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B-2017-0198CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0198 10148 CARMEN RD CUPERTINO, CA 95014-2760 (357 09 06 1) RANDO AAA HVAC INC SAN JOSE, CA 95125 IOWNERIS NAME: MARSEILLES SHIRLEYATRUSTEE I IDATE ISSUED: 02/01/2017 I I OWNER'S PHONE: 408-202-6733 I I PHONE NO: (408) 293=4717 I License Class WARM -AIR HEATING VENTILATING AND AIR-CONDITIONING Lic. #768871 Contractor RAN DO 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. I have and will maintain a certificate of consent to self -insure for Worker's BUILDING PERMIT INFO: X BLDG —ELECT —PLUMB X MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: REPLACE FURNACE (SAME LOCATION) 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 Sq. Ft Floor Area: Valuation: $3500.00 permit is issued. APPLICANT CERTIFICATION I certify that I have readthis 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 regeulatjppssper-thge C,upertjlao-Murricipal.Code, Section 9.18. Date 2/1/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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) z. 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: 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. z. 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. 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. 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 2/1/2017 "N Number: Occupancy Type: 357 09 061 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Abby Ayende 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: 2/1/2017 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 Cu ertino Municipal Code, Chapter 9.12 and. the Health & Safety C , ctions 25505; and 25534. Owner or authorized age Date: 2/1/2017 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 Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional 3 aooi(qa GE ERAL PERMIT APPLICATIONar— COMMUNITY DEVELOPMENT DEPARTMENT . BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 +CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • buildingQcupertino.orq misc F�PT"TTMRTNCr WtfPruA111il11AT I—ltr cr"m7170n, f-1„ PROJECT ADDRESS � Q � � � ^ - o co i (r r LICENSE NUNIBER API, # �+ •` . ,. �1 CKI ,`u OWNER NAME (�`, PHONE i vt✓ e �- J2 F-MAIL STREET ADDRESS I� i� E -!\TAIL _ _ �/')s�/ll I`J y 1(/y •l✓`' ! f' ' / CITY, STATE, ZIP 1VA FAX CONTACT NAMES (f Ykr� PHONE� ��^ 3E `J� -MAIL STREET ADDRESS u �V_ � CITY, STATE, ZI - O g I FAX ❑ (ANNER ❑ OWNER -BUILDER ❑ 0WMMAGENT CONTRACTOR ❑ CONTRACTOR A(:FNT ❑ APrT4rrFrT I -I CONTRACTOR NAME LICENSE NUNIBER � C/4:3 � � BUS. I IC A COMPAi`fY1VAME - 1• Y ac -, E -!\TAIL _ _ �/')s�/ll I`J y 1(/y •l✓`' ! f' ' FAa .2 13 -I;� I f, 1 IJ [Jew STREET ADDRESS f% ` CITY, S_TAT�E, ZP , / i l�� l/ 9 �� 4� PHONE �/J j L t d ARCHITECTIENGINEER.NAME LICENSENUMBER BUS. LIC ' CONIPANY I,AME E-MAIL FAX STREET ADDRESS CITY,, STATE, ZIP PHONE USE OFSFD or Duplex STRUCTURE: El Commercial El MiJJiti-Family PROJECT IN WILDLAND URBANINTERFACE AREA ❑ Yes ❑ No PROJECT IN FLOOD ZONE ® Yes ❑ NO DESCRIPTION OF WORK TOTAL VALUATION:" RECEI VED BY: " J By my signature below, I certify to each of the following: I -am the property owner or authotiZed 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 ofiVork and verify it is accurate. I agree to comply with all applicable Iocal ordinances and state laws rely' c�v twb • ing constructs . I authoziu representatives of Cupertino to enter the ve-iden property for inspection purposes. Signature of Applicant/Agent: Date: SLIP EMENTAL INTFORMATION REQUIRED OFFICE USE ONLY a . - ❑" STANDARD U _ _ <" ❑"LARGE" . a 'EJ JOR MA MEPMiscApp 20 H. doe revised 03116/11 CERTIFICATE OF COMPLIANCE CFIR-ALT 02-E Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 1 of 3) Project Name: STACEY HOWARD -10148 CARMEN I Date Prepared: 2017-01-31 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 CF1R-ALT-02 document for each dwelling unit. 01 Project Name STACEY HOWARD -10148 CARMEN 02 Date Prepared 2017-01-31 03 Project Location 10148 CARMEN ROAD 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name STACEY HOWARD -10148 CARMEN 07 Zip Code 95014 08 Dwelling Unit Conditioned 800 Installing Installing Installing Floor Area (ft) Location or Area by this SC ducted containing system Number of Space entirely new 09 Climate Zone 4 10 Conditioning (SC) Systems in 1 component? components? feet of ducts? duct system? this Dwelling Unit: Alteration Type 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 (ft) system? component? components? feet of ducts? duct system? SC system? Alteration Type TRANE WHOLE HOUSE 800 Yes No Yes No No No Altered space conditioning system C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)1Diib) This section does not apply to this project. Registration Number: 217-A020034571A-000-000-0000000-0000 CA Building Energy Efficiency Standards - 2016 Residential Compliance Registration Date/Time: 2017-01-31 13:39:28 Report Version: 2016.1.005 Schema Version: rev 10/16 HERS Provider: CaICERTS Report Generated: 2017-01-31 13:40:24 