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B-2016-1858 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1858 19750 AUBURN DR CUPERTINO,CA 95014-2414(316 35 017) CALIFORNIA DELTA MECHANICAL OWNER'S NAME: KANDURI SYAMALARAO V AND AKELLA PADMA DATE ISSUED:05/02/2016 OWNER'S PHONE:408-807-5764 PHONE NO:888-828-0707 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class CC20 Lic.#811114 Contractor CALIFORNIA DELTA MECHANICAL Date X BLDG -ELECT -PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing X MECH X_RESIDENTIAL_COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: INSTALL(N)A/C IN REAR YARD&REPLACE(E)FURNACE I hereby affirm under penalty of perjury one of the following two declarations: 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 erformance of the work for which this permit is issued. 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 is issued. Sq.Ft Floor Area: Valuation:$8000.00 APPLICANT CERTIFICATION 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 Number: Occupancy Type: 31635 017 and state laws relating to building construction,and hereby authorize 316 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and will comply with all non-point source regulations per the CuafoTno Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 05/02/2016 Issued by:MELISS Date:05/02/2016 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is r. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended or offered for inspection. sale(Sec.7044,Business&Professions Code) z. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:05/02/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER t. 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 performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code,forthe performance of the work for which this California.Health&Safety Code,Sections 25505,25533,and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous 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 Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sectio ,25505,25533,and 25534 Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent:.,w. APPLICANT CERTIFICATION Date:05/02/2016 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.) to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 05/02/2016 Professional GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT'DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE o CUPERTINO, CA 95014-3255 (408)777-3228 ®'FAX(408)777-3333•buildinggcupertino.org CUPEIMNO m1bu �3 Z o/46 �5 ❑PLUMBING ®MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS APN# U j OWNER NAME E-MAIL - STREET ADDRESS CITY, S TE,ZIP FAX_ 7--l-0 (/� - L /T/ cv �h n D/ CONTACT NAME / P 0 E-MAIL i/© ST ET ADDRESS CITY,STATE,ZIP / FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT Q CONTRACTOR ❑CONTRACTOR AGENT 0 ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CO RAC NAME LICEN, I� �EIS LICENSE TYPE Q BUS.LIC#2 Z -7-S MCO AI\ AME E-MAIL FAX G/j�y l/Z ,n5 ST ET ADDRESS CITY,STATE,ZIP P E LL «C ,l4 2 -20 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTIFAMILY PROJECT IN bVILDLAND ❑ YES PROJECT IN ❑ YES IS THE BLDG AN ❑ YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO EICHLER HOME? ❑ NO DESCRIPTION OF WORK /_ / TOTAL VALUATION: q LJ By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on 2-pr r owner's behalf. I have read this application and the inforniation I have provided is correct. . read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building con - ron. authorize representatives of rpertinb to enter the above-identified property for in ection purposes. Signature of Applicant/Agent: / Date: SUPP NT L INFORMATION REQUIRED oFFzcE iisE onL� ,x' ❑ OVER THE COUNTER E .- ❑ EXPRESS Y ` U ❑ STANDARD U' ..I ❑ LARGE ❑ )\'Ir1JOR MEPMiscApp_2011.doc;revised 06/21/11 CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E Alterations to Space Conditioning Systems(formerly CF-1R-ALT-HVAC) (Page 1 of 3) Project Name: 19750 Auburn Dr Date Prepared: 2016-04-27 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 CFIR-ALT 02 document for each dwelling unit. 01 Project Name 19750 Auburn Dr 02 Date Prepared 2016-04-27 03 Project Location 19750 Auburn Dr 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name 19750 Auburn Dr Dwelling Unit Conditioned 07 Zip Code 95014 08 Floor Area(ft2) 1875 Number of space conditioning 09 Climate Zone 4 10 (SC)systems in this dwelling 1 unit. B.Space Conditioning(SC)System Information 434 "`i ✓ .:,`fit 01 02 03 : : 04 .E 05 06 U7° f 08 r 4. ,0, . . 