15030077CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 18960 NEWSOM AVE
CONTRACTOR: A-1 HEATING AND
PERMIT NO: 15030077
COOLING
OWNER'S NAME:
SAN JOSE, CA 95110
PHONE NO: (408) 283-9915
JOB DESCRIPTION: RESIDENTIAL EJ COMMERCIAL E]
LICENSED CONTRACTOR'S DECLARATION
REPLACE (E) 35K BTU WALL HEATER, SAME LOCATION
License ClassLic.
ate 1
ContractorA
I hereby affirm that I am lice&IA'
nder 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.
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: $1593
have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 37535013 00
Occupancy Type:
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 DA ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
180 DA ED INSPECTIO .
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 o
e Vie. 3
y' --Daft:
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
918.
RE -ROOFS:
Signature Date �J5*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. 1 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(x) 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
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
performance of the work for which this permit is issued.
have Worker's Compensation Insurance, as provided for by
the Health & Safety Code,
DateN
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
I
I hereby affirm that there is a construction lending agency for the performance of
become subject to the Worker's Compensation provisions of the Labor Code, must
work's for which this permit is issued (Sec. 3097, Civ C.)
forthwith comply with such provisions or this permit shall be deemed revoked.
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 representativesiof.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 MunicipaTCode, Section
Licensed Professional
918.
Signature Date
03/11/2015 09:44 F.a.X
01002
GENERAL PERMIT APPLICATION
o
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION MEP
10300 TORRE AVENUE • CUPERT(NO, CA 950143255 �O
CUPERTINO I (408) 777-3226 • FAX (408) 777-3333 • bulldlnp(Mcuperti o,orn \V r M I S
PI-IJMBIING CHANICAL ELECTRICALMISCL- LANBOUS
PROJGCT ADDRESS 6A
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APN A01
OWNER NAME „
CONTACT NAMP .
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FAX
OWNER ❑ OwNma[nimim O owaRAGENT 13 CONTRACTOR OCoNTRACtORAGWr - ❑ AR(WI-RCr ❑ DEVELOPER ❑ TENANT
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ARCHrreCdENGINHFR NAME
LICENSE NUMBER
BUS. LIC a
COMPANY NAME,
E-MAIL
PAX
S7REtirADDRESS
CITY, STATS, ZIP
PHONE
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suu.DING: OCOMMERCIALUABAN RVACBAREA [3NO
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IS THE BLDG AN ❑ YES
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By my signature below. I cortin to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. 1 have read this
application and the information I have provided is correcL 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 1 b ' ding eonstruc I authorize representatives of Cupertino to enter the aboN•i qe pro arty for inspection purposes.
Signature ofApplicanUA.ge Date:
SUPPLEMENTAL INFORMATION REQUIRED
OPPICE USE ONLY
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VLrR-1'HIFCOtrKIBN
❑ STANDAW
❑ LARGE
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1iMEPMlscdpp 2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
IAADDRESS:
18960 NEWSOM AVE
DATE: 03/12/2015
REVIEWED BY: MELISSA
MISC ITEMS
I-APN: 375 35 013
BP#:
"VALUATION: 1$1,593
*PERMIT TYPE:- Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY-PENTAMATION
SF'D or Duplex
USE
PERMIT TYPE: FURN/AC
�
wORK
REPLACE E 35K BTU WALL HEATER SAME LOCATION
SCOPE
' .
Mech. Plan Check 1 0.0 hrs $0.00 Phwp/i. I'/stn € he,,,k F c, f'lzw (111ucC4
Mech. Permit Fee: 1MPERMI7 1'?ar.=r,.
Other Mech. Insp. Fo.0 hrs $48.00 L1f/Fer.l Irrr; Ir=Li I
E3
T1er:n. lrsl!. 1 t�: 1'r'ra rr-..ls;.s�;..l
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 Dept for addn'l info.
Revised: 02/14/2015
-FEE ITEMS (Fee Resolution 11-053 E . 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Y
-Man Check
Fee
PME Plan Check:
$0.00
Permit f*e :
PME Unit Fee:
$72.00
PME Permit Fee:
$48.00
Administrative Fee: IADMIN
$45.00
Work Without Permit? 0 Yes 0 No
$0.00
Travel Documentation Fee: ITRA VDOC
$48.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
1 $1.00
n OTN
$214.50
.
$0.00 �.. TOTAL FEE::
$214.50
Revised: 02/14/2015
CUPERTINO
Address
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 ina(a)cupertino.org
PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE
HAS BEEN SIGNED 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
Date: ...................
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.
Contractor Name:
Signature...................................................................Lic.#......................................
Date: ...................
Smoke and CO form.doc revised 03118/14
CUPERTINO
Address / 0 q [/ V 4 V e w
02]
ILE
ql I
PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE
HAS BEEN SIGNED AND RETURNED TO THE BUILDING DIVISION
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:
19 No Go to Question 2.
Date:
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.
Sign below and skip the rest of the form
Owner' Signature:
IV 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 fonn.
Owner' Signature: Date:
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.
