B-2017-1514 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1514
1131 KENTWOOD AVE CUPERTINO,CA 95014-5807(359 31 011) EDWARD GEORGE
HEATING INC
MOUNTAIN VIEW,CA
94043
OWNER'S NAME: SHANMUGAM ELANGOVAN AND ELANGOVAN REVATHY DATE ISSUED:09/08/2017
OWNER'S PHONE:408-775-2522 PHONE NO:(408)593-3831
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-20 Lic.#647616
Contractor EDWARD GEORGE HEATING INC Date 01/31/2019 X BLDG _ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing
X 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:
REPLACE FURNACE SAME LOCATION;REPLACE AC UNIT SAME
I hereby affirm under penalty of perjury one of the following two declarations: LOCATION
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
'performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
rip Section 3700 of the Labor[Code,for the performance of the work for which this
,permit is issued. Sq.Ft Floor Area: Valuation:$7400.00
APPLICANT CERTIFICATION
I certify that I have read this applicationand 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 359 31 011
representatives of this city to enter upon,the above mentioned property for
inspection purposes. (We)agree to saveindemnify and keep harmless the
City of Cupertino against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue againsf 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 eerthero.ertino Municipal Code,Section 9.18. 180•DAYS FROM LAST CALLED INSPECTION.
Signara-
Date 0/-08-2017 Issued by:Kim Dunbar
Date:09/08/2017
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:0/-08-2017
I hereby affirm under penalty of perjury one of the following three declarations: •
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 liave 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
1permit 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
material. Additionally,should I use equipment or de ices which emit hazardous
shallinotemploy:any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Q.a` Management District I
I Woiker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cu. o Mu c al Code,Chapter 9.12 and
,exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code s 25;0.,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. /�
Owner or authorized agent"
revoked. -
APPLICANT CERTIFICATION
Date:0/-08-2017
I 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'witli all non point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.181J ' I understand my plans shall be used as public records.
SiSignature, Date 0/-08-2017 Licensed
9 Professional
/ CONSTRUCTION PERMIT APPLICATION
\ COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
(.:0,. 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
�.,qs
4 (408)777-3228 • building@cupertino.org PEMIT#B- Z® l 4- - 1 tel'Ifi
CUPERTINO REV# DEF#
❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. - MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PRO ECT ADDRE APN/1 — i
�'/", ,fit-,utwood Av 5q— 310I I •
01/11\1E?NAME WI E-MAIL
/ A go>lAit) 54A T4s) 'VD 7.7,s-Mj..
SI/3/Rl ri\-AWo AU (ate STATE,ZIP
cio 9Sdig
D CONTRACTOR NAME ❑OWNER-BUILDER COMPANY^ NAME ,/� //jq_ LICENSE NUMBER LICENSE'TYPE
RS SO � 1✓c7,u4,JZ�D I--k-A4
STATE, Z�� /�
STREET ADDRESSI
104 4r> P iU/ i!!L? U� �I►/j/� CO/1-s( �7 L�j7
E-MAIL ' i PHONE L S
8v/4 � erdfl cOP�/ca 93( $VB3 3 33 i 7135 / -9,1/40//13)/,o/ ?
0 ARCHITECT ❑OWNER ❑OWNER AGENT ❑CONTRACTOR AGENT ENGINEER❑DEVELOPER ❑TENANT
CONTACT NAMEE-MAIL '
L-� . /3a � /1.96, 5A / am
,. ' L '
DECRIPTON
���/4 ce :e-- elkaigl / A/6 tA44 ft,
SINGLE-FAMILY/DUPLEX ❑MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL I
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES S TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED I
BATHROOM SF SF I SF SF ❑DETACHED
EXiSiNG El YES EICHLER ,❑YES .SECOND STORY ADDITION DYES
FIRE SPRINKLERS 0 NO ❑ NO 0 NO
DWELLING SECOND DWELLING ❑YES ❑ATTACHED DETACHED OTHER
UNITS# UNIT ADDITON: ❑NO S F '
POOLS! .❑FIBERGLASS 0 VINYL=LINED D GUNITE 0 PREFABRICATED 40y6DN:POOL-SF I. I ' SPA-SF I SPA ATTACHED❑YES 0 NO I TOTAL-SF .
REC V Y: zi...,4t...44
Comore rial or Multi-Familu Buildings wa Public'Swimming Pools requires Department of Environmental Heath anproval
RE-ROOFII EXISTING ROOF TYPE ❑BUILT-UP ROOF❑ASPHALT SHINGLES WOOD SHAKES E WOOD SHINGLES❑TILE OTHER(SPECIFY)
, REMOVE/REPLACE El NO IF NO PLYWOOD ❑1" ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
EYES It OF LAYERS THICKNESS❑5/8" OTHER ❑OSB ❑CDX OTHER I .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 I Sof 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.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-identified property for ins 'on p poses. I acknowledge and authorize all information contained on this application form
to be made aviailable for public recor . 9,-ru 720 )
Signature of Applicant/Agent:'.. 1€ Date: ! I
SUPPLEMENTAL INFORMATION REQUIRED
*New SFD/Second Dwelling 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 Materials are being used as part of this project. '
*Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. ,
*HOA-Provide a letter of approval from the Home Owner's Association
B1dgApp_2017.doc revised 08/01/17
o I/11=yr L,r+urvrINIM
ALTERATIONS - HVAC
CEC-CF1R-ALT-03-E(Revised 01/16) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ALT-03-E
Alterations-HVAC CZ 1,3 to 7 and 16 (Page 1 of 1)
Site Address: Enforcement Agency: Date Prepared: Permit#:
New:Ducting or Lineset Conditioned
Equipment Type E ui ment Efficiency
Thermostat
Required R-value Floor Area(ftZ
❑ Packaged System IV Evaporator Coil AFUE COP 0 R-6 (CZ/-10,12&13)Ducts Served by system 0 Setback
Split System ❑Condensing Unit V SEER
0 R-81 (CZ 11,14-16)Ducts /'/30 ft2 , (If not already
HSPF 0 z R-2.8 Lineset3 present,must
❑ Furnace ❑ Lineset EER be installed)
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below.At permit application this
form is allowed to be filled out by hand..For final inspection all forms are to be registered(no hand filled forms allowed)and a copy left on site.
