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15090194 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10842 NORTHFIELD SQ CONTRACTOR:AIR QUALITY HEATING PERMIT NO: 15090194 &AIR OWNER'S NAME: KOSTA ACHIN 720 NORTHRUP ST DATE ISSUED:09/29/2015 OWNER'S PHONE: 6502542009 SAN JOSE,CA 95126 PHONE NO:(408)293-7138 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ License Class Lic ADD AIR CONDITIONING TO EXISTING SYSTEM. y.-#"T� ContractorA�! Date I hereby affirm that 1 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. Sq.Ft Floor:►rea: Valuation:$6000 1 hereby affirm under penalty of perjury one of the following two declarations: 1 1 have and will maintain a certificate of consent to self-insure for Worker's CPN Number:31637038.00 Occupancy Type: Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 2. 1 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 PERMIT EXPIRES IF WORK IS NOT STARTED permit is issued. WITHIN 180 DAYS OF PERMIT ISSUANCE OR APPLICANT CERTIFICATION 180 DAYS FROM LAST CALLED INSPECTION. I certify that 1 have read this application and state that the above information is correct.1 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 1 tis a cd by:;n5A/v/ i'//G Date: LS 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 of the granting of this permit. Additionally,the applicant understands and will comply with RE-ROOFS: all non-point source regulations per the Cupertino Municipal Code Section 9.18. All roofs shall be inspected prior to any roofing material being installed.If a roof is AA � installed without first obtaining an inspection,I agree to remove all new materials for Signature ��/L____� Date inspection. fry/ Signature of Applicant: Date: ❑ OWNER-BUILDER DECLARATION ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: r 1,as owner of the property,or my employees with wages as their sole HAZARDOUS MATERIALS DISCLOSURE compensation,will do the work,and the structure is not intended or offered for 1 have read the hazardous materials requirements under Chapter 6.95 of the sale(Sec.7044,Business&Professions Code) California Health&Safety Code,Sections 25505,25533,and 25534. I will main(all) 2. 1,as owner of the property,am exclusively contracting with licensed contractors to compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& construct the project(Sec.7044,Business&Professions Code). Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air I hereby affirm under penalty of perjury one of the following three declarations: contaminants as defined by the Bay Area Air Quality Management District 1 will 1 1 have and will maintain a Certificate of Consent to self-insure for Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation,as provided for by Section 3700 of the Labor Code,for the Health&Safety Code,Sections 25505,25533,and 25534. performance of the work for which this permit is issued. Owner r h rized agent: 2. 1 have and will maintain Worker's Compensation Insurance,as provided for by Date:—O*r Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 7 CONSTRUCTION LENDING AGENCY s. 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 I hereby affirm that there is a construction lending agency for the performance of work's Compensation laws of California. If,after making this certificate of exemption,I for which this permit is issued(Sec.3097,Civ C.) become subject to the Worker's Compensation provisions of the Labor Code,I Lender's Name must forthwith comply with such provisions or this permit shall be deemed Lender's Address revoked. ARCHITECT'S DECLARATION APPLICANT CERTIFICATION I understand my plans shall be used as public records. 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 Licensed Professional 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, costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18, Signature Date GENERAL PERMIT APPLICATION MEP COMMUNI TY DEVELOPMENT DEPARTMENT -BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 (408)777-3228 • FAX(408)777-3333• building(cDcupertino.oro ISC CUPERTfNO 1'1"gFa'qy ❑PLUINIBING CHANICAL ❑ELECTRICA-L ❑A111SCELLANEOUS PROJ Cf.hDDRESS .SPN R �� 57 , O G OWNTER NAME / n S `b' P 0 , 2v E-1✓ia IL STREETP.DDRESS © fy� `�rl / CITY, ST E,ZIP F.kx (� 7 !