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B-2017-0873CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0873 10146 CARMEN RD CUPERTINO, CA 95014-2760 (357 09 061) RANDO AAA HVAC INC SAN JOSE, CA 95125 OWNER'S NAME: STACY HOWARD DATE ISSUED: 06/01/2017 OWNER'S PHONE: 408-202-6733 PHONE NO: (408) 293-4717 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C43 -C20 Lic. #768871 Contractor RANDO AAA HVAC INC Date 09/30/2017 X BLDG _ELECT _PLUMB 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 CONDENSER - SAME LOCATION 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. 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 Sq. Ft Floor Area: Valuation: $8835.00 permit is issued. APPLICANT CERTIFICATION I certify that 1 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 and state laws relating to building construction, and hereby authorize 357 35709 061 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 regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. t Signature'-, � �� Date 06-01-2017 Issued by: Kim Dunbar OWNER -BUILDER DECLARATION Date: 06/01/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the RF -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 of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 06-01-2017 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 performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE z. 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 the Health & Safety Cod"ections 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked.O J wner or authorized agent: APPLICANT CERTIFICATION Date: 06-01-2017 1 certify that I have read this application and state that the above information is CONSTRUCTION LENDING 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. 1 understand my plans shall be used as public records. Licensed Signature Date 06-01-2017 professional GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 misc CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building orq cupertino. 272or--d$er3 ❑PLUMBING ❑MECHANICAL rEELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS 0 1 D� l•� V — /�i I APN # -CF)(� OWNERNAME&0 PHON _ fL 4924 W33 -MAIL STREET ADDRESS 0 C Y, S TE, (� /�_ �,� FAX CONTACT NAME PHO ��+�,+^ W L E-MAIL STREET ADDRESSi0i ,STATE Zi C P /a FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT 11 ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME LICENSE NUMBE LICENSE TYrq� BUS. LIC # Kim COMPANY NAME 1 E-MAI?)661 `��.I.VAAd ` C�)h F -_ 6111 i �J I� STREET ADDRESS /^' \� C T cR - / P ARCHTTECT/ENGMER NAMES LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF SFD or Duplex ❑ Multi -Family STRUCTURE: [I Commercial PROJECT IN WILDLAND URBAN INTERFACE AREA E] Yes ❑ NO PROJECTTN FLOOD ZONE ❑ Yes El No DESCRIPTION OF WOR r)dar TOTAL VALUATION: �^ I r 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 info d'ota I h e provided is collect. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state Jaws relatili� o g cons ction. I authorize representatives of Cupertino to enter the abov i¢gn ed perty for inspection pwposes. Signature of Applicant/Agent: T.- EECDate: �-(* SU EMENTAL INFORMATION REQUIRED OFFICE usE',oivtY .' ❑ QUER Txe CotIDIT R s © STANDARD 1 ❑ LARGE: ❑ MAJOR MEPMiseApp 201Ldoe revised 03116111 _.. CERTIFICATE OF COMPLIANCE CFiR-ALT-02-E Alterations to Space Conditioning Systems (formerly CF -IR -ALT HVAC) (Pagel of 3) 1 Project Name: STACEY HOWARD I Date Prepared: 2017 -OS -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 02 Date Prepared 2017-05-31 03 Project Location 10146 CARMEN ROAD 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name STACEY HOWARD Dwelling Unit Conditioned 07 Zip Code 95014 08 2053 Floor Area (ftZ) Installing Installing Installing Number of Space 09 Climate Zone 4 10 Conditioning (SC) Systems in 1 more than 40 entirely new entirely new this Dwelling Unit: B. Space Conditioning (SC) System Information 01 02 03 04 05 06 07 08 09 10 'Ifs 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 (ftZ) system? component? components? feet of ducts? duct system? SC system? Alteration Type TRANE WHOLE HOUSE 2053 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. Registration Number: 217-A020182059A-000-000-0000000-0000 Registration Date/Time: 2017-05-31 12:24:14 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-05-31 12:22:13 Schema Version: rev 10/16 CERTIFICATE OF COMPLIANCE CFiR-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 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 No heating This field or This field or Central split C Outdoor This field or This field or TRANE furnace component section is not section is not AC condensing SEER 14 Setback section is not section is not altered applicable applicable unit applicable applicable Reauired 