B-2017-1955 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1955
10225 RICHWOOD DR CUPERTINO,CA 95014-3360(369 08 043) PELLE HEATING&
AIR INC •
SAN JOSE,CA 95111
OWNER'S NAME: KRISHNAMURTHY SRINIVASAN AND GOPAL MEENA TR DATE ISSUED: 11/14/2017
OWNER'S PHONE:408-821-0330 PHONE NO:(408)978-7060
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-20 Lic.#809887
Contractor PELLE HEATING&AIR INC Date 10/31/2019 X BLDG _ELECT _PLUMB
X
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing 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:
ADD AC UNIT-(SIDE OF HOUSE)
I hereby affirm under penalty of.perjury one of the following,two declarations:
i. 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.
4,04//- I have and will.maintain Worker's Compensation Insurance,as provided for by
tion 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$4900.00
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 369 08 043 • •
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 egulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
400 ature,,< .� Date 11/14/2017 Issued by:Jasmine Archbold
i Date: 11/14/2017
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
' i. ';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)
2. '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:11/14/2017
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,for the 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
shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous
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 t r Wealth&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. •
O, e' or authorized agent• 'i_
APPLICANT CERTIFICATION r :11/14/2017
I certify that I have read this application and state that the above information is CONSTRUCTIO ENDING 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. I understand my plans shall be used as public records.
Signature Date 11/14/2017 Licensed
Professional
-
CONSTRUCTION PERMIT AggI.I BU®D NG DIVISIONItS
MUNITY DE
VELOPMENT DEPARTMENT
. CUPERTINO CA 95014=3255
�/ COM10300 TORRE AVENUE r
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• buildis� @cupertino.or
(408)777-3228 UN# DEF#
CLIP EVKT148®
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ADDITION ❑
❑NEW CONSTRUCTION ❑
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PROJECT ADDRESS i022 .
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OWNER NAME t =•J I`cShnoi p Al i tr j
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brCONTRACrOR NAME 0 OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
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0 ARCHITECT '❑OWNER ❑OWNER AGE ONTRACTOR AGENT❑ENGINEER 0 DEVELOPER 0 TENANT
CONTACT NAME
Jess
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STREET ADDRESS CITY,STATE,ZIP / ✓✓ PHONE 7o
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DECRIPTON
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]SINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL I
P1STING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES# TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED
BATHROOM SF SF SF SF 0 DETACHED
EXISING ❑YESEICHLER 0 YES SECOND STORY ADDITION 0 YES
FIRE SPRINKLERS 0 NO. 0 NO 0 NO
DWELLING SECOND DWELLING ❑YES 0 ATTACHED 0 DETACHED OTHER
UNITS# UNIT ADDITON: 0 NO S F
POOLSI 0 FIBERGLASS ❑VINYL-LINED ❑GUNITE 0 PREFABRICATED
POOL-SF SPA-SF I SPA ATTACHED❑YES ❑NO I TOTAL-SF
RECEIVED BY: y ,1 �� a s.:
Commercial or Multi-Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval q
RE-ROOF EXISTING ROOF TYPE: ❑BUILT-UP ROOF 0 ASPHALT SHINGLES WOOD SHAKES 0 WOOD SHINGLES❑TILE OTHER(SPECIFY)
REMOVE/REPLACE❑NO IF NO PLYWOOD 01" ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
DYES' #OF LAYERS' THICKNESS El 5/8" OTHER ❑OSB 0 CDX OTHER '12 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF ['ASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 OTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy SF #of SQUARES
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 Worl<C and verifyitls accurate. I agree
to comply with all applicable local;ordinances and state laws relating to bui ping construction. I authorize representatives of Cupertino to
enter the above-identified propertyfor ins. o .urposes. I aci. 'Med; .. . authorize all information co tamed on this application form
to be made available for public record.
Signature of Applicant/Agent ! /�, /''-7 _ // /�
' SUPPLEMENTAL INFORMATION REQ D Date: G /
*New SFD/Second Dwe]Iing Units/Multifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings Provide a completed Hazardous Materials Disclosure form if any Hazardous Maatioterian.ls are being used as part of this project.
ng Permit applic
*Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Buildi
*HOA-Provide a letter of approval from the Home Owner's Association
BldgApp_2017.doc revised 08/01/17
CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E
Alterations to Space Conditioning Systems(formerly CF-1R-ALT-HVAC) (Page 1 of 3)
Project Name: Krishnamurthy Srini Date Prepared: 2017-11-06
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 Krishnamurthy Srini 02 Date Prepared 2017-11-06
03 Project Location 10225 Richwood Dr 04 Building Type Single family
05 CA City Cupertino 06. Dwelling Unit Name Srini Krishnamurthy
Dwelling Unit Conditioned
07 Zip Code 95014 08 ` 2 2032
-. i. z i` Floor Area(ft )
Number of Space
09 Climate Zone 4 10 Conditioning(SC)Systems in 1
this Dwelling Unit:
B.Space Conditioning(SC)System Information1 lq;t.n
01 02 03 04 P _. `05 t i)6. ;,' 07 08 09 10
Is the S5 Installing a i . i.:,,k,
SC System SC System CFA served system a'' "t=efrigerarnt '"`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(ft2) . system? component? components? feet of ducts? duct system? SC system? Alteration Type
Srini Whole House 2032 Yes Yes Yes No No No Altered space
Krishnamurthy - 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:417-A020126704A-000-000-0000000-0000 Registration Date/Time:2017-11-06 14:23:37 HERS Provider:CHEERS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2016.1.006 Report Generated:2017-11-06 14:23:39
Schema Version:rev 10/16
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
No heating This field or This field or All new This field or This field or
Srini Central gas Central split
component section is-not section-is not- cooling SEER 14 Setback section is not section is not
Krishnamurthy furnace AC
altered applicable applicable components applicable applicable
Required Documentation:
CF2R-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 10,1L a d,13)and R8(CZ 11 and14-16)
CF2R and CF3R-MCH-20-H-Duct Leakage Test required when heating or cooling components are inStk1400kfiecfWttems,or when more than 40 ft of duct length is replaced
-Leakage rate compliance:<=15%or<=1D%leakage to outside,or seal all accessible leaks.
CF2R and CF3R-MCH-25-H Refrigerant Charge verification required when refrigerant containing components.4rp 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.
El E. Entirely New or Complete Replacement Duct System,with or without Equipment Changeout(Sections 150.2(b)1Diia and 150.2(b)1E, F)
his'Set rdbes not apply"to'thls 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:417-A020126704A-000-000-0000000-0000 Registration-Date/Time:-2017-11-06 .14:23:37- _ - - -- - - HERS Provider:CHEERS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2016 1.006 Report Generated:2017-11-06 14:23:39
Schema Version:rev 10/16-
-
0/16 - -
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. I certify that this Certificate Of Compliance documentation is accurate and complete.
Documentation Author Name: Documentation Author Signature:
Jessica Valencia Je-s-LowValenaia,
Company: Signature,Date:
Pelle Heating and Air,Inc. 2017-11-06
Address: CEA/HERS Certification Identification(if applicable):
3751-0 Charter Park Court
City/State/Zip: phone:
San Jose CA 95136 408 978-7060
Responsible Person's Declaration statement f00,0
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. `j
2. I am eligible under Division 3 of the Business and Professions Code to accept responsibil y fortjte building design or system design identified on this Certificate of Compliance(responsible designer).
3. That the energy features and performancespecifications,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 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 pe..crnrt application.
5. I will ensure that a registered copy of this Certificate of,Compliance shall,be made.availablewith tFebuildingpermrt(sf`assued for the building,and made available to the enforcement agency for all applicable
inspections.I understand that a registered copy of this Certificate of Compliance is required"fo be included v ith'the documentation the builder provides to the building owner at occupancy.
Responsible Designer Name: $ „Responsible,Desjgr\erxkSignature:
Jessica Valencia ' Jervf/ae
Company: Date Signed:
Pelle Heating and Air,Inc. 2017-11-06
Address: License:
3751-D Charter Park Court - 809887
City/State/Zip: Phone:
San Jose CA 95136 408-978-7060
Digitally signed by CHEERSTM. This digital signature is provided in order to secure the content of this registered
document,and in no way implies Registration Provider responsibility for the accuracy of the information. _.
Registration Number:417-A020126704A-000-000-0000000.0000 Registration Date/Time:2017-11-06 14:23:37 HERS Provider:CHEERS
CA Building Energy Efficiency Standards-2016 Residential Compliance Report Version:2016.1-.006 Report Generated:2017-11-06 14:23:39
Schema Version:rev 10/16
SMOKE / CARBON MONOXIDE ALARMS
V 7viUm -;..,a
�. OWNER CERTIFICATE OF COMPLIANCE
ia,
4.14%.. 11,
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUP ERTIN O (408)777-3228•FAX(408)777-3333•buildinoecuoertIno.orq
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PURPOSE
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 E ALARM CO ALARM
Outside of each separate sleeping area in the immediate vicuuty of the X X
bedroow(s)—(Smoke alarms shall not be located within 3 feet of bathroom door)
On every level of a dwelling unit includxn basements and habitable attics X X
Within each sleeping room X
Carbon Monoxide alarms are not required iii 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.
In existing dwelling units, alarms axe 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 alarm(s)referenced above has/have 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
Address. (012-s- g,CI)UQOc Dr C )pP lhO PermitNo.5-2011 qS3
Specify Number of Alarms #Smoke Alarms E3L1 #Carbon Monoxide Detectors. _E
I have read end agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name:
Contractor Name: _
Sionature.... Date:
.34 rIi � G ",� ( -. Uc.# SU f�6P 7 Dale: /./../5.1-1, r7
C �� 1 are Signalure � . .
Smoke and COform.doc revised 01/10/2017