B-2016-1631 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1631
11053 BEL AIRE CT CUPERTINO,CA 95014-4701(356 16 049) T F F HEATING AND
AIR CONDITIONING
MILPITAS,CA 95035
OWNER'S NAME: DURHAM STEPHEN J AND EILEEN S TRUSTEE DATE ISSUED:03/25/2016
OWNER'S PHONE:408-446-1876 PHONE NO:(408)515-5832
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class WARM-AIR HEATING VENTILATING AND AIR-CONDITIONING
Lic.#917350 X BLDG ELECT PLUMB
— — —
Contractor T F F HEATING AND AIR CONDITIONING Date 06/30/2016 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 JOB DESCRIPTION:
license is in full force and effect. REMOVE&REPLACE(E)FURNACE,SAME LOCATION
I hereby affirm under penalty of perjury one of the following two declarations:
r. 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
0 perf nance of the work for which this permit is issued.
lave 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:$1950.00
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above APN Number: Occupancy Type:
information is correct.I agree to comply with all city and county ordinances 356 16 049
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 PERMIT EXPIRES IF WORK IS NOT STARTED
City of Cupertino against liabilities,judgments,costs,and expenses which WITHIN 180 DAYS OF PERMIT ISSUANCE OR
may accrue against said City in consequence of the granting of this permit.
Additionally,the applicant understands and will comply with all non-point 180 DAYS FROM L CAL + + ON.
source regulations per the Cupertino Municipal Code,Section 9.18.
Issued b AMES
Signatureoe Date 03/25/2016 Dat
OW R-B iLDER RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed.If a roof is
following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
r. I,as owner of the property,or my employees with wages as their sole inspection.
compensation,will do the work,and the structure is not intended or offered for
sale(Sec.7044,Business&Professions Code) Signature of Applicant:
2. I,as owner of the property,am exclusively contracting with licensed Date:03/25/2016
contractors to construct the project(Sec.7044,Business&Professions Code).
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 HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
2. 1 have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will
Section 3700 of the Labor Code,for the performance of the work for which this maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous
a. I certify that in the performance of the work for which this permit is issued,I material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to 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
Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code,Sections 25505,25533,and 25534.
exemption,I become subject to the Worker's Compensation provisions of the
Labor Code,I must forthwith comply with such provisions or this permit shall Owner or authorized agent:
be deemed revoked. Date:03/25/2016
APPLICANT CERTIFICATION CONSTRUCT N LEN N Y
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance
correct.I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued(Sec.3097,Civ C.)
relating to building construction,and hereby authorize representatives of this city Lender's Name
to enter upon the above mentioned property for inspection purposes. (We)agree
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 ARCHITECT'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
Professional
Signature Date 03/25/2016
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
CUPI"RTINO (408)777-3228• FAX(408)777-3333• building(o-cuoertino.oL9
T17- 0ic, 16 -
❑PLUMBING ECHANICAL ❑ELECTMCAL ❑MISCELLAIN'EOUS
PROJECT ADDRESS APN n j
OWNER NAME ` t ' r Vl.. Du(WA
PHONE 0S E- AILSTREET ADDRESS " ' CITY, STS A,IP l:^ ��f A r�iFAX
NAME ��`� �r {!O o PHONE �,8`--- /
STREET ADDRESS Y V C Gt (�J CITY,STATE, ZIP �j O FAX
❑ ONR`ER ❑ OWNER-BUILDER OWNER AGENTT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME �� ��( r� LIC ENSEI�'UASER �1 LICEN'S TYPE 20 BUS.LIC, /
COMPANY NAME -TF F- t1 / 4c ` E-MAIL '4c—^ Gck-o 01r. I FAX l
STREET ADDRESS b o CITY,STATE,ZIP PHONE
ro
ARCIMECT/ENGINEER NAME LICENSE NUMBER BUS.LIC n
COMPANY NAME F_-h4AIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF FD or DUPLEX ❑ TULTI-FAMILY PROJECT LN wILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES
BI=IN'G: ❑COMMERCIAL URBAN IN'T'ERFACE AREA ❑ NO FLOOD ZONE ❑ NO EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
c
TOTAL VALUATION: S� REC
By my signature below,I certify to each of the fol]owing: I am the property owner or authonz 157 ac e prope s behalf. M
application and the information I have provided is correct. I have read the Description of Work and verify it is acc _ee to comply with all applicable local
ordinances and state laws relating to building constructi . I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTA—ETNTORMATION REQUIRED oFFtc
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AfEPA1iscApp_2011.doc revised 06/21/11
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems(formerly CF-IR-ALT-HVAC) (Page 1 of 3)
Project Name: Stephen Durham Date Prepared: 2016-03-25
A.General Information
MR-ALT-02 is applicable to multiple space conditioning systems contained within a single dwelling unit.When multiple dwelling units must be documented,
use one MR-ALT-02 document for each dwelling unit.
01 Project Name Stephen Durham 02 Date Prepared 2016-03-25
03 Project Location 11053 Bel Aire Ct 04 Building Type Single family
05 CA City Cupertino 06 Dwelling Unit Name Stephen Durham
07 Zip Code 95014 08 Dwelling Unit Conditioned 2600
Floor Area(ft2)
Number of space conditioning
09 Climate Zone 4 10 (SC)systems in this dwelling 1
unit.
