B-2016-1458CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B -2016-14S8
1210 STAFFORD DR CUPERTINO, CA 95014-4952 (362 11 016)
(A & H HEATING & AIR
CONDITIONING
SERVICE INC)
SAN JOSE, CA 95110
OWNER'S NAME: Chao Rita J And Gaddy John C Et Al
DATE ISSUED: 03/02/2016
OWNER'S PHONE: 408-628-2818
PHONE NO: 408-279-0722
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class Lic. #f , 1 t 0 7 �Z- ('^Z
Contractor (A& H HEATING & AIR CONDITIONING SERVICE INC) Date)
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:
RELOCATE FURNACE TO ATTIC (SUPPORTED BY CEILING
I hereby affirm under penalty of perjury one of the following two declarations:
FRAMING, LOCATED ABOVE HALLWAY WITH AN ATTIC OPENING
1. I have and will maintain a certificate of consent to self -insure for Worker's
OF 22"X54"); EXTEND GAS AND ELECTRICAL; PSI TEST GAS LINE;
Compensation, as provided for by Section 3700 of the Labor Code, for the
ADD LIGHT FIXTURE AND OUTLET TO ATTIC SPACE; REPLACE AC
performance of the work for which this permit is issued.
UNIT IN SAME LOCATION.
r =z. I have and will maintain Worker's Compensation Insurance, as provided for
ly�'�''W by Section 3700 of the Labor Code, for the performance of the work for which
this permit is issued.
Sq. Ft Floor Area:
Valuation: $10000.00
APPLICANT CERTIFICATION
certify that I have read this application and state that the above
information is correct. I agree to comply with all city and county
APN Number:
Occupancy Type:
ordinances and state laws relating to building construction, and hereby
362 11 016
authorize 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
PERMIT EXPIRES IF WORK IS NOT STARTED
expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally, the applicant understands and will
comply with all non -point source regulations per the Cupertino Municipal
180 DAYS FROM LAST CALLED INSPECTION.
Code, Section 9.18. )
Signature ` ' Date ^2L
Issuedby:Ph ng
Date:
OWNER-BUILDER DECLARATION
RE -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
1. 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)
Signature of Applicant:
z. I, as owner of the property, am exclusively contracting with licensed
Date:
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
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
by Section 3700 of the Labor Code, for the performance of the work for which
maintain compliance with the Cupertino' Municipal Code, Chapter 9.12 and the
this 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 provisions of the
eq
Labor Code, I must forthwith comply with such provisions or this permit shall
Owner.,or aut on ed agent.' -F
be deemed revoked.
Date.',_ L g
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY I
certify that I have read this application and state that the above information is
I hereby affirm that there is 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
ARCHITECT'S DECLARATION
understands and will comply with all non -point source regulations per the
I understand my plans shall be used as public records.
Cupertino Municipal Code, Section 9.18.
Licensed
Professional
Signature Date
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
Clip R'!'lNtO (408) 777-3228 • FAX (408) 777-3333 • building(Wcupertino.org
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OWNER NAME n `.,.�A w �OCfl�f U)D
PHONE D {f/iSr��
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STREET ADDRESS o J � { ,A _�
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CONTACT NAME r A
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PHONE
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STREET ADDRESS
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FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT IA CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER. ❑ TENANT
CONTIJ� 1 NAME
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LICENSE �.TW., Z
LICENSE T E G
BUS. LIC # C 7 Q
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COMPANY NAME
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STREET • 'ftol-��„ /
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P�HgN�E
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL - _..
FAX
STREET ADDRESS
CITY, STATE; ZIP
PHONE
USE OF FD or DUPLEX ❑ MULTI -FAMILY
PROJECT INWILDLAND ❑ YES
PROJECT N ❑ YES
IS THE BLDG AN ❑ YES
BUILDING: ❑COMMERCIAL
URBAN INTERFACE AREA NO
FLOOD ZONE ❑ NO
EICHLERHOME? ❑ NO
DESCRIPTION OF WORK
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TOTAL VALUATION: f 0 "_1*
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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 b Vi 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 relatingto 'Id" constructing. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
{'� .— ��
I).&,—
Signature of Applicant/Agent: .&,— Date: ✓
SUPPLEMENTAL INFORMATION REQUIRED
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MEPMisc,4pp_2011.doc revised 06121111
CERTIFICATE OF COMPLIANCE CFIR-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF411-ALT HVAC) (Page 1 of 3 )
Project Name: CHAO Date Prepared: 2016-02-21
A. General Information
CFIR-ALT 02 is applicable to multiple space conditioning systems Contained within a single dwelling unit. When multiple dwelling units must be documented,
use one CFIR-ALT d2 document for each dwelling unit.