(/G CONTACT NAME O �`„ / PHONS E-MAIL STREET ADDRESS CITY,STATE,ZIP F.AX ❑ OR'NrZ.t ❑ OV,^.cR-BTMDE:t ❑ OWNER AGM'T CO!-MACTOR ❑CONTRACTOR AGETT ❑ ARCHITECT ❑ ENOINEER ❑ DE,,LOPER ❑ T= AT? CONT. CTO Ne l LI t BUS.LIC r COMPANY N.AN,E E-MAIL �7 FAX STREET ADDRESS n ,` CITY,ST.(/ T',Z1P /I�(f J I RCHITECT/ENGt SER NAME LICENSE NUDfBER BUS.LIC C/ COMPANY NAME E-MAIL — I FAX STREET.4DDRESS CITY,STATE,ZIP PHONE USE OF VS FD or DUPLEX ❑ MULTI-F.A.,CLY PROJECT IN WILDLAND ❑ 17S PROJECT IN ❑YES IS THE BLDG.4N ❑ YES BUII.DING: ❑C0h9IERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO EICHLER HOME? p DESCRIPTION OF WORK TOTAL VALUATION: // RECEIVEDBY: By my signature below,I certlfy to each 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 correct. I ha a read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to bu d' g con ction. orize representatives of Cupertino to enter the above-idem' ed pro Pty fl inspection purposes. Siggnah:re of Applicant/Agent: Date: SUPPLEMENTAL II\ RMATION REQUIRED OFFICE USE ONLY OVER-THE-CO LITER ` ❑ E.XI'F.ESS ❑ ST ND.!,RD ❑ GE ❑ m-10 R A1EPMisc.4pp_2011.doc revised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION [APN: DDRESS: 10842 Northfield Scl DATE: 09/29/2015 REVIEWED BY: Sean BP#: *VALUATION: 1$6,000 PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair TPENTAMATION FURN/AC USE: PERMIT TYPE: PRIMARY SFD or Duplex WORK Add air conditioning to existing system. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES A/C Units (<=1OK cfm) 1BREMAIR 1 # $72 TOTALS: $72.00 Mech. Plan Check TO.0 hrS $0.00 Fmech. Permit Fee: IMPERAII7' Other Mech. Insp. 0.0 hrs $48.00 Ll L- NOTE. This estimate does not include fees due to other Departments(i.e. Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Thesefees are based on the preliminarl information available and are only an estimate. Contact the De t or addn'l info, FEE ITEMS (Fee Resolution I1-053 U. 4/13) FEE QTY/FEE MISC ITEMS Plan Cluck Fee: Suppl. PC.'Fee PME Plan Check: $0.00 )lit Fee: 111sp I. , PME Unit Fee: $72.00 PME Permit Fee: $48.00 Colts 'tic'llotl Tax: Administrative Fee: ]ADMIN $45.00 Work Without Permit? O Yes (E) No $0.00 IfIvanced P/r.umillif Fees: Travel Documentation Fee: ITRA VDOC $48.00 Stronp,Motion Fee: IBSEISMICR $0.78 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $214.78 $0.00 TOTAL FEE: 1 $214.78 Revised: 07/02/2015 STATE OF CALIFORNIA ALTERATIONS - HVAC CEC-CFIR-ALT-03-E Revised 06114 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE CF1R-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#: Equipment Type4— / Equipment Efficiency New:Ducting,Plenums,Lineset Conditioned Thermostat l,(A I Required R-value Floor Area(sq ft) C3 Packaged System Evaporator Coil AFUE COP 13R-6 (CZ 1,3-7)Ducts ./ Sery by ystem Setback plit System Condensing Unit SEER ❑ R-8' 16)Ducts ry//+' sq ft not already HSPF 13R-6(allll Q's)Plenums � present,must ❑ Furnace 1cLineset 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 for 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. HVAC Changeout/Repair Required Compliance Documents to be left on site for Final: Can-include new ducting All E CF1R-ALT-02-E 'Condenser Unit,Evaporator Coil, CF2R:MECH-01,MECH-20-HERS Air Han er urn 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 ❑B.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' CF1R-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(.58W/CFM),Air Flow z 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: 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. ❑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 space but less than All New Ducts' CF2R:MECH-20-HERS CF3R:MECH-20-HERS Installer lLegpirecl to:Duct leakage I<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. '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. '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-2Y..",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. 