09 10 Is the SC""' Installing a SC System SC System CFA served systema refrigerant Jnstalliii nevik Installing Installing- Installing Identification or Location or Area by this SCducted 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 3 Ton A/C Whole Home 1875 Yes Yes Yes No No No Altered space Condenser&Coil conditioning system C. Extension of Existing Duct System,Greater Than 40 Feet(Section 150.2(b)1Dii b) This section does not apply to this project. Registration Number:216-A0157978A-000000000-0000 Registration Date/Time: 2016-04-27 15:28:21 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007. Report Generated:2016-04-27 15:28:16 Schema Version:0.555SDD CERTIFICATE OF COMPLIANCE CF1R-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)1E 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 3 Ton A/C Central gas Central split No heating This field or This field or All new This field or This field or Condenser& component section is not section is notAC cooling SEER 14 Setback section is not section is not Coil furnace altered applicable applicable components applicable applicable Reouired Documentation: CF211-MCH-01-E-Space Conditioning Systems Ducts and Faris -Duct insulation requirement for new plenums:R6. MR-MCH-20-1-1&MR-MCH-20-1-1—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:<_15%,or<_10%leakage to outside for seal all accessible leaks. CF2R-MCH-25-H&MR-MCH-25-H Refrigerant Charge Verification required when refrigerant containing components ate installed or altered(applicable in CZ 2,8-15).. CF2RCF3R-MCH-23&CF3R-MCH-23 Air Flow>_:300 CFM/ton required when MCH-25 is required. Exceptions: -Duct systems registered with HERS provider as previously sealed are exempt from-MCH 20 Duct Leakage Testing requirements -Heating-only systems and Air Handler/Furnace changes do not,requirevenfication of Air Flow MCH�23,,or Refngerarit`'Charge MECH 25`� Existing duct systems constructed,insulated or sealed with asbestos�are exem t€from MCH=20 puct Leakage Testrng r gwrement's � . _ aA Vp 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-A0157978A-000000000-0000 Registration Date/Time: 2016-04-27 15:28:21 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016704-27 15:28:16 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: st, w Fiore,Stephen � Company: Signature Date: CALIFORNIA DELTA MECHANICAL INC 2016-04-27 15:28:21 Address: CEA/HERS Certification Identification(if applicable): 1235 GRAND AVE City/State/Zip: Phone: SPRING VALLEY CA 91977_ 480-898-0007 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 of the Business and Professions 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 ofthe California Code of Regulations. 4. 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 bwlding permit application. 5. 1 will ensure that a registered copy of this Certificate of Compliance shall be.made:wMlable'with the building permit(s),issued for'the building,,and made availableto enforcement agency for all applicable inspections.I understand that a registered copy of this Certificate of Compliance is_required to be included with the.documentatiion the builder provides to.the building owner at occupancy. Responsible Designer Name: Responsible Designer Signature. Fiore,Stephen Company: Date Signed: CALIFORNIA DELTA MECHANICAL INC 2016-04-27 15:28:21 Address: License: 1235 GRAND AVE 811114 City/State/Zip: Phone: SPRING VALLEY CA 91977 480-898-0007 Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document and in noway implies Registration Provider responsibility for the accuracy of the information. Registration Number:216-A0157978A-000000000-0000 Registration Date/Time: 2016-04-27 15:28:21 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residential Compliance Report Version:2013 Rev 1.007 Report Generated:2016-04-27 15:28:16 Schema Version:0.555SDD CUPERTINO f2C-P L1`YG� �,2N e� I'p �uildinca Department r g f AN Tv!` .S�i+c�X11 /4/i n+d tf�'1 �. �N A-1C REVIEWED FOR CODE COMPLIANCE � T- Reviewed By: Y f4! f w m Y co .p m Y m cn CIO, • T �l,%~,.nz���c,���?ijS a�� G/�j�(°pA � Elk. -;ca( j ��'/�f�o,o'��j.1`.'✓,_�c�0i�• �` � �'o�R-1/,� I uj o VIM` A � "���+1` p/•, OLS �S SCi+ Yl�/ lJ L' t p; o Sf Off. .lam oi r`50� s��"©°% Co �;�tioPL PLAN C EC Y 17750 A4bLry P- m 's ®A 2 1- PLANNI14b DEPT CUPERTINO