01
Project Name
CHAQ
02
Date Prepared
2016-02-21
03
Project Location
1210 STAFFORb DR.
04
Building 'Type
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
CHAD
07
Zip Code
95014
Q8
Dwelling Unit Conditioned
1800
entirely new
entirely new
Name
Floor Area (ft2)
System (ft2):
system?
component?
components?
feet of ducts?
Number of space conditioning
SC system?
09
Climate Zone
4
10
(SC) systems in this dwelling
1
Yes
No
No
No
unit.
S. Space Conditioning (SC) System-lnfbrmation { -
T _
e.
OZ 02 OS.� . 04 b5 a :�06 .. 07 •''`
08 09 10
C. Extension of Existing Duct System, Greater Than 40 Feet (Section1S0.2(b)1Diib)
This section does not apply to this project.
Registration Number: 216-A0068055A-000000000-0000 Registration DateMme: 2016-02-2121:10:28 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2018- Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-02-21 21:10:40
Schema Version: 0.555SDD
SC System
SC System !'
`CFA served
system a - '
refkgQrant
Installing new°SC
installing '
Installing
Installing
Identification or
Location or Area
by this SC
'ducted
containing
system
more than 4
entirely new
entirely new
Name
Served
System (ft2):
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
System 1
Location 1
1800
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section1S0.2(b)1Diib)
This section does not apply to this project.
Registration Number: 216-A0068055A-000000000-0000 Registration DateMme: 2016-02-2121:10:28 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2018- Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-02-21 21:10:40
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CFIR�ALT-024
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 2 of 3 )
D. Altered Space Conditioning System (Sections 150.2(b)IE 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
System �
Central gas
Gas furnace
AFUE
0.8
Central split
All new
cooling
SEER
14
Setback
Less than or
equal to 40
R-6
furnace
Aur
AC
components
feet
Rhe aired Docgmentation:
CF211-MCH-01-E -Space Conditioning Systems Ducts and Fans.
-Duct insulation requirement for new plenums: R6.
CF2R-MCH-20-H & CF311-MCN-20�H -Duct Leakage testing required when heating or cooling components are installedin ducted systems, or when more than 40 ft of duct length is replaced;
-Leakage rate compliance::5 15%, or 510% leakage to outside, or seal all accessible leaks.
MR -MCH -25-H & MR -MCH -25-H Refrigerant Charge Verification required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15).
CF211MR-MCH-23&CF311-MCH-23AiKFWWw i300`CFIV/ton required'when.MCH-25 is required.__.__
Exceptions:
-Duct systems registered with HERS provider 2s previously sealed are exempt from MCH720 Duct leakage Testing requirements.-,
-Heating-only systems and Air Handier/Furnace changes do not require verificat oti,of'Aiir Flow �MCH=23,'orRefrigerant Charge M, H
y � from MCH=20 Duet LeakageTesting Kequire'merits.
Existing duct systems constructed, insulated or sealed with-a'sbestos;are exem
E. Entirely New or Complete Replacement Duct System, with or without Equipment Cha ng'eout,(Sections 150:2(b)1Diia and 150.2(b)lE, F)
r
r , a :,
. _ j.tfi
This section does. not apply to this project.
F. Entirely New or Complete Replacement Space Conditioning System (Section 1S0.2(b)IC)
This section does not apply to this project.
