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15090193CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20333 CLIFDEN WAY CONTRACTOR: AIR QUALITY HEATING PERMIT NO: 15090193 & AIR OWNER'S NAME: WILLIAM THROM 720 NORTHRUP ST DATE ISSUED: 09/29/2015 OWNER'S PHONE: 4082551849 SAN JOSE, CA 95126 PHONE NO: (408)293-7138 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ —� ;1 REMOVE AND REPLACE FURNACE AND A/C IN SAME LOCATION. License Class ritJ Lic. # Contractor A2& Date I hereby affirm that I am licensed under he 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. Sq. Ft Floor Area: Valuation: $9000 1 hereby affirm under penalty of perjury one of the following two declarations: t 1 have and will maintain a certificate of consent to self -insure for Worker's 11N N amber: 36937004.00 Occupancy Type: Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 2. 1 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. PERMIT EXPIRES IF WORK IS NOT STARTED APPLICANT CERTIFICATION WITHIN 180 DAYS OF PERMIT ISSUANCE OR I certify that I have read this application and state that the above information is 180 DAYS FROM LAST CALLED INSPECTION. correct. I agree to comply with all city and county ordinances 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 Issued by: ��%!� ,�'`'7 %L'i Date: indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with RE -ROOFS: all non -point source regulations per the Cupertino Municipal Code, Section 9.18. All roofs shall be inspected prior to any roofing material being installed. If a roof is Sianatttrc ^� Date installed without first obtaining an inspection, I agree to remove all new materials for ` inspection. Signature of Applicant: Date: ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER the follo%sing two reasons: 1 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for HAZARDOUS MATERIALS DISCLOSURE sale (Sec.7044, Business & Professions Code) 1 have read the hazardous materials requirements under Chapter 6.95 of the 2 1, as owner of the property, am exclusively contracting with licensed contractors to California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain construct the project (Sec.7044, Business & Professions Code). compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. I hereby affirm under penalty of perjury one of the following three declarations: Additionally, should 1 use equipment or devices which emit hazardous air 1 have and will maintain a Certificate of Consent to self -insure for Worker's contaminants as defined by the Bay Area Air Quality Management District 1 will Compensation, as provided for by Section 3700 of the Labor Code, for the maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. performance of the work for which this permit is issued. 2 I have and will maintain Worker's Compensation Insurance, as provided for by Owner or h ' ed agent: Section 3700 of the Labor Code, for the performance of the work for which this Date:42*/, permit is issued. 3 I certify that in the performance of the work for which this permit is issued, I shall CONSTRUCTION LENDING AGENCY not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I f hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) become subject to the Worker's Compensation provisions of the Labor Code, 1 Lender's Name must forthwith comply with such provisions or this permit shall be deemed revoked. I coder's Address APPLICANT CERTIFICATION ARCHITECT'S DECLARATION I certify that I have read this application and state that the above information is „ nderstand my plans shall be used as public records. correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter I icensed Professional 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 may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date I~ � �e CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPI✓ENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildina aOcuoertino.org 1 �� /) /�{'� m I S C 7PLU,S NG YMECFAMCAL 17ELF-ClRIC -L I—IMES CELLANEOL; c MEPMiscApp_2011.doc revised 06121/11 OWNER NAVE /'�/J I "vl � / „�^ PH T� � � /.{!� E-1✓SIL STRUT ADDRESS M( .3 / CITY, ATE, ZIP 6 FAA CONTACT N.MME lm i N PHONE STRicTA.DDRESS� CITY, STATE, ZIP FA -X ❑ OWNM ❑ 0W1 : R -BIRDER ❑ OM^ ER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCEU ECT ❑ ENGIE-HER ❑ DEVELOPER ❑ Z\AI.T CON R4CTOR N?? E LICE ' N �, - LICENSE i BUS. LIC' COWANY NAJa E -NAR FAX STREBTADDRESS CITY, T.?TE ZIP r• ARCHDTECT':T'GZNEER N,'J\M --- -- LICENSE N IMBER BL'S. L1C COMPANY N_AWb E-hiAm FAY, -- STRE-7 ADDRESS CITY, STATE, ZIP PHOTS L' E OF F n ar DUPLEX E3IdULTI-FAMRY PROTECT LN P9RDLA-\TTD L-1YiS PROirCT IN BUIIDL4G: ❑ C01,ev=CIAL URBAN INTERFACE AREA ❑ NO I FLOOD ZONE ElYES ❑ NO IS THM BLDG .AN 131--s EICEL.ER IiON.E?NO DESCRIPTION nF VVOPK —— TOTAL VALUATION: By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property downer'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 b ilding c nstruction.A authorize representatives of Cupertino to enter the above -id ntified opa for inspection purposes. SignmxeofAppliczut/.4gent: Date: �,] SU-PPLEb1ENTAI. II\'FOR-MATION REQUIRED OFFICE 1 SE O,iY O VER-T_HE-COT--N TE R . LJ E.