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14120019 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21611 COLUMBUS AVE CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 14120019 CONDITIONING OWNER'S NAME: WU DONALD S AND GINA C 1712 STONE AVE DATE ISSUED: 12/03/2014 OWNER'S PHONE: 4083938608 SAN JOSE,CA 95125 PHONE NO:(408)293-4717 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL Ok REMOVE AND REPLACE FURNACE IN SAME LOC License Class O?Z-'I Contractor AAA t�'tJ C A- Date2- Ihereby affirm that I am licensed under the provisions of C apter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 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 erformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$4200 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 APN Number:35618031 00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPUZES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 D OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FR L S CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, /_ /� costs,and expenses which may accrue against said City in consequence of the Issued b Date: fir/ granting of this permit. Additionally,the applicant understands and will comply y' with all non-point source regulations per the Cupertino Municipal Code,Section 9 / 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. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,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 sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.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 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertin Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Sa o e,Sectio 255 5 33,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner authorized agent: Date: permit is issued. I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certificate of exemption,I become subject to the 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) Lender's Name APPLICANT CERTIFICATION Lender's Address I 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 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9 18. Signature Date GENSRAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT--"#V.14DING OIVISION \� I: 103*00 TORRE AVENUE -CUPERTINO; CA 95014-3255 \'L • FAX 408 777.3333 •buildin____a(g�cupertino.ora m1sc CUPEI'tT,1N'4 (408)777-3228 ( ) \� r '. ........... PLtliv®WC} ly(ECHAMCAL ELECTRICAL MtISCELLA OUS PROJECT ADDRESS t(/�I' rte`v��(y� APN N OWNER NAME54 E-MAIL l-J .PAX rrm rAvop s-s 2411 CdUm � C. o a CONTACT NAME PHONE E MAIL CITY,STAN ZIP FAX STREET ADDP:ESS a. ♦ ❑dWNER ❑ OWNAR•BUILOER ❑ OWNERAOM?r CONTRACTOR 000NTRACTOR'A0E1'rr ❑ APCKrMCT Q gNOKM, ❑ oEVBLOPER ❑ TENAHT �u% U SE E BUS.UC i CONP.t.gCT:^^.":hig . ` i^�O LICENSEMJMBER c7�✓ �`� COtnaANY NAME C•MAIL FAX I a ^O V1•W 3 STREET ADDRESS t/r r "1 : 2 g LICENSE NUtrO)ER BUS.UC t FAX CITY,STATE,ZIP PHONE JECT USE OF FD or Duplex p Muni-Family PROJECT 1N WmDLAND PROIN Yes -E—?o O CoTnmcrcia] URBAN INTERFACE AREA O Yes � FLOOD ZONE Q s-.ucrv_Ra_: 4 TOT4I.VALIJATION: low,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's this ISP on ar, informadon I have provided is corTev have read the Description of Work and vc.^�i; s acc��nm I agree to cc P �. cer C e.tiov;•iCe nfied pr pe C ,.0-s arC:..:x laws relating to b ding constry tin orize representatives of Cupertino r _ c i;oanVt�gsnt; � Date; _ -- SUPPL AL VFORM7170O REQUIRED' : CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 21611 columbus ave DATE: 12/03/2014 REVIEWED BY: Mendez APN: BP#: *VALUATION: $4,200 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: p PERMIT TYPE: i WORK remove and replace furance in same loc SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $143 TOTALS: $143.00 RR w Mech.Plan Check 0.0 hrs $0.00 llinnoh 111an C:he,(.'t Mech.Permit Fee: 1MPERMIT Ph/M!". 