B-2019-0214 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2019-0214
10467 ANSON AVE CUPERTINO,CA 95014-1346(326 41 112) A R S AMERICAN
RESIDENTIAL
SERVICES OF
CALIFORNIA INC dba
ATLAS TRILLO
965 RIDGE LAKE
BLVD SUITE 201
MEMPHIS,TN 38120
OWNER'S NAME: DATE ISSUED:02/05/2019
OWNER'S PHONE: PHONE NO:48-283-9536
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C20 Lic.#742039 •
ContractorR S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC -X BLDG _ELECT _PLUMB
dba ATLAS TRILLO 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 SAME LOCATION
I hereby affirm under penalty of perjury one of the following two declarations:
1. 1 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.
have and will maintain Worker's Compensation Insurance,as provided for by
rection 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$5825.00
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 326 41 112
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 cruCupertinoig said 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 regulations per the pertino Municipal Code,Section 9.18.
Issued by:Kim Dunbar
Signature Date 2-5-2019 Date:02/05/2019
OWNER-BUILDER DECLARATION
RF-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
i. 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) j Signature of Applicant:
2, I,as owner of the'property,am exclusively contracting with licensed; Date:2-5-2019
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
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 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 foriwhich 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 emit hazardous
shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
Worker's Compensation laws of California. If after making this certificate of the Health&Safety Code,Sections 25505,25533,and 25534.
exemption,I become subject to the Worker's Compensation provisiods of the
Labor Code,I must forthwith comply with such provisions or this permit shall Owner or authorized agent: (
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is l hereby affirm that thereis a construction 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
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 expenses which may accrue against said City in
consequence of the granting of this permit. Additionally,the applicant understands ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
CONSTRUCTION PERMIT APPLICATION
,.......,,
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
Sr/ 10300 TORRE AVENUE • CUPER11NO, CA 95014-3255
i( 1, 6-2-Iq
(408) 777-3228 • building@cupertino.org PERMIT#B- 73 9 -
CUPERTINO
413 0 NEW CONSTRUCTION 0 ADDIIION ALTERATIONX01.1. ?MEP ORE-ROOF 0 SWIMMING POOL/SPA
1PROJECT ADDRESS APN 8
046-1 ptv‘ f.‘ .N.g) - 2) p - I - 11 '1
OWNER NAME 8. PHONE E-MAIL
\I \\I- NrcAjtjl0\-. VNCAAX.8 0A-4\Ls t-ibb—' 1,0-' ct51,75
STREET ADDRESS an', STATE,ZIP
I/°L'U91 homo04 Asiku
0 CON TRACTOR NAME CI OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
PSS 1)%fV.1611."5\ 11t';-&; - 1%-k 6 9 Cao
STREET„ADDySS .,,r, •-• CITY,STATE, ZIP
9(0 ) 11Alk La...i.Lid cib\-4$1 kAlAtAkl\fl'A S V4' 2 1(2.--0
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E-MAIL PHONE BUS.LIC#1/
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0 ARCHITECT 0 OWNER DOWNER AGENT)1(CONTRACTOR AGENT ID ENGINEER 0 DEVELOPER 0 TENANT
CONTACT NAME E-MAIL
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRWFON rs, cur , \e...AEa jain
eAts., 5\10e) 9 Iiki.., 4.- u
tv.A.,0-t1J
INGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL
REMODEL
I NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES# TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
REMODEL sKITCHENATTACHRE0EMDODDELETOTI-IRACHED OTGIARAiERGE 0 ATTACHED
'BXISATT7HROGOUMSESFEXISTING SF SF SF 0 DETACHED
EXISING ..... 0 0 YES EiciThER E1 YES SECOND STORY ADDITION 0 YES
Li
FIRE SPRINKLERS NONO 0 NO
DWELLING SECOND DWELLINGEIYE0
uNris# UNIT MARION:
I
CI NO SF
POOLS! 0 FIBERGLASS 0 VINYL-LINED 0 GUNITE 0 PREFABRICATED
, POOL-SF SPA-SF SPA ATTACHED DYES 0 NO I TOTAL-SF i
REC D;11: //
5
11 TOTAL VALUATION:
Commerdal or Mulfi-Fandly Buildi go with Public Swinuning Pools reauires Department of Environmental Heath apprcroal ‘,... , 625
RE-ROOF EXISTING ROOF TYPE: El BUILT-UP ROOF 0 ASPHALT SHINGLES 0 WOOD SHAKES 0 WOOD SHINGLES 0 TILE OTHER(SPECIFY)
REMOVE/REPLACE 0 NO IF NO PLYWOOD El alf PITCH:0 NS" PLYWOOD TYPE: . 1 ROOF CLASS
DYES #OF LAYERS
THICKNESS 05/8 OTHER [JOSS El CDX OTHER -- 12•
PROPOSED ROOF TYPE:OBUILT-UP ROOF OASPHALT SHINGLES 0 WOOD SHAKES OWOOD 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 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 inspectio, 0,rposes. I acknowledge and authorize all information contained on this application form
to be made available for public record. .--------------
Signature of Applicant/Agent: _...../ ,,.. 5Date:
SUPPLEMENTAL INFORMATION AIL-TIRED
*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 201 7.doc revised 08/01/17
100%H
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems(formerly CF-1R-ALT-HVAC) (Page 1 of 3)
Project Name: VIKRAM KAWSHIK Date Prepared: 2019-02-04
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 VIKRAM KAWSHIK 02 Date Prepared 2019-02-04
03 Project Location 10467 Anson Avenue 04 Building Type Single family
05 CA City Cupertino 06 Dwelling Unit Name 10467 Anson Avenue
Dwelling Unit Conditioned
07 Zip Code 95014 Floor Area(ft2)
2
Number of Space
09 Climate Zone 4 \ ` 10 Conditioning(SC)Systems in 1
this Dwelling Unit:
B.Space Conditioning(SC)System Information
01 02 03 04 05 . -Th 06 ' 07 08 09 10
Is the SC Installing a
SC System SC System CFA served system a refrigerant nstalling 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
System 1 Location 1 2 Yes Yes Yes No No No
Altered space
conditioning system
C.Extension of ExistingDuct System,Greater Than 40 Feet(Section150.2(b)1t
Ysiib)
This section does not apply to this project.
