15110027Q
a ('
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRES&I-`' 73 STAFFORD DR
CONTRACTOR: SERVICE CHAMPIONS PERMIT NO: 15110027
OWNER'S NAME':'" PINAI{I &,MEENAKSHI MUKERJI
7020 COMMERCE DR DATE ISSUED: 11/04/2015
OWNER'S PHID, NE:.;4088737302
PLEASANTON, CA 94588 PHONE NO: (925) 4444444
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL
�+ Z�:i n D'l p
9License Class .::.::; ., :• Lic: # ;
REPLACEMENT OF FURNACE AT (E) LOCATION
Contractor
I hereby affirm that I, ari► Itcerised under the provisions of Chapter 9
(commencing with ISection;7000) of Division 3 of the Business &Professions
Code,and that my license; is in full force and effect.
i'
I hereby affirm under penalty of perjury one of the following two declarations:
I have and,will maintain a,certificate`ofconsent to self -insure for Worker's
Compensation;'as, provided for by; Section 3700 of the Labor Code, for the
Sq. Ft Floor Area:
Valuation: $4739
erformance of the work;forwhich this permit is issued.
have and'..wii maintain;'.Workers Compensation Insurance, as provided for by
Sectron 3..700 rof the Labor'Code for the performance of the work for which this
APN Number: 36206027.00
Occupancy Type:
permit is issued , r
;APPLICANT CERTIFICATION
I certify that i have read this application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
1 . •.
correct. I''agree;to'complywith all city and county ordinances and state laws relating
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building, cons ction, and hereby authorize representatives of this city to enter
7..
upon`the above mentioned pproperty for inspection purposes. (We) agree to save
180 DAYS FROM LAST CALLED INSPECTION.
indemnify and ]seep harmiess the'City'of Cupertino against liabilities, judgments,
costs;'and expenses which may a'c'crue against said City in consequence of the
l
Issued by: ``� Date:
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source:,regulations per the Cupertino Municipal Code, Section
l
RE -ROOFS:
Signature '�, Date
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
.., . ,
❑ ii! -:!!{OWNER -BUILDER DECLARATION
..,I ' ;'
I hereby affirm thati,I am,,exempt from the Contractor's License Law for one of
Signature of Applicant: Date:
the following two reasons*.,,,. : ' i`
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I, as owner of the ppropertyp or'm em to ees with wages as their sole compensation,
; Y. P Y g P
will do'the,work 'and the structure is not intended or offered for sale (Sec.7044,
Busmess & P[ofessions Code) '
I �:�:i ' *ei I A �•rii i �.
I, as, ownet, of tt►eproperty;; :exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the pr9Ject`(See.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
'California
Health & Safety Code, Sections 25505, 25533, and 25534. I will
I herebyAffrrm under penalty, of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations: ;,'4i':i�. i,, •' ;, a 1 S!,.'. ; , `
Health &Safety Code, Section 25532(a) should I store or handle hazardous
I have'andiwiIY intain a Certifioate'of Consent to self -insure for Worker's
Compensation; as provided. for'by Section 3700 of the Labor Code, for 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
' `
performance of the Yvork'for„which this'permit is issued.
will maintain compliance with the Cupertino Municipal Code Chapter 9.12 and
P � P P � P
'` '
I have and will'niaintairi Workers Compensation Insurance, as provided for by
I
the Health & Safe Code Sections 25505 25 33 and 25534. ,^
Safety ' '
,. r : . abo .6 ..
Section 3700':;of.the'Lyabor.Code, for the performance of the work for which this
�1 �5
:
perrmt,is,iissueil,
Owner or authorized agent. Date:
I certifp;ihk in the. pei forma ice of the work for which this permit is issued, I shall
T.
not-employarry!pers64 in any manner so as to become subject to the Worker's
ationilavrs,6f,Califoinia.. If, after making this certificate of exemption, ICONSTRUCTION
LENDING AGENCY
=Aectiiifthe Worker's Compensation provisions of the Labor Code, I must
I hereby affirm that there is a construction lending agency for the performance of
forthwith comply:with such'provisions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
`i
Lender's Name
fit;+ ,I !il .APPLICANT CERTIFICATION
Lender's Address
I certify that I have read'this',application and state that the above information is
correct. I agreeito comply with all city and county ordinances and state laws relating
to buil1. ding.;copstruction;'and.he'reby authorize representatives of this city to enter
upon,the:above ,mentioned propeity'for inspection purposes. (We) agree to save
indemni �and;kee armiess';the'Ci of Cu ertino against liabilities, judgments,
f}; P11� h' P g J g
ARCHITECT'S DECLARATION
�.,r••ii,� nip;, ,
costs; ;and expenses jwhich may accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting of;this� permit;•Additiorially, the applicant understands and will comply
with alli noxi-poiniisource;regulations per the Cupertino Municipal Code, Section
Licensed Professional
Signature' `_":i'I" Date
CUPERT[t O
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 T ORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 • buildlno(Q70UDertino.OrO
❑PLUI"mNG tv1ECKkNT1C.4L ❑ELECTRICAL
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USE OF SF or DUPLEX ❑ X✓,ULTI-FAb'JLY PROJECT LN WZDLP.ATD ❑ YrS PROTECT LN ❑ YES
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IS THE BLDG AN ❑ YES
BU' LING: ❑ COI D, CIA JP3P?' Li=t ACL AREA ❑ NO FLOOD ZONEEl ):-o
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DESCRIPTION OF VVO.RK
TOTAL V 4I.UATION:
By my sigmatw-e below, I certify to each of the following: Iain the property Owner or autborized agent to act on the prope, ty owner's be i I hive read this
application and Le information I have provided is correct. I have read the Description of'Work and verify it is accurate. I agree to comp r h all applicable local
ordXmances and state lavN,S relaturg to ' ']ding consuction I au` n-= representatives of Cupertino to enter the above -identified prerty for inspection purposes.