1'enn"'/I rther Mech.Insp. 0.0 hrs $48.00 C awi Plumb 7ns�> t1;l�e� 1:�'<:� It�sp. L1 NOTE: This estimate does not include fees due to other Departments('tie.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Theseees are based on the relimina information available and are onl an estimate. Contact the Dept or addn'l in o. FEE ITEMS (Fee Resolution 11-053 Ef: 7f /1/13) FEE QTY/FEE MISC ITEMS Nun {'heck t`.e'(': PME Plan Check: $0.00 PME Unit Fee: $143.00 PME Permit Fee: $48.00 �',rszstlrzciit,�t �cF:�: Administrative Fee: ]ADMIN $45.00 Work Without Permit? 0 Yes 0 No $0.00 -lEI'�'catIC: 'Cl ti'tr<tYEl�it7� /''e.'£'S: Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICR $0.55 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $285.55 $0.00 TOTAL FEE: $285.55 Revised: 10/01/2014 STATE OF CALIFORNIA ALTERATIONS - HVAC CEC-CFIR-ALT-03-E Revised 06/14 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE CFIR-ALT-03-E Alterations-HVAC CZ 1,3 to 7 and 16(formerly CF-IR-ALT-HVAC) (Page 1 of 1) Site Address: Enforcement Agency: Date Prepared: Permit#: VC Equipment Type Equipment Efficiency New:Ducting,Plenums,Lineset Conditioned Thermostat Required R-value Floor Area(sq ft) ❑Packaged System ❑Evaporator Coil S:?%kFUE COP ❑R-6 (CZ 1,3-7)Ducts Served by system El Setback ❑Split System ❑Condensing Unit SEER ❑R-8' (CZ 16)Ducts sq ft (If not already HSPF ❑R-6(all Q's)Plenums present,must Furnace ❑Lineset 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 filled out by hand. For final inspection all forms are to be registered(no hand filled forms allowed)and a copy left on site. HVA Chane Repair Required Compliance Documents to be left on site for Final: Can-include new ducting All Equipment, CF111-ALT-02-E Condenser Unit,Evaporator Coil, CF2R:M€CH-01,MECH-20-HERS Air Handler/Furnace CF3R:MECH-20-HERS Installer Requirement:Duct leakage(:5_15%or,<109/6 to outside,or seal all accessible leaks) Exempted from duct leakage testing if: ❑1.Duct 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' CFiR-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>_350 CFM/ton(or Standards Table 150.0-C/D alternative) ❑3.All New Ducts 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: CF211-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 z 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 CFIR-ALT-02-E CF2R:MECH-20-HERS space but less than All New Ducts' CF3R:MECH-20-HERS Installer Required to:Duct leakage(<15%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 material,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. I R-5(1"thick insulation)for linesets 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-2W,2.5-3T-2%",3.5 to 4T-2%",5T-4%" 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 for approval with this building permit application. Responsible Designer Name: esponsib e ' ner Signat� Date Signe . License: C l2 3 C3�� 1 Company: Address: City/State/Zip: Phone: �fl� �� A-�� ► (2 a e `saN�� `�S" �Zpf 3 q9 ( i For assistance or questions regarding the Energy Standards,contact the Energy Hotline at:1-800-772-3300 CUPERTINO WATER- CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 F I L-E (408) 777 - 3228• FAX (408) 777 -3333 • building(a.cupertino.org Owner Name A`h 4 t; l/ I!U Permit No. go 1,7 Address Please refer to the attached California Civil Code Sections 1101.1 - 1101.8 which are part of this Certification form. 1. Is your real property a registered historical site? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form. Owner' Signature: Date: X 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 110 1. 