B-2017-0146CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0146
10243 BEARDON DR APT 3 CUPERTINO, CA 95014-1922 (326 32 025) IRANDOAAAHVAC
OWNER'S NAME: CHIN GOODWIN RAND ALICE L S
OWNER'S PHONE: 408-255-6200
T Tl VXTOWL A!'+Tf1ntC i WIM AP ATitlhT
License Class C-43: C-20 Lie. #7(18871
Contractor RANDO AAA HVAC INC Date 09/30/2017
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
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
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 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
sourcf;.r6-g`ulafi6-nq per tF�g Cpoertino Municipal Code, Section 9.18.
Date 1/26/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. 1, 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).
I hereby affirm under penalty of perjury one of the following three declarations:
n. 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. 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 is issued.
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 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.
SAN JOSE, CA 95125
ISSUED: 01/26/2017
PHONE NO: (448) 293-4717
BUILDING PERMIT.' INFO:
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 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.
Signature Date 1/26/2017
BLDG —ELECT — PLUMB
MECH X RESIDENTIAL COMMERCIAL
DESCRIPTION:
ACE WALL FURNACE - LIVING RM
Ft Floor Area: I Valuation: $3000.00
APN Number: Occupancy Type:
326 32 025
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION,
by: MELISSA NAMES
RF 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: 1/26/2017
94%
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 complianceCupertino Municipal Code, Chapter 9.12 and
the Health afety Code, ctions 2 OSy2 33, and 25534.
Owner or authorized agent:
Date: 1/26/2017
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
Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional
a
GENERAL PERMIT APPLICATION m P
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COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING. DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - building(a)cupertino.oM
CUPERTINO R misc
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By my signature bel I certify to ea of the following: I am the property -owner or authorized agent to act on the property owner* 's behalf. I have read dris"'
application and the i7o'Duatioil! T bav pr � i d 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 u . g ns -uction I rc-prcsentatives of Cupertino to enter the abov" 4,1-" A-A my for inspection purposes.
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Signature of t'�
Applicdnvgunt; Date
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SUPKEENTAL INFORMATION REQUIRED bFF1CF USE ONLY
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AIEPMiscApp_20 11.doc revised 03/16111
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CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC)
Project Name:
HOGIN & ASSOCIATES-BEARDON DRIVE I Date Prepared:
CF1R-ALT-02-E
( Page 1 of 3 )
2016-12-12
A. General Information
CF111-ALT 02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented,
use one CHR -ALT -02 document for each dwelling unit.
01
Project Name
HOGIN & ASSOCIATES-BEARDON DRIVE
02
Date Prepared
2016-12-12
03
Project Location
10243 BEARDON DRIVE APT 3
04
Building Type
Multi -family
OS
CA City
Cupertino
06
Dwelling Unit Name
HOGIN & ASSOCIATES-BEARDON DRIVE
07
Zip Code
95014
08
Dwelling Unit Conditioned
800
-'Installing ;,
Installing
Installing
Floor Area (ft2)
Location or Area
by this SC
ducted
containing
system
of space conditioning
entirely new
09
Climate Zone
4
10tems
FNber
in this dwelling
1
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
B. Space Conditioning (SC) System Information
01
02
03
04."
05 ' :.
06 ' ' °,'
01
08.
09
10
Is the SC
Installing a
SC System
SC System
CFA served
,system a
refrigerant
..Installing'hewtk
-'Installing ;,
Installing
Installing
Identification or
Location or Area
by this SC
ducted
containing
system
more than 40'
entirely new
F entirely new
Name
Served
System (ft2)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
System 1
WHOLE HOUSE
800
No
No
No
No
No
No
No alteration
performed
C. Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b)1Diib)
This section does not apply to this project.
D. Altered Space Conditioning System (Sections 150.2(b)1E and F)
This section does not apply to this project.