Registration Number:216-AQ068055A-000000000-0000
Registration Date/Time: 2016-02-21 .21:10:28
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2018 Rev 1.007 Report Generated: 2016-02-^21 .21:10:40
Schema Version: 0.555SDI)
C;FRTIFICATE OF COMPLIANCE CF111-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 3 of 3 j
Documentation Author's Declaration Statement
IJ certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name,
Documentation Author Signature:
Phelps, Dale
Company:
Signature Date:
A & H HEATING & AIR CONDITIONING SERVICE INC
2016-02-2121:10:28
Address:
CEA/ HERS Certification Identification (if applicable):
770 CHESTNUT STREET
City/state/Zip:
Phone:
SAN JOSE CA 95110
408-279-0722
Responsible Person's Declaration statement:',,
I certify the following Under penalty of perjury, under the laws o,f;he state of Caiifornia:
1. The information provided on this Certificate of Compliance -is true -and correct,
2. I am eligible under Division 3 of the Business and professions Code to accept�responsibilityfor the building design or system design identified on this Certificate of Compliance (responsible designer).
energy p g g y design identified on this Certificate of Compliance conform to the
3. That the eYoer features and performance specifications, materrais, components, and manufactured devices for the building design or s stem
requirements of Title 24, Part 1 and Part 6 of the California, Code of Regulations. w
4. The building design features or systemtfesi n features p ormatron provided on atherappircalile"compliance documents, worksheet's,
g g g Identified on this Certificate of Compliance are consistent with the inf
Calculations, plans ands ecif!cations submitted to the enforcement agency for'approval with this buiidmg permit application.
p
51 I will ensure that a registered copy oftlsCertificate of Cornpiiance shatl,be,�ma{Jo auaila,ble with the buiiding permits) issued for.ttrabuilding, and made avadabte<;to,the.enforcement agency for all applicable
inspections.l 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,
gesponsible Designer �ame: � ���. i � . � t +�
Responsible Designer signature: :� u
Phelps, Dale
Company,
Date Signed:
A $4 H HEATING & AIR CONDITIONING SERVICE INC
2016-02-2121:10:28
Afd Bess:
License:
170 CHESTNUT STREET
304472
eitl /State ip; _
Phone:_
L -'r JOSE CA 95110
408-279-0722
Aigitally signed by 0010ERrS. chis digital 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.
Ito;Olstrailorl Numbor: 216•Ab068055A-000000000-0000 Registration Date/Time: 2016-02-21 21:10:28 HERS Provider: CaICERTS
C Thrift iri8 Energy Efflciendy Standa fds - 201ZI' Residential CohiPliance Report Version: 2018 Rev 1.007 Report Generated: 2016-0221 21:10:40
Schema Version: 0.555SDD
WNERCERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE b CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - buildingftcupertino.org
- --2 t b-
1,7.1-o /-.7fAK0r-7-VF- qp-
PF4]R-MITC-ANNOTBIFr,71NAIjr!,IDANDCOMPL-FTEDUNTIIITHIS
CERTIFICATE
PURPOSE
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section 8314, 2013 CBC Sections 420.6 and 907.2.11.2 Where no interior access for
inspections are required.
GIENERAL IN, VORMATION
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 h -i the following locations:
ARIA
SMOKE ALARM
CO At
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
Carbon Monoxide alarms are not required in dwellings which do not contain fuel -bu'
MR% appliances and that
,
dono=t have an,attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
(COC Section 420.61 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, dwellhLig,-tmnits; alarms are permitted to, be solely battery operated where repairs or alterations do,
not res4ft, bit the removal oaf wall and ceiling. ft- mslaes, or there is no, arccess� by mneaits of at fiic, base. ment or e Fawj�
sp,ace. Refer to CW Section 8314 and CB, C Seddans, 907.2.11.4 and 42U,2. An electrical per imit is required . �ed,
Uir,
allar-in,s win ch m- u-'st be com.miected to, the buildirtg wiring.
As owner 4 the ab°overeferenced pr oper, ty, T hereby certify tha4 thee- allaym(s)) re
installed inc, ac, e @T, dant ce with the m a n, u-, f a, c tur er's ina sb actionsla md in com, c e
am,dl Caififlon—dal Be skdeni-lia-11 Codes. Tl e alarms have been teste d,a ndl aT. e operatic
11 hrve? read, c7Rd, aoree.- to cami g wltft fh'Pithan .,:ziqn, r,11 ron,dlrthnm� mf
teed above has/have been
Li the C ailiff oaimlia
as, of the, date siggedt
zA1:.7PP'= P.nit
"M
............................
Son .... ...... ...................................................
-
t cq'
. .................