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 De' ner N me: Respo lie DeJ5igner Signature: Date Sig ed: License: Co any: . Addr s: City/State/Zip: Phone: 7 Lu*Q,M 1.A 0Dr�- zo -3 For assistance or q estions regarding the Energy Standarcig,contact the Energy Hot Ine at:1-800-772-3300 ?57U w ^ 00 E v M N Na N W 7 O Ql 'D p, N N V T a � 00 O O O C00 H f0 N E ''y 'y v 'C -(O N LL d m O Q1 V u0 « Y :Y p O Q Q a LA v O o L N W Y S � in y Q) e,. m C C v C N T N p 0) Ln 7 O vY+ vT+ z t O _ C N a 00o _ 3 m Z m y E v r,4c c Ln-� W tDD 00 = T c 4l fl- OC O O O y 41 vii z CL 7 C C v E C 4 O O CL m v, 4, v o o v o 0 v 3 c c p a+ C 4 40 N n L �_ c N �- c O N N F+ z 01 v c E c Y a 0 m a, 4 a C O u C 0 v Zto m V � d - a- n' .N E -aj u N N - Q C C w N :24J fl_ H _ O v V O 0 0 LU 3 d 0A OD to (U L a+ V1 n. O p CL a C C C < 0 3 ate+ of 47 � Ln t' 6J 4J 4J 4J O E N v E C L E m Ln o bD a 5 3 3 o z _ C c ul Z C O co O 0 LL Z 7 O C N O } 47 N O N N _ N a W m N C W 00 O EO O. 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Q v V) %v 7 01 W c 2 ;.. 0 m0 O w c 2 � � m0 � ~ d v U E v a 0 v Z �n Q .: N rvi v vi o a v Z in '� m w `-' O - �u E = -8O Z aY nn E �_ v O Y Z v Q V Q uQ an iv vv) OC " ria U° Q ¢ n uN w U p WATER-CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE FILE COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 1 C U P S RT I N O 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 �, I408)777-3228 �AyXs408)777-3333• buildina(�cupertino.org O� Owner Name �7'j'j4¢_ - /L/ Permit No. f y y YL / �7 �-- Address i'f� l5 7 L /U� �� � s (id&Z6 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. XInto 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. .XNo 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. )�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. 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.. 5. Please check ONE of the following: jX 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. 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,as the owner or owner's agent of this property, certify under penalty of perjury that non-compliant plumbing fixtures will be replaced prior to date specified above with Nvater-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: Date: 1,,li//j- Upon completing and signing tlus Certificate,please return it to the Building Division in order to final your building permit. SB4072015.docrevised 08126115 BUILDING PERI\HT.CANNOT BE FIN aLED AND COI\11PLETED_UNTIL THIS CERTIFICATE HAS BEEN SIGNED AND RETURNED TO THE BUILDING DIVISION- Non-Compliant Water-Conserving Plumbing Fixture Plumbing Fixture! (Fixture Complying with Current Code Applicable to New Construction) Maximum Water Usage/Flow Rate Fixture Type 2013 CPC Ch. 4 2013 CPC Ch. 4 2013 CPC Ch. 4 Water Usage 2013 CALGreen Div. 4.3 2013 CALGreen Div. 4.3 2013 CALGreen Div. 5.3 !Flow Rate 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. SB4071015.doc remised 08126115 SMOKE / CARBON MONOXIDE ALARMS FILE OWNER CERTIFICATE OF COMPLIANCE =(T I/ COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333• buildingal�cugertino.org Permit No. � L / AddressT�y � ��1 ��"�` ' #of Alarms Smoke: Carbon Monoxide: : PERMIT CANNOT BE FFNALED AND COID�LETED UNTIL THIS CERTIFICATE HAS BEEN SIGNEDAND RFTURNFD 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 X X bedroom(s) 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. 1 have read and agree to comply with the terms and conditions of this statement Owner(or Owner Agent's)Name: �v,� �1 t�• a Si nature...... ..� l�lsr1.............................................................................Date: Contractor Name: Signature...................................................................Licl......................................Date: ................... Smoke and CO form.doc revised 03/18/14