioning System (Sections 150.2(b)1E and F) _
This section does notapply to this project.
E. Entirely New or Complete Replacement Duct System,with or without Equipment Changeout(Sections 150.2(b)1Diia.and 150.2(b)1E,.F)
This section does not apply to this project.
F. Entirely New or Complete_Replacement Space Conditioning System (Section 150.2(b)1C)
This section does not apply to this project.
44417,
Registration Number:217-A020370031A-000-000-0000000-0000 Registration Date/Time: 2017-10-25 12:03:41 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2016.1.006 Report Generated:2017-10-25 15:03:30
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 accurateand complete.
Documentation Author Name: DocurientatiortAuthof:Signature:
Rando,Eric - a
Company: Signature Date:
RANDO AM HVAC INC 2017-10-25 12:03:41
Address: CEA/HERS Certification Identification(if applicable):
1712 STONE AVENUE N/A
City/State/Zip: Phone:
SAN JOSE CA 95125 408-293-4717
Responsible Person's Declaration statements;.
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 Busi ess''and Professions Code to,accept-responsibility for the building design or system•design identified on this Certificate of Compliance(responsible designer).
3. That the energy features and performance specifications materials components,and anufactured 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 s.
on this Certificate of Compliance areCo sistentwithlthe information provided oriatherapplicabte compliance documents,worksheets,
4. The building design features or system design features identified
calculations,plans and specifications submitted to the enforcemen�-agency fo,approvalywith this building permit application. 6 ° ?
5. I will ensure that a registered copy of this`Certificate Co ipliance shall mane available with;ti-a building=permit(s)issue for tlLebuilding,andjnade available to the,enforcement agency for all applicable
inspections.I understand that a registered copy of thistertificate of Compliance isrequred to be,included•wLh the,documentationvthe builder pro tides tithe building owner at occupancy.
Responsible Designer Name: Responsible Designer Signature: !� �
Rando,Eric
Company: Date Signed:
RANDO AAA HVAC INC 2017-10-25 12:03:41
Address: Licenser =
1712 STONE AVENUE _ _ 768871- = _ _ - _ - - _
City/State/Zip: _ Phone: - - - - - - -
SAN JOSE CA 95125 _- 408=293=4717___=_ _- =-- :_:-___-_: _. __ _
Easy to Verify
at CaICERTS.com
Digitally signed by CaICERTS. This digital signatureis provided in order to secure the content of this registered document,and in no way implies g o
Registration Provider responsibility for the accuracy of the information.
Registration Number:217-A020370031A-000-000-0000000-0000 Registration Date/Time:- --2017-10-25 12:03:41 - HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2016.1.006 Report Generated:2017-10-25 15:03:30
Schema Version:rev 10/16
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
,"-fP-;:;!:
CUPERTIMO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildings cupertino.orq
PERl1 .1 CANNOT§BE F NAEI D UNTIL TFII$CERTIFICA1 IIAS BEEN ' �'
,,, °, "'` z 3 �.xx xi`k >'}t a`,sas � f "` ` ,-"x L;fir" s ., ,�
,Nt CUIVIPLETED SIGNED AND RF3'FI f ED Of i DE >€a NW) BION ft1T
,� �t ''`iia A�Y�.. z�"8�vc�xant�� ��,.u�= Z .,
_ 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 907.241.2 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 907.2.11.4'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 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.
I o � VAX n
Address: () Permit N.' �-
Specify Number of AIarms:' four � aril on lulon de etectgrs 1.
I have read and agree to comply with the terms and conditions of this statement
ri.Owner A entsl)Name: .. 00r AZ&KG-rd Vet,1/
17� Signature. .t. j .. c
Contractor Name: �f� f r
�I'Yl
gni()CLO Signature ... ... . . . Lic.#71.1e ..g1.1 Date:�.l.(2
Smoke and CO form.doc revised 01/10/2017