B-2016-2902CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-2902
10959 MARIA ROSA WAY CUPERTINO, CA 95014 (356 19 043)
AIR QUALITY
HEATING & AIR
CONDITIONING
INCORPORATED
SAN JOSE, CA 95126
OWNER'S NAME: MAH ROBERT WEBER AND LANI CHOW TRUSTEE
DATE ISSUED: 10/12/2016
OWNER'S PHONE: 408-528-5475
PHONE NO: (408) 920-3910
LICENSED CONTRACTOR'S DECLAR ATION
BUILDING PERMIT INFO:
License Class C220 Lic. #769446
Contractor AIR QUALITY HEATING & AIR CONDITION ING INCORPORATED
X BLDG _ELECT X PLUMB
X MECH X RESIDENTIAL _ COMMERCIAL
Date 06/30/2017
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.
REPLACE 2 (E) FURNACES (GARAGE/ATTIC) & 2 (E) A/C UNITS
(SIDE YARD); REPLACE WATER 50 GAL WATER HEATER
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
performance of the work for which this permit.is issued.
:q0:/ 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
Sq. Ft Floor Area:
Valuation: $0.00
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 19 043
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
1$0 DAYS FROG- SPECTION.
source regulations per the C pertino Municipal Code, Section 9.18.
_
Issued by: MELISSA
Signature J Date 10/12/2016
Date 10/12/2016
/�
O R-B Tir DF1 D R TION
_
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE-ROOFS:
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
1. 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. 1, as owner of the property, am exclusively contracting with licensed
Date: 10/12/2016
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. I 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
3. 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: 10/12/2016 /
ENCY
APPLICANT CERTIFICATION
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
and will comply with all non-point source regulations per the Cupertino Municipal
ARcfHTECT'S DECLARATION
I understand my plans shall be used as public records.
Code, Section 9.18.
Licensed
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
UFS Eti` Nt (408) 777-3228 • FAX (408) 777-3333 • building(a-cupertino.org MISC
_ 73 Z O z
PLUMBING 9MECHANICAL'CAL ❑MISCELLANEOUS
PROJECT ADDRESS l
1 () G'7 9 51 ax-\% zcsc, ?, APN # 7 -5:'K r j' _0Y3 1
OWNER NAME \ i ^
PHONE G 2
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
A. Cks3;-
FAX
CONTACT NAME /� ��^..�"� (
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PHONE kA(Z �V &S Q
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STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑. ENGINEER. ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
v- C PrA ,
LICF.,EE E
I V / J
LIC E TSE_
BUS r rr
COMPANY NAME j�
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E-MAILE�-yMAIL ,��rrq-y�.'.,
(W-cl w46
FAX ,}rte c
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C•/
STREET ADDRESS
CITY, STATE ZIP p _ ry /
� a V-0 �� c C-6 12- C
PHONE-
_40 ' l2_0} 'SC'a
ARCIIITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ AFD or DUPLEX ❑ MULTI -FAMILY
BUILDING: ❑COMMERCIAL
PROJECT IN WILDLAND ❑ YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ YES
FLOOD ZONE ❑. NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
TOTAL VALUATION: 2 CE�VED B:
By my signature below, I certify 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 have 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'ldin constAiction. I authorize representatives of Cupertino to enter the above -identified
I property for inspection purposes.
Signature of Applicant/Agent: J. 1� Date: 10 / f/fZ/ G0 I (4
AL INFORMATION REQUIRED
MEPMiscApp_2011.doc revised 06121111
M
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT HVAC) (Page 1 of 3 )
Project Name: 10959 Maria Rosa Way Date Prepared: 2016-09-12
A. General Information
CF1R-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
10959 Maria Rosa Way -
02
Date Prepared
'2016-09-12
03
Project Location
10959'Maria Rosa Way
04
Building Type
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
10959.Maria Rosa Way
Identification
y stem
r ig a`t
�Jnstalh��
�,.g
sta
07
Zip Code
95014
8
Dwelling Unit Conditioned
2789
containing
system
`
t
Floor Area (ft2)
09
Climate Zone
4
component?
