B-2016-2116CITY OF CUPERTINO
BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-2116
22545 SALEM AVE CUPERTINO, CA 95014-5648 (342 12 098)
SUPREME AIR
SYSTEMS INC
CAMPBELL, CA 95008
OWNER'S NAME: READY JAMES F AND YUMIKO M TRUSTEE
DATE ISSUED: 06/13/2016
OWNER'S PHONE: 408-257-0372
PHONE NO: (408) 376-0406
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
I
License Class SOLAR Lic. #740667
X BLDG ELECT PLUMB
Contractor SUPREME AIR SYSTEMS INC Date 12/31/2017
_ _
X MECH X RESIDENTIAL COMMERCIAL
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.
JOB DESCRIPTION:
REPLACE FURNACE AND A/C - GARAGE
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.
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: $12140.00
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
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
342 12 098
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, ost and expenses which
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequenc the granting of this permit.
'
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally b applica nderstands and comply with all non-point
6.18.
FROM LAST CALLED INSPECTION.
source r ,Mations per h rtino Muni 1 al Code, Section
i
180 DAYS
Signatur jDate 6/ 3/2016
Issued by: Abby A eende
Date: 06/13/2016 �4
ER-�DECL��Tl
I hereby affirm that I am exempt fr e Contractor's License Law for one of the
I
RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
1. 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 ofApplicant:
contractors to construct the project (Sec.7044, Business &i Professions Code).
Date: 6/13/2016
I hereby affirm under penalty of perjury one of the following three declarations:
"A"
2. I have and will maintain a Certificate of Consent to self-insure for Worker's
ALL ROOF COVERINGS TO BE CLASS OR BETTER
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
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
s. 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 a or de e which emit hazardous
air contaminants as defined by t ay Area allty anagement District I
Worker's Compensation laws of California. If, after making this certificate of
will maintaincomplianc r e Cup 'no icipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health Safe Code, Sectio 2 05, 25 33, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized gent:
APPLICANT CERTIFICATION
Date: 6113/201
I certify that I have read this application and state that the above information is
CO TRU LE ING GEN
correct. I agree to comply with all city and county ordinances and state laws
I hereby affirm that there is a construction lendino age cy for the performance
relating to building construction, and hereby authorize representatives of this city
of work's for which this permit is issued (Sec. 30 7 iv 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.
1 understand my plans shall be used as public records.
Licensed
Signature Date 6113/2016
Professional
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPM NT DEPARTMENT • BUILDING DIVISION ia
10300 TORRE AVENUE • UPERTINO, CA 95014-3255
CUPERTINO (408) 777-3228 • FAX (408 777-3333 • building(aD-CUpertlno.OrQ 211 (Pmisc
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OWNER NAME i y �^
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CONTACT NAME
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❑ OWNER ❑ OWNER -B
DER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR VA NAMP/� y� LICENSE NUMBER 2r� iy LiCEN�SE TYPE
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COMPANY NAME E-MAIL
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BUS. LIC #
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FAX�
STREET ADDRESSI
CITY, STATE, ZI
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PHONE
ARCHITECT/ENGINEER NAM
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'LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUP X ❑ MULTI -FAMILY
BUILDING: ❑ COMMERCt,Ma
PROJECT IN WILDLAND ❑YES
URBAN INTERFACE AREA [3NO
PROJECT IN ❑ YES
FLOOD ZONE 11 NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORKC-e J_ RC `01 C -C rn 0C - (OtA6 2
i
TOTAL VALUATION: , �"�
RECEIVED BY:
By my signature below, I ceqify to each of the following: I am the property owner or authorized agent to act on the property o ner'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 building construction. I authorize representatives of Cupertino to enter the above-iden ifiieed operty for inspection purposes.
Signature of Applicant/Agent: _� � � + -� Date: & 3 %
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
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❑ OVER-THE-COUNTER
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EXPRESS
STANDARD ❑ STANDARD
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❑ LARGE
E3 MAJOR
MEPMiscApp 2011.doc revised 06/21/11
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC)
Project Name:
22545 SALEM AVE I Date Prepared:
CF1R-ALT 02-E
(Page 1 of 3 )
2016-06-13
A. General Information
MR -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
22545 SALEM AVE
02
Date Prepared
2016-06-13
03
Project Location
22545 SALEM AVE
04
Building Type
Single family
05
CA City
Cupertino
06
Dwelling Unit Name
22545 SALEM AVE
07
Zip Code
95014
08
Dwelling Unit Conditioned
1500
,. Installing
Installing
-- -- - - - - -
-Floor-Area-(ft-2-)—
--
by this SC
ducted
containing
system
more than 40
entirely new
Number
Number of space conditioning
09
Climate Zone
4
10
(SC) systems in this dwelling
1
feet of ducts?
duct system?
SC system?
Alteration Type
unit.
