15040016CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10399 RIVERCREST CT
CONTRACTOR: AVA CONSTRUCTION
PERMIT NO: 15040016
OWNER'S NAME:
CUPERTINO, CA 95014
PHONE NO: (408) 387-0999
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E]
?
REMOVE AND REPLACE FURNACE & DUCTS
License ClassrLic.#
04r L i
Contractor Date (
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.
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
Sq. Ft Floor Area:
Valuation: $5000
performance of the work for which this permit is issued.
I 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: 32637052.00
Occupancy Type:
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 DAYS 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 DAYS440M LAST 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
s�
granting of this permit. Additio ally, the applicant understands and will comply
Issued by: Date:
with all non -point source r ions per the Cupertino Municipal Code, Section
9 18.
RE -ROOFS:
Signature_ Date_7
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
1, 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(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 Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25505, 25533, and 25534. 1.
Section 3700 of the Labor Code, for the performance of the work for which this
� 2 /
permit is issued.
Owner or authorized agent: Dater
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
Compensation laws of California. If, after making this certificate of exemption, I
CONSTRUCTION LENDING AGENCY
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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
918.
Signature Date
+CUPERT.INY3
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION %1)�
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 �(3
(408) 777-3228 • FAX (408) 777-3333 • building(alcupertino.org /�
F-1 PLi TMBING I—I MECHANICAL F— ELECTRICAL I—I MISCELLANEOUS
PROJECT ADDRESS I r7 f
('
APN �� /f� 6u -
OWNTER NAME
FAX
CONTACT NAME
PHONE
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OwNER-BUILDER , ❑ OwNERAGENT
❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
�I y v J
LICENSE NUMBER �%j� 2
LICENSE TYPE
BUS. LIC *#
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX ❑ MULTI-FAMQ,Y
BUILDING: ❑ COMMERCIAL
PROJECT IN WII.DLAND ❑ YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORKwo
TOTAL VALUATION:
RECEIVEDBI
By my signature below, I certity to each of the followin :
application and the information I have pro '
ordinances and state laws relating to bu g
Signature of Applicant/Agent:
the property owner or authorized agent to act on the property owne . I have read this
have read the Description of NVork and verify it is accurate. I agree to comply with all applicable local
authorize representatives of Cupertino to enter the above -id tifi property for inspection purposes.
Date:
SUPP E TAL INFORMATION REQUIRED
01
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OVER TiDC TINTER �;
I ENPRES a� +
V.
MIN
MEPMiscApp_2011.doc revised 06/11/11
��,,� CITY OF CUPERTINO
Fw-m- - 1 TIFF FQTIMATnR — RITILDING DIVISION
61'
ADDRESS: 10399 rivercrest ct
DATE: 04/01/2015
REVIEWED BY: mendez
Plan Check Fee:
APN:
BP#:
`VALUATION:
1$5,000
*PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE: p
$0.00
PENTAMATION FURN/AC
PERMIT TYPE: i
WORK
remove and replace furnace & ducts
SCOPE
APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES
Furnace, Forced -Air 1MFR=<100 1 # $143
TOTALS: h $143.00
Mech. Platt Check 0.0 hrs $0.00 Plumb. Plan Check Zletc. Plan Check
Mech. Permit Fee: IMPERMIT Plumb. Permit Fee: T;Iec Permit Fee,
Other Mech. Insp. 0.0 hrs $48.00 Chher Plumb Imp. Li oder E-lec. 1psp.
1 teck. Insp. Fee: Ph:mb. Insp. Fee: lltec. Insp. Pee:
NOTE: This estimate does not include fees due to other Departments (Le. Planning, ruouc worKs. rlre, aamiary newer utszr/cy acauu/
___ t__- _ .. z,.-,../ .,.. ILrantart the Dent far addn'l info_
FEE ITEMS (Fee Resolution 11-053 E . 7/1/132
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
SLlI7pl. l'C I'ee
PME Plan Check:
$0.00
Perrrz i I lF'ee:
suppl. Insp I ee
PME Unit Fee:
$143.00
PME Permit Fee:
$48.00
Construction Tax:
Administrative Fee: 1ADMIN
$45.00
Work Without Permit? ® Yes (E) No
$0.00
fJdv zce d Phir ing Tees:
A
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: IBSEISMICR
$0.65
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
$285.65
$4.00 FEE:
. . ..,
$285.65
Revised: 02/14/2015
r
CUPERTINO
Address 1 n 3TI
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 • building aacupertino.or4
? Wa OC,T C -r. #
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
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.