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 Installing 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
System 1 Location 1 2600 Yes No Yes No No No Altered space
conditioning system
C. Extension of Existing Duct System,Greater Than 40 Feet(Section 150.2(b)1Diib)
This section does not apply to this project.
Registration Number:216-A0114016A-000000000-0000 Registration Date/Time: 2016-03-25 09:05:05 HERS Provider:CalCERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-03-25 09:04:59
Schema Version:0.555SDD
CERTIFICATE OF COMPLIANCE CF111-ALT 02-E
Alterations to Space Conditioning Systems(formerly CF-1R-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
Central gas All new Central split No cooling This field or This field or This field or This field or
System 1 AC heating AFUE 0.8 component section is not section is not Setback section is not section is not
furnace components altered applicable applicable applicable applicable
Required Documentation:
CF2R-MCH-01-E-Space Conditioning Systems Ducts and Fans
-Duct insulation requirement for new plenums:R6. r;
CF2R-MCH-20-H&CF3R-MCH-20-H—Duct Leakage testing 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:55
15%,or 10%leakage to outsidd,'or seal all accessible leaks.
CF2R-MCH-25-H&CF3R-MCH-25-H Refrigerant Charge Verification required when refrigerant containing components are Installed or altered(applicable in CZ 2,8-15).
CMCF313-MCH-23&CF3R-MCH-23 Air Flow�t 300'CFM/_ton regiaired when:MGH-25 is required.
Exceptions:
-Duct systems registered with HERS provider as'previously sealed are exempt from MCH20 Duct Leakage Testing requirements; r
-Heating-only systems and Air Handler/Furnace changes do not.,require venfication'of Air Flow MCH-23,lor'Refrigerant Charge MECH 2S 4' 4
-Existing duct systems constructed,insulated or sealed with asbestos-.are exemprfrom MCH`-20 Du"tr1-6kage Testing regwremer.s ' ' '
.l`
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 does 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:216-A0114016A-000000000-0000 Registration Date/Time: 2016-03-25 09:05:05 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-03-25 09:04:59
Schema Version:0.555SDD
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: T�J�r
Ferreira,Tony f
Company: Signature Date:
T F F HEATING AND AIR CONDITIONING 2016-03-25 09:05:05
Address: CEA/HERS Certification Identification(if applicable):
299 CORNING AVENUE
City/State/Zip: Phone:
MILPITAS CA 95035 408-786-8120
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 ofthe'Biisiness`and Prdfessions 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. I
4. The building design features or system,design features identified on this Certificate of Compliance are consistent with the information.provided on oth'Wapplicable"compliance documents,worksheets,
calculations,plans and specifications submitted to the enforcementagency forapprovalwith this building permiE application.
5. I will ensure that a registered copy of this Certficate of Compliance'shall be:niade available with the 6.fldirig.permit(s),issued for the building,and made available;to.the`enforcement agency for all applicable
g copy p q , p, _ides to the building owner at occupancy.
inspections.I understand that a re istered co of this Certificate of Com liance.is.re uired to be,included with the.documentation.the builder royid
Responsible Designer Name: Responsible Design"er S'ignafure. `
/may o
Ferreira,Tony O
Company: Date Signed:
T F F HEATING AND AIR CONDITIONING 2016-03-25 09:05:05
Address: License:
299 CORNING AVENUE 917350
City/State/Zip: Phone:
MILPITAS CA 95035 408-786-8120
Digitally signed by CaiCERTS. 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 Number:216-A0114016A-000000000-0000 Registration Date/Time: 2016-03-25 09:05:05 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-03-25 09:04:59
Schema Version:0.555SDD
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
Ct, PERTINO 10300 TORRE AIWENUE•CUPERTINO,CA 95014-3255
(408)777-3228• FAX(408)777-3333•building(o-kupertino.org
Ad s V J l L 1. Y v v #of Alarms Smoke Carbon 1Vlonox e:
PERMIT CANNI�T I3E,FINALED AND COMPLETED UNTII;THIS GERTIPICATE
:HAS BEEN,� �,f,�ANI)BETY7RNED TO THE I3iTQ:,DIlYG T)IVISIOI�. ..
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 sleepingroom 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 8314 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 tog,6mdlywykftternfFcondi4ons of this statement
Owner0 ownerA aenfs)_Nama:_
v� W� Si nature .............`..Date. k °
p-ntr—1-- M.
P
Snake and CO fotm.doc revised 03/18114
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT.BUILDING DIVISION
CUPlERT1N0
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3 FAX 08)777-3333•building -cupertino.orct �f„
Owner Name,( I Permit Non KJ
Address rlCIA4��tl(O_Qi A-
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.
'0°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.
Q The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
Cj I$°No Go to Question 3,
3. Is water service permanently disconnected for your building?
El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
El%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.
uYes 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:
'�L- 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).
1,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 water-conserving plumbing fixtures in accordance with Civil Code Sections 110 1.1
through 1101.8,the current California Plumbing Code and Cal' is G en Building Standards Code,and manufacturer's
installation requirements,and that the w ter, e g plumb g 1 s comply with the requirements as indicated in the
table on the following page.
Owner or Owner Agent's Signature j Dafe iWsIle
Upon completing and signing this C6-i`E ficate,please return it to the Building Division in order to final your bui ding permit.
SB4072015.doc revised 08126115