S1gmatue. ofA plicant/Agent: Date:
SUPP_ENfENT?�, LX�rOR>'IATION REQULp.FD
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11,1'EPn4'isc4DP_2011.doc revised 06/21/11
CITY OF CUPERTINO
FFX FSTIMATOR — BUILDING DIVISION
APPLIANCE /EQUIP TYPE
ADDRESS: 1173 STAFFORD DR
DATE: 11/0412015
REVIEWED BY: PHUONG
UNITS
A PN:- 362-06-027
BP#:
*VALUATION: 1$4,739
*PERMITTYPE:t-,:-, Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: .�.SFDpr Duplex
#
PENTAMATION
FURN/AC
PERMIT TYPE: A
WORK
REPLACEMENT OF FURNACE ATE LOCATION
S O P
C T
APPLIANCE /EQUIP TYPE
FEE ID
FEE
QTY
UNITS
BP FEES
F urn a F orced=Air
IMFR=<100
1
#
$143
$0.00
-A
PM[E-;'.Unit Fee:
$143.00
PM.E:Perm it, F,ee:
$48.00
Administrative Fee:, ]ADMIN
$45.00
Work ,Wi tb,6ui Permit? 0 Yes (D No
TOTALS: $143.00
Mch-'Plan 6 hq6k 0.0 1 hrs. $0.00 11hj,,vb. l'i'lin Cheek Phn-i (71ieck
Mech. Permit Fee: IMPERMIT 111unib. 1,e/ E 'C' J'er,,nif Fee.
Other Mech. Insp. 0.0 hrs $48.00 other J,!,,!r,? ; IjiS[k Elec. lits!).
IA4?ch. lh.v4, .j fi'ee:
NOTE: : This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, sanitary sewer District, 'ycnool
-District; etc.)'. '.these, Lees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'l info.
FEE A'EM19 ('Fee" R'esohition 11-053 &' 711113)
FEE
QTY/FEE]
MISC ITEMS
Plan:.
SuPPI., 1"C J;�'e
PNM Plan Check:
$0.00
PM[E-;'.Unit Fee:
$143.00
PM.E:Perm it, F,ee:
$48.00
Administrative Fee:, ]ADMIN
$45.00
Work ,Wi tb,6ui Permit? 0 Yes (D No
$0.00
Advdiftx4-1 )kinningf, ee s
A
Travel Documentation Fee: I TRA VD OC
$48.00
StrbmM'oti6ti Fee: -', IBSEISMICR
$0.62
Select an Administrative Item
Bldg Stds'(-'bmmi§sion Fee: IBCBSC
$1.00
SUBTOTALS:
$285.6
2 $ 0. 0 0, TO'
E $2
85.621
Revised: 10/01/2015
STATE OF CALIFORNIA
ALTERATIONS - HVAC
CECZFiR-ALT4)3.E (Revised 06114) CALIFORNIA ENERGY COMMISSION
CE�iTiFICATE OF COMPLIANCE CFIR-ALT-03-E
Alterations - HVAC CZ 1, 3 to 7 and 16 (formerly CF -1R --ALT HVAC) (Page i of 1)
Sit! Address:
Enforcement Agency:
Date Prepared:
Permit#:
Eq ipment Type-
Equipment Efficiency
New: Ducting, Plenums, [inset
Conditioned
Thermostat
Required R -value
Floor Area (s4 ft
0P ckaged System
0 Evaporator Coil
� AFUE
COP
0 R-6 (CZ 1,3-7) Ducts
Served by system
Setback
13 S lit System
0 Condensing Unit
SEER
HSPF
R 8' (CZ16) Ducts
0 R-6 (all Ws) Plenums
sq ft
(If not already
present must
,.,
F mace
0 Uneset
EER
0 R-5 or R7.5 Unesets
be installed)
H RS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this
fotm 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.
