B-2017-0091CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR_ :
PERMIT NO: B-2017-0091
10893 LEAVESLEY PL CUPERTINO, CA 95014 (356 15 026)
ON-TIIviE AIR
CONDITIONING &
HEATING INC
PLEASANTON,CA
94588
OWNER'S NAME: BARKER CHARLES B 3 AND SUSAN M TRUSTEE
DATE ISSUED: 01/18/2017
OWNER'S PHONE: 408-252-3495
PHONE NO: (925) 444-4444
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C220 Lic. # 18 7040
Contractor ON-TIME AIR CONDITIONING & HEATING INC Date 09/30/2017
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:
REPLACE FURNACE, SAME LOCATION (GARAGE)
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
performance of the work for which this permit is issued.
vI 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
Sq. Ft Floor Area:
Valuation: $15797.00
permit is issued.
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 ordinances
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
35615 026
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 inconsequence 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 regulations per the; -Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LA SPECTION.
Signature ' s°`- Date 1/18/2017
Issued by:
't
Date: 01/18/2017
OWNER DEC>✓ " TION
-BUILDER
I hereby affirm that I �amgx�empt from the Contractor's License Law for one of the
RE ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
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.
sale (Sec.7044, Business & Professions Code)
z. 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: 1/18/2017
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
o
performance of the work for which this permit is issued.
HAZARDOUS MATERIALS DISCLOSURE
z. 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
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
3. I certify that in the performance of the work for which this permit is issued, I
Health & Safety Code, sihould I store or handle hazardous
Section 25532(a)
material. Additionally, should I use or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
yuli eh AMent
air contaminants as defined by the Bay�iAreAir 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 & Safeode, $ections•25505, 25533, and 25534.
tp M
Labor Code, I must forthwith comply with such provisions or this permit shall
fr
be deemed revoked.
Owner or authorized agen�A'
APPLICANT CERTIFICATION
Date: 1/18/2017 rl i
I certify that I have read this application and state that the above information is
COM AINDINGAG' CY
I hereby affirm that there is a c6n, iht clion lending agecy for the performance
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
of work's for. which this permit is i sue c. 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,
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
ARCM RCT°S DECLARATION
and will comply with all non -point source regulations per the Cupertino Municipal
I understand my plans shall be used as public records.
Code, Section 9.18.
Licensed
Signature Date 1/18/2017
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX {408) 777-3333 o building(aD-cupertino.org
7PLUMBING F IMECHAAIICAL FIFLFCTRTCAT
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STREET ADDRESS 10 "6�•�J
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT EI CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPERG
CONTRACTOR NAME�.�^ n f o ^ _ LICENSE BE A
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COMPANY NAME
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ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF XID or DUPLEX
BUILDING: ❑ COMMERCIAL
❑ MULTI -FAMILY
PROJECT IN WILDLAND ❑ YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK " && /►
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TOTAL VALUATION: t
�% RECEIVEDBY:: -
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By my signature below, I certify t6each 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 cor ec I have read the Description of Rork and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building constructi . I authorize representatives of Cupertino to enter the above -i entifiproperty for inspection purposes.
Signature of Applicant/Agent: Date:
,.
SUPPLEMENTAL FORMATION REQUIRED
OFFICE USE ON LY
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W-:
OVER-THE-COU\TER ,
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❑ LARGE,
MAJOR, >:
MEPMiscl4pp_2011.doc revised 06121/11
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC)
Project Name:
CHRIS BARKER I Date Prepared:
CF1R-ALT-02-E
(Page 1 of 3)
2017-01-17
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
CHRIS BARKER
02
Date Prepared
2017-01-17
03
Project Location
10893 LEAVESLEY PLACE
04
Building Type
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
house
SC System
SC System
CFA served
system a
Dwelling Unit Conditioned
Inst'ailing new SC
07
Zi Code
p
95014
08
Floor Area (ft2)
2110
by this SC
ducted
containing
system
Number of Space
entirely new
EmateoneCli
Z
4
10
Conditioning (SC) Systems in
1
component?
components?
feet of ducts?
duct system?
this Dwelling Unit:
Alteration Type
B. Space Conditioning (SC) System Information
01
02
03
04
05
06
07
08
09
10
Is the SC
Installing a
SC System
SC System
CFA served
system a
refrigerant
Inst'ailing 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
2110
Yes
No
Yes
Yes
No
No
conditioning system
C. Extension of Existing Duct System, Greater Than 40 feet (Section150.2(b)1Diib)
This section does not apply to this project.