Data '
Smoke and;Z&f
,brnj,db,c-
revis.ed0317'8114L
'-W,A,T,,,�ER,-�CONS,MVIU(;,P,LUM13INC; FIXTURES
OWNER CER TIM ATE OF COMPLIANCE
Wmmfuj LAITY.DL
�EVEOPUEW'�
�TDE.P�ARWIqT.,,,BU
_-
,E11 � 10 3 W TO,' , (1_t)qNG DIVISION
CUPERTINO . RRE-AMEtM-CUP.F-RTINO.CA95914aM
1(409) 777-3228 1, FA) 4R- 777-3353 a bu
ildingacupapitno.om
Owner Nam4_9117rA � (� '2- 016
Permit N.#
Address 1-7-10 4-rA�APPT—> -r?P ,A/
1. Is your real proprwty a registered historical site?
0 Yes CivilrCode Sections 1101.1 through 1101.18 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- plumbiftg fixtures is not technically feasible?
0 Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
0 The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
IFX No Go to Question 3.
3. Is water service, pennana, ently disconnected Gd _f ryo your building?
0 .
F1 Yes Civil Code Sections 1101.1 through, 1101.8 do not apply. Skip the rest of the form and I sign bottom of form.
�KNo Go to Question 4.
4. Is your real property built and available for use or occupancy of, or before January 1, 1994?
0 No My real, property is built and available for use or occupancy after January 1, 11594.
Civil Cade Sections 1101.1 throdo doriotapply. Skip the rest of the form and sign bottom of form.
ffi Yes My real property is built and available for use or occupancy on or before January 1, 1§94.
Civil Cade Sections 1101.1 through 1101.-9 apply. Check one of the three following �statements and sign
bottom,, of form.
5. Please check ONE of the following-.
Vq 21 MYpropertyigak-oingle-fai-nity,t-esidentiatreylproperty. See Civil Code Seddon 1101.4.
O atdaffer January 1, 2014, building- alterations. or improvements shall r q uirealb noun -compliant ompliant plumbing fixtures
tube replazedlwitty water-congervingpl-,urnbit,,",gfixtures throughout the building; Unorbefore January 1, 2017, all non-
compliant p1wrIbing fixtures- shall be replaced with water-conservitig, phim.,bigg fixtures (regardless of whether
piopertyundergoes alterations orimpfavenen.ts).
M,,YPfopertyisamrtttifainilyrestden-tialreEtlprciperW. See Civil Code Sectioft, 1,101.5
On, and, after January 1, 2014, specified bmildiffg alterations or imptervefftents shallrequire non- compliant
plumbing f�m,ture3.to,btreplaced with water -conserving p -t,, --bingfIx res.
um tu
On, or, before January 1, 2019, 611 non-compll antplumbrng fixtures, shall' be replaced with water -
Conserving plumbing fixtures throughout the bugft ((regardless of whethtrpropertyVidlergoes, alterations or
in provemenft-).
D M',yproperty isaco-.mmercial-re'a-1,',property: S,*f,,e,Civil Code Section 1101.5.
On and affer, January 1, 29,14, specified buildinlg adtelafiow, or improvements shall, reqxxir.e no I n- compliant
plumbing fixtures to, be replaced, with, water -conserving gluinbing fixtures.
On or. btfw& Yantiaq 1,
, 2DIR, all non: ea in- plian f plumbing fixtures shall.I be replaced( with water- conserving
plum%ig fixitares-, ffixottgfizwe the building (regaTdilleSE; Gf whether property undergor's, afterations or im pioven entsq'.
11, as, the owner or` owner's agend of tfii3 property, certify under penalty of perjury that non-com, pliant plumbing fixtures will. be
'U
'in
Code replaced; prior to, date- speeilfit-d above, with water-conservihg plumbing FrAtures, in accordance with Ccivit, Code- Sections 1, 1,0,1. 1,,
1v
m
tkiough 11811. ffie, current Ca,166moia plumbing Code, and California ia Green. Building S%.ta, ndw&i Code, &,,
andm, anufacturer"s
instillatiou. requiremen-tst, and that the, water -conserving plumbing fixtures comply with the r ents; as indicated in, the,
e quirem
table on ffre: fflbwingpng:
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