I have read and agree to comply with the terms and conditions of this statement
Owner (or Owner Agent's) Name:
Signature........................................................................................................... Date: ...................
Contractor Name:
.....................................Lic.# ... !..�j.......... Date:
V (
Smoke and CO form.doc revised 03/18/14
CUPERTINO
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(4A088)) 7'7`7--3228 • FAX (408) 777-3333 building(d)cupertino.ong /
Owner Name � Permit No. S
Address 10319' Ile l V`64 c� C 6a" rIMb , Gh q5
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:
�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 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:
o 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:
,2T"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 110 1. 1 through 1101.8 do not apply. Sign below and skip the rest of the form.
Yes
Owner' Signature:
Date:
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.
Myproperty 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).
❑ Myproperty 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).
❑ Myproperty 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 03118/14
I
On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with watec
plumbing fixtures throughout the building (regardless of whether property undergoes alter &I
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 Stan ards Code, and manufacturer's installation requirements, and
that the water -conserving plumbing fixtures complyiequirements as indicated in the table below. / /
Owner's (or Owner Agent's) Signature: Date: `V ` l.I r 7
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.
SB4072014.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.
SB4072014.doc revised 03/18/14
STATE OF CALIFORNIA
ALTERATIONS - HVAC
CEC -CFIR- ALT -03 -E (Revised 06/14) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R- ALT -03 -E
Alterations - HVAC CZ 1, 3 to 7 and 16 (formerly CF-1R-ALT-HVAC) (Page 1 of 1)
Site Address: / pr2 lips � � /
V.
Enfom A
Date P ep r
Permit #:
Equipment Type ��f/1'
Equipment Efficiency
New: Dutting, Plenums, Lineset
Conditi ned
Thermostat
Required R -value
Floor Area (sq ft)
❑ Packaged System
❑ Evaporator Coil
r AFUE
COP
❑ R -6 (CZ 1,3 -7) Ducts
Served by system
❑ Setback
lit System
❑Condensing Unit
SEER
11 R -8' (CZ 16) Ducts(j(�
sq ft
(If not already
XFurnace
❑ Lineset
EER
HSPF
❑ R -6 (all CZ's) Plenums
`
present must
❑ 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 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.
1. HVAC Changeout /Repair
Required Compliance Documents to be left on site for Final:
Can include new ducting
All Equipment,
CF1R- ALT -02 -E
Condenser Unit, Evaporator Coil,
CF2R: MECH -01, MECH -20 -HERS
Air Handler /Furnace
CF3R: MECH -20 -HERS
Installer Requirement: Duct leakage (<15% 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 ❑ 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
New HVAC System
Required Compliance Documents to be left on site for Final:
All new equipment and All New Ducts.
CF111- 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) -HERS2
Installer Requirement: Duct leakage < 6 %, Fan Efficacy (.SSW /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
CF111- ALT -02 -E
DuctsZ and one or more of the following:
CF2R- 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.
New Ducting over 40 feet
Required Compliance Documents to be left on site for Final:
Adding or replacing ducts in unconditioned
CF1R- ALT -02 -E
space but less than All New Ducts2
CF2R: MECH -20 -HERS
CF3R: MECH -20 -HERS
Installer Required to: Duct leakage (:L15% 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.
3 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 -2 % ", 2.5- 3T- 2Y44 ", 3.5 to 4T -2%", ST -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.
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.
Responsible Desi ner Name:
SX
Responsible Desi S' n
Date Signe :
License:
r
L
e
Company Y.
Address.
^/
City /State/Zip:
Phone:
�?3 Z1
/ For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1- 800 - 772 -3300