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)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 Central gas All new No cooling This field or This field or This field or This field or TRANE furnace heating AFUE 81 No cooling component section is not section is not , Setback section is not section is not components altered applicable applicable applicable applicable Required Documentation: CF213-MCH-01-E - Space Conditioning Systems - Duct insulation requirement for the new portions of supply -air and return -air ducts or plenums: R6 (CZ 1-10, 12 and 13) and R8 (CZ 11 and 14-16) CF2R and CF3R-MCH-20-H - Duct Leakage Test 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, or seal all accessible leaks. CF2R and CF3R-MCH-25-H Refrigerant Charge verification required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15). CF2R and CF3R-MCH-23 Airflow Rate >= 300 CFM per 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 require verification of Air Flow MCH -23, or Refrigerant Charge MCH -25. -Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH -20 Duct Leakage Testing requirements. E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150Z(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: 217-A020034571A-000-000-0000000-0000 CA Building Energy Efficiency Standards - 2016 Residential Compliance Registration Date/Time: Report Version: 2016.1.005 Schema Version: rev 10/16 2017-01-31 13:39:28 HERS Provider: CalCERTS Report Generated: 2017-01-31 13:40:24 c 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: Rando, Eric Company: Signature Date: RANDO AAA HVAC INC 2017-01-31 13:39:28 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 devices for the building design or system design identified on this Certificate of Compliance conform to the _manufactured requirements of Title 24, Part 1 and Part 6 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 otherapplicable 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 buildirig permits) issued for the building, and made available.to the enforcement agency for all applicable inspections. I understand that a registered copy of thisCertificate of Compliance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Designer Name: Responsible Designer Signature: Rando, Eric Company: Date Signed: RANDO AAA HVAC INC 2017-01-31 13:39:28 Address: License: 1712 STONE AVENUE 768871 City/State/Zip: Phone: SAN JOSE CA 95125 408-293-4717 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: 217-A020034571A-000-000-0000000-0000 Registration Date/Time: 2017-01-31 13:39:28 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-01-31 13:40:24 Schema Version: rev 10/16 CUPERTINO PURPOSE SMOKE / CARBON MONOXIDE ALARMS OWNER. CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(g.cupertino.org PERMIT CANNOT BE FINALED_ UNTIL THIS CERTIFICATE HAS, BEEN COMPLETED, fiiGN£D. AND RFT R FD TO THE BUELDING DIVISION This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2016 CRC Section R314, R315, 2016 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, 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 SMOKE ALARM CO ALARM_ Outside of each separate sleeping area in the immediate vicinity of the bedroom(s) - (Smoke alarms shall not be located within 3 feet of bathroom door) X X On every level of a dwelling unit includin basements and habitable attics _ X X Within each sleeping room I X _ __1 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. hi existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do not result inn 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 alarm(s) referenced above has/1-lave been installed in 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 of the date signed below. �J -70111 11 Jlj� Address: 10VA1 Z� �� V (� � d,� ( i( �� Permit No X 11 v ` I? Specify Number of Alarms: # Smoke Alanns: I 2 1 # Carbon Monoxide Detectors: Smoke and C) form.doc revised 01/10/1017 CUPERTINO Owner Name Address I01_q WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777- 8 - FAX 408) 7t-3333 - build ingCa)cupertino.org 1"7 �; \ � / l G� Cj L� f �l Permit No.y V ( l 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. KNo 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. ❑ The licensed plumber's certification has been provided to the Building Division. Skip the rest of the form and sign bottom of form. .X No Go to Question 3. 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. 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. Yes 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.. Please check ONE of the following: 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). 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 Building Standards Code, and manufacturer's installation requirements, and that the water -conserving plumbin fixtures comply with the requirements as indicated in the table on the following nage. , A I Owner or Owner Agent's Signature: i"3Cb ; H (_ I Date: I Upon completing and signing this Certificate, pl it to the Building Division in order to final your building permit. SB407 2015.doe remised 08126/15