Number of space conditioning
feet of ducts?
duct system?
SC system?
Alteration Type
10
(SC) systems in this dwelling
2
Yes
Yes
Yes
No
unit.
No
B. Space Conditioning (SC) System Information
�� ° .
' '
01
02 43 w
04
0
lk,
7
� 09
10
SC System
SC System CFA served
Is the SC"
r
i��
nstallong a
t01
f ri die
'
�� ����
""�
V.
+,w
Identification
y stem
r ig a`t
�Jnstalh��
�,.g
sta
ns alh
�ga
r#nstalling
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
2789
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
System
Location2
2789
Yes
FYes
Yes
No
No
No
Altered space
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)1Dib)
This section does not apply to this project.
Registration Number: 216-A0335984A-000000000-0000 Registration Date/Time: 2016-09-12 11:31:04 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-09-12 11:31:37
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -1R -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:
Velluto, Angie
Company:
Signature Date:
The Energuy CA LLC
2016-09-12 11:31:04
Address:
CEA/ HERS Certification Identification (if applicable):
1215 K St., 17th Floor
City/State/Zip:
Phone:
Sacramento CA 95814
J
877-600-0123
Responsible Person's Declaration statem0k4•,k
I certify the following under penalty of perjury, under the Iaws'of the State of California:
1. The information provided on this Certificate of Compliance irs true_ and correct.
2. t am eligible under Division 3 of thg.Business°and Professions Code to acceptresponsibilityfor the building design or system design identified on this Certificate of Compliance (responsible designer).
3. That the energy features and pert `ance specifications, materials,°com onents, and anufactu ed devices for the buildlindesign or system desi n identified' on this Certificate of Compliance conform to the
N
requirements ofTitle 24, Part 1 andPart ',ofthe Californt Code of 13=
4. The building design features or system design features identified o is Certiiiat f C m lance ar to thermovded o' t ic)conpliance documents, worksheets,
calculations, plans and specifications sutmittedto he ercemen gencyfo v3this buil ng per' t a 'licat5. I will ensurethat a registered copy ofthisCertifica plianceail�ble � rkki ki jl g p� mit ;µisSfon!"t, t ��, g, an' a avai b r ha nforcement agency for all applicable
inspections. I understand that aregistered copy of thi d cate of Conp�ance i�requis d toncludedSh th �cum��ation theb� er p des totle bu,dng owner at occupancy.
Responsible Designer Name: 1 1. FA 4,0Responsible
De ig er Signature:i` 460
Velluto, Angie
(�( 0
Company:
Date Signed:
The Energuy CA LLC
2016-09-12 11:31:04
Address:
License:
1215 K St., 17th Floor
City/State/Zip:
Phone:
Sacramento CA 95814
877-600-0123
Digitally signed by Ca/CERTS. 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-A0335984A-000000000-0000 Registration Date/Time: 2016-09-12 11:31:04 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-09-12 11:31:37
Schema Version: 0.555SDID
CUPERTINO
SMOKE 1 CARBON MONOXIDE
OWNER CERTIFICATE OF COB
COMMUNITY DEVELOPMENT DEPARTMENT .
10300 TORRE AVENUE • CUPERTINO, CA 9501
(408) 777-3228 • FAX (408) 777-3333 • building
PURPOSE
This affidavit is a self -certification for the installation of all required Srnol
compliance with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 90
inspections are required.
GENERAL INFORMATION
Existing single-family and multi -family dwellings shall be provided with
Monoxide alarms. When the valuation of additions, alterations, or repair.