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, 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 requiremet P., - Heating -only systems and Air Handler Furnace changes do not require verification of Air Flow MCH 23 ;ar Refrige nt Cha€ge M -H 25i� Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH 2C#`puCt Leakage Testi' 8 reyui Mts IR v T E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(4)lDiia 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)iC) This section does not apply to this project. Registration Number: 217-A020182059A-000-000-0000000-0000 Registration Date/Time: 2017-05-31 12:24:14 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-05-31 12:22:13 Schema Version: rev 10/16 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. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: T/e Rando, Eric t Company: Signature Date: RANDO AAA HVAC INC 2017-05-31 12:24:14 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 Part 6 of the California Code of E3egUiat7ons. 4. The building design features or system design features identified orhis Certificate of 6mphance are stertLwith the information provided on'other applaable"t-cdmpliance documents, worksheets, calculations, plans and specifications submitted to the 4 rcemen gency for apprpvai wjh this building permit applicatiob. z; _ 5. 1 will ensure that a registered copy of this Certificate'of 66pIiance ihall be trade available with,the bonding permits) issued forthe-ba ldifig, and "made avaifable to,theenforcement agency for all applicable inspections. I understand that a registered copy of this Gotificate of Compliance isrequired to beincluded with the documentation„the boil der provides to the building owner at occupancy. Responsible Designer Name: Responsible Designer Signature: l Rando, Eric Company: Date Signed: RANDO AAA HVAC INC 2017-05-31 12:24:14 Address: license: 1712 STONE AVENUE 768871 City/State/Zip: Phone: SAN JOSE CA 95125 408-293-4717 Easy to Verify ❑E E 91 at CaICERTS.com 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 1 responsibility for the accuracy of the information. E Registration Number: 217-A020182059A-000-000-0000000-0000 Registration Date/Time: 2017-05-31 12:24:14 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-05-31 12:22:13 Schema Version: rev 10/16 CUPERTINO E.R1VIh 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(a)cupertino.org ANNOT BE FINALED. IIIINTYI,:THIS :CERTYFICATE HAS. BEEN :>.:;:.: " OT ....... EBULD SIGNEH..)'fir`.-f..,IVII!DSIO7 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 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 including basements and habitable attics X X Within each sleeping room X 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. 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 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: Permit No. � r ( � 13 Specify Number of Alarms: 4 Smoke Alarms: Carbon Monoxide Detectors: I have read and aoree to comoly with the terms and conditions of this statement Owner (or Owner Agent's) Name: ""--�- //�� ��pp ./ t�.l l_. � 1 Signature ................. ...... !..,.�1,^................................................................ Date:................... Contractor Na e: _ ' p i - Signature ............... ..........:.... .. ................ Lic.# .......... .......... Date: .......... 'J A Smoke and COforntdoc revised 0111 012 01 7 CUPERTINO Owner Name Address WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (4R) 777-3228 - FAX (408) 777-3333 • buildina(a cupertino.org _ Mu,)Q r'Cl Permit No.� Is your real property a registered historical site? ❑ Yes Civil Code Sections. 1101.1 through 1.101.8 do not apply. Skip the rest of the form and sign bottom of form. *No Go to Question 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. 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 fonn. .K 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 fonn. 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 fonn., Please check ONE of the following: `�A 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-conseiving plumbing fixtures (regardless of whether properly 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 iumproveiments 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). ❑ Mypropertyis 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-conseiving 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 peijuiy 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 plumbing fixtures comply with the requirements as indicated in the table on the following Daae. 1'1 i Owner or Owner Agent's Signature: `f 2!�;k � ]-A r" Date: Upon completing and signing this Certificate, plea�eturn it to the Building Division in order to final your building permit. SB4072015.doc revised 01/05/17