Registration Number:419-A020010792A-000-000-0000000-0000 Registration Date/Time:2019-02-04 09:50:50 HERS Provider:CHEERS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2018.0.001 Report Generated:2019-02-04 09:50:50
CERTIFICATE OF COMPLIANCE CF1R-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)
—
01 02 03 04 05 06 07 08 09 10 11 12
Heating Cooling
System Heating Altered Heating Minimum Altered Cooling Minimum Required New or
Identification System Heating Efficiency Efficiency Cooling Cooling Efficiency Efficiency Thermostat Replaced New Duct
or Name Type Components Type Value System Type Components Type Value Type Duct Length R-Value
-
All new All new This field or This field or
System 1 Central gas heating AFUE 81 Central split cooling SEER 14 Setback section is not section is not
furnace components AC components applicable applicable
Reauired Documentation; _ s
CF2R-MCH-01-E-Space Conditioning Systems '4
-Duct insulation requirement for the new portions of supply-air and return-air ducts or plenums R6(CZ 1=10,12 and(13)and R8(CZ 11 and 14-16)
CF2R and CF3R-MCH-20-H-Duct Leakage Test required when heating or cooling components are installed in dacted systems,or when more than 40 ft of duct length is replaced
-Leakage rate compliance:<=15 percent or<=10 percent leakage to outside,or seal all accessible leaks.
CF2R and CF3R-MCH-25-H Refrigerant Charge verification required when refrigerant containing components are installed or altered(applicable in CZ 2,8-15).
CF2R and CF3R-MCH-23 Airflow Rate>=300 CFM per ton required when MCH-25 is required. '�,,
Exceptions: �`
-Duct systems registered with HERS provider as previously sealed are exempt from MCH-20 Duct Leakage Testing requirements.
-Heating-only systems and Air Handler Furnace changes do not require verification of Air Flow MCH-23,or Refrigerant Charge MCH-25.
-Existing duct systems constructed,insulated or sealed with asbestos are exempt from MCH-20 Duct Leakage Testing requirements.
E. Entirely New or Complete Replacement Duct System,with or without'Equipment p
p ys � � Ch'angeout(Sections 150.2(b)1Diia and 150.2(b)1E, F)
This section does not apply to this project.
F.EntirelyNew or Complete Replacement Space ConditioningSystem(Sectio '
p
11'150.2(b)iC)
This section does not apply to this project.
Registration Number:419-A020010792A-000-000-0000000-0000 Registration Date/Time:2019-02-04 09:50:50 HERS Provider:CHEERS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2018.0.001 Report Generated:2019-02-04 09:50:50
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 accurate and complete.
Documentation Author Name: Documentation Author Signature:
Nicole Godina Nizol&god,e4ta,
Company: Signature Date:
The Energuy 2019-02-04
Address: CEA/HERS Certification Identification(if applicable):
1215 K Street
City/State/Zip: Phone:
Sacramento CA 95814 877-600-0123
Responsible Person's Declaration statement
I certify the following under penalty of perjury,under the laws of the State of California:
L The information provided on this Certificate of Compliance is true and correct
2. l am eligible under Division 3 of the Business 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 manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the
requirements of Title 24,Part land Part 6 of the California Code of Regulations.
4. 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.
5. I will ensure that a registered copy of this Certificate of Compliance shall be madbtavailable`with tie pennit(s)Issued for the building,and made available to the enforcement agency for all applicable
inspections.I understand that a registered copy of this Certificate of Compliance is required to be inctuded with the documentation the builder provides to the building owner at occupancy.
Responsible Designer Name: Responsible Designer Signature:
Jane Taitano-Scott Ja.ne/T witana-Scott
Company: Date Signed:
ARS dba Atlas Trillo 2019-02-04
Address: License:
965 Ridge Lake Blvd Suite 201 , 742039
City/State/Zip: Phone:
Memphis TN 38120 408-286-8931
Digitally signed by CHEERS'. This di9ital signature is provided in order to secure the content of this registered
document, and in no way implies Registration Provider responsibility for the accuracy of the information.
Registration Number:419-A020010792A-000-000-0000000-0000 Registration Date/Time:2019-02-04 09:50:50 HERS Provider:CHEERS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2018.0.001 Report Generated:2019-02-04 09:50:50