1 through 1101.8 do not apply. ❑ The licensed plumber's certification has been provided to the Building Division. Sign below and skip the rest of the form. Owner' Signature: I No Go to Question 3. Date: 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form. Owner' Signature: No Go to Question 4. Date: 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. Sign below and skip the rest of the form. Owner' Signature: Date: 2'Yes My real property is built and available for use or occupancy on or before January 1, 1994. Civil Code Sections 110 1. 1 through 1101.8 apply. Refer to the attached. V—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. SB407 2014.doc revised 03118114 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). UWe, the owner(s) of this property, certify under penalty of perjury that non - compliant plumbing fixtures have been replaced with water - conserving plumbing fixtures in accordance with Civil Code Sections 110 1. 1 through 1101.8, the current California Plumbing Code and California Green Buildi AStandards Code, and manufacturer's installation requirements, and that the water - conserving plumbing fixtures corniAv wjfh,the_requirements as in a e m the table below. Owner's (or Owner Agent's) Signature: Date: / -�z& /O rz /LLI Upon completing and signing this Certificate, please return it to the Building Division in order to final your permit. 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. SB407 2014.doc revised 03118114 Non - Compliant Water- Conserving Plumbing Fixture Fixture (Fixture Complying with Current Code Applicable to New Construction) —Plumbing 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 /flow rate is equal to or lower than the figure shown, it is not required to be upgraded. SB407 2014.doc revised 03118114 CUPERTINO 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 • build ing(alcuperti no. org F "Irl- -T CA ' % f /j P H (, Y V i�JU S Permit No. 14 (Z �-� Address 1i,[ � ( VELA V iJO ►1rtM- it of Alarms Smoke: � Carbon Monoxide: f 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 8314 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 have been tested and are operational, as of the date signed below. ,—N 1 have read and aaree to comolvnn�t Khe Perms and conditions rfl is_s#at? ent Owner (or Owner Agent's) Name: (� V, Signature ......... t .. ........... ........................... ............ Date: ................... Co tractor Name: "7 1 � ( Date: Si nature ............ ............ u Smoke and CO foi-m.doc revised 03118114 D Contractor Name: Job Name or No: Type of Test: Home Owner Name Job Address: Job City, State, Zip: Type of Install: Contractor Notes: Test Order Form — Residential Alterations (Fill Out Form Online and email to trent @norcalducttest.com) AAA FURNACE 0281793 New Test GINA WU 21611 COLUMBUS AVENUE CUPERTINO, CA 95014 Date: CF1R Completed By: Supply Vent Location: Sq. Ft. of Home: Phone No: Alternate No: Alteration Install Date: REPLACE EXISTING FURNACE - LM 12/4 - No A/C in home ❑NEW Duct Notes: System Air Flow: N/A Meas: Target: Evap Coil Brand: F] Condenser Brand: N/A Furnace /AHU Brand: TRANE Model: Model: Model: TDD2B080A9V3VA / 'f P7,00 / T FILIE 4 � C's _j f/j- 1,4— r 12/04/14 MONIQUE FEATHERSTON Unknown Serial No: Serial No: Serial No: 14384TT01G 1,571 (408) 393 -8608 11/04/14 Duct Leakage: Exem t- Asbestos Meas: Target: % In Notes: Time: 08:00 Air Flow: N/A Meas: Target: Notes: Inv Date: 12/11/14 Fan Efficacy: N/A Meas Watts: Notes: RCV: N/A Notes: NOTE: THERE IS NO EXEMPTION FOR INACCESSIBLE DUCTS. A SMOKE TEST MUST BE PERFORMED ON ALL FAILED SYSTEMS TO IDENTIFY AND SEAL ALL ACCESSIBLE LEAKS. NOR -CAL DUCT TEST CHARGES AN ADDITIONAL $69 FOR THIS TEST WHEN FAILING RESULTS ARE FOUND FOR THE DUCT LEAKAGE TEST. RE -TESTS FOR TOTAL DUCT LEAKAGE AFTER CORRECTIVE MEASURES HAVE BEEN PERFORMED MUST BE ORDERED AT YOUR REGULAR TESTING RATES. Area: South Day: Thurs Date: 12/11/14 Time: 08:00 Levels:1 Confirm: Yes -done Rate: $ 176.00 DC #: Inv Date: 12/11/14 Inv #: CaICERTS: done Itrtoho sent Nor -Cal Duct Test Order Form - Residential Alt Page 1