Q( 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 properly 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.doe revised 03118/14
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/We, 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 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
�/`� `�`�' " Date: Ll —S5 —7 J
Upon completing and signing this Certfficate, 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 03/18/14
Non -Compliant
Water -Conserving Plumbing Fixture
Fixturel
(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 03/18/14
03/12/2015 07:28 FAX
STAW of CALIFORNIA
ALTERATIONS - HVAC
CEC-WI -03.11 Read cal
CERTIFiCAT'E OF COMPLIANCE
Alterations - HVAC CZ 1, 3 to 7 and 16 (formerly CF-IR- ALT=HVAC)
_ [a 002
CFIR -ALT 03 -E
(Page 1 of 1)
I Add�t
Enforcement Agency:
D t Pre aredc
Permita.
-
ec
Z
_Equipment Type ___ _ , . , _- ., Equipment
New: Ducting, Plenums, Uneset
Required R•value
Conditioned
Floor Areas ft
Thermostat = _
O Packaged System O Evaporator Coll %AFUE, COP Cl R -6 (071,3 -7) Ducts Se red by s stem ❑ Setback
(1/not already
O Split System O Condensing nit SEER C7 R -8' (Ci 16) Ducts sq ft
y g PF C3 R -6 (all CVs) Plenums present must
haurnece CjUneset'" ' EER� belnstall
O R -5 or R7.5 Lineset'
HERS VERIFICATION SUMMARY Installer datermInes work to be completed and matches to one of the options below. At permit application this
,.
form lrellowedto be illledrout ` hdAd.�Forflnaffns ° ctibn`altfor'ms °ard to berg Istered' do hand fIIIQd forms atlowed and a copy left on site. s -
TO 1. HVAC Changeout/lfepeir . Required Compliance pocuments to be left on site for Final:
.Con Mdude.new dual
All Equipment,
CFIR ALT -02 -E
Condenser Unit Evaporator Coll,
CFZR: MECH•01, MECH -20 -HERS
Air Handler urnsce
CF3R; MECH40 -HERS
Installer Requirement•. Dud leakage (g,15% or, < 10%to outside, orseal all accessible leaks)
Exempted from duct leakage-tssting If:
01. Duct system registered with HERS provider as previously sealed, or O 2. There Is less then 40 linear feet of duct In unconditioned
space, or ❑ 3. Existing duct systems are constructed Insulated or sealed with asbestos list manufacture date of bulidl
2. Now HVAC System
Required Compliance Documents to be left on site for Final:
All new equipment and All Now Ducts'
CF1R- ALT -02 -E
CF2R- MECII.01, MECH- 20•HERS, MECH -22 -HERS, MECH -(23 or 24) -HERS
CF3n- ML•CH- 20•HERS MECH -22 -HERS MECH•23or24 -HERS'
Installer Requirement: Duct leakage: 6 %, Fen Efficacy (.59W /CFM), Air Flow 2 350 CFM /ton (or Standards Table 150.0 -C/ 0 alternative)
O S. All New Ducts with Replacement
Required Compliance Documents to be left on site for Final:
Includes replacing or installing All New
CFIR -ALT 02 -E
Ducts' end one or more of the following:
CF2R. MECH -01, MECH -20 -HERS, MECH -(23 or 20HERS
Condenser Unit, Evaporator Coll Furnace
CF3R- MECH- 2041ERS MECH 23 or 24 -HERS
Installer Requirement Duct leakage 16%, Alr Flow a 350 CFM /ton (or Standards Table 1513.0•C / D alternative)
L7 Exem ed from duct leakage testln g 1 existIng ducts stems are constructed insulated or sealed with asbestos,
❑ 4, Now 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 Now Ducts
CF3R: MECH -20 -HERS
Installer Required to: Duct leakage (5.15% or, < 10%to outside, or seal all accessible leeks)
O Exempted from duct leakage testing I existing duct systems.are constructed, Insulated or sealed with asbestos.
' All new ducting R -8 required when more then 40 ft Installed and R -6 when less than 40 ft installed. This Includes In walls, between floors etc.
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 roused
parts from the dwelling unit's existing duct system (e.g., registers, grilles, boots, air handler, plenums, duct material.
' R -5 (e thick insulation) for iinesets 1" and less. R -7.5 (L5" thick )nsulatlon) for linesets over i Inch. Most mfg will require Suction line Diameter
with Insulation as the following 1.544 2�L 2.5.3T 2W 3,5 to 4T -2W, ST-W
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
I certify the following under penalty of perjury, underthe Jews of the State of California:
L The information provided on this Certificate of Compliance Is true and correct.
2. 1 am eligible under Dlvblon 3 of the California Business and Professions Code to accept responsibility for the information on this document.
3. That the energy features and performance speclflcadons 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 tha energy features and performance spedfleatlons, materials, components, and manufactured devices for the building dosign 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 otherappllcable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement
a e_ncy for approval with this building Permit application.
Responsible Designer Name= Rea Ible Owisner5 nature: p i 11 9 ad: L1
il
n
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For assistbhce or questlons regIding tree Energy 51anciarala, contact line tnergy Hotline all a -evv -i is --