if 1.HVAC Changeout/Repair Required Compliance Documents to be left on site for'Final:
(Can include new ducting)
All Equipment, CF1R-ALT-02-E
Condenser Unit,Evaporator Coil, CF2R:MCH-01,MCH-20-H
Air Handler/Furnace CF3R:MCH-20-H
Installer Requirement:Duct leakage'(515%or,510%to outside,or seal all accessible leaks)
Exempted from duct leakage testing if:
1.Duct system registered with HERS provider as previously sealed,or 0 2.There is less than 40 linear feet of duct in unconditioned
• space,or ❑3.Existing duct systems are constructed,insulated or sealed with asbestos(list manufacture date of building,
❑2.New.HVACSystem Required Compliance Documents to be left on for Final:
All new equipment and All New Ducts' CF1R-ALT-02-E
CF2R-MCH-01-E,MCH-20-H,MCH-22-H,MCH-(23 or 24)-H
D05�i (f-S CF3R-MCH-20-H,MCH-22-H,MCH-(23 or 24)-H'
Installer Requirement:Duct leakage<5%,Fa'n Efficacy(0.58W/CFM),Air Flow>_350 CFM/ton(or Standards Table 150.0-B/C alternative)
0 3.All New Ducts with Replacement Required Compliance Documents to be left on site for Final:
Includes replacing or installing All New CF1R-ALT-02-E
Ducts'and one or more of the following: CF2R-MCH-01-E,MCH-20-H,MCH-(23 or 24)-H
Condenser Unit,Evaporator Coil,Furnace CF3R-MCH-20-H,MCH-(23 or 24)-H
Installer Requirement:Duct leakage<5%,Air.Flow>_350.CFM/ton(or Standards Table 150.0-B/C alternative)
0 Exempted from duct leakage testing if existing duct systems are constructed,insulated or sealed with asbestos.
❑4.New Ducting over 40 feet Required Compliance Documents to be left on site for Final:
Adding or replacing ducts in unconditioned CF1R ALT 02 E
space but less than All New Ducts' CF2R MCH-20 H
CF3R-MCH-20-H
Installer Required to:Duct leakage(<15%or,<10%to outside,or seal all accessible leaks)
0 Exempted from duct leakage testing if existing duct systems are constructed,insulated or sealed with asbestos.
'All new ducting requires R-8 insulationwhen more than 40 ft installed in CZs 11&14-16 and R-6 in CZs 1-10,12&13,and R-6 insulation when less
than 40 ft installed.This includes in walls,between floors etc.
2 A New Duct system is when the duct system is constructed of at least 75%new duct material,and up to 25%may consist of reused parts from the
dwelling unit's existing duct system(e.g.,registers,grilles,boots,air handler,plenums,duct material.
R-2.8(1"thick insulation)for linesets 1"and less.
Contractor(Documentation Author's/Responsible Designer'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. I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the information on this document.
3. That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24,Parts 1 and 6 of the California Code of Regulations(CCR).
4. 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 CCR.
5. 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.
Responsible Designer N me: R ble De.Q er Si_ •tures D to Signed: cense:
, ,� 5 d - ` , -r—�a�7 Cdt�6V76/11
Company: 7 Address: City/State/Zip: Phone:
Dao try A /a5Y1� /r r Al/ �'d�jv(WCA 9°03 `713( jc3 3y3/
For assistance or questions regarding the Energy Standards,contact the Energy Hotline at:1-800-772-3300
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
sem_, COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
CUPER1.tNt3 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333• buildino(r�cupertino.orq
ERM C NO:T R PL ALEDEDINTILi THIS CERTIheATE HA
OPLTET. I! STTN; D D TO,: E4D . I)1V1 of
PURPOSE
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms
for compliance with 2016 CRC Section R314,2016 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 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 X X
the bedroom(s)
On every level of a dwelling unit including basements 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 907.2 114 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
r t
Address. F t .<Q.P)<---C od Aye; L'Ct - rz 1 C J Permit No. gni 7_t 5
Specify Number of Alarms' 4 Smoke AIarms. L 6 I #Carbon Monoxide Detectors 11,1
I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name:
Signature Date: gltsli7
Contractor Name.
Signature Lica Date:
Smoke and CO fonn.doe revised 12/15/16