$1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 requin
Monoxide Alarms be installed in the following locations:
ARMS
IANCE
NG DIVISION
and Carbon Monoxide Alarms for
.11.2 where no interior access for
>moke Alarms and Carbon
to existing dwelling units exceeds
that Smoke Alarms and/or Carbon
AREA
S
OKE 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
Witlun each sleeping room
X
Carbon Monoxide alarms are not required in dwellings which do not con ain fuel -burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined wit smoke alarms shall comply with
CBC Section 420,6 and shall be approved by the Office of the State Fire M irshal.
Power Supply: In dwelling units with no commercial power supply, alar (s) maybe 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 alar) (s) referenced above has/have been
installed in accordance with the manufacturer's instructions and in comp iance with the California Building
and California Residential Codes. The alarms specified below have been tested and are operational, as of the
date signed below.
,�each, C,�,2or��02-
Address: "'/ f. - USS , Permit No.
Specify Number of Alarms:
# Smoke Alarms:
have read and aurae to
C
Owner (or Owner Agent's) Name:
Signature....,..... ��...... ............................. .......Date: 12, 13lf
............ ........ ..
Contractor Name:
Signature......... ....................... ..........' ........Lic.# ......... ...............Date:
Smoke: and COform.doc revised 09/2?:16
WATER -CONSERVING PLUMBING 171 'SURE.
a
OWNER CERTIFICATE OF COMPLIA CE
COMMUNITY DEVELOPMENT DEPARTMENT . BUILDING I IVISION
CUPERTINO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
4081 777328 • tr {48) 777 3333 uildin cu ertino.a
Owner Nam Gi 1J1' it No, _ 2�f •--.1Ga2
Address [ e 1 1t
1. Is your real property a registered historical site?
El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of he form and sign bottom of form.
6 2'No Go to Question 2.
2. Does your real propertyliave a licensed plumber certifying that, due to the ageor col
plumbing, installation of water -conserving plumbing fixtures is not technically feasil
El Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
❑ The licensed plumber's certification has been provided to the Building
Skip the rest of the form and sign bottom of form.
{a I—To Go to Question 3.
3. Is water service permanently disconnected for your building?
11 Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of
G Nio Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1,
No My real property is built and available for use or occupancy after January
Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of
E es My real propeity is built and available for use or occupancy on or before J
Civil Code Sections 1101.1 through 1101.8 apply. Check one of the thre
bottom of form.,
5. Please check ONE of the following;
r
13''My property is a single-family residential real property. See Civil Code Sectic
On and after January 1, 2014, building alterations or improvements shall req
to be replaced with water -conserving plumbing fixtures throughout the buildin
compliant plumbing fixtures shall be replaced with water. -conserving ph
property undergoes alterations or improvements).
❑ My property is a multifamily residential real property. See Civil Code Section
On and after January 1, 2014, specified building alterations or improvements s
plumbing fixtures to be replaced with water -conserving plumbing fixtures.
On or before January 1, 2019, all non-compliant plumbing fixtures shall be rel
conserving plumbing fixtures throughout the building (regardless of whether F
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
plumbing fixtures to be replaced with water -conserving plumbing fixtures.
On or before January 1, 2019, all non-compliant plumbing fixtures shall
plumbing fixtures throughout the building (regardless of whether property un(
of the property or its
form and sign bottom of form.
9947
1994.
ie form and sign bottom of form.
nuary 1, 1994.
following statements and sign
.01.4.
all non-compliant plumbing fixtures
in or before January 1, 2017, all non -
ng fixtures (regardless of whether
191.5.
dj require non- compliant
with water-
y undergoes alterations or
require non- compliant
replaced with water- conserving
)es 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 water -conserving plumbing fixtures in accordance
with Civil Code Sections 1101,1
through 1101.8, the current California Plumbing Code and California Green Buildin
Standards Code, and manufacturer's
installation requirements, and that the water -Conserv' plumbing fixtures comply
`th the requirements as indicated in the
table on the following page.
Owner or Owner Agent's Signature�
pato ' ; /� �
Upon completing and signing this Certificate, please return it to the Building Division in order to final your building permit.
SB407 20115. doe revised 08/26/15