B-2016-2592CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
19479 ROSEMARIE PL APT 1 CUPERTINO, CA 95014-3452 (375 01 007)
CALIFORNIA DELTA
MECHANICAL INC
6056 E BASELINE RD
MESA AZ 85206
NO: B-2016-2592
OWNER'S NAME: COHEN DAVID N ET AL I I DATE ISSUED: 08/25/2016 I
PHONE: 650-766-9160
LICENSED CONTRACTOR'S DECLARATION
License Class C-20 Lic. # 41114
Contractor CALIFORNIA DELTA MECHANICAL INC Date 8/31/2018
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:
1. 1 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.
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
permit is issued.
APPLICANT CERTIFICATION
certify that 1 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, 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.
Date 8/25/2016
14=01 01 :: II 1 t 1 Y i►
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. 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)
2. I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code)..
NO: 888-828-0707
PERMIT INFO:
BLDG —ELECT —PLUMB
MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
UNIT 1 - REPLACE A/C (SAME LOCATION)
Sq. Ft Floor Area: I Valuation: $9488.00
APN Number: Occupancy Type:
37501 007
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
by: AbbL, eL nde
RE -ROOFS:
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.
Signature of Applicant:
Date: 8/25/2016
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF
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.
2. 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
permit is issued.
s. 1 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 become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
APPLICANT CERTIFICATION
I certify that 1 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, 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.
Date 8/25/2016
tt A tt
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
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
the Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized agent- . - ----'"--
Date: 8/25/2016
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT * BUILDING DIVISION
10300 TORRE AVENUE CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildinoCDcupertino.org
CUPERTIN
❑PLUMBINTG MECHANICAL ffTELECTRICAL ❑MISCELLANTEOUS
PROJECT ADDRESS 1-7 t17 �� �' 7NOZVNERNAME C1 P NE E-h2AIL
STREET ADDRESSCITY, S TE, ZIP FAX
CONTACT NAME /� PHONE E-MAIL
STP,EETADDRESS CITY, STATE, ZIP FAX
4 ! r2 2
❑ OwNER ❑ OWNER-BUILDFR ❑ OwNERAGENT CONTRACTOR 4 CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTTTRAC-LOR NAMF LICENSE NUA4BER LICENSE TYPE I BUS. LIC -
CQJMPANY NAME r E-MAIL FAX
ST ET ADDRESS CITY, STATE, ZIP y
PZ204fa ^ r
ARCHITECT/ENGINEER NAME LICENTSE NUMBER BUS. LIC -1-
COMPANY
COMPANY NAME E-MAIL I - FAX
STREET ADDRESS CITY, STATE, ZIP PHONE
USE OF ❑ SFD Or Duplex Q Multi-Family PROJECT IN «RLDLAND I PROJECT N
STRUCTURE ❑ Commercial I URBAN INTERFACE AREA Q Yes ❑ NTO FLOOD ZONE ❑ Yes ❑ NO
DESCRIPTION OF WORK �-
a - Cy < cl1 �' Ul�i
fir_
TOTAL VALUATION:!91 `� e 01 RECEIVED BY �f
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By my signature below, I certify to each of the following: I al roperty 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..- ve read the Description of �7ork and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building . I authorize representatives of pertino to enter the above-identified property for inspection purposes.
Si --nature of Applicant/Agent:Date:t7tC
EM INFORMATION REQUIRED oFFicE,usE o iY � . ,
O1,ER THE COUTTER
,WRESS
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.;� STAN'D ARD
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T�ZAJOR
A7EPA7iscApp_.2011.do0 revised 03/16/11
ALTERATIONS - HVAC
c
CEC-CFI R -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 -IR -ALT -HVAC) (Page 1 of 1)
Site Address:
Enforcement Agency:
Date Prepared:
Permit#:
Equipment Type Equipment Efficiency
New: Ducting, Plenums, Lineset
Conditioned
Thermostat
Required R -value
Floor Area (sq ft)
❑ Packaged System
O Evaporator Coil
AFUE
COP
❑ R-6 (CZ 1,3-7) Ducts
Served by system
Setback
Split System
El Condensing Unit
.SEER
13sqft R-8' (CZ 16) Ducts
(If not already
El Furnace
11 Lineset
EER
HSPF
El R-6 (all Qs) Plenums
present, must
❑ R-5 or R7.5 Lineset3
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 allovwed to b'e flied"out'by hand: For final inspection all forms are to be registered (no handfilled forms allowed) and a copy left on site.
❑ 1. HVAC thangeout/Repair
Required Compliance Documents to be left on site for Final:
Can include new ducting
All Equipment,
CFIR-ALT-02-E
Condenser Unit, Evaporator Coil,
CF2R: MECH-01, MECH-20-HERS
Air Handler/Furnace
CF3R: MECH-20-HERS
Installer Requirement: Duct leakage (:S.15% or,:L10% 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 D 2. There is less than 40 linear feet of duct in unconditioned
space, or 113. 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' CFIR-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 >_ 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 CFIR-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 CFBR-MECH-20-HERS, MECH-(23 or 24) -HERS
Installer Requirement: Duct leakage < 6%, Air Flow_ 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 duds 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 (:<_15% or, 5_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 dud system (e.g., registers, grilles, boots, air handier, plenums, duct material.
3 R -S. (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-2%", 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. I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the information on this document.
3.1 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 Designer Name:
Responsible Designe at re ---•—"""`
Date Signed:
License:
/
Company:
Address:
City/State/Zip:
Phone:
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300