-U'i.E_c ❑ GE MEPMiscApp_2011.doc revised 06121/11 CITY OF CUPERTINO §�W'o FEE ESTIMATOR — BUILDING DIVISION i ADDRESS: 20333 Clifden Way DATE: 09/29/2015 REVIEWED BY: Sean UNITS APN: BP#: "VALUATION: 1$9,000 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: I PENTAMATION FURN/AC I PERMIT TYPE: WORK Remove and replace furnace and A/C in same location. SCOPE 'uppl. /u'sp Pec APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES Furnace, Forced -Air 1MFR=<100 1 # $143 A/C Units (<=10K cfm) 1BREMAIR 'uppl. /u'sp Pec 1 # $72 PME Unit Fee: $215.00 PME Permit Fee: $48.00 _T_T „r, �u i,� null 1(n: Administrative Fee: (ADMIN $45.00 Work Without Permit? O Yes (D No $0.00 TOTALS: A Travel Documentation Fee: ITRA VDOC $215.00 Strong Motion Fee: IBSEISMICR NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District etc.. These fees are based on the Preliminary information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 71 11/13) Mech. Plan Check 0.0 1 hrs $0.00 FMech. Pen -nit Fee: I MPERAM' Other Mech. Insp. 0.0 hrs $48.00 QTY/FEE MISC ITEMS NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District etc.. These fees are based on the Preliminary information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 71 11/13) FEE QTY/FEE MISC ITEMS /'%till ( he ck 1'c'C. �rr1,1>l. PC 1,ce PME Plan Check: $0.00 , ,vnit 2, 'uppl. /u'sp Pec PME Unit Fee: $215.00 PME Permit Fee: $48.00 _T_T „r, �u i,� null 1(n: Administrative Fee: (ADMIN $45.00 Work Without Permit? O Yes (D No $0.00 Wn/i' ed Phltlnill � / c: A Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICR $1.17 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $358.17 $0.00 TOTAL FEE: $358.17 Revised: 07/02/2015 STATE OF CALIFORNIA ALTERATIONS - HVAC CEC-CFiR-ALT-03-E Revised 06/14 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE CF1R-ALT-03-E Alterations - HVAC CZ 1, 3 to 7 and 16 (formerly CF -IR -ALT -HVAC) (Page 1 of 1) Site Address: Zio 131 33 61611-1--A97 a/4-6( ,/ Enforcement Agency: Date Prepared: Permit#: Equipment Type Equipment Efficiency New: Ducting, Plenums, Llneset Required R -value Conditioned Floor Area (sq ft) Thermostat ❑ Packaged System Evaporator Coil AFUE COP ❑ R-6 (CZ 1,3-7) Ducts J Served by ystem etback (If already Split System ondensing Unit cj SEER ❑ R-8' (CZ 16) Ducts /✓ l� /sq ft ( not HSPF ❑ R-6 (all CZ's) Plenums P resent, must Furnace 1 iI.eset EER ❑ R-5 or R7.5 Lineset' 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. HVAC Changeout/Repair Required Compliance Documents to be left on site for Final: Canlnclude new ducting All Equipment, CF1R-ALT-02-E Condenser Unit, Evaporator Coil, CF2R: MECH-OS, MECH-20-HERS Air Handler/Furnace CF3R: MECH-20-HERS Installer Requirement: Duct leakage (:5_15% or, < 10% to outside, or seal all accessible leaks) Exempted from duct leakage testing if: ❑ 1. Dud system registered with HERS provider as previously sealed, or ❑ 2. There is less than 40 linear feet of duct in unconditioned space, or ❑ 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-MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS CF3R-MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS' Installer Requirement: Duct leakage < 6%, Fan Efficacy (.58W/CFM), Air Flow t 350 CFM/ton (or Standards Table 150.0-C / D alternative) ❑ 3. All New Duds 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-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_ 350 CFM/ton (or Standards Table 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 CF2R: MECH-20-HERS space but less than All New Ducts' CF3R: MECH-20-HERS Installer Ranuired to: Duct leakage L15% or, < 10% to outside, or seal all accessible leaks) Exempted from duct 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 materlal, 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. ' R-5 (1" thick insulation) for Iinesets 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 1.5-2T-2%", 2.5-3T-2%", 3.5 to 4T -2%a", 5T-4Ys" 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. 1 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. S. 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 forapproval with this buildin permit application. R spon ble i rName: Res7)77�� Date Sf ed License:Cl Y G Cy: Ad ess: /VD C4 Phon e: For assistance or quIestions regarding the Energy Standards, fontact the Energy Hotline at: 1-800-7772�-3300 � P1Q CERTIFICATE OF COMPLIANCE Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) Project Name: 20333 Clifden Way I Date Prepared: CF1R-ALT-02-E (Page 1 of 3 ) 2015-09-28 A. General Information CHR -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. O1 Project Name 20333 Clifden Way 02 Date Prepared 2015-09-28 03 Project Location 2033 Clifden Way 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name 20333 Clifden Way 07 Zip Code 95014 08 Dwelling Unit Conditioned 1845 Installing Installing Installing Floor Area (ft2) Location or Area by this SC ducted containing system Number of space conditioning entirely new 09 Climate Zone 4 10 (SC) systems in this dwelling 1 component? components? feet of ducts? duct system? unit. Alteration Type B. Space Conditioning (SC) System Information O1 02 03 04 05 06 07 08 09 10 Is the SC Installing a 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 Altered space System 1 Location 1 1845 Yes Yes Yes No No No conditioning system C. Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b)1Diib) This section does not apply to this project. Registration Number: 215-A6340209A-000000000-0000 Registration Date/Time 2015-09-28 16:37:19 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-09-28 16:37:17 Schema Version: 0.555SDD CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 2 of 3 ) D. Altered Space Conditioning System (Sections 150.2(b)lE 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 Dud or Name Type Components Type Value System Type Components Type Value Type Duct Length R -Value Central gas Gas furnace Central split All new This field or This field or System 1 furnace AHU AFUE 0.96 AC cooling SEER 14 Setback section is not section is not components applicable applicable Required Documentation: CF2R-MCH-01-E - Space Conditioning Systems Ducts and Fans -Duct insulation requirement for new plenums: R6. CF2R-MCH-20-H & MR -MCH -20-H — Duct Leakage testing required when heating or cooling components are installed in ducted systems, or when more than 40 ft of duct length is replaced. -Leakage rate compliance: <_ 15%, or15 30% leakage to outside, or seal all accessible leaks. CF2R-MCH-25-H & CF3R-MCH-25-H Refrigerant Charge Verification required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15). CF2RCF3R-MCH-23 & CF3R-MCH-23 Air Flow i 300 CFM/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 MECH-25. -Existing dud systems constructed, insulated or sealed with asbestos are exempt from MCH -20 Dud Leakage Testing requirements. E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)1Diia and 150.2(b)lE, 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. Registration Number: 215-A6340209A-000000000-0000 Registration Date/Time: 2015-09-28 16:37:19 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-09-28 16:37:17 Schema Version: 0.555SDD CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 3 of 3 ) Documentation Author's Declaration Statement 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Farber, Matt Company: Signature Date: AIR QUALITY HEATING & AIR CONDITIONING INCORPORATED 2015-09-28 16:37:19 Address: CEA/ HERS Certification Identification (if applicable): 720 NORTHRUP STREET City/State/Zip: Phone: SAN JOSE CA 95126 408-293-7138 Responsible Person'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. 1 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 1 and 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. S. I will ensure that a registered copy of this Certificate of Compliance shall be made available with the building permit(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 included with the documentation the builder provides to the building owner at occupancy. Responsible Designer Name: Responsible Designer Signature: Farber, Matt Company : Date Signed: AIR QUALITY HEATING & AIR CONDITIONING INCORPORATED 2015-09-28 16:37:19 Address: License: 720 NORTHRUP STREET 769446 City/State/Zip: Phone: SAN JOSE CA 95126 408-293-7138 Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document, and in noway implies Registration Provider responsibility for the accuracy of the information. Registration Number: 215-A6340209A-000000000-0000 Registration Date/Time: 2015-09-28 16:37:19 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-09-28 16:37:17 Schema Version: 0.555SDD CUPERTIiNO SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.org PERMIT CANNOT BE FINALED UNTIL THIS CERTIFICATE HAS BEEN COMPLETED, SILGNE'D, 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 2013 CRC Section R314, 2013 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 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 bedroom(s) X X On every level of a dwelling unit including basements 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. l Address: �33� MAKc / Permit No. _50�011� Specify Number of Alarms: # Smoke Alarms: # Carbon Monoxide Detectors: 1 1 have read and agree to comply with the terms and condj#J:ons of this statement Owner (or Own Agent's Name /�/� - Signature ............................................................................................................. Date:7/�f /, �� v ............................................................................................................................. Contractor NaWk: Signature.................................................................. Lie.# ...................................... Date: Smoke and CO form. doc revised 09127116 Owner Name WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building0cupertino.org Address U ) 3 3 1. Is your real property a registered historical site? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. `< No Go to Question 2. 2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the property or its plumbing, installation of water -conserving plumbing fixtures is not technically feasible? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. ❑ The licensed plumber's certification has been provided to the Building Division. Skip the rest of the form and sign bottom of form. No Go to Question 3. . 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. No Go to Question 4. 4. Is your real property built and available for use or occupancy on or before January 1, 1994? ❑ No My real property is built and available for use or occupancy after January 1, 1994. Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the fonn and sign bottom of form. Yes My real property is built and available for use or occupancy on or before January 1, 1994. Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign bottom of form.. 5. Please check ONE of the following: My property is a single-family residential real property. See Civil Code Section 1101.4. On and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1, 2017, all non- compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless of whether property undergoes alterations or improvements). ❑ My property is a multifamily residential real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water - conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). ❑ My property is a commercial real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). I, as the owner or owner's agent of this property, certify under penalty of perjury that non-compliant plumbing fixtures will be replaced prior to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 through 1101.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's installation requirements, and that the water -conserving plumbing fixtures comply with the requirements as indicated in the table on the following page, d A I Owner or Owner Agent's Signature: _jO/A/.., A,- 4-7 lei^ Date: q/--2 �, //�c' I Upon completing and signing this Certificate, return it to the Building Division in order to final your SB4072015.doc revised 08126115 1. If the existing plumbing fixture water usage/clow rate is equal to or lower Man the ngure snown, it is not requirea to oe upgraaea. SB4072015.doc revised 08126115 Non -Compliant Water -Conserving Plumbing Fixture PlumbingFixture (Fixture Complying with Current Code Applicable to New Construction) Maximum Water Usage/Flow Rate Fixture Type Water Usage 2013 CPC Ch. 4 2013 CPC Ch. 4 2013 CPC Ch. 4 /Flow Rate 2013 CALGreen Div. 4.3 2013 CALGreen Div. 4.3 2013 CALGreen Div. 5.3 Single -Family Multi -Family Commercial Residential Residential Water Closets Exceed 1.6 Single flush toilets: 1.28 gallons/flush (Toilets) Gallons/flush Dual flush toilets: 1.28 gallons/flush effective flush volume (the composite, average flush volume of two reduced flushes and one full flush Urinals Exceed 1.0 0.5 gallons/flush Gallons/flush Showerheads Exceed 2.5 2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of gallons per minute U.S.' EPA WaterSense Specification for Showerheads (A hand-held shower is considered a showerhead.) For multiple showerheads serving one shower, the combined flow rate of all showerheads and/or other shower outlets controlled by a single valve shall not exceed 2.0 gallons per minute @ 80 psi, or the shower shall be designed to allow only one shower outlet to be in operation at a time. Faucets — Exceed 2.2 gallons Maximum 1.5 gallons per Within units: 0.5 gallons per minute @ 60 Lavatory per minute minute @ 60 psi; minimum Maximum 1.5 gallons psi Faucets 0.8 gallons per minute @ per minute @ 60 psi; 20 psi minimum 0.8 gallons per minute @ 20 psi In common and public use areas: 0.5 gallons per minute @ 60 psi 1.8 gallons per minute 60 psi Faucets — Exceed 2.2 gallons 1.8 gallons per minute @ 1.8 gallons per minute 1.8 gallons per minute @ 60 Kitchen per minute 60 psi @ 60 psi psi Faucets May temporarily increase May temporarily up to 2.2 gallons per increase up to 2.2 minute @ 60 psi, and must gallons per minute @ default to maximum 60 psi, and must 1.8 gallons per minute @ default to maximum 60 psi 1.8 gallons per minute Where faucets meeting @,60 psi the above are unavailable, Where faucets meeting aerators or other means the above are may be used to achieve unavailable, aerators or reduction. other means may be used to achieve reduction. 1. If the existing plumbing fixture water usage/clow rate is equal to or lower Man the ngure snown, it is not requirea to oe upgraaea. SB4072015.doc revised 08126115