Registration Number: 216-A0458389A-000000000-0000 Registration Date/Time: 2016-12-12 15:34:25 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-12-12 15:33:44
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 2 of 3 )
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.
w
Registration Number: 216-A0458389A-000000000-0000 Registration Date/Time: 2016-12-12 15:34:25 HERS Provider: CaICERT$.
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-12-12 15:33:44
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CFIR-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:
Rando, Eric
�E
Company:
Signature Date:
RANDO AAA HVAC INC
2016-12-12 15:34:25
Address:
CEA/ HERS Certification Identification (if applicable):
1712 STONE AVENUE
N/A
City/State/Zip:
Phone:
SAN JOSE CA 95125
408-293-4717
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 Part6 of the 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 building permit application.
5. 1 will ensure that a registered copy of this Certificate of Compliance shall be.made'available with the building p'ermit(s) issued for'th,e building, and; available to the.enforcement agency for all applicable;
_mad:
inspections. I understand that a registered copy of this Certificate of Compliance is :required to be,included with the documentation.the builder provides to the building owner at occupancy.
Responsible Designer Name:
Rando,
Responsible Designer Signature:
Eric
CfiG�ii"CR�1
Company:
Date Signed:
RAN DO AAA HVAC INC
2016-12-12 15:34.25
Address:
License:
1712 STONE AVENUE
768871
City/State/Zip:
Phone:
SAN JOSE CA 95125
408-293-4717
Digitally signed by Ca10ERTS. 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-A0458389A-000000000-0000 Registration Date/Time: 2016-12-12 15:34:25 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.008 Report Generated: 2016-12-12 15:33:44
Schema Version: 0.555SDD
i UPERTINO
SMOKE i. CARBON MONOXIDE ALAR9
_
OWNER,CER— TIPICATE 4P COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORF�E AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333,, buildina(dcuoertino.orc
o
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2016 CRC Section 8314, 8315, 2016 CBC Sections 420.6 and 907.2.11.2 where no interior. access
for inspections are required.
GENERAL INFORMATION
i2xisting sbagle-family and multi -family dwellings shall be provided with Smoke Alarms and Carbon
Tonoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds
$1000.00, CRC Section 8314, R315, 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 _ _ j SMOKE AL_ACtl12_-- CO ALARM
Outside of each sepaGaie sleeping area in the immediate vicinity of the I X - - X
bed-room(s) - "'Smoke alarms shall not be located within 3 feet of^bathroom door) i
()n. every level of a dweliin- Llxuit. UIC1U dingy—basements and. habitable attics — � X
"Jithii> each sleeuin„ :oor, - ;
C-a.rbon .Monoxide alarms are r -Lot required in dwellings vti•Inich do not contain fuel -burning appliances anal that
do not have_gin attached garage. Carbon monoxide alarms combined wi'd,l smoke alarms shall co.taply v ith
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
1-'o nTer Supply: In dwelling units ivith no commercial power supply, alarm(s) may be solely battery opezai:ed
In existing dwellingunits, alarms are permitted to be solely battery operated where repairs or alterations do
notresult in the removal of wall' and ceiling finishes or there is no access by hearts 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 requi.^ti _1,`0
5.i of :ms Whic:l'?. must be cormected -,o the uffldln-- irinc.
As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/have been
installed itz accordance with the ;.manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms specified below have been tested and are operational, as o f tide
date sighed below.
Address: a � ���t i�C,�. %� _.lL�_ �1'- _ Permit No.L�'
Specify Number of .Alarms:
I Smoke Alarms:
'°1/ I
i nave r eae a! -,o agree to comply witn the Terms ano coraitions of this statement
Ownsr (cr O:vner Attaent's! Name:
C-'iG1,i1U 1 �i signature .Date:3lt![. !
................................................................................................. ....... .
Contractor Name:
L `Jt) i`�( 1._ !- :(; ( Signature _:-:.. I. 1 - ..t.;;.::.5 Lica w Date: 1( 1