i. HVAC Changeout/Repair
Required Compliance Documents to be left on site for Final:
include new ducting
Al ' Equipment,
CF111-ALT 024
ndenser Unit; Evaporator Coil,
CF2R: MECH-01, MECH-20-HERS
Al Handler/Furnace
CF3R: MECH-20-HERS
In Wier Requirement: Duct leakage (S.0%or,: 10% to outside, or seal all accessible leaks)
Exempted from duct leakage testing if:
1. Duct system registered with HERS provider as previously sealed, or 0 2. There is less than 40 linear feet of duct in unconditioned
s • ce, or O 3. E)dsfdng ducts stems are constructed, Insulated or sealed with asbestos list manufacture date of building
0 2. New HVAC System
Required Compliance Documents to be left on site for Final:
Al( new equipment and All New Ducts'
CFiR-ALT 02-E
CF211-MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS
CF311-MECH-20-HERS, MECH-22-HERS MECH- 23 or 24 HERS=
In ler Requirement: Duct leakage: 6%, Fan Efficacy (.SSW/CFM), Air Flow z 350 CFM/ton (or Standards Table 150.0-C / D alternative)
0 3. All New Ducts with Replacement
Required Compliance Documents to be left on site for Final:
1 dudes repladng or Installing All New
CFiR-ALT 02-E
cts' and one or more of the following:
CF211-MECH-01, MECH-20-HERS, MECH-(23 or 24) -HERS
ndenser Unit, Evaporator Coil, Furnace
CF3R-MECH-20-HERS, MECH 23 or 24YHERS
Installer Requirement: Duct leakage:S 6%, Alr Flow a 350 CFM/ton (or Standards Table 150.0-C / D alternative)
11 0 Exem ted from duct leakage testi 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:
i
Adding or replacing ducts in unconditioned
CF111-ALT 02-E
s ce but less than All New Ducts'
CF2R: MECH-20-HERS
CF3R: MECH-20-HERS
In' eller Required to: Dud leakage (:S.15% or, < 10% to outside, or seal all accessible leaks)
0 Exempted from duct leakage testing I existing dud systems are constructed, Insulated or sealed with asbestos.
I 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.
i
'A New Dud 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
p arts from the dwelling unit's existing duct system (e.g., registers, grilles, boots, air handler, plenums, duct material.
a R-5 (1" thick insulation) for linesets 1" and less. R-7.5 (L5" thick insulation) for Iinesets over 1 inch. Most mfg will require Suction line Diameter
Wh Insulation as the following1.5-2T-2W, 2.5-3T-2%", 3.5 to 4T 27A" 5T -4X"
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
I ertify the following under penalty of perjury, under the laws of the State of California:
t.
1 The information provided on this Certificate of Compliance is true and correct.
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 Callfomia 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.
RTponsiWe Designer Name:
Responsibi
Design Signature:
Date Signed:
[I -,
License:
I 1-10 Ll
0 &� n e),troo 14 S
S
C pany:
rurvt Ic9n.S
Address:
qi)w Cb 1�f �l
City/state/zip:
�4 i�l tt� 1�1 `�ys S
Phone:
1 zs `lyy -Nil y
For assistance or questions regarding the Energy Standards, cdttat t the Energy Hotline at: 1-800-M-3300
SMOKE I CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
DEVELOPMENT DEPARTMENT • BUILDING DIVISION
COMMUNITY
10300 TORRE AVENUE - CUP:ERTINO, CA 95014-3255 FILE ,34,v
'(408) 777-3228 - FAX (40$) 777-3333 •building a(�cupertino.orq
ITi t a
i�itD els % f 5 �. #,olAm?"r6ls :�unQ e: Call on M noxrde:
PERN[IT CANNOT BE FINAIXI) AND COMPLETE? UNTIL THIS CERTIFICATE
figEN SJUNM AND TO TRI ID
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
Outside of each separate sleeping area in the immediate vicinity of the
level of a
Within each sleeping room
unit including basements
SMOKE ALARM CO ALARM
X X
X X
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 -whore 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 have been tested and are operational, as of the date signed
below.
Smoke and CO f&man.d'ac t,evised 03/18,/14
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
I (408) 777-3228 • FAX (408) 777-333a e building(Wcuper ino.orp
uwner.iv:arne a�� _ ,. ,U1 Permit No.
Address
1. Is your real property a registered historical site?
El Yes Civil Code Sections 1101.1 through 1`101.8 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 isnot 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.
o 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 form 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 sMl`1 requife-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 vnprovements).
1, 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
conserving plumbing fixtures comply with the requirements as indicated in the
installation requirements, and that the water-
table on the following page
—r �iDate I Z�%�
cOwner-or-0w!T6r Agents Signature: %�i� �.N ems"
�r Upon completing and signing this Certificate, please return it to the Building Division in order to final your building permit.
SB4072015.doc revised 08126115