Registration Number: 417-A020005147A-000-000-0000000-0000
Registration _Date/Time: 2017-01-17 13:12:24
HERS Provider: CHEERS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-01-17 13:12:25
Schema Version: rev 10/16
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 Duct
or Name
Type
Components
Type
Value
System Type
Components
Type
Value
Type
Duct Length
R -Value
All new
No cooling
This field or
This field or
Less than or
system 1
Central gas
furnace
heating
AFUE
0.8
No cooling
component
section is not
section is not
Setback
equal to 40
R-6
components
altered
applicable
applicable
feet
Required Documentation:
CF2R-MCH-01-E - Space Conditioning Systems
- 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 CF311-MCH-20-H - Duct Leakage Test 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% or <= 10% 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 Changeout (Sections 150.2(b)1Diia and 150.2.(b)1E, F)
This section doe's 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: 417-A020005147A-000-000-0000000-0000
Registration Date/Time: 2017-01-17 13:12:24
HERS Provider: CHEERS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-01-17 13:12:25
Schema Version: rev 10/16
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:
April Rodriguez
Apr6bR0dv'4uek
Company:
Signature Date:
I Permit E Raters
2017-01-17
Address:
CEA/ HERS Certification Identification (if applicable):
31225 La Baya Drive
City/State/Zip:
Phone:
Westlake Village CA 93291
818-735-7886
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.
5. 1 will ensure that a registered copy of this Certificate of Compliance shall be.made available with the building permit(si 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:
Lyndy Rose
Lyn4 20
Company:
Date Signed:
On -Time Air Conditioning & Heating Inc dba Service Champions
2017-01-17
Address:
License:
7020 Commerce Drive
817040
City/State/Zip:
Phone:
Pleasanton CA 94588
925-444-4444
Registration Number: 417-A020005147A-000-000-0000000-0000
Digitally signed by CHEERS'"'. This 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.
Registration Date/Time: 2017-01-17 13:12:24
HERS Provider: CHEERS
CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-01-17 13:12:25
Schema Version: rev 10/16
SMOKE / CARBON MONOXIDE ALARMS
.OWNER CERTIFICATE OF COMPLIANCE
PEW
'Co
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 907.2.11; 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, 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
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
Within each sleeping room
X
X
I 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 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.
Address: f0 1 Z-CV-,9S' l �G �yt Q Permit No. it
Specify Number of Alarms: # Smoke Alarms: ��� # Carbon Monoxide Detectors:
I have read and agree to comply with the terms and conditions of this statement
[70wne_,!or Owner Agents) Name:
4r lr�� i�G%tr lir` Signature.......................................................... ............................. Date:vl.,A
contractor Name:
Sianature.................................................................. Lic.# ..........:........................... Date:..................
Srraoke and COforrn.doc revised 01/10/2017
Owner Name
Address
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 7 7-3228 • FAX (408) 777-3333 • build inq&cupertino.or_q ®^
o� , - moi-'&' Permit No A `Z0 00
l� —
/19 93
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.
A 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.
�k 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.
I X 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..
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-coinpliant 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 iunprovements).
I, as the owner or owner's agent of this property, certify under penalty of perjury that non-coinpliant 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.
Owner or Owner Agent's Signature: / ,,f Date: T
Upon completing and signing this Certificate, please return it to the Building Division in order to final your building permit.
SB4072015.doc revised 08/26/15
1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shown, it is not required to be upgraded.
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
Gallons/flush
0.5 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/flow rate is equal to or lower than the figure shown, it is not required to be upgraded.
SB4072015.doc revised 08126115