Location 1
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 (ft2)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
System 1
Location 1
1500
Yes
Yes
Yes
No
No
No
Altered space
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b)1Diib)
This section does not apply to this project.
r r'�1. f �--.C�� � fig f� r � �I���;/7
Registration Number: 216-AO217701A-000000000-0000
Registration Date/Time: 2016-06-13 09:15:46
HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-06-13 09:16:03
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CF111-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -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
RequiredNew
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
Central split
All new
This field or
This field or
System 1
furnace
heating
AFUE
80
AC
cooling
SEER
14
Setback
section is not
section is not
components
components
applicable
applicable
Required Documentation:
CF2R=MCH_-01=E _-Space Coon itiomng Systems Ducts and ans
-Duct insulation requirement for new plenums: R6.
CF2R-MCH-20-H & CF3R-MCH-20-H — Duct Leakage testing 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: 515%, or15 10% leakage to outside, or seal all accessible leaks.
CF2R-MCH-25-H & CF3R-MCH-25-H Refrigerant Charge Verification required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15).
CF2RCF3R-MCH-23 & CF3R-MCH-23 Air Flow z 300 CFM/ton required when MCH -25 is required.
Exceptions:
-Duct systems registered with HERS provider as previously sealed are exempt from MCH720 Duct Leakage Testing requirements. _
-Heating-only systems and Air Handler/Furnace changes do not require verification of Air Flow MCH 23, or Refrigerant Charge MECH-25.,
Existing duct systems constructed, insulated or sealed with asbestos are exempt �from MCH -20 Duct Leakage Testin'g,requirement's.
E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections-150.2(0)11)iia 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: 216-A0217701A-000000000-0000 Registration Date/Time: 2016-06-13 09:15:46 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-06-13 09:16:03
Schema Version: 0.555SDD
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: (dale/
Dizdarevic, Jasmina
(�/`-�
Company:
Signature Date:
The Energuy CA LLC
2016-06-13 09:15:46
Address:
CEA/ HERS Certification Identification (if applicable):
1215 K St., 17th Floor
City/State/Zip:
Phone:
Sacramento CA 95814
877-600-0123
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 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 permit application.
S. I will ensure that a registered copy of this Certificate of.Compliance shall be made available'with the building permits) issued 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 to be included with the documentation the builder provides to the building owner at occupancy.
Responsible Designer Name:-: - - -
Responsible Designer Signature
Dizdarevic, Jasmina
Company:
Date Signed:
The Energuy CA LLC
2016-06-13 09:15:46
Address:
License:
1215 K St., 17th Floor
City/State/Zip:
Phone:
Sacramento CA 95814
877-600-0123
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: 216-A0217701A-000000000-0000 Registration Date/Time: 2016-06-13 09:15:46 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-06-13 09:16:03
Schema Version: 0.555SDD
SMOKE / CARBON MONOXIDE ALARMS
OWNEREjUl CERTIFICATE F COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT 4 BUILDING DIVISION
CUPER71NO 10300 TORRE AVENUE - CUPERTINO, CA 95014.3255
(408) 777-3228 - FAX (403) 777-3333 - btiildincaPeuPertinQ arq
Address U 545 -n-,,,jpoce
�
P 1�T CA T BE FENALED ANI TDS TT ;� r T
PURPOSE
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CPC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 ivhere no interior access for
inspections arerequired.
GENERAL INFORMATION
Existing single-family and multi -family dw" ellln.gs shall berov
� sded with Smoke Alarms and Carbon
Monoxide alarms. VtThen the valuation of additions, alterations, or repairs to existing dwelling unii s exceeds
$1000.Go, CIBC Section 8314 and CBC Sections 907.2.11.5 and 420.6 require that Brooke Alarms and/ r Carbon
1\-fonoxide Alarms be installed in the following Ideations:
AREA
Outside of each separate sleeping area in the immediate vicinity of the
i SMOKE kLARM
X1
CO
_ —
ALARM
bedroom(s) ;
s
On every level of a dwelling =it including basements
Within eachi sleeping room
�
Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning applian;
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall com
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal,
Power Supply: Iii dwelling units with no commercial rawer supply, alarm{s) mar be solely batter
In existing dwelling units, alarms are permitted to be solely battery operated ,here repairs or alter
not result in the removal of wall and ceiling finishes or there is no access by means of attic, basemen
space. Refer to CPC Section 8314 and. CBC Sections 907.2,11.4 and 420.6.2. An electrical permit is re
alarms which midst be connected to the building wiring.
As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/1
installed in accordance with the manufacturer's instructions and in compliance with the California I
and. California Residential Codes. The alarms have been tested and are operational, as of the elate sili
below.
I have read and agree to comply with the tert;7s and Cor�ft1ilons of
(or ovrnar Agent's) Name: ,
Smoke and CO forn.e%c
and that
with
cons